Éamon Ó Cuív (Galway West, Fianna Fail)
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I thank the Minister of State, Deputy Butler, for coming to the House and I know of her personal concern in regard to this matter. I believe Covid taught us one thing and that is the value, where it is a viable option, of caring for loved ones at home, particularly in old age. Moreover, that is often the desire of families. We all resolved after Covid to ensure that this would be a more viable option and that more people who want to be cared for at home, both by themselves and by their families, would be given that option. To do that, we need strong State supports. It is a very economical way of doing this but to do it, we need home care packages and home carers. However, in reality, the opposite is happening.

I will give a few examples. I know the case of a lady with multiple sclerosis and diabetes who has been awarded 42 hours, so that is approved. The agency that was given this package by the HSE has handed it back and there are now no carers. It handed it back on the understanding that it did not have the carers. As the HSE has stated that it also does not have the carers, she is only in receipt of 13 hours weekly that is provided by carers. There is another case where the carer was not replaced when she went on annual leave and no arrangements were put in place to cover the carer's leave. Everybody is entitled to leave. There is another case of a constituent who was awarded 16 hours of home care per week but has not been given more than six hours in any given week. On and on it goes.

I want to highlight these particular cases because it is a human tragedy that this is happening. Of course, it is making people reassess the option of caring for people in their own home environment which, as I said, is often the choice. However, it is not viable if people do not have the support.

What I am hoping to hear tonight is that the Government has a plan to address the issues. One of the fundamental issues, by the way, is that the profession of caring in the home is not a particularly well-paid profession. As I have argued for years, there is too big a gap between what the top of the public service is paid and what the bottom of the public service is paid, and we need to address this. It is coming back to haunt us that this issue has been allowed to go on. I hope the Minister of State will have some answers tonight. I know she is sympathetic. If she needs support in looking for the money, she will get the support of every Member of the House in making a stand. People who are caring and being cared for deserve the best and home is the best in many cases, although I am not ruling out the incredible role that nursing homes also play.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising the issue. I notice Deputy Joan Collins is also here and listening; we had a discussion earlier in the back corridor, and many other Deputies have raised the situation with me.

The issue is not funding. If the issue was funding, I would be able to go and look for more funding and I feel I would secure it. My budget for home care for this year is €666 million, it increased by €150 million this year and I have secured the same increase for next year, which is to deliver 24 million hours of home care. The Deputy is right that Covid has taught us the value of caring for people at home. I want to see the Sláintecare model, that is, the right care at the right time in the right place, as close to home as possible.

By the end of October, almost 17 million hours had been provided to over 54,000 people, which is about 2.5 million more hours compared to the period last year, so we have made a lot of improvements this year alone. Significant inroads have been achieved in reducing the waiting list for funding approval for new and additional services. In January 2020, there were 7,800 people waiting for funding and it was down to 400 in September 2021, so I have managed to reduce the number of those waiting for funding for home care by 88%.

Therein lies the problem and the problem has got worse during the year. There are delays between the approval of funding and the delivery of home support hours, and the number of people in this category has increased steadily this year, primarily due to staff capacity issues. At the end of September this year, there were 4,933 people assessed and waiting for care to become available but the funding has been provided to provide the package. That is the most frustrating part for me - the fact I actually have the funding for the first year ever. I often stood on the other side at the House, talking to my predecessor, the former Minister of State, Jim Daly, and the funding was not available at the time due to different issues. Now, the funding is available, which is what makes it most frustrating.

The HSE is acutely aware there are increasing capacity issues across both direct and indirect provision. It continues to advertise on an ongoing basis for healthcare assistants and it recruits as many suitable candidates as possible. For example, the community healthcare organisation, CHO, covering the Deputy's area, CHO 4, is recruiting 300 home care assistants and that was put out for advertising last week. Every single HSE area and every single CHO is trying to recruit as many people as possible. They are recruiting through a variety of channels, both at local level and through the shared services office of the HSE's health business services. I recently started a round of meetings with the older person's lead in each CHO to discuss these challenges and to discuss day-care respite and community step-down. If we want to keep the throughput in our acute hospitals, the only way we can do that is by having the supports at home. I am also meeting regularly with Home and Community Care Ireland, HCCI, which represents the private providers, and they also continue to recruit home support workers.

I have established a cross-departmental strategic workforce advisory group. The role of the group will be to facilitate the views of stakeholders and to examine workforce challenges in home support and nursing homes. The areas to be considered include recruitment, retention, training, career development and the sustainable employment of home care workers into the future.

Éamon Ó Cuív (Galway West, Fianna Fail)
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I take my hat off to the Minister of State for all that has been done. However, how am I meant to go back to a constituent who was awarded just 14 hours home help weekly?

The hours were meant to be divided between morning and evening but the hours are only being given in the morning and the wife of the person being cared for has to put her husband to bed. However, because of the condition he is in, this requires two people. She was told that the latest they could come was 6.30 p.m. It is not a viable option to put somebody to bed at 6.30 p.m. because if that is done, he or she will be up very early the following morning and we will have the same problem in reverse.

I acknowledge all the statistics and the work the Minister of State is doing but that is no good to the person facing the individual dilemma. Funding is being provided but not funding in the normal sense. I accept that there is extra funding and that it is now much quicker to get the hours granted. We used to have the problem of getting the hours granted and now we have the problem of getting the carers. There is a problem this society has to look at. I recall the late Frank Prendergast, who was a Labour Deputy in this House and a trade unionist, talking to me time and again about how over the years the gap in how we pay people was growing. These are front-line workers. It is becoming more obvious across society that critical services are not being provided because we refuse to restructure our society to properly reward those providing the same services. Then we wonder why we cannot provide the services.

Mary Butler (Waterford, Fianna Fail)
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I will go back to the cross-departmental strategic workforce advisory group. I announced a call for submissions last Friday to further identify key issues in recruitment and retention and to inform the establishment of the group in early 2022, which is January as far as I am concerned as it needs to be done as soon as possible. We are all aware that terms and conditions vary from the private sector to the HSE. The HSE pays approximately €16 per hour plus travel. Some of the private operators pay the minimum wage and others pay more. There are challenges there and those operators are losing staff to the HSE.

We have had a lot of talks with the HSE and a few recommendations have gone to the Department of Public Expenditure and Reform to be examined. For example, we have some young people who avail of Student Universal Support Ireland, SUSI, grants who are allowed to work a certain amount of hours per month and we are trying to double that. We are also considering supporting people who receive a Department of Social Protection payment working a set amount of hours, as happens with the disability grant, so that they would not lose their supports and their medical cards would not be affected. We hope we can encourage more people back into the workforce that way.

I understand exactly where the Deputy is coming from. I get these queries in my constituency office as well; I would say there is no Deputy who does not get them. The problem we have is that a lot of carers work split shifts in the morning and the evening. Some 75% of all carers work part time. Everybody wants his or her loved one to be put to bed last but when carers are going out at 5 p.m., 6 p.m., 7 p.m. and 8 p.m. in the evening, they go to one house and move on to the next. That side of it is very difficult but all I can do is provide a commitment that I will continue to do everything in my power to try to get more home care workers into the system. As the Deputy knows, we are challenged in that we have more people working than we ever had in the history of the State. We are challenged with hospitality, home care and retail and it is quite difficult. All I can say is I am working at this every day.