Brendan Howlin (Wexford, Labour) | Oireachtas source

I compliment my colleague, Deputy Duncan Smith, on his long advocacy for home care workers and home care support, and for tabling the motion. No Member of this House has not struggled with difficult cases from constituents desperate to continue living at home or families desperate to have loved ones come home from long-term hospital care, only to be told again and again that there is no home help service or that what is available is inadequate to allow the loved one to be treated at home or to remain living at home.

The unfolding disaster of next year's health budget stems from a clear showdown between the Department of Health and the Department of Public Expenditure, National Development Plan Delivery and Reform, where trust has quite frankly broken down and the funding Minister in the latter Department has clearly and publicly signalled he simply does not accept the costings of his colleague, the Minister for Health, and has, therefore, underprovided for healthcare for next year. This power play will make a difficult situation that exists at present, which the Minister has acknowledged, immensely more difficult next year.

The 5,300 healthcare support assistants employed by the HSE cannot meet current demand, as the Minister of State knows. Giving people 30 minutes of home support is wholly inadequate and further recruitment to that cohort of 5,300 is now embargoed. It makes no sense. It makes no sense to keep people in acute hospital beds when they want to be at home and when, if the resources were there, they could be at home. Meanwhile, the HSE is contracting in 13,000 or so home care workers from private providers at an enormously more significant cost. The whole thrust of Sláintecare is the creation of an integrated, single-tier, universal public health system. The direction of travel of Government is to increase dependence on private providers for nursing home care and home support care. Less than 40% of home support is now directly provided by the HSE; it is 60% privatised. The basic philosophy underpinning the agreed all-party approach to the provision of healthcare, Sláintecare, the health system of the future, is being systematically undermined by Government policy. The increase in funding for home support next year is 0.4%, which is less than half of 1%, at a time inflation, not to mention wage inflation, is expected next year to be in excess of 3%. Add that to an ageing and growing population and we know what is now inadequate provision will be grossly inadequate next year.

The CEO of the HSE has said, in essence, that he is going to produce a service plan to meet projected need. I have never heard the head of any State agency say he is going to provide for a deficit, that is, to ignore the inadequate budget he has been provided because it is so patently inadequate. This is extraordinary and is an extraordinary way to run our most important public service. The long-promised statutory underpinning of home support, which the Minister of State referenced, needs to be produced. The programme for Government promised this but we still await its introduction. Such a vital service cannot be run in such an ad hoc manner where location and availability of staff determines whether a person can be provided with an essential public service. We would not tolerate that in education, for example. Why would we not demand the same level of support for our elderly as we do for our young? We have had a cross-departmental strategic workforce advisory group set up by the Minister of State and it has made recommendations but as my colleague, Deputy Nash, has so clearly said, the most fundamental is to have a joint labour committee to determine proper pay across public and private to ensure there is proper recruitment. Our health service has grown in an unstructured way into public health, voluntary health and private health. The strains on this disjointed service have long been recognised, namely, different terms of pay, different types of service and geographical inequalities. We had hoped we would resolve that now. The Minister of State can do that for home care if she accepts the motion.

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