Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I am happy to support the legislation. It is overdue in many respects. There is no denying the importance of regulation, particularly in the health and social care area. As we know, the legislation dates back to 2005 in respect of the inclusion of social care workers. At the time, that was highly significant. The work of dealing with children, older people and some of the most vulnerable people in our society is very important. It is essential that the people working in that sector are properly regulated. We have to ask why there has been such a delay.

It is very important that the State has a regulatory system that we can have confidence in and that we legitimise the profession, protect the public and provide a structure for appraisal and approval of training and qualifications.

However, as I said, the progress has been painfully slow. I do not know why that is the case. We are just moving at a piecemeal, slow pace when there are several professions that need to be regulated. I do not know why we could not have done that by statutory instrument on an ongoing basis and why the progress could not have been quicker than has been the case. I do not know why that is. Is it a funding issue with CORU? Is there a problem with CORU? Why is it not able to move through the professions more quickly? Alternatively, is it the case that it has requested the Minister to move on different professions and the Minister or, perhaps, successive Ministers have been slow to do that? It is important we know the reason for what would appear to be a completely undue delay in regulating the professions. As I said, health and social care professionals should all be regulated. Why is it taking so long and why is it so slow?

On social care workers, clearly the register is still not operational. We are told that it is set to open in November 2023. However, there are other requirements in terms of experience working in the sector. Therefore, it is likely that with qualifications and experience, people will not be able to register until 2025. Was this not foreseen? Why was provision not made for this? People have been working in this sector for years on end. Are we talking about post-qualification experience? What is it? There is huge confusion about how one actually qualifies in this area. Why have we not sorted this out before now?

It is undoubtedly a complex environment for a couple of different reasons. The previously unregulated status of social care work has been a problem in respect of new regulation. The range and diversity of titles, practices and routes into the sector has been diverse and wide and all of that needed to be brought into line and streamlined. Again, why that is only happening now?

In 2018, a Social Care Ireland survey regarding registration awareness noted that respondents indicated 80 different job titles in that sector. There have been some tangible developments in recent years. In 2015, the social care workers registration board was established with CORU. That was a certain amount of progress. More recently, the code of professional conduct and ethics and the standards of proficiency in education and training were published. However, there is still no clear pathway for fully regulated and recognised roles within social care.

Obviously, serious problems arose in relation to those students in the Dublin Business School. That was very bad practice all around. It was a devastating blow for the students. This course was established four years ago in 2018 and it is still not accredited by CORU. Why was there not clarity about that? The Dublin Business School has serious questions to answer in relation to that. Students must now be provided with clear options to strengthen their qualifications. The Minister raised the issue of refunds for students. I do not know if that has happened, but it should happen. However, more important than getting refunds is having a clear pathway to early recognition of the academic work that they have done and, indeed, for many of those students, the previous work experience they have had in the sector.

There is no doubt that an acute shortage of social care workers is looming now. Despite a relatively strong supply of graduates in this area, there is a shortage. That is because the importance of social care was not recognised in this country until relatively recently. There have been debates on this in the UK for the past 20 years. We are very much fixed on the idea that we are talking about expensive healthcare and very highly qualified people. We talk about consultants, GPs and nurses. However, actually a huge amount of care in the general health area relates to social care. That is where the big demands are. We hear all of the publicity around long hospital waiting lists, and they are a scandal. However, the reality is that most people who contact us as public representatives with regard to waiting lists are asking about older people, in particular, but also about young children and people with disabilities. Effective and well-resourced social care is needed in all of those areas. That is where the big demand is. Very often, if people cannot access social care locally in their community, they are left in situations where their condition inevitably gets worse and they inevitably end up having to go to a consultant or be admitted into hospital. A whole range of services needs to be properly recognised and resourced at community level.

That, in many ways, is what Sláintecare is about. It is the lowest level of complexity. People start off with different conditions that are not complex and need care and support. That is the whole social care area. If that is addressed, it has downstream effects. It slows down conditions getting worse and becoming a bigger burden of demands on the health service. We need to get back to early intervention, early diagnosis of conditions and providing appropriate staff in the appropriate place. We have not been good at doing that in this country.

In 2019, 14 educational providers were providing 34 social care programmes or pathways into social care. This was happening. The educational systems, particularly post-leaving certificate providers, were gearing up for that. However, unfortunately, there was not the necessary recognition of those qualifications, which are very often level 5 qualifications, and then clear pathways provided into higher level qualifications, recognition of that and regulation.

Between 2015 and 2019, Tusla experienced a 30% increase in referrals, but only a 1% increase in the social care workforce. The austerity period brought very significant challenges with cuts, embargoes and moratoriums. Of course, many of those cutbacks and austerity measures were very short-sighted because they resulted in even more serious problems and a lack of an adequately qualified and available workforce in this very important area. The cost of living and spiralling rents, of course, added to that.

This is a predominantly female profession. Some 86.7% of respondents to a Social Care Ireland recruitment and retention survey in 2021 were female. Increased privatisation and the use of agency workers to bolster the service provision has undoubtedly been a factor in this. In many ways, we are seeing creeping privatisation in the social care area. That is largely to do with the fact that at HSE level and at Department of Health level there is no recognition of the importance of social care. It is seen as some kind of afterthought that should be farmed out to the voluntary sector. People were doing it on a voluntary basis for a long time.

That sector cannot operate on a shoestring, which is what the expectation was. It was not professionalised and put onto a proper financial footing. We are paying a big price for that now. Due to the lack of recognition of the importance of social care, we ended up with a very expensive model of care in this country. Services were dictated, in the main, by consultants, when we should have been looking at services at local level led out by social care professionals.

Sláintecare recognised that healthcare and social care are inextricably linked. That has to be recognised.

Services and facilities have been disconnected or competing for far too long. We should be operating a system of integrated care. There has been recent recognition of that and I very much welcome the integrated care hubs that are being developed. They make absolute sense. They take work out of hospitals and they recognise the importance of health and social care professionals and the fact that they play, and are capable of playing, a key role in the delivery of health services and that can happen at community level.

The current disconnect between healthcare and social care is very evident in waiting lists. The health system waits until conditions become serious before intervening and that inevitably ends up with long waiting lists for hospital services. On 5 July, there were 102 people across the acute system awaiting a discharge home, with 61 of them waiting for a carer to be assigned. I do not have the up-to-date figures in that regard but what we have seen through the years is that there have been several hundred people in very expensive acute hospital beds ready to be discharged but there was insufficient funding at community care level to provide the kind of home supports they needed. That issue, more than any other, typifies the dysfunction within the health service. There are people using hospital beds who want to go home and are ready to go home and it is in their healthcare and other interests to do so. It is a much cheaper model of care yet there is that disconnect between the acute hospital sector and social care. It is the way we should be going. There is no justification or defence for a situation where there is not an adequate budget for home care and then people end up staying in hospital beds which, in turn, has an impact on waiting lists. More important, at the end of May there were 4,720 people waiting who had been assessed and approved for home support but were awaiting a carer to be assigned.

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