Bríd Smith (Dublin South Central, People Before Profit Alliance) | Oireachtas source

I thank the Labour Party for tabling this motion, which highlights the problem with our two-tier health system and the specific impact on the provision of care for the elderly in regard to home-help hours. Indeed, the facts and stark statistics laid out in the motion illustrate that we are dealing with a scandal of historic proportions when it comes to the care of our elderly. That scandal is not just in home help but right across the system. We now have a system that has moved from 80% of care of the elderly being in public facilities and 20% in private facilities to the absolute opposite, namely, 80% in private care homes and only 20% in public care homes.

Last month was the month to raise awareness of older people's needs but our awareness does not seem to have been raised very high. We are currently facing a situation in the public system where Cherry Orchard Hospital is going to empty two wards and move 68 people out in the next two weeks. It is not acceptable and it will not be allowed to happen, as far as the workers and families are concerned.

I say that as a by-the-by. In 2012, the home care system was dismantled. I live in the Ballyfermot community and the home help system that existed there was very strong. Neighbours knew each other and looked after one another. They were able to visit each other frequently. It had its problems, in that people were not trained properly and it needed upgrading but it certainly did not need the massive privatisation that followed and which put a focus on time pressure, low pay and the profits of companies that moved in. People who suffer from dementia and need care often get four or five different people visiting them in one week. That still happens. We do not know who is monitoring all this privatised care.

There is a deep irony in the Labour Party tabling this motion and highlighting the issue, given that it was in government with Fine Gael, under the then Minister, James Reilly, when that system was dismantled and privatised in 2012. That said, the motion needs to say something further, namely, that we need a nationalised healthcare system, especially when it comes to the care of the elderly in society. That must cover both home care and nursing home care. The staff should be public servants with sick pay schemes, union representation and career paths. They should not be working for a provider that is privatised and puts them under time pressure, all for the profit they make. That is the least the workers and the elderly deserve and will be an absolute minimum demand of any left government in the future.

The proliferation of private care of the elderly was a conscious decision of successive Governments of Fianna Fáil and Fine Gael since the foundation of the State and in the past three decades, with the adoption of privatisation and a neoliberal model. Of course, they have been helped by others who joined them in coalition Governments. In recent decades, however, they have been encouraging the privatised firms to provide care for the elderly and general health on a for-profit basis. The justification for this is absolute rubbish. They say it is more efficient but it is not cheaper for the public purse and it does not provide better services or care for elderly people. I have heard the Minister of State, Deputy Butler, eulogise the spending on this aspect of health and the expansion of home care hours but the historic reality is one of underfunding, with a reliance on voluntary and religious provision of essential care. It is no accident that sections 38 and 39 workers have been forced to repeatedly demand pay parity and basic rights.

Under the OECD average, Irish health spending per person under the public component is lower than that in many other countries. It is 73% in Ireland, 86% in Norway, 84% in Sweden, 84% in Denmark and 82% in the Netherlands. In other words, the public part of what we spend is much lower than it is in other countries, including in the UK, where it is 79%. In 2019, the HSE spent 31% of its budget on outsourcing to outside agencies, including religious and for-profit organisations, home care providers and non-religious voluntary hospitals. Since the 1980s, the subsidised expansion of the private healthcare industry has created a powerful lobby of private hospitals, insurance companies, nursing homes, home care providers and their owners and they are determined to block reform. Uniting them all is a shared class interest in perpetuating private ownership and control of healthcare and the right to profit from it. In 2019, Julien Mercille produced a report titled The Growth of Private Home Care Providers in Europe: The Case of Ireland. He showed the effect of State policies in the area of home care provision and noted that the amount of money received by private providers increased from €3 million in 2006 to €176 million in 2019. Private providers had more than 80 members, employing a total of 14,000 carers. Industry sources estimated that approximately 75% of the revenue of private providers is obtained from public sources. How is that more efficient, cheaper, better for workers or better for the elderly?

The funding for private home care provision has shifted from the HSE to private operators in a big way. The top five home care providers received grants of €128 million and accumulated profits of €2.3 million. The parent companies of the top three providers received HSE grants and are based outside Ireland, in Switzerland, France and the United States. The previous owners of Bluebird, who now run Clemac Home Care Services, were paid nearly €1 million by the State in 2018. During the pandemic, a survey carried out by carers in Ireland found that 450 qualified public and private carers who responded to the survey said they were earning €12 per hour or less. I met many of them during the pandemic. They put themselves at great risk to continue to do their work of caring for the elderly at home. I, too, thank and praise them for doing that.

What we have is a private for-profit sector that absolutely needs a dysfunctional public system to survive and profit. This State has continually abdicated its responsibility for providing basic and fundamental services in healthcare for the people of this country under successive Fianna Fáil and Fine Gael Governments, which we have had since the foundation of the State. That, too, needs to change.

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