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

I welcome the motion by Sinn Féin, which the Social Democrats will support. It is a timely debate following the publication of the report by the strategic workforce advisory group last month. I also welcome the strong endorsement by the Minister of State, Deputy Butler, of all 16 of the group's recommendations. I assure the Minister of State that she will have the full support of the Social Democrats if she proceeds to implement those in a timely way. However, I am concerned that there is no clear timeline for the implementation. While she talks about getting moving on it straight away, she does not set out a timeline. It is a real weakness that needs to be addressed. That is why I have tabled an amendment to the motion calling for the publication of a timeline before Christmas or the end of the year.

The issues and solutions have been identified pretty well in the report. We need to accelerate the kind of reform set out in the report because we cannot continue our overreliance on institutional care, not least in the aftermath of Covid-19 and the devastating impact it had on nursing homes. It also put the issue of institutional care under the spotlight. I can recall Deputy Varadkar, who was Taoiseach at the time, as far as I can recall, talking about us needing to radically change our view of the best model of care for older people. Nothing has happened since then. There was all this talk about things having to change drastically but nothing has happened.

We know that older people, in the main, do not wish to be in nursing homes. We also know there are many people in nursing homes who should not be there at all. They are there because no home care was available for them or for different reasons. However, people should be given choices, the first of which is to be at home, living as independently as possible with home care. We also have to look at the area of housing for older people. I have been talking about this for years. There are good models of housing around. We should ensure that people have some kind of sheltered housing option to which to move when their house is too big or unmanageable. Phased grades of support should be then made available up to nursing home level but nursing homes should be the last option.

More than 6,000 people are on a waiting list for home care. That is a scandal. There have been more than 8,000 delayed discharges so far this year, of which more than 10% were due to a shortfall in home carers. It makes no sense whatsoever to have large numbers of people in such situations. At any one time, there are approximately 600 people in hospital who are ready to be discharged. It is crazy that such a situation is allowed to continue for want of adequate home care, staffing, funding or step-down facilities. It is an example of the dysfunction within the health service, which should change very urgently. We cannot stand over a situation in which there is such a level of waiting lists and inappropriate use of expensive acute hospital beds. However, under the watch of successive Governments, we have seen not the State taking on responsibility for the provision of services directly but creeping privatisation of the home care sector, with funding to private providers increasing from €3 million in 2006 to €176 million in 2019.

Like a great many other aspects of our health and social care system, the State has become disproportionately dependent on outsourcing care. I was at the SIPTU conference a couple of weeks ago where one of the speakers was Ms Emma Dowling. She is the author of an excellent book, The Care Crisis, which I recommend the Minister of State reads if she has not done so. It is a terrific book. Ms Dowling made a good point in her presentation to SIPTU, when she said that rather than talking about outsourcing of care, we are talking about extraction of wealth from the care service. That is what it is. It is a model that includes the profit margin. Why are we doing this? Why are we making businesses out of what should be State-provided caring facilities?

I will make another recommendation. A woman in DCU, Professor Kate Irving, has written extensively on caring. She has written specifically on dementia but has also made important points with regard to caring generally. In a recent paper, which I would be happy to share with the Minister of State, Professor Irving made the point that we will continue to place responsibility for any version of person-centred care on the least qualified persons in the chain, that is, the home support workers. It is a very good description. I hope that we will all get to that critical point at our lives late in life but we will all more or less be looking for care at a certain stage. It has been decided by successive Governments that those providing critical care - a sensitive need for proper care - are probably the lowest paid and least qualified of all workers in our economy. That seems to turn logic on its head.

To make matters work, we still have no regulatory framework or independent regulator. All we have is the HSE acting as a proxy regulator of providers to deliver home care on its behalf while home care provided directly by the HSE effectively undergoes no such scrutiny as it cannot be independent of itself. Worst of all, in theory, providers outside of the tender do not have to adhere to any standards whatsoever. That is the current situation which is, frankly, unacceptable.

I think everyone accepts that the current tendering model is not fit for purpose. It has created a race to the bottom with the providers competing solely on price. Not only is this bad for the client, it is completely unsustainable for workers' pay and conditions. It is November and it is still my understanding that the invitation to tender has not been issued. I read the Minister of State's amendment carefully and tried to get around the weasel words but it was not clear whether the tender has been issued. It was supposed to be issued by the end of quarter 3 for implementation by 1 January.

I wrote to the Minister of State last April when the plan to dramatically reduce the number of providers was first mooted. Seven months on, providers are still anxiously awaiting clarity, especially smaller, not-for-profit and community providers. Will she, please, update the House on the upcoming home-care tender? The last I heard, Grant Thornton had been hired to assist with the procurement strategy but that was during the summer. I did not understand the need for private, third-party assistance then and I certainly do not see the need now. The Minister of State managed to miss the quarter-3 deadline even though she had employed outside consultants.

At the very least, will she give an assurance that the tender will ensure all home care workers receive a living wage at a minimum? That is the recommendation. She acknowledges that in her amendment but she does not commit to doing so. Will she give an assurance that when the tender document is issued to invite tenders, it will provide for the payment of the living wage, at a minimum, in accordance with the recommendations in the report? I have tabled an amendment to provide for that. Since the advisory group published its report, the living wage for 2022-23 has increased to €13.85.

Will the tender provide for that at a minimum? Further changes are required to address chronic low pay in the sector. A reformed tender model should insist on an incremental pay scale that recognises a worker's length of service, training and qualifications. At the crux of this is a lack of recognition of the vital work of the professional home carer and this should not be the case. It would also be remiss of us not to acknowledge this is a workforce dominated by women and that is certainly a factor in the historical undervaluing of this work. If there were proper pay scales, it would not be as difficult to recruit staff and we would have a lot more men going into the service as well, thus there are strong arguments for this, apart from the right of workers to decent pay.

Ultimately, these workers deserve our respect, not just in the form of positive platitudes but tangible measures that recognise the importance of their work, respect them and recognise the importance of collective bargaining, among other things. Without these reforms we will struggle to retain and recruit staff. I will forward the documentation I have quoted but I ask her to clarify what the situation is with the tender document and the living wage.

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