Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Taoiseach today tried to minimise what was revealed in the "Prime Time Investigates" programme showing the neglect and abuse of older people by private home care providers under contract to the HSE. He spoke of four cases, as if it concerned only four older people. This is a total misrepresentation. The programme covered two major home care providers which were given the task of caring for a large number of older people. It also investigated the cases of a number of individual older people whose experience is clearly representative of others who have experienced the gross inadequacy of the home care being provided by some agencies and individuals in the State. People were justifiably appalled by these revelations, and the Taoiseach's response to them is totally inadequate. Among those appalled at the revelations are the many genuine and professional carers in both the public and private sector, who should be fully recognised and acknowledged.

An important first step in response to this scandal would be for the Government to admit that this has come about as a direct result of Government policy and HSE negligence. As far back as 2004, an evaluation of home care in the then Eastern Regional Health Authority area was carried out by Dr. Virpi Timonen. In his report, published by the ERHA itself, Dr. Timonen recommended that there should be more careful monitoring of the quality and adequacy of the services. His report highlighted the lack of national standards for any form of home care service. Dr. Timonen stated in his report:

Inadequacy of basic home help services, due to funding constraints, recruitment difficulties and lack of adequate structures, is causing a problem. Large numbers of older people in need of help experience problems accessing services. Lack of adequate day care and respite care services, and the uneven distribution of these services across the country, also poses a problem.

One of the main motives behind the introduction of the home care grants was responding to unmet care needs resulting from the absence or inadequacy of other services. The lack of comprehensive services, the uneven distribution of services and the structural problems identified in 2004 were not fixed. They have still not been fixed. Instead, Government and HSE policy has become increasingly reliant on putting public money into the private for-profit home care sector, which has now grown to some 150 companies across the State.

Is the Government proud of the fact that last week it reduced the minimum wage, putting more money in the pockets of the type of shark we saw on the "Prime Time Investigates" programme - people posing as care providers who exploit untrained and unqualified care workers, many of them immigrants, by paying minimum or below-minimum wages? In one case a person was illegally paid €4.88 per hour; another was paid €300 for a month's full-time work. This surely exposes the disgracefully low value placed on the work of caring for our older citizens. It is at one with the shameful decision in last week's budget to cut carer's allowance and carer's benefit by another €8 per week. There has been a total reduction of more than €16 per week in each benefit since 2009.

We should all be greatly concerned at the standard of care for older people in general and at some - but by no means all - of the people who have got involved in it as a profitable business rather than as a caring profession. We must ask what will be done to ensure that HIQA and the HSE have the ability and the resources to prevent such abuse either in nursing homes or in people's own homes.

To give but one example, the HSE has coerced all but a few of the residents of Loughloe House in Athlone to leave, despite their desire to remain and a community campaign to keep this public facility open for current and future residents. HIQA did not recommend that this facility close, but the HSE, pursuing Government policy, is determined that it will. Home care packages were offered to the residents as one of their options.

The home care scandal exposes the abject failure of this Government's policy of privatising health and personal social services. These private for-profit companies are receiving millions of euro every year from the HSE. Apart from the pittance paid to care staff, this public money is going into the pockets of the owners. Therefore, I call on the Government to take four steps as follows: it must put in place, without further delay and on a statutory basis, regulations for the home care sector; empower and provide the resources for HIQA to monitor compliance with these regulations; establish proper qualifications, pay and conditions for home care workers; and change Government policy from privatisation to direct provision of home care by the HSE.

John Moloney (Laois-Offaly, Fianna Fail)
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I am responding on behalf of my colleague, the Minister of State, Deputy Áine Brady, who cannot be here this evening. I thank Deputy Ó Caoláin for raising the matter.

I am sure all Members of the House will join with me in expressing concern at the incidents highlighted in the "Prime Time Investigates" programme last night. The central focus of Government policy for older people who need care is that they should be able to receive high-quality care and they should be at the centre of all decisions regarding their care. The key element that must exist between the provider of care, whether public or private, and the recipient of that care is trust. This is fundamental to any service, but particularly health or personal social services, whose recipients are likely to be vulnerable. As an immediate response, the HSE is investigating the cases raised in last night's programme and is now reviewing all service delivery under its auspices to ensure that proper standards of care are being met. The executive will terminate contracts and change providers in cases in which this is necessary.

I emphasise, however, that in the vast majority of cases the HSE works in a close and beneficial partnership with high-quality home care providers in the non-State sectors. The HSE also has complaint mechanisms and an elder abuse network. In responding to referrals, the HSE provides a discreet and confidential service which may include counselling, mediation and anger management, as appropriate. Anyone who encounters elder abuse or inadequate care should report it to a GP, a HSE social worker, a public health nurse, a member of the Garda Síochána, or anyone they trust. The introduction of the nursing homes support scheme and the bringing into force of new regulatory standards for the long-term residential care sector demonstrates the priority the Government places on high-quality services for older people. Notwithstanding the severe financial pressures of recent times, there has been an expansion of the home care package initiative nationally through the provision of an additional €10 million in 2010 and a further €8 million in budget 2011. This year we protected the levels of other community-based supports for older people, such as home help, meals on wheels and day or respite care, and we also intend to do so in 2011.

With regard to the possible regulation of home care services, the July 2008 report of the Commission on Patient Safety and Quality Assurance recommended, among other things, the extension of any licensing systems in health care to the primary, community and continuing care sector. More recently, in July 2009, the Law Reform Commission published a consultation paper entitled Legal Aspects of Carers. This considers the legal issues surrounding home care and makes several provisional recommendations in the area of standards and regulations generally.

The Department of Health and Children accepts the need for a more standardised approach to the regulation of home care generally, whether by statutory or non-statutory providers. The HSE and the Department have progressed various improvements in home care provision overall during 2010, especially relating to the governance of services. These measures will be published and implemented in 2011 and include national guidelines and procedures for standardised implementation of the home care packages scheme, quality guidelines for home care support services for older people and national guidelines for the home help service. In addition, the HSE published its public procurement framework for home care services on 22 October last and is progressing this important measure, in conjunction with the other measures I have outlined, to ensure best provision to clients. Approved providers must meet and be monitored on a range of standards such as vetting, training, elder abuse protocols, supervision and client feedback.

As indicated to the House in a reply to a parliamentary question on 22 June last, the question of possible changes to legislation, including regulation and inspection, for the area of home care for older people generally is under consideration. The Department is examining the regulation of this sector in the overall context of the licensing of health care providers. Legislation is currently being prepared in this regard, taking into account the recommendations of the Commission on Patient Safety and the Law Reform Commission. The Government is determined to do everything possible to protect all older people in care. Our approach is to progress the various initiatives I have outlined, while examining the options and implications of introducing statutory regulation. I assure the House that the Department of Health and Children will work closely with relevant statutory and non-statutory organisations to take all measures necessary to ensure quality standards for all people receiving home care.