Clare Daly (Dublin North, Socialist Party)
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101. To ask the Minister for Health the oversight that exists of providers of home care packages; and his plans to ensure that patients and their families receive appropriate care and assistance in their homes. [14913/14]

Patrick O'Donovan (Limerick, Fine Gael)
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106. To ask the Minister for Health his plans to introduce minimum standards in terms of training, inspections, reporting for the provision of care to elderly persons and vulnerable adults in their own homes; if he will provide details of any legislation which he will bring forward; and if he will make a statement on the matter. [14702/14]

Clare Daly (Dublin North, Socialist Party)
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The question relates to the oversight or rather the lack of oversight of those who provide care in people's homes, including basic medical care and also monitoring of people. I am referring to those who are sick and elderly. It appears to be a system for which nobody is accountable. What improvements does the Minister of State intend to introduce?

Alex White (Dublin South, Labour)
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I propose to take Questions Nos. 101 and 106 together.

The programme for national recovery 2011-16 commits to developing and implementing national standards for home support services, which will be subject to inspection by the Health Information and Quality Authority. Primary legislation and resources will be required for the introduction of a statutory regulation system for home care services. This is being considered in the wider context of the licensing of public and private health service providers. I would like to emphasise, however, that there are effective measures that can be applied pending statutory regulation, and the HSE already applies a high level of quality control and supervision to the services provided by external providers with HSE funding.

The HSE's procurement framework for home care services includes quality and screening requirements. Providers of home care services are monitored through service level agreements with the HSE. They are required to provide a prescribed range of information in regard to the services they provide, and are supervised through regular local operational meetings and reviews of clients' care plans. The following areas are included in this context: principles of service delivery; confidentiality; a complaints procedure; consent; staff training; governance and management; and workforce related matters. The purpose of these measures is to promote quality and safety and to ensure a more standardised approach to service provision nationally. Audits are completed and quarterly reports are requested and reviewed. Supporting this is the ongoing monitoring and review of individual clients and their care by HSE professionals, such as public health nurses.

Home care services are reviewed regularly by the HSE. In addition, the HSE has in place a complaints procedure that is available to all service users. I would like to assure the Deputies that complaints are monitored as an indicator of quality of care provided and to ensure the clients' needs continue to be supported.

Clare Daly (Dublin North, Socialist Party)
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From listening to the Minister of State's response, one would think the system had a mechanism in place for dealing with this. Unfortunately, in my experience, that is not the case. I would like the Minister of State to explain where we are with the legislation and the statutory improvements which I believe are necessary.

I have had two very serious cases brought to my attention recently. One involved a woman who was released from hospital with a terminal condition, whereby some facilities were provided by a HSE-funded service but others were a package she got from an organisation but which she paid for herself privately, and which was outside the scope of monitoring as a result. The woman had paid, and paid handsomely, to have somebody residing in her home at night who would be awake if she needed them. Sadly, her experience was that, in many instances, she was left calling for that home care worker but getting no response and being left in soiled bedclothes overnight, and so on. Everywhere that complaint was taken, nothing was done about it. It seems those services that are not funded by the HSE are outside the remit of regulation. I believe it is an area that needs particularly close attention.

Alex White (Dublin South, Labour)
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First, as I have indicated to the House, primary legislation is required and is intended to be brought forward for the introduction of a statutory regulation system, which is, of course, the most secure and best way to address the reasonable issues the Deputy raises concerning a regulation system for home care services. The programme for Government gave that commitment. I do not for a moment want to downplay the importance of the issue the Deputy raises because it is of huge importance to individuals and their families, as the Deputy rightly said. Nonetheless, the Deputy will be aware there is quite a volume of legislation being addressed within the Department of Health at this time. We are looking at the licensing of public and private health service providers as a broad piece of work. Legislation that is needed in regard to home care and home help is being brought forward and developed in that broader context of the licensing process.

Clare Daly (Dublin North, Socialist Party)
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While I appreciate there is a heavy workload, the problem is the Government is more than halfway through its term. Sadly, the woman I spoke about died, and her family are left with the legacy of feeling she suffered an indignity in her last weeks and months at home. They went everywhere, already coping with their loss, to try to get an explanation as to why the service they paid for so expensively did not allow that woman to remain at home in dignity.

Only last night, I heard of another couple who have now decided to move in to a nursing home. The decider was that the man woke up last night to see a rat at the end of his bed. This is an elderly couple who have home care providers coming in to mind them.

A rat does not just appear from nowhere. The fact this was allowed to happen in a home means we urgently need regulation in this area for basic human dignity, never mind the amount of money being spent on it.

