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

I know that. That is what I am saying, however - they were assessed. The bar is quite high to get approval for home care. These were nearly 5,000 people who were approved for home care but the staff were not available. This has been raised with the Minister of State. In fairness, I know she is very committed to her portfolio but this has been raised with her on umpteen occasions. One has to ask why this issue is not being addressed properly and why are we still in this indefensible situation. From an organisational and financial point of view, it is indefensible. The key thing, however, is that there are 5,000 people in their own homes, many of them in their late 80s and 90s and many very infirm, left in dangerous situations on their own at home. It is inevitable that many of those people will end up going into nursing homes because there are not basic supports available to them at home. That issue has to be addressed as an absolute priority. When is the Minister of State going to resolve this? It is dragging on far too long. She promised a statutory right to home care. When will we see that? When will the staffing shortages be addressed?

There is an issue there relating to the disparity in the contracts and the terms and conditions of employment in the community, voluntary and private sector home care areas. The HSE funded and employed home care workers are on a regular and relatively decent salary. They have security and all the other entitlements that permanent workers have. People employed in the community sector or, more important, the private sector, however, are getting far less than they would as HSE workers. The terms of the contract do not even recognise things such as travel time. That can all be addressed by the Department. It seems that the most recent tender was specifically designed to drive down the cost. It represented a race to the bottom, essentially, and we are now paying a price for that. In the new tender, the Minister has to address those issues and equalise the pay. Ideally, far more of the home care staff should be employed by the State because it is a key area of health and social care provision. We should seek to have those staff employed by the State. I am concerned about the privatisation that is going on in this area in particular and the downgrading of that work. We are paying a price for it now because of the staff shortages. There is also the issue of the need for an employment regulation order to cover this. I would very much welcome such an order.

The same issue pertains in the disability sector, of course, in terms of the dire shortage of staff. I refer to the children's disability network teams. More than 17,000 children with disabilities are still awaiting their first contact in what was supposed to be a new system that would address their needs. Of them, 8,000 are waiting more than a year. The vacancy rate in the teams across the sector is approximately 28%. That has to be dealt with as a priority.

In the few minutes I have left, I note that the Medical Council's medical workforce intelligence report was published this month. It lays bare major problems relating to non-consultant hospital doctors, NCHDs. This issue has to be addressed. There has been really good research done on this whole area, led by Dr. Niamh Humphries in the hospital doctor retention and motivation project that has been running in recent years. Dr. Humphries and her colleagues appeared before the health committee earlier in the year. I raised the matter with the Minister for Health on umpteen occasions. That research sets out clearly why the majority of Irish-trained doctors are leaving our shores as soon as they can. I raised this issue earlier today. NCHDs are leaving Ireland in their droves. They are leaving as a result of their poor treatment in their training. Career structures are very poor and they have to move every six months. Imagine doing that with a family and the crisis in housing. How would one do it? Some 25% of NCHDs are breaching the European directive on working hours. They are forced to do that and cannot avoid it because hospitals are insisting that they work over the 48-hour limit. Some of them do not even get paid for that work. Imagine having that kind of gruelling regime and not even getting paid for it. They complain of burnout, bullying within their profession and a general lack of respect. They are leaving our shores in droves. Is it any wonder that is happening? There are currently almost 900 consultant vacancies. Attention was drawn to this yesterday, particularly in the context of the impact of those vacancies on emergency departments, EDs, and the shocking conditions and waiting times that exist there. That comes about largely as a result of major levels of consultant vacancies right across the board. One can imagine the impact of those 900 consultant vacancies. Is it any wonder that the health services cannot recruit to those posts, given the experiences of NCHDs early in their careers? In addition, only 50% of the internationally trained healthcare graduates have access to a training programme in hospitals. We are hugely dependent on them but they are being treated extremely badly.

This is at the centre of the problems within the health service. There are major problems in respect of recruitment and retention of staff and unless the Minister gets serious about this, sets up an urgent task force, ensures adequate placements in the health service and ensures adequate training places in colleges, the health service will continue to deteriorate.

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