David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I thank everybody who contributed to this debate. I also thank both Ministers of State for their contributions. This is one of those areas where we all agree on most of what we are saying. We all agree that people, in the first instance and where possible, should be cared for in the home and that those people doing the caring should be better looked after. It then becomes an issue of speed of delivery, and the reforms and changes that are necessary, in addition to political will.

I welcome the Minister of State's commitment to include in future tendering documents the matter of the living wage for all those who will provide home care, but the question has to be asked why it has taken so long. We have raised the issue of pay and terms and conditions of employment for a long number of years. It seems it is only when it gets to a point of crisis that we are then forced to act when these have been issues for many years. In fact, even the living wage will not be enough in the medium to long term, given the level of work that needs to be done.

I will focus on what the motion actually calls for because it is important that whenever we sit in this House, we do our best to implement changes that we have collectively agreed to, in some instances, or that we may not have in some areas. The Government has agreed to bring forward legislation in the form of the health amendment licensing and professional home support providers Bill, which needs to be expedited, as well as the regulations that are in draft form and will provide a regulatory framework for this sector, which I want to see. That needs to be done as quickly as possible. The programme for Government also committed to a commission of care. That still has not happened.

The logic of that commission is to modernise the home care sector and to better align care, from home care or care in the home to family carers and, then, to nursing home or residential care and palliative care, so aligning all the different strands of care and looking at how we integrate and align all those models. A commission on care would be an opportunity to do all that.

The Minister of State, Deputy Butler, when presenting her countermotion, talked about the ICPOP teams. I fully support those teams. Not all of them are up and running. We need to make sure they all are. In fact, we need more of them because they will be crucial as we roll out a statutory home care scheme and more people with more complex needs are cared for in the home.

One of the things we need to do, as part of new regulations, is to introduce and to integrate safeguarding into the standards and regulations. We need stand-alone adult safeguarding legislation across all strands of care. That came up in the area of nursing homes. I know HIQA has talked about it for some time. Safeguarding for both adults and children is very important, and I want to see legislation in that area with HIQA as the regulator, certainly in the short term.

There is a commitment to home support offices as part of the statutory home care scheme. I advocate that we would have a regional office in all the regional health areas. We now have to look at policy from when we establish regional health areas. That will be a game changer, and everything we do has to align with that strategy. I would like to see regional home support offices, as opposed to one central office, put in place if possible.

We need to develop a career pathway for carers. That has to involve a greater role for nurses, physiotherapists and allied health and social care professionals. That multidisciplinary model of care in the home will be crucial if more people are to be cared for.

We need to do more regular audits and reviews of those who receive care. That means in some cases people will need more or less care, but that is a better way of ensuring we use the resources we have in the most effective way.

We have to increase funding of home support, which includes adaptations of homes and all the other things people need to be cared for in the home. It is not just a carer. Sometimes it can be housing adaptation grants, personal assistance or wraparound services.

The motion calls for a lot more than that. Very often the Government says we do not bring forward solutions. It cannot say that when it comes to this motion. Again, I thank my colleagues, those in government and those in other Opposition parties, for their contributions.

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