David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann: notes that:

— the nature and level of care delivered in the home must change to facilitate people staying at home for longer, to reduce periods of stay away from home either at hospital or at other care facilities, and to implement the Right Care, Right Place, Right Time policies;

— the average person in receipt of home care receives approximately eight hours of care a week, and this is likely to grow significantly as higher levels and greater volume of care is delivered in the home;

— to deliver higher complexity care in the home, the home support system must be modernised, and an increase of care delivered in the home will have consequences for the level and complexity of care delivered in nursing homes and other long-term residential care settings;

— as per the report in the Irish Times on the 1st November, 2022, more than 7,800 people have experienced unnecessary and costly delayed discharges from hospital so far this year due to a failure to plan and align community services with hospital need, such as step-down beds and home care packages, including more than 1,000 delayed discharges directly linked to home care shortages, which is directly contributing to the trolley crisis;

— the Health Service Capacity Review 2018 - Review of Health Demand and Capacity Requirements in Ireland to 2031, which was conducted based on lower population growth estimates than transpired, forecasted a minimum of 120 per cent increase in demand for home support from 2016 to 2031, but such demand at that level has already been reached and is expected to increase further;

— 62 per cent of home care is delivered by non-Health Service Executive (HSE) providers, with only 38 per cent of home support services delivered directly by the HSE, amounting to over €400 million in 2021 being paid to non-HSE providers of home care;

— the Minister of State with Reasonability for Mental Health and Older People, committed to the establishment of the full complement of 30 Integrated Care Programme for Older Persons (ICPOP) teams by Q3 2022;

— the Programme for Government: Our Shared Future commits to "introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care" and to "establish a commission to examine care" and the Government's commitment to establish a national home support office; and

— the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on the 15th October, 2022, made 16 recommendations across recruitment, pay and conditions, barriers to employment, training and professional development, and sectoral reform;

condemns:

— the failure of the previous Fine Gael-led Government and then Minister for Health, Simon Harris TD, and his predecessors, to plan for, train, recruit, and retain enough nurses, healthcare assistants, and home carers to sustainably expand home care services, which directly led to the crisis in home care that is being experienced at present;

— the failure of the Minister for Health, Stephen Donnelly TD, to significantly advance proposed legislation such as the Health (Amendment) (Licensing of Professional Home Support Providers) Bill and the Health (Amendment) Bill relating to enhanced governance of nursing homes;

— the failure to deliver 1,000,000 home support hours in 2021 which were owed and budgeted for, as indicated in the HSE's National Service Plan 2022; and

— the overreliance of successive Governments on private home care providers, instead of investing in home care as a public health and social care service and career; and

calls on the Government to:

— expedite the proposed Health (Amendment) (Licensing of Professional Home Support Providers) Bill and new regulations for providers of home support services to construct a modern regulatory framework for home care;

— establish a commission on care and bring together social care sectors and stakeholders to modernise the home care sector and better align care, including family carers, care in the home, nursing home and residential care, and palliative care;

— fully commission the 30 ICPOP teams and transparently publish their staffing complements, with a view to fully staffing all teams;

— integrate adult safeguarding legislation into new regulations for the home care sector with the Health and Quality Information Authority as the regulator;

— establish regional home support offices to be embedded within regional health areas to ensure compatibility with forthcoming organisational reforms;

— develop a career pathway for carers and carers with an advanced skillset, and a greater role for nurses, physiotherapists, and allied health and social care professionals, including at advanced practice grades, in delivering high-quality home care;

— ensure more regular and holistic reviews of the health and care needs of persons receiving home care and home support to ensure they are in receipt of the type, quality, and intensity of care that they need;

— increase funding for home support services generally, with targeted increases in funding for healthy age-friendly homes, housing adaptation grants, personal assistance and assisted living services, and intensive home care packages to enable people to live at home for longer;

— introduce additional access routes to working in home care for people who are interested in additional but less than full-time employment in the sector, particularly in rural and underserved areas;

— invest in home care to ensure it is a viable alternative to nursing homes and residential care, where the choice is appropriate;

— establish a high-level workforce planning group to deliver accountability and joined-up, cross-Government planning for training, recruitment, and retention of health and social care professionals across the entire health sector, including home care; and

— modernise the tendering and funding model for providers of home care to prevent a race-to-the-bottom in costs and quality, to be underpinned by a collective agreement on employment standards in the sector that ensures a level playing field, high care standards, and fair remuneration for workers.

