Marie Sherlock (Dublin Central, Labour)

I thank Deputy O'Flynn and his group for this important motion, which raises a whole raft of really important issues with regard to care in the community and at home, and indeed for any person with care needs. While most of the conversation today is about older people, it is about care right across the ages.

It is five years since the Minister of State's Government committed to a statutory right to home care support. I must tell him that I am now probably more pessimistic than ever that it is going to be delivered by the Government any time soon, particularly when we hear from the Minister for Health that the funding is still being considered. There is a real concern now that if we are going to wait for the various ducks to be put in a row, we are never going to have it. This Government needs to change tack and ensure that all efforts are put towards launching that statutory right in the immediate future. The importance of that statutory right is absolutely plain to see in respect of the growing share of older persons we have in our communities, the longer life expectancy, the desire to be looked after at home and, of course, the better health outcomes when people are looked after at home.

However, we currently have a haphazard system of care in the community. There is an irony in the fact that you have a right to be looked after in the hospital system but no right to be looked after at home, and that has given rise to this haphazard system where there is inconsistent access to public health nurses, and a postcode lottery with regard to where you can access home care supports. In far too many areas, I see there is little or no occupational therapist advice, so families have to figure it out for themselves. I am reminded of a number of people coming to me over the last 12 months and being utterly baffled as to how they can help their spouse remain at home, try to procure the various equipment, and care for them. There is no centralised point of information. The public health nurse system should be that point but when we look at the figures, we see that there are fewer public health nurses now across the country than there were in 2019. That is damning of this Government. It is a reflection of the complete under-resourcing of community health nursing. It is a reflection of the lack of understanding and the lack of importance applied to public health nurses, which is a vital role in the community.

We know there were just over 1,500 public health nurses - 1,507 - in February of this year. That is down from 1,539 in December 2019. Obviously, our population has grown since then and the need within our population has also grown since then. As we know, public health nurses make very important decisions in the community with regard to who can access home care packages and equipment. If we do not have enough of them, there are going to be massive issues. We saw that earlier this year, particularly in my own area, where developmental checks for infants had to be scaled back because of a staffing issue in CHO 9. We know, just as crucially, that older people are suffering because we do not have enough people on the ground.

The other key point is the postcode lottery for home care support. Here in Dublin, there is not as big a problem as there is in Cork and Kerry. I know from my family members where I come from originally that people who need that care are not accessing it because the bodies are not on the ground. That is down to pay, the inconsistency of hours, the lack of certainty with regard to hours, and the travel allowances. Ultimately, it is an allowance by the Department of Health, the HSE and the Government of this day to ensure that whatever growth we have had in home care support is by the private sector as opposed to the HSE.

In order to ensure we have proper terms and conditions for those workers, we need to ensure they are going to be HSE workers.

If we look at recruitment over the past number of years, we see that the HSE hours grew by 12% between 2020 and 2024, as opposed to 36% in the private sector. I believe that this approach is wrong because we are condemning far too many people who want to work in the home care sector to a life of precarity. The Government has to reverse tack and ensure that more people are employed by the HSE. We see in the nursing home sector that people want to work in HSE-run nursing homes. They are leaving private sector nursing homes because of the pay and conditions. In the home care sector, we need to make sure there are more HSE bodies on the ground delivering those vital services to people in order that they can stay in their homes.

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