Sorca Clarke (Longford-Westmeath, Sinn Fein) | Oireachtas source

After the most recent election, an exit poll conducted by The Irish Timeshighlighted that 40% of voters said health was the most important issue influencing their vote. The subsequent pandemic has further highlighted the need for systematic change within our health service. Therefore, I welcome the introduction of the Bill this evening.

The programme for Government includes a commitment to "Expand community-based care bringing it closer to home, in line with the Sláintecare Implementation plan" and "Introduce a statutory scheme to support people to live in their own homes which will provide equitable access to high quality, regulated home care." Covid-19 and its devastating impacts and consequences for residents in nursing homes must make this even more of a priority for the Minister of State, Deputy Butler, and her colleagues in government. I would also like to think that when the Minister of State and her colleagues say "statutory", they mean statutory and not the channelling of more public funds into agencies and commercial providers in the private sector as the first port of call over the public sector.

There can be no doubt that there needs to be a radical shift in how we care for our elderly, our more vulnerable and those who provide that care. The policies of successive Governments over recent decades have resulted in an expansion of home care in the private sector, coupled with a devaluing of public and not-for-profit providers. The main issue that has contributed to this growth of private sector providers is the lack of capacity in the public sector. Instead of the State investing in the public provision of care to address capacity, funds have been channelled towards private providers. As my colleague, Deputy Tully, has outlined, this has been to the tune of more than €100 million. The implementation of competitive tendering in 2012, which was a startling development whereby private companies compete with one another to win contracts to provide care, was based on criteria that included price. This cultivated the conditions necessary for the growth and profits of the private sector of home care provision. This has had repercussions for the home care workers and for the quality of care provided. I hope it is obvious to the Minister of State, as it always has been to me and my Sinn Féin colleagues, that when the provision of care is based on a business of profit, care can also be sacrificed to that profit.

Another unsettling fact that has become more widely known is that there is a vast disparity of working conditions among carers in the public and private sectors. Those employed directly by the HSE have guaranteed hours of work, sick pay and pensions. On the other hand, those employed by private care are often on low pay and have precarious if-and-when contracts. The Home Care Coalition estimates that while there has been a 20% reduction in the provision of home care demands since the arrival of Covid-19, the end result has been the reduction of hours and income for home carers in the private sector. Crucially, these workers have not been laid off and are not entitled to the pandemic unemployment payment.

A further discrepancy that needs to be tackled is the issue of unpaid travel time. HSE-funded packages are often subcontracted out to private providers, yet they do not include pay for travel time. HSE staff are entitled to travel allowance. If a private home care provider has to travel between six or seven clients per day, over the course of the week this leads to hours of unpaid work.

When I recently met representatives of the Irish Farmers Association, IFA, and business representatives in Longford-Westmeath about their pre-budget priorities, both sectors raised the fair deal scheme as an issue. A key concern of the IFA is the urgent need to reintroduce the nursing homes support scheme (amendment) Bill 2019. This is a key ask because since the introduction of the scheme, it has been a potentially uncapped liability for farm businesses and for small family-owned businesses. These are productive assets required to generate income. They are not a measure of additional capacity to pay. The current fair deal scheme has seen anxiety and significant uncertainty for family farmers and for small family-owned businesses. There is a genuine fear that the viability of farms and businesses will be undermined while families attempt to meet the cost of care. I put it to the Minister of State that this is very unfair. Traditionally, farms and small businesses in my constituency have been passed down through generations. One barrier to the next generation taking over the farm can be the death of a person associated with it, whereby the fair deal scheme includes assets transferred within the last five years. One vital factor for constituencies like mine with very rural communities is the importance of these farms and businesses because they continue to operate when other employers do not. They play a vital role in supporting rural employment and the social fabric of many small rural towns and villages.

When the Minister of State, Deputy Butler, spoke at length on licensing, a question jumped to my mind. I am sure it occurred to others in the Chamber tonight. Will this equate to another financial burden intended to be borne by already low-paid workers in the private home care sector?

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