I am sharing time with some of my colleagues. It is good to see the Ceann Comhairle.

There is a crisis in home care which many of us have been talking about for many years. In October 2022, more than 5,100 people were on waiting lists for home care. Many of these people were in hospitals waiting to be discharged. We all signed up several years ago to the policy of right care in the right place at the right time. In the first instance, this means people being cared for in the home. We have far too many people who need intensive home care packages or home care support and cannot get these supports because the resources and capacity are simply not there. The truth is that last year hundreds of thousands of hours of home care could not be delivered because the staff simply could not be got. I have engaged with the organisations that provide the vast majority of home care. We know these are mainly in the private sector, along with an element of provision in the HSE. As the Minister of State knows, we rely on the private sector for much of this care.

There have been real challenges in this are for far too long. The sector has low levels of pay and is mainly populated by women who do an extremely difficult job. Talking to carers, especially given that most of them are women, it is possible to get a sense of what they do every day. This includes having to lift people, change them and care for them. This is a physically demanding job. We then look at the levels of pay received for this work. These people are working in an unregulated sector, one that does not value the work they do. Is it any wonder then that we have such levels of staff turnover and a retention and recruitment crisis?

I know the Department undertook work to examine all these issues and there is a report that needs to be implemented. I put it to the Minister of State that unless we deal with the issue of pay in this area, we will never truly value home care. I appeal to the Minister of State and her Government to put in place a collective pay agreement for the home care sector. It is one of the solutions proposed in this motion and one my colleagues and I have been calling for for many years. This is the best way to level up and create a level playing field between HSE and non-HSE staff and ensure we have pay parity to enable us to recruit the staff we need. That is important.

I have also been saying for some time that the problems in our accident and emergency departments in our hospitals will be resolved, in part, by putting more capacity into our hospitals. I think we all accept that hospitals need more consultants, nurses, healthcare assistants, specialist staff, junior doctors, beds and surgical theatre capacity. Hospitals need all this and more. Equally, though, part of the solution to what is happening in our hospitals is that we have far too many people in hospitals who should be being cared for elsewhere. One of the key tenets of Sláintecare was that we would start to reorientate our spending to other elements of care that are less costly but much more beneficial for patients and the healthcare system. Part of this involves step-down and recovery beds and residential care settings, but also home care.

Promises were made that we would have a statutory home care scheme. There is still no date for when this scheme will be put in place. Several pilots were undertaken but we have no sense yet as to when this scheme will happen. The average number of home care hours a person gets is about eight. If we are to move to a statutory home care model which allows for much greater levels of care in the home for people with higher needs, which they will have, and more dependency, it will mean providing many more hours of home care. Many providers told me recently that this will mean, in some cases, providing 20, 30 or 40 hours of home care.

If we cannot provide home care to people as it is, even before we start to extend and improve home care and provide more opportunities for others to be cared for in the home, what chance will we have when the statutory home care scheme comes into place? We need to start planning now. We have left it far too late. While the Minister of State has commissioned a report, which I welcome, we need action on all fronts on this issue. We need to regulate the sector. We need a Bill that does this. There are draft regulations that need to be fast-tracked and put in place. Once and for all, we need to deal with the recruitment and retention issues and put in place a fairer scheme, a fair rate of pay and a fair collective agreement that creates a level field that will allow us to recruit more staff into a crucial sector. More importantly, that will allow us to value the work these people do.

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