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

I thank the Labour Party for tabling this motion. It is a very topical motion on what is a very pressing issue to which the Government needs to give urgent attention. The Social Democrats are very happy to support the motion.

For over five years, a statutory right to home care has been promised and yet it still has not been delivered. We are told that work is ongoing but we still have no idea when the legislation will be published. It is becoming clear that there is no real sense of urgency about getting this over the line. In fact, it seems to be getting pushed further and further down this Government's agenda. I regularly request updates on the statutory scheme but all I ever seem to get are stock responses about progressing regulation. There is no question but that a regulatory framework is desperately needed. However, that is only one part of the broader reform programme.

Reading between the lines, one cannot help thinking that there is not much appetite for legislating for a statutory scheme, or at least not this side of the general election, it would appear. Publicly, this Government may espouse the importance of home care but the waiting lists tell a very different story. As of last June, almost 6,200 people were on a home care waiting list, an increase of 1,500 since May 2022. Clearly action is needed to reverse these spiralling waiting lists but, instead, home-care hours are being cut by almost 2 million this year to 22 million hours and there will be no increase next year, we are told. We know that home-care hours were reduced in order to deliver a so-called living wage for workers. However, it must be said that this Government is using the term "living wage" somewhat loosely. A €13.10 per hour rate is not a living wage; it is €1.70 below it and the Minister knows that. Furthermore, there is no commitment to maintaining parity with the recommended living wage going forward. There is no question that home-care workers deserve a pay increase and much better terms and conditions but that should not have come at a cost to patient care. The funding should have been provided to deliver on both commitments - to a real living wage and to the full 23.9 million home-care hours already contained in the national service plan for this year - but this Government is so short of ambition that it could not honour either one.

In terms of the other strategic workforce advisory group recommendations, progress has been painfully slow. A response to a parliamentary question in September indicates that of the 16 recommendations, only one had been implemented, four were at an advanced stage and the status of the remaining 11 was not provided. It is completely unacceptable that over a year since the report was published, we still do not have an implementation plan. What is the hold-up? The Minister of State, Deputy Butler, has talked about her commitment to this, and many people feel she has a personal commitment, but she is simply not delivering in terms of getting all of the ducks in a row and ensuring that adequate funding is provided and the political support is there.

The cross-departmental implementation group met again almost a month ago, yet there is still no sign of a plan. As we head into the winter months, this should be an absolute priority, not least given the HSE's latest plan to tackle delayed discharges. Transferring patients to nursing homes, possibly miles away from their homes, has been described as a dysfunctional response by Professor Des O'Neill, the chairperson of the Irish Society of Physicians in Geriatric Medicine. On Sunday, he said that the HSE directive amounted to the warehousing of older people, potentially in settings that cannot meet their needs. There is no denying that delayed discharges are a major issue in our hospitals. At any one time, around 600 patients are ready to leave their hospital bed but there is no step-down facility or home care available for them. This is a major concern for the system but, much more importantly, for patients. However, the answer is not to force older people into nursing homes or strip them of their own agency. We have known for years that this is a problem and that there are logjams and blockages in the system but the whole emphasis is on acute beds, without having dealt with the upstream issues that cause these blockages. The answer is alternative models of care like home care and temporary rehabilitation beds along with, of course, increased hospital capacity. After all, most older people would much prefer to remain in their own home and be cared for there but the State is continuing with its over-reliance on the nursing home sector instead of scaling up home care, despite all of the evidence to support this as the optimal model of care.

In terms of beds, the Government has repeatedly failed to deliver. Not one new bed was provided for in this year's HSE service plan. Every single one of the additional 184 acute beds and 26 critical care beds mentioned in the plan was actually an overdue bed. Each one has been committed to in previous winter and service plans. As of August, only four of those 184 overdue acute beds had been delivered, while not even one of the critical care beds had been provided. What is happening here? It seems that lip service is just being paid. When it comes to critical care beds, we know the huge problems that existed during the Covid period. We also know that we are at a point where beds were promised years ago but the promises that were made have still not been met. Clearly the issue of overcrowding and delayed discharges is one of poor planning and delivery. Pitting patients against each other will not change that and it is deeply unfair for the Government to engage in that.

Before concluding I would like to make some points about care. Historically, care has been undervalued and under-recognised by the State, be it paid or unpaid. When this Government finally holds a referendum on Article 41.2 at some point in the future, the replacement article must address this by enshrining the value of care work in the Constitution. In terms of social care, it is also imperative that the commission on care examines, in detail, the increasing privatisation of care and the impact this has on the quality of care provided. In 2020, the Taoiseach and the Minister for Health said very clearly, based on the experience of Covid in nursing homes, that we need a new model of care. We are still waiting for that new model of care to be announced by this Government. The arrangements at the moment do nobody any service.

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