Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

I move:

That Dáil Éireann:

acknowledges that: — there is still no statutory right to home help or legislative underpinning for the home support scheme despite long standing commitments to act;

— the delayed referendum to replace Article 41.2 of Bunreacht na hÉireann, if passed, will finally insert language that recognises and values care within the home and the wider community; and

— the Commission on Care for Older Persons is due to finally get underway in January 2024, and while Ireland has a growing population, it also has an ageing demographic profile requiring increased resourcing of elder care; recognises that: — the State has a central role in providing care for people in the community and in their home, but there is growing healthcare privatisation through the outsourcing of more and more care, diagnostics, treatments, employment and services instead of investing in the permanent capacity of our public health service;

— over 60 per cent of State-funded home care is provided by private and voluntary providers, but there is no requirement for these contractors to engage in collective bargaining, despite a long-standing recruitment crisis in the sector; and

— home carers directly employed by the Health Service Executive (HSE) as Health Care Support Assistants (HCSAs) have better pay, and stronger terms and conditions compared to those working for private providers, creating a two-tier workforce and pay disparity for people doing the same job; notes that: — the health budget for 2023 originally funded over 23.9 million hours of home support in the HSE National Service Plan 2023, with a total budget of €723 million, but this was cut to 22 million hours in July in order to fund an increased rate of €31 per hour for providers, a so-called "living wage" floor of €13.10 per hour for workers and payment for travel time;

— Budget 2024 provides again for only 22 million home support hours, and allocated just an extra €2.8 million in funding for inflationary pressures, a 0.4 per cent increase;

— as of the end of June 2023, 10.55 million home support hours were delivered nationally to 53,579 people with a further 6,020 people assessed and waiting for a carer to be assigned, but no data is collected on how long people must wait;

— before the new tender 40,000 people over the previous year received care through private providers charged to the HSE at a rate of €26.50 per hour, while workers still had no predictable income;

— under the new HSE Home Support Authorisation Scheme 2023, the day rate for providers is now €31 per hour, but payments to workers are not indexed to increases in the Living Wage, which is now at €14.80 per hour;

— in the public service a HCSA can start on more than €16 per hour rising to over €20 on their salary scale, while privately employed home carers are paid €13.10 per hour, with providers funded at a rate more than twice that;

— the HSE, in October, abandoned a cost saving plan that would have cut 15 minutes from an hour of private home help, reducing it to just 45 minutes; and

— it is a year since the publication of the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants and while some recommendations have been partially acted on, there is no fully resourced implementation plan; further notes that: — the failure to fully resource the home support service and waiting lists for homecare packages leads to discharge delays in acute hospitals, and at the end of June there were nearly 500 delayed transfer of care patients;

— there is a postcode lottery when it comes to home care waiting lists, and evidence that those in rural areas wait longer due to a lack of mileage and travel costs for carers;

— social welfare rules create disincentives for part time work by home carers, reducing the hours they can work;

— the lack of progress on employment terms and conditions, including travel expenses, a competency framework, recognition of training, and a pension scheme, are further barriers to recruitment; and

— there has been a shocking inconsistency in the payment of the Covid-19 Pandemic Special Recognition Payment to home carers and other healthcare workers; and calls for: — the adequate funding of our health service, the immediate reversal of the recruitment embargo on health workers, and a commitment not to block the hiring of public service HCSAs;

— restoration of the 1.9 million hours of home help support cut in July 2023, and no cuts to the duration of home support hours;

— a guarantee that home carers are paid, at a minimum, the new Living Wage rate of €14.80, and payment to be provided for mileage expenses and travel time between care locations, along with guaranteed hours and continuity of income for HCSAs;

— a commitment in outsourced State contracts that private home care providers engage in collective bargaining with recognised trade unions, and the introduction of a Joint Labour Committee for workers in the private care sector to set employment standards;

— a published and resourced implementation plan for the recommendations of the Strategic Workforce Advisory Group report, to deliver on the recruitment needed to clear the current waiting list for home care and support before Christmas, and sufficient resources to be put in place to address the winter health crisis;

— annual targets to increase the proportion of home support hours provided directly by the HSE, in order to achieve a publicly provided service;

— the collection of data by the HSE on how long people are waiting for home care and the adequacy of the hours granted;

— the payment of the Covid-19 Pandemic Special Recognition Payment to those home and family carers, and all those other health workers in Health Information and Quality Authority registered settings excluded to date;

— an end to the payment disparity between home support for older people, and those with disabilities; and

— a commitment to the referendum to recognise care work in 2024.

I am sharing the opening slot with my party leader, Deputy Bacik. We bring this motion today because home care and home help are a core pillar of what the Labour Party is trying to promote and support from opposition, namely, the improvement of the levels of care throughout our society. We feel that in the area of health, budget 2024 has let people down on many levels. One area that has not received the level of notice it deserves is how the budget has let down home help, both the workers and those who need the care.

Home care workers are some of the many unsung heroes in our health service. They are underpaid, overworked and there is not enough of them. The people who are in need of home help, those who receive it and the 6,000 who remain on waiting lists, are crucially important in terms of health delivery in our country. In many ways, they are unseen and invisible. They are not in a waiting room or on a trolley. They are not being counted.

