Fergus O'Dowd (Louth, Fine Gael)
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10. To ask the Minister for Health the way that he proposes to address the large shortfall of homecare assistants nationally through better pay and working conditions and through specific recruitment drives; and if he will make a statement on the matter. [25454/22]

Fergus O'Dowd (Louth, Fine Gael)
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Older people are being encouraged to stay in their homes as long as they can, especially as they age and get sick. The demand for home carers has never been greater and neither has the funding. However, the fact is every week we find people who have been assessed as needing home care for whom there is no carer available. At the end of March over 5,458 people nationally had been assessed as needing a home carer but not having one. There were 90 patients in acute hospitals awaiting discharge with nobody to look after them. How does the Department intend to recruit adequate and appropriate care for these people and keep them out of long-term care?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for his question and his continued interest in this particular sector. We have had many conversations on it. He is right the demand for home support has never been higher and its importance as an alternative service to long stay care has grown considerably over the past number of years. It is also a much more cost-effective way for the State to support people compared with them being in acute hospitals or nursing homes. In budget 2021 I secured additional funding of €150 million to progress the development of a reformed model of service delivery to underpin the statutory scheme for the financing and regulation of home support services and to provide 5 million additional hours of home support. I am delighted this funding has been maintained into 2022.

Last year we delivered 20.9 million hours, which is up 2.9 million on the previous year. That is a huge increase. We are currently supporting 55,000 people on a daily basis but there are challenges. On the figures the Deputy referred to, we had three areas that were especially problematic, namely, CHOs 4, 5 and 7. This week alone I had meetings with the chief officer and the older person's lead in both CHO 4 and CHO 7 to see what more I can do to help them. One thing we have done is I have put in place a cross-departmental strategic workforce advisory group. This group has met all the key stakeholders. We are trying to make home care an attractive, viable option as a career choice. That group is working well. There will be significant recommendations out of this I will bring to the Minister and with his support these can be brought to Cabinet. We will be looking for funding in next year's Estimates because this is a serious piece of work. The second piece I discussed with the Minister of State, Deputy English, yesterday concerned working outside the EU to encourage people and to make permits available so those outside the EU might come to Ireland to provide home care.

Fergus O'Dowd (Louth, Fine Gael)
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I very much welcome the initiatives but they do not change the fact that home care was provided by the State through the HSE and that has changed now. I get glossy brochures regularly from big companies that are moving into this area and treating it as a market rather than what I believe it should be, which is a career for people.

My point is I do not see any sign of a national recruitment drive. I see no ads on the television. I do not hear it on the radio. I welcome the Minister of State's initiatives on visas for people coming from abroad or outside the EU but we are not doing enough. We must tackle it. We must make it a career. It was a career in the health service; it was respected and was acknowledged as a very important one. We need to recruit full-time carers into the HSE, pay them and give them a career. The people want them and need them. It keeps them out of inappropriate care and out of acute hospitals. As I said, 90 such people were in acute hospitals at the end of March taking up beds because they could not go home. I welcome the Minister of State's initiatives but we need more action.

Mary Butler (Waterford, Fianna Fail)
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The Deputy is quite right in what he says. A national recruitment drive is really important. As he knows, we have nine CHOs and they vary. CHO 9, which covers north County Dublin, delivers all its supports through both voluntary and private.

There is no HSE. It is something that evolved over many years. Its waiting list is the lowest in the country with 50 people waiting. Yesterday, I met with CHO 4, which is Cork-Kerry, and 75% of its home care is provided through the HSE and 25% is provided through the voluntary and private sectors. It is important to consider the voluntary sector here. Last week, I met with Northside Homecare Services in north County Dublin. It is a voluntary, not-for-profit organisation and it delivered 900,000 hours last year. It is doing phenomenal work on the ground.

However, I agree with what the Deputy said. We are doing a rolling recruitment campaign in certain CHOs, not all of them. The terms and conditions provided by the HSE include €16 per hour plus mileage. They are attractive compared to some in the private sector, but I agree with the Deputy and my meeting yesterday was focused on that.

Fergus O'Dowd (Louth, Fine Gael)
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I support the Minister of State with regard to community care and voluntary organisations. However, it is not possible in some communities to do that, particularly as towns grow to become cities and people are not as neighbourly. They do not know their neighbours as well as was previously the case and that community benefit is lost. I am delighted that it is there. Could the Minister of State let me have a note on how much is paid to private providers nationally and the number of hours they provide? They appear to have a significantly greater payment for the individual service they provide than the individual worker. However, it has to be a career, and it has to happen now.

The other point is one on which we all agree. There is a large number of people who are inappropriately in nursing home care. They do not need to be there and they are charged a fortune. In many cases they are getting excellent care, but in others they are getting very poor care. They need that care at home. That is the place to be. All supports we can provide there would be very welcome. I look forward to the Minister of State's national recruitment drive and I welcome her involvement with the Minister of State, Deputy English, with regard to access for people outside the EU.

Ruairi Ó Murchú (Louth, Sinn Fein)
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We have spoken previously about this issue in home care. We all welcomed the work of the workforce advisory group. It has to look at the issues of visas and tax breaks. Pay rates have to be on the table, as well as expenses. There are anomalies among the various CHOs. However, we need a timeline. Beyond that, there is the wider issue of workforce planning to ensure we will have enough people to be able to cover what needs to be done because there are families under significant pressure as they cannot get people to provide adequate hours for their loved ones so they can stay in their homes.

Mary Butler (Waterford, Fianna Fail)
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We have had many conversations about home care, and I know everybody feels the same. I am in a unique position as Minister of State in that I have a budget of €672 million to deliver home care. Every one of those packages, apart from what comes in rolling over ten or 14 days, is funded. The other ones will be funded very quickly. The issue is not funding.

One issue we have, and I provided money in the Estimates last year and again this year for it, is that some of the CHOs, not all of them, are still working on a paper basis. They do not have a fit-for-purpose information technology, IT, system. We piloted an Irish company, which I will not name, in CHO 3, which is the area of Limerick, Clare and parts of Tipperary. This pilot has worked extremely well. I wrote to Mr. Paul Reid last week to see if it can rolled out across all nine CHOs. All the chief officers are very supportive of it. Trying to work a paper system for home care in 2022 is not fit for purpose. The IT system would also be way more effective with regard to waiting lists.

I will provide the note requested by Deputy O'Dowd.