Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank Sinn Féin for tabling the motion, which also gives me a chance to speak about disability services. My colleague, the Minister of State, Deputy Butler, will be issuing a timeline in respect of the strategic workforce advisory group recommendations and has already commenced work on some of the recommendations. I acknowledge the input of all Deputies who contributed. It is clear that we all have a strong desire to ensure those who need a safe and regulated home support service in a timely manner have access to it.

I will speak first about what the Government is doing to address some of the immediate challenges we face and then speak more generally about what the Government has achieved so far, with all the extensive reforms that are taking place. Home support is a priority for the Government. The population is growing and ageing, and that means the demand for home support services increases every year. I am pleased to state that funding has kept pace with this demand. As noted by the Minister of State, Deputy Butler, we have provided an additional €200 million for home supports since 2021. This is a 42% increase. Next year, the overall budget will be in excess of €700 million. This will go towards progressing the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services. It will also deliver approximately 24 million hours of home care in 2023, more than ever before.

The Government is working to ensure that people with disabilities are enabled to live an independent life of their choosing, just like any other person, in line with Transforming Lives, the disability reform policy. Year on year, the HSE has consistently increased the number of hours of personal assistant, PA, service delivered to people with a disability. The national service plan for 2022 outlines the HSE's commitment to deliver 1.7 million hours of PA services to 2,587 people. I sought a sixfold increase in the budget of 2022 to ensure we would have such funding for it. This reflects an additional 120,000 hours of PA services in 2022 to expand and enhance supports for people to live self-directed lives in their own communities. This is the single biggest increase in PA hours in the past ten years.

It is not often that I agree with Deputy Bríd Smith but it is important that we reflect on her portrayal of how home care should be delivered. It is how I envisage it within disabilities. Deputy Nolan also spoke in the same vein. It is about giving hours to family carers so that they can support people within their communities while they are awaiting more long-term supports. When people are discharged from hospital or if there is a need or an acuteness within a family setting, they would have a blanket number of hours to support families with disabilities in that manner.

However, it is increasingly difficult to find workers to deliver all this care. Having listened to the commentary this evening, I make the point that it is not just the section 39 organisations that have an issue; the HSE also has an issue in this regard. I make the point to Deputy Cullinane that what I have tried to do in recent months is to look at the whole framework. In the context of disabilities, if it were possible to abolish the current framework, I would throw that framework out the door, start again and make all the recruitment agencies take responsibility in the context of certain things that when we have on the critical skills list, such as a required standard of English, and also the qualifications needed to deliver of PA and home support in disabilities. That work in respect of the skill sets should be done when the provider or recruitment agency is seeking staff abroad rather than when the staff arrive in Ireland or when there is a time lag on it. Another reason for abolishing the whole framework piece is that it is restraining us from making progress. The whole tendering process in that regard is too much of a quagmire. If it was abandoned, and given that we know the requirements in delivering PA and home support within disability, we would see a sizeable cosmic shift in that space. It is something on which I am working with the HSE. It is slow to move but we will get there.

As regards pay and conditions, it is important to recognise that one of the recommendations is for rolling recruitment campaigns by the HSE but, even though the terms and conditions are better, the HSE is struggling to recruit. That is why I speak about the family carers model. It is closest to home for the delivery of care. The Minister of State, Deputy Butler, and I have discussed ad nauseam the possibility of the HSE providing that care in as close a circle as possible. Rather than people travelling 20 miles or 30 miles to deliver care, there would be a far more structured and streamlined delivery of care and it would be far more manageable. It is the way that home care was done back in the day and there were far better outcomes from it.

Preliminary data for September show there are 6,255 people assessed and awaiting a carer to become available and seven people waiting for processing for funding approval. From that, we can see that funding is not the issue; it is actually manpower on the ground. It is important to note that the number of people waiting across both categories was reduced from 9,000 to 6,226. The current waiting lists are predominantly made up of people who have been approved for support but are waiting to be assigned a carer, so it is clear that funding is not an issue.

On the reform of home care supports, the programme for Government commits to the introduction of a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality regulated home care. The Department of Health is currently developing a regulatory framework for home support providers with the aim of ensuring that all service users are provided with high quality care. This will comprise primary legislation for the licensing of home support providers, regulation that will set out the minimum requirements a provider must meet to obtain a licence and, last, the HIQA national standards. We have to remember we are delivering this in people's homes. We do not need to over-regulate it from a HIQA point of view, such as requiring that door frames have to be a certain width before we can send in a provider. We have to be realistic, agile and pragmatic in our support. The heads of Bill are currently being drafted by the Department with a view to bringing the Bill through the Houses of the Oireachtas at the earliest opportunity. Regulations are at an advanced stage.

Throughout the development of these regulations, the Department has sought full participation of home care providers, trade unions, NGOs, international colleagues, academics, health and social care professionals, families and, most important, the service users themselves. For example, in August the Department completed a public consultation on the draft regulations. A report on the submissions received is currently being compiled by the Institute of Public Health and will be published shortly. The findings from the consultation will inform amendments to the regulations. This will ensure the regulations are ambitious but achievable.

Moreover, they will put the welfare of the service user at the centre of everything they do. In addition, HIQA is developing standards for home care and home support services that will go out for public consultation early next year.

In parallel to the work of the statutory scheme, a modern needs assessment tool, the interRAI, will be introduced nationwide to determine the prioritisation of the levels of care required. The Department and the HSE have developed a comprehensive operational model for the roll-out of the interRAI tool. This will facilitate efficient, fair and transparent care needs assessment and planning and appropriate service delivery. There has been significant progress in this area and the recruitment of 128 interRAI care needs facilitators has commenced. The HSE is also testing and learning how best to roll out the interRAI through the pilot that is under way in four sites throughout the country. The evaluation of the outputs from the pilot sites will soon commence. This will be critical to the development of a new home support scheme.

The HSE is undertaking a recruitment process for a number of key posts to support the establishment of a national home support office. Funding is provided for 15 full-time jobs, including community healthcare organisations and home support manager posts. A proposed location in Tullamore is currently being explored by the HSE. While we are seeing good progress in the area of home support, all these investments in home support reform will take time to deliver. They are essential, if we are to see sustainable improvement. The proposed reforms are about ensuring that appropriate, high-quality, regulated and safe care is delivered to the population in accordance with the Sláintecare model.

On Deputy O'Donoghue's point on St. Joseph's, St. Gabriel's and Enable Ireland, it is important to again say that while I appreciate that funding is an issue, in this case, the issue is in fact trying to get people and the training of personnel. As Minister of State, I allocate €33 per hour to the HSE; that is not what is paid to staff who are delivering the service. It is time that a living wage is provided to people working in the home care sector. We need to make it attractive. We also need to encourage people who live locally to come back into the sector in order to build that relationship that was spoken about.

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