Some are in wards awaiting delayed discharge. Many are at home being cared for by overstretched family members and friends. This area of care needs focus and funding, but this is not what happened with budget 2024. We need urgent action from the Government to lift the health service recruitment embargo and to provide increased funding for our health service. Our health service is symbiotic: underfunding in one aspect of our healthcare system reverberates across the entire system.

This is why we need to see a reversal of the recent cut of 1.9 million home support hours immediately and to see an increase in the funding for hours from the €23.9 million that was originally planned for in 2022. Providing adequate funding for home support hours will allow people to transition from hospital settings to the requisite care provided in their homes. In June of this year, there were nearly 500 delayed discharges from our hospitals. I have raised many times our hospital trolley crisis, which is now a year-round crisis and averages about 500 people per day. While it is not directly related, if 500 people are delayed getting into the hospital system and an average of 500 people are being delayed in getting out of the hospital system, unless we have the measures downstream beyond the hospital setting in the form of home help, we will never truly be able to tackle or beat our trolley crisis.

One of the main areas of concern with home help relates to the level of outsourcing. Currently, there are 18,000 home care workers in our country. The HSE employees over 5,300 HCSAs but with the recent recruitment embargo applying to them, any future growth in that area will have to come from the 13,000 who are currently employed by the private and voluntary sector and not from the public service. This is something we cannot tolerate. The Government and the HSE have stated that the reduction in hours from 23.9 million to 22 million was to allow providers to deliver a living wage for workers. However, we have not seen that happen. Alone, the rights group for older people, has labelled this move as "shrinkflation".

The Government knows that this move has also resulted in care cramming where, due to the demand of care, care in the home is being rushed and delivered by providers who are overstretched and do not have the workforce to meet the level of demand. Part of the reason for this relates to the recruitment and retention crisis. Because the pay remains below the living wage, the pay is too low. Despite the Government's efforts in recent years and despite the efforts of the Minister of State, this has not been delivered. The living wage will increase next year to €14.80. Wages in the private and voluntary sector of home care do not match that and therefore, these organisations are struggling to get the staff required. When these organisations are providing 60% of home care, we know this is a core reason for the crisis.

The level of demand on the service is increasing every year. We have seen a 3.7% increase in people needing home care from 2022 to 2023 so far. Our ageing population is a key factor in this. It is a great testament to many aspects of our society that our population is growing and people are living longer. However, if people are living longer, they will contract more chronic illnesses and will get sicker, therefore requiring more care at home. Unless we have a structure driven and delivered by the State, we will not be able to meet our basic demographic demands.

Regarding the increased demand for care, according to the HSE service plan for 2022, we have an acute shortage of care workers. HSE data indicated that as of July 2022, a total of 5,312 people were waiting for home support from HSE services for older people because no care workers were available to provide them. We know that has now increased to 6,020, an increase of 800 in the course of a year, which is absolutely unacceptable.

The HSE service plan report suggested a number of actions the Government could take to improve recruitment in the care sector that we would welcome. These include: a national campaign to raise the profile and promote the training opportunities available for a career as healthcare assistant and home care worker; a public employment services review with a view to further increasing the number of jobseekers who become healthcare assistants or home support workers; the continuation of a rolling recruitment campaign in each community healthcare organisation for as long as the positions remain unfilled; and a review to be undertaken on the eligibility criteria for State benefits with a view to ensuring that they do not unnecessarily disincentivise engagement in part-time employment. Implementing these suggestions alongside the core request of improving the wages, as we have previously outlined, would significantly alleviate the current pressures on the home care sector.

Home care is an issue close to the hearts of people throughout the country and close to the hearts of those of us in the Labour Party. We believe that home care providers and the issue of care deserve to be recognised in our Constitution. The delayed referendum to replace Article 41.2 of Bunreacht na hÉireann, if passed, will insert language that recognises the value of home care. We ask the Government to commit to advancing this referendum as soon as possible and to promise that we will see no more unnecessary delays. It is November 2023. This is the month in which we expected to be campaigning on a referendum and we seem further away from that referendum than ever.

A couple of days ago, Sage Advocacy, the national advocacy service for older people, released the results of a RED C poll, which showed that more than 80% of people believe that care for older people is too concentrated in private providers and that more State involvement is needed. The results of this survey show that home care is an important issue for people in this country. As we know in politics, it is extremely rare to get 80% agreement on anything, which highlights just how highly people value this. The survey, which was initiated by Sage Advocacy in advance of the establishment of the commission on care for older persons, has provided a very clear message which we hope the Government well take on board when the commission finally gets under way in January 2024.

People who have worked hard for their whole life deserve proper care as they age. Those who are sick and vulnerable and are able to be cared for in the home deserve this. The Government must be reminded in the starkest possible terms that those providing care and rehabilitation in the home ultimately save the State millions of euro. It is where people want to be cared for and made healthy again. It is the cheapest and most cost-effective way of doing it and yet the State continues to fail. Those workers who are underpaid, undervalued and overstretched are shouldering a burden that is beyond them in many ways. Those who require the care but are not getting their full hours every week and those who remain on waiting lists deserve so much more than they are getting. We call on the Government to support our motion.

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