Alex White (Dublin South, Labour)
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The HSE is progressing a range of measures to improve its home care provision overall, to standardise services nationally and to promote access, quality and safety. For example, there is a procurement framework for home care services with quality and, most important, screening requirements applying to services procured by the HSE from external providers. A national tender system introduced in 2012 has been extended and the HSE proposes to tender again during 2014. The national guidelines for the standardised implementation of the home care package schemes have been introduced in parallel with the procurement framework. Following recent Labour Relations Commission recommendations on annualised contracts and minimum hours for home help staff directly employed by the HSE, new contracts will be operational with effect from April 2014. In accordance with the HSE operational plan for 2014, a review of home and community care will be undertaken. This will be of interest to the Deputy. An activity and resource review is to be completed by the second quarter. Service improvement initiatives are to be progressed between the second quarter and the fourth quarter and a review of models of service delivery, including the review of existing guidelines, will also be progressed throughout this year. I take the Deputy's point but the HSE is addressing these issues in an appropriate way and the legislation will be brought forward.

Patrick O'Donovan (Limerick, Fine Gael)
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I have raised this issue with the Minister of State and his colleague, the Minister of State with responsibility for disability, equality and mental health. This issue is of significant concern to me because I have seen the lack of standards, inspections and training in my constituency. This is not confined to the private sector because it might be easy to blame the private sector. We do not have minimum standards, inspection regimes and ongoing continuing professional development for people who are delivering an essential service and who represent the difference between a person taking up an acute bed in a hospital, which we do not have, or being maintained at home with their family knowing they will be adequately cared for. It is not as if we are not putting a lot of money into this. Hundreds of millions of euro are going into the private sector each year for the delivery of private home care packages for vulnerable adults and elderly people. I concur with the comments of the previous speaker. This legislation is needed as a matter of urgency before there is a "Prime Time" special on this issue. To be honest, I am shocked it has not been done up to now.

Alex White (Dublin South, Labour)
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I do not know if I can put it any better than I have. I take the points raised by both Deputies. In fairness, one hears accounts of bad experiences or those that certainly have been less than satisfactory. Other accounts are relayed, perhaps not as often, where people have very good experiences. I do not think it is universally bad but the way we can reassure the public and people affected is principally to have legislation in place because that secures a system in place that this House oversees in order that the Oireachtas is clear about the basic minimum standards. The HSE understands its responsibility in respect of a procurement framework, national guidelines and the initiatives I have mentioned that are in the service plan this year, such as an activity and resource review, service improvement initiatives and a review of models of service delivery. These are all directed towards ensuring proper standards are in place and that none of the kinds of incidents that have been related by both Deputies ever recurs. The Government is committed to ensuring this is the case.

Patrick O'Donovan (Limerick, Fine Gael)
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The Law Reform Commission published a draft of what could form the basis of the heads of a Bill. I ask that this be referred to the Oireachtas Committee on Health and Children by the Department of Health and that the committee begin hearings about whether this could be looked at for the second half of the Government's term of office in respect of the provision of a legislative basis for the delivery of private home care. The Minister is quite right. The experience is not universally bad. About 90% of it is probably delivered very well. However, in respect of the protection of vulnerable groups like children, people with intellectual disabilities or elderly people in nursing homes, we have seen that it takes a very difficult case for legislation to be brought in.

In advance of the broadcasting of the kind of "Prime Time" programme to which I referred, which as sure as night follows day will occur, as was the case last week with the programme on the ambulance service, we should be proactive and encourage the Oireachtas Committee on Health and Children to conduct hearings on this matter and to engage with elderly people, their families, care providers, the Department of Health, the HSE and others to determine how best to deal with this. I have a great fear this issue will be left behind.

Alex White (Dublin South, Labour)
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The Deputy makes some very good points and I welcome his suggestion that the Oireachtas Committee on Health and Children would, on its own initiative, address this issue. When the legislation is brought forward by the Minister, it will be subject to pre-legislative scrutiny by the committee, but given that it may be some time off - one hopes not too far off - perhaps it is something the committee would look to address. I am aware of the report from the Law Reform Commission and I take the points made by the Deputy. I will certainly communicate them to my colleague, the Minister of State, Deputy Kathleen Lynch.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Given there is a little time left, I wish to ask a supplementary question.

Michael Kitt (Galway East, Fianna Fail)
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The Deputy had not indicated.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I will be brief. Is the Minister of State aware that many workers in this particular area who work for companies which have contracts with the HSE for home care provision are being grossly inadequately paid? Some are on the minimum wage or barely above it. Is he also aware of the type of disgraceful contracts they are being asked to accept, whereby there is no certainty of work from week to week? They have no idea of the number of hours they may have and that, in turn, has a very negative impact on those being cared for because there is no continuity of care. They do not know who to expect. That is a very serious matter and I ask the Minister of State to take it on board and to share with us his intent to address this issue.

Alex White (Dublin South, Labour)
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I am aware of the contracts issue being of difficulty. Indeed, the issue was raised in the Labour Court last year. I am not sure if the Deputy is aware that there have been recent Labour Court recommendations on annualised contracts. The Labour Relations Commission, LRC, has addressed that issue and, as I understand it, has resolved it. As a consequence of the LRC recommendation, minimum hours for home help staff directly employed by the HSE will be in place soon. New contracts have been prepared and will be operational from this month.