Patrick O'Donovan (Limerick, Fine Gael)
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I thank the Ceann Comhairle for selecting this issue because Deputies routinely request Topical Issue debates. In the recent past, there has been considerable discussion about the provision of home care and home help. What constitutes home care and home help is very different in different parts of the country. What they have in common is that, in all instances, an elderly person or vulnerable adult is at the centre of the care provision. In 2011, the Law Reform Commission underlined the need for a legislative framework in home care provision. This arose in the aftermath of the investigation and report on Leas Cross, where vulnerable adults and elderly people in a private nursing home environment were subject to obvious abuse. The concern for vulnerable adults, elderly people, their families and home care providers arises in respect of standards, legislation, regulations, inspection, complaints mechanisms and associated penalties where there are obvious failures in the protection of vulnerable adults and old people.

Where would one find a person in a more vulnerable state than an old person at home, bed-ridden, unable to do anything, not exposed to any outside inspection and with no one passing by as someone in a nursing home would have? These people are totally dependent on the home care provider or the person coming in to provide a home care package. The vulnerability of the person can be exposed and exploited and there is an urgent need to ensure we are not just reacting to another investigation with another hidden camera, highlighting another element of abuse or worse, and dealing with the aftermath of someone found dead or seriously injured at home.

The programme for Government refers to this, and a Bill, which was a copy and paste exercise of what the Law Reform Commission proposed in its report, was brought before the House. In recent weeks, with public discourse on what home help is, how it is constituted, how people get medically assessed for it and its standards and assessment regime, it is urgently required not only to protect the elderly or vulnerable person but also for those who go into people's houses. I have a personal involvement in this. Are these people trained and qualified? Do they have the necessary competencies to deliver home care at the level the public health nurse or district nurse decides it is needed?

The Law Reform Commission report states that home care provision ranges from companionship to home care to complicated provision of home care, where a catheter bag needs to be changed, an incontinence pad needs to be administered or drugs need to be administered daily. There may be no family involvement. The State recognises that the best place for elderly people is in the home, if possible. Between now and 2041, the number of people over the age of 65 will double.

We also know that 95% of people over the age of 65 live at home. This is urgently needed and I impress its urgency upon the Minister. I know there is a legislative backlog and that many things have priority, but we had a referendum for one cohort of vulnerable people and we need to legislate for this group.

Alan Shatter (Dublin South, Fine Gael)
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I thank the Deputy for raising this matter and apologise on behalf of my colleague, the Minister for Health, that he is not here this evening. He has a commitment that he has to keep and he asked me if I would respond to the Deputy.

Government policy is to support older people to live at home and in their communities for as long as possible. This is realised by the Health Service Executive through a range of community-based services such as mainstream home help and enhanced home care packages or by other supports such as meals-on-wheels and respite or day care. These services, often delivered in partnership with non-statutory agencies, are designed to be as flexible as possible to best meet the needs of individual recipients and their families.

Government for National Recovery 2011-2016 commits to developing and implementing national standards for home support services, which will be subject to inspection by the Health and Information Quality Authority, HIQA. New statutory regulation of this sector will have to take account of various issues, such as those raised in a recent report of the Law Reform Commission, entitled Legal Aspects of Professional Home Care. This, in turn, is a follow-up to its 2009 consultation paper, Legal Aspects of Carers.

Primary legislation and resources will be required for the introduction of a statutory regulation system for home care services. The question of possible changes to legislation, including regulation and inspection for home care services for older people, is under consideration. The Department is at present examining this matter in the overall context of the licensing of health care providers. Legislation is being prepared in this area, taking into account various recommendations of the Commission on Patient Safety and the Law Reform Commission. Various options are being considered, including the complex legal issues involved and the need to prioritise legislation across the social care area overall, including that relating to children and disabilities.

It is important to emphasise that statutory regulation or licensing is only one way of improving the safety and quality of services and that other measures have or are being taken to improve the standards of community service for older people delivered by, or on behalf of, the HSE. These are reflected in the HSE service plan 2012 and include a public procurement framework for home care services finalised earlier this year, with quality and screening requirements. In addition, various operational initiatives such as new national quality guidelines for home care support services and new national home help guidelines have been developed by the HSE. These various measures, taken together, have been designed to improve relevant aspects of HSE home care nationally, including non-statutory provision for care recipients under the auspices of the executive.

The Government has embarked on a major reform programme for the health system, the aim of which is to deliver a single-tier system where access is based on need, not income. A number of important steps will be achieved in a planned way, including regulation of the specific sectors I have outlined, and each of these will play a critical role in improving our health and personal social services overall.

Patrick O'Donovan (Limerick, Fine Gael)
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I thank the Minister for his reply. I go back to what I said about the difference between home care and home help and the public and private provision of those services. In some instances, the man or woman who comes into an elderly person's house is paid about €9 per hour while the company that sends them in is paid up to €27 per hour. There is no standardisation across the board.

The Government, and the previous Government, were anxious to ensure this service be given out to a private provider in order that it would not be the State's problem. This is the State's problem, however, if we are providing the money for the service. Are the standards, assurances and quality being delivered to the people who need it? I recently saw a media report of a company dealing with vulnerable people in County Wicklow that is under investigation by the Garda. This is not the sort of thing we want to see happening in the future.

A fortnight ago, we had a referendum to enshrine rights for vulnerable children in the Constitution. Elderly people who are living alone are vulnerable adults. Some may be blind or deaf or have a learning difficulty. They do not have the luxury of having their point of view articulated in this House as often as they would like. This is critical, however. We cannot afford to wait until there is another Leas Cross, another hidden camera or, worse, someone is allowed to abuse his or her position so that a life is put in danger.

This is not just about protecting the service user. It is also about protecting the service provider, that is, the individual man or woman who is going into a house to administer care. The establishment of the new training agency, SOLAS, is an opportunity for the Department of Health to agree national standards in order that the service given to every single person, whether a child, a young vulnerable adult or an elderly person living alone, can be inspected by HIQA and the standard of care provided, whether publicly or privately, out of the State's purse is the same for all. This is something we should be trying to achieve.

Alan Shatter (Dublin South, Fine Gael)
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On a personal level, I share the views expressed by the Deputy. There is a need to ensure individuals who are recipients of care at home are not placed in danger. There is a need to ensure the individuals providing that care are properly trained and adequately regulated. There must be a standardisation of the care provided, a uniform approach and proper regulatory oversight. I am willing to draw to the Minister's attention the comments made by the Deputy. I hope the reforms the Minister envisages and is working on can be put in place as soon as possible to address the many concerns the Deputy, quite properly, expresses.