Patricia Ryan (Kildare South, Sinn Fein) | Oireachtas source

When the Government came to power in 2020, its programme for Government promised a statutory home care scheme along with various other commitments for fair and affordable home care, removing inpatient charges and medicine costs. Further to that, in 2022 the Government committed to its implementation by 2023 yet here we are, more than halfway through 2024 and close to the end of the Government's five-year term, and what has it delivered? This scheme seems to be plagued by the same thing as the national children's hospital: delays and more delays. This is confirmation yet again of empty Government promises and platitudes with no substance.

Ireland's people are growing older, with the Institute of Public Health predicting the number of people over the age of 65 to top 1.5 million by 2051. If this Bill were to deliver on all the Government's promises, our older and ageing population could look forward to being supported to live in their own homes with equitable access to high-quality and regulated home care. We expected a fair-deal-type scheme tailored to suit the needs of the home care system, which would deliver universal home care and enable more people to age in place in their own homes, thereby relieving pressure on hospitals, but what we got is more akin to a licensing scheme for private providers than a fit-for-purpose statutory home care system. After four years, we have a scheme funded on private provision of care, contradicting the universal accessible and affordable home care scheme committed to in the programme for Government in 2020. This could not be further from the fundamental Sláintecare principles that more care should be delivered in the home, enabling people to age in place for longer. The care of our elderly cannot and should not be commodified by being reduced to a bottom-line, minimum-cost, maximum-profit issue. The move from the race-to-the-bottom, lowest-cost-tender model to an authorisation-based one is welcome. The pricing set by the HSE is still far below the level necessary to attract and retain qualified staff in the sector. However, regulating providers is not enough. We need a system that is statutorily funded, recognises different levels and complexities of care, and is something our present and future generations of elderly can trust will be there when they need it.

In 2021, a report into the regulation of home care by HIQA stated:

Every citizen of Ireland, or someone close to them, will need some form of support in their own home during their lifetime. As such, it is no longer viable to apply a directionless lens towards the provision of homecare. Rather, there needs to be a complete overhaul of the homecare sector.

In its recent progress report on statutory home care, Home and Community Care Ireland referred to the home care sector as the Cinderella of the healthcare system due to the lack of progress and the Department of Health's failure to give timelines for the scheme's implementation. This is unacceptable so many years after Government promises and commitments were made and, it would appear, quickly forgotten. The Government has effectively dropped the ball on this. The scheme as it stands is, at its best, a licensing scheme for providers. It does nothing to deliver desperately needed reform and highlights the lack of joined-up thinking and communication between Departments. It is light years away from the complete overhaul HIQA has called for.

Our ever-increasingly ageing demographic needs to be acknowledged. The foundations for statutory universally accessible and affordable home care system that is fit for purpose need to be put in place now and not later. Action now will ensure our future older generations - that means the Minister of State and I - can look forward to being able to age in place in our own homes for as long as we are able to, hopefully supported by a genuine public health and social care system. As Sinn Féin spokesperson for older people, I am well aware of the current failings of our home care system. Thousands are on waiting lists for home care. Some 3 million home care hours were lost in 2023 due to staff shortages. Elderly people are languishing in hospital because home adaptations have not been done. Elderly cancer survivors are caring for their sick spouses because there is no staff to deliver the home care package and all because of a HSE recruitment embargo. These are the harsh realities being faced by our vulnerable senior citizens because the system as it stands is dysfunctional at best. What is needed is a statutory home care system to deliver accessible, fair and affordable care, giving people the opportunity to stay in their homes knowing the supports they need are there for them and they will not be forced into residential care by default.

I know the Minister of State has said she prefers to see people ageing at home and I take that on board. We need a system that lives up to the expectations of the promises and commitments in the programme for Government. This Bill does not even come close to that. We, in Sinn Féin, would deliver as set out in our document, Priorities for Change in Health and Social Care. We are committed to delivering the right care at the right place at the right time. This means putting measures and supports in place to allow older people to age in their homes for longer, modernising the home supports scheme and making it a statutory scheme to enable more complex care to be delivered in the home where needed. We would prioritise development of public home care services, widen the remit of nurses and other essential health professionals to deliver more and better services in the home, and reduce pressures on acute hospitals at the same time. In essence, Sinn Féin would deliver a home care scheme that would be fit for purpose, accessible and affordable, and above all, provide a statutory right of access. The Minister of State mentioned in her speech earlier that it was important during Covid to keep people home and keep them safe. I thank her for that and I take that on board, but I have asked several times in this House for a Covid inquiry. To date, we have not been given a date for such an inquiry. Would it be possible to get one?

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