Pauline Tully (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I think we are all in agreement that home support is so important. It can provide assistance with a wide range of activities and allows people to live at home as independently as possible whether they are ill, frail or disabled. It helps with washing and personal care and so on. I wish to say at the outset that not all disabled people need or want home care support. Many do not require this service. In fact, they require a personal assistance service, which is something different, in order to enable them to live independently.

There has been a growing crisis in home care support over the last number of years. The demand for home care is growing considerably and we can see an increase year on year in the number of people being approved for hours and being allocated home care. The disability capacity review shows that the growth in ageing of the disability population is likely to drive increased demand for home care services much further, as is the fact that people are living longer and are going to need more care in order to live at home. The failure in home care provision is compounding further the pressure on our hospitals because the lack of alternatives in community care has left thousands of people in hospital longer than they should be.

For the same reason many disabled people are also left to languish in nursing homes, not somewhere they chose to be but there was no alternative because the care was not available in addition to the accessible housing. Many people cannot return home because no carer is in place to provide the care they need once they return home.

The Government seems to have thrown in the towel over the programme for Government commitment to implement a statutory home support scheme over its term in government. Instead, it is talking about introducing a Bill which is entirely about licensing and regulation of the market for private home care providers. At a recent health committee meeting on 19 June to commence the pre-legislative scrutiny of this Bill, a principal officer from the social care division in the Department of Health who was asked whether the Bill delivers statutory rights to home care answered that it does not. She went on to confirm that it is about licensing and regulation, but does not cover affordability, access, a statutory right or any of those issues. When asked how advanced a Bill to deliver statutory home care was, the principal officer replied:

To be clear, I did not say a Bill is in development and did not mean to imply it is. There is preparatory work for a Bill that will happen at some stage, once it has been determined exactly what the content of it will be.

We are now four years into the term of a Government that committed to deliver a statutory right of access to home care in its programme for Government, and yet it is not even at the stage of having a Bill in development. It is a safe bet at this point that by the end of the Government's term we will not have a statutory home care scheme in place as it had committed to implementing. It looks like the best the Government will deliver is licensing and regulation of the market of private home care providers. In 2017 the then Minister for Health, the current Taoiseach, committed to the introduction of a statutory right to home care. When he was questioned about it in 2020, he said the scheme was almost ready. We are now four years on and it seems the Government is nowhere near ready.

The failure to deliver its programme for Government commitment to a statutory home care scheme is pushing older and disabled people into hospitals and nursing homes or into early admission into long-term residential care when they could be cared for in their own home if that is their wish. The Ombudsman's Wasted Lives report stated that the implementation of this scheme is necessary to address the current bias in favour of placing people in institutional settings.

A large number of people have been assessed as needing home support and are waiting very lengthy periods due to the lack of carer availability. Hundreds of these people are experiencing delayed transfer from acute settings. There are no carers available because the Government failed to plan for a sufficient workforce. When the changes to pay and conditions were introduced, no additional money was provided for that. In an act of sleight of hand by the Government, the number of home care hours provided was reduced to pay improved rates and conditions for the staff. I absolutely agree with improved conditions and rates of pay for staff, but unfortunately older people and disabled people pay the price for that by having their hours of care reduced. It has left many family carers to carry the burden on their own. I am constantly contacted, as I am sure all Deputies are, by families who do not have sufficient carers.

In one instance, an elderly woman was confined to bed and required two carers at a time to lift her using a hoist to change her. Sometimes only one turned up. Sometimes none turned up. She actually spent one weekend where she had no carers at all. She ended up not eating or drinking so that she would not soil herself because otherwise she would have been left lying in this for some time.

I know of another woman who has locked-in syndrome and cannot move anything other than her eyes. She has a home care package in place, but her mother told me it has never been realised. There are three visits a day requiring three carers at a time because it requires the use of a hoist. They never know when one carer or two carers will turn up or even when none might turn up. They do not know from moment to moment how many carers will be there and if there will be sufficient carers. That is not fair on that family.

It was inevitable that this crisis would get worse because home care staff were included in the recruitment freeze. The authorisation scheme introduced last summer is a step in the right direction. It moved away from the low-risk cost tender model. However, the pricing set by the HSE under the new system is not sufficient to cover the new cost of travel time and hurts the ability of the sector to continue paying above-average rates of pay. It is further damaged by the continued pay gap between section 39 and HSE service providers. Importantly, it only deals with older persons' services and does not apply to disability services which means that more complex care is less attractive for providers. In November of last year during the debate on a motion on home care workers and home support, the Minister of State with responsibility for disability, Deputy Rabbitte, said:

The HSE is currently progressing the development of a new disability service procurement framework with the expectation of finalising the framework in quarter 1 2024. Any amendment to the disability service home support rates will be considered in the context of the procurement exercise...

We are now at the end of quarter 2 of 2024 and I ask the Minister of State to update us on the status of that and if it is almost completed.

The Government promised a statutory home care scheme and failed to deliver it. At best it will get the health (amendment) (licensing of professional home support providers) Bill 2024 passed, which will license and regulate home care providers. The Bill does not provide for or chart a path to universal access. It does not meet the expectations set under Sláintecare or in the programme for Government. Home care is essential to reducing pressures in hospitals, discharging patients on time and maintaining independence for people who do not need nursing home care. Sinn Féin would deliver a statutory home care scheme centred on access to give people the choice to remain at home instead of moving to a nursing home.

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