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

I thank the Regional Group for tabling this motion. The Social Democrats will support it. In 2018, a statutory right to home care was first promised, with 2021 being the target date for its introduction. Now, five years on, this Government still has not delivered it despite numerous promises from the Minister of State, Deputy Butler, and other Ministers. What is the problem? Why is the Minister of State not delivering on what she said she would do and what is so desperately needed?

The Covid pandemic is usually blamed for any delays in progressing Sláintecare reforms. In some instances, that is a reasonable defence. However, when it comes to home care, the pandemic should have acted as a catalyst for reform and not a barrier. Lessons have to be learned from the experience of the pandemic as regards elder care. One only has to look at what happened in the nursing home sector to understand why that is the case. Instead, this Government has dragged its heels rather than accelerate reform of a sector marked by increasing privatisation, poor pay and the continued dominance of institutional care. Even the new home support tender, which was supposed to herald improved pay and conditions for home care workers, falls entirely short. Not only was the process mishandled by the Minister, it has not even delivered on the recommendations of the strategic workforce advisory group. For a start, workers will not receive the living wage, currently set at €13.85 per hour. Instead, the Government is doubling down on its own version of the living wage, which, of course, is not a living wage at all. This shows a complete disregard for home care workers.

Care work should be valued and regarded as a viable career. We cannot continue to expect this workforce, 87% of whom are female, to deliver high-quality, person-centred care in the absence of adequate pay, terms and conditions, and opportunities for career development. While significant progress has been made on pay and conditions for carers working directly for the HSE, staff within the private sector, who provide more than 60% of HSE-funded home care, still face serious challenges and disincentives. These workers are not covered by any collective negotiating agreements and face resistance to trade union membership and attempts to organise. This is just another reason the State must expand direct provision of home care and reduce our overreliance on outside providers.

On travel, the new tender also disappoints. Home care workers should receive mileage but instead only travel time at a rate of €2.99 per hour will be covered. This is again another broken promise. This is a completely inadequate response to the costs incurred by these workers, given the distances travelled by many of them, particularly in rural areas, and the considerable expense of running and fuelling a car.

Another recommendation of the advisory group that remains unaddressed is the review of social welfare eligibility rules. The current three-day rule is extremely restrictive and in need of reform. A new system, based on cumulative hours worked, would free up capacity in the sector and help reduce our stubbornly high waiting lists. I raised this with the Minister for Social Protection last February, but she showed no sense of urgency. The Minister for Health and the Minister of State with responsibility for older people need to urgently engage with her to move forward on this important issue. The point is the manner in which there is a demand for home care means it is spread over the whole week, sometimes six days in the week, and the three-day requirement is just not relevant to people working in the sector, which is why we need it to be addressed urgently. We simply cannot allow this situation to continue deteriorating.

At the end of March, more than 6,000 people were on a home care waiting list. They had been approved but the staff were not there. In addition, from the acute hospital perspective, there are regularly 600 delayed discharges. In the short term, these unacceptably long waiting lists could be addressed by better pay and conditions. While in the medium term we need to seriously examine the model of home care provision in this country, this must be part of the commission on care.

We know what is happening, driven by the Government in particular, is a drive towards incentivising nursing home care, and the use of a large tax-based model that is entirely inappropriate. The Government is driving outsourcing and privatisation and losing all sight of what is in older people's best interests. We have to change approach on this. We cannot continue with this. We cannot have older people being warehoused and this kind of creeping privatisation we have seen right across elder care. It is simply not good enough. The starting point has to be an immediate statutory right to home care.

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