David Cullinane (Waterford, Sinn Fein)
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I move:

That Dáil Éireann: notes that:

— the nature and level of care delivered in the home must change to facilitate people staying at home for longer, to reduce periods of stay away from home either at hospital or at other care facilities, and to implement the Right Care, Right Place, Right Time policies;

— the average person in receipt of home care receives approximately eight hours of care a week, and this is likely to grow significantly as higher levels and greater volume of care is delivered in the home;

— to deliver higher complexity care in the home, the home support system must be modernised, and an increase of care delivered in the home will have consequences for the level and complexity of care delivered in nursing homes and other long-term residential care settings;

— as per the report in the Irish Times on the 1st November, 2022, more than 7,800 people have experienced unnecessary and costly delayed discharges from hospital so far this year due to a failure to plan and align community services with hospital need, such as step-down beds and home care packages, including more than 1,000 delayed discharges directly linked to home care shortages, which is directly contributing to the trolley crisis;

— the Health Service Capacity Review 2018 - Review of Health Demand and Capacity Requirements in Ireland to 2031, which was conducted based on lower population growth estimates than transpired, forecasted a minimum of 120 per cent increase in demand for home support from 2016 to 2031, but such demand at that level has already been reached and is expected to increase further;

— 62 per cent of home care is delivered by non-Health Service Executive (HSE) providers, with only 38 per cent of home support services delivered directly by the HSE, amounting to over €400 million in 2021 being paid to non-HSE providers of home care;

— the Minister of State with Reasonability for Mental Health and Older People, committed to the establishment of the full complement of 30 Integrated Care Programme for Older Persons (ICPOP) teams by Q3 2022;

— the Programme for Government: Our Shared Future commits to "introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care" and to "establish a commission to examine care" and the Government's commitment to establish a national home support office; and

— the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants was published on the 15th October, 2022, made 16 recommendations across recruitment, pay and conditions, barriers to employment, training and professional development, and sectoral reform;

condemns:

— the failure of the previous Fine Gael-led Government and then Minister for Health, Simon Harris TD, and his predecessors, to plan for, train, recruit, and retain enough nurses, healthcare assistants, and home carers to sustainably expand home care services, which directly led to the crisis in home care that is being experienced at present;

— the failure of the Minister for Health, Stephen Donnelly TD, to significantly advance proposed legislation such as the Health (Amendment) (Licensing of Professional Home Support Providers) Bill and the Health (Amendment) Bill relating to enhanced governance of nursing homes;

— the failure to deliver 1,000,000 home support hours in 2021 which were owed and budgeted for, as indicated in the HSE's National Service Plan 2022; and

— the overreliance of successive Governments on private home care providers, instead of investing in home care as a public health and social care service and career; and

calls on the Government to:

— expedite the proposed Health (Amendment) (Licensing of Professional Home Support Providers) Bill and new regulations for providers of home support services to construct a modern regulatory framework for home care;

— establish a commission on care and bring together social care sectors and stakeholders to modernise the home care sector and better align care, including family carers, care in the home, nursing home and residential care, and palliative care;

— fully commission the 30 ICPOP teams and transparently publish their staffing complements, with a view to fully staffing all teams;

— integrate adult safeguarding legislation into new regulations for the home care sector with the Health and Quality Information Authority as the regulator;

— establish regional home support offices to be embedded within regional health areas to ensure compatibility with forthcoming organisational reforms;

— develop a career pathway for carers and carers with an advanced skillset, and a greater role for nurses, physiotherapists, and allied health and social care professionals, including at advanced practice grades, in delivering high-quality home care;

— ensure more regular and holistic reviews of the health and care needs of persons receiving home care and home support to ensure they are in receipt of the type, quality, and intensity of care that they need;

— increase funding for home support services generally, with targeted increases in funding for healthy age-friendly homes, housing adaptation grants, personal assistance and assisted living services, and intensive home care packages to enable people to live at home for longer;

— introduce additional access routes to working in home care for people who are interested in additional but less than full-time employment in the sector, particularly in rural and underserved areas;

— invest in home care to ensure it is a viable alternative to nursing homes and residential care, where the choice is appropriate;

— establish a high-level workforce planning group to deliver accountability and joined-up, cross-Government planning for training, recruitment, and retention of health and social care professionals across the entire health sector, including home care; and

— modernise the tendering and funding model for providers of home care to prevent a race-to-the-bottom in costs and quality, to be underpinned by a collective agreement on employment standards in the sector that ensures a level playing field, high care standards, and fair remuneration for workers.

I am sharing time with some of my colleagues. It is good to see the Ceann Comhairle.

There is a crisis in home care which many of us have been talking about for many years. In October 2022, more than 5,100 people were on waiting lists for home care. Many of these people were in hospitals waiting to be discharged. We all signed up several years ago to the policy of right care in the right place at the right time. In the first instance, this means people being cared for in the home. We have far too many people who need intensive home care packages or home care support and cannot get these supports because the resources and capacity are simply not there. The truth is that last year hundreds of thousands of hours of home care could not be delivered because the staff simply could not be got. I have engaged with the organisations that provide the vast majority of home care. We know these are mainly in the private sector, along with an element of provision in the HSE. As the Minister of State knows, we rely on the private sector for much of this care.

There have been real challenges in this are for far too long. The sector has low levels of pay and is mainly populated by women who do an extremely difficult job. Talking to carers, especially given that most of them are women, it is possible to get a sense of what they do every day. This includes having to lift people, change them and care for them. This is a physically demanding job. We then look at the levels of pay received for this work. These people are working in an unregulated sector, one that does not value the work they do. Is it any wonder then that we have such levels of staff turnover and a retention and recruitment crisis?

I know the Department undertook work to examine all these issues and there is a report that needs to be implemented. I put it to the Minister of State that unless we deal with the issue of pay in this area, we will never truly value home care. I appeal to the Minister of State and her Government to put in place a collective pay agreement for the home care sector. It is one of the solutions proposed in this motion and one my colleagues and I have been calling for for many years. This is the best way to level up and create a level playing field between HSE and non-HSE staff and ensure we have pay parity to enable us to recruit the staff we need. That is important.

I have also been saying for some time that the problems in our accident and emergency departments in our hospitals will be resolved, in part, by putting more capacity into our hospitals. I think we all accept that hospitals need more consultants, nurses, healthcare assistants, specialist staff, junior doctors, beds and surgical theatre capacity. Hospitals need all this and more. Equally, though, part of the solution to what is happening in our hospitals is that we have far too many people in hospitals who should be being cared for elsewhere. One of the key tenets of Sláintecare was that we would start to reorientate our spending to other elements of care that are less costly but much more beneficial for patients and the healthcare system. Part of this involves step-down and recovery beds and residential care settings, but also home care.

Promises were made that we would have a statutory home care scheme. There is still no date for when this scheme will be put in place. Several pilots were undertaken but we have no sense yet as to when this scheme will happen. The average number of home care hours a person gets is about eight. If we are to move to a statutory home care model which allows for much greater levels of care in the home for people with higher needs, which they will have, and more dependency, it will mean providing many more hours of home care. Many providers told me recently that this will mean, in some cases, providing 20, 30 or 40 hours of home care.

If we cannot provide home care to people as it is, even before we start to extend and improve home care and provide more opportunities for others to be cared for in the home, what chance will we have when the statutory home care scheme comes into place? We need to start planning now. We have left it far too late. While the Minister of State has commissioned a report, which I welcome, we need action on all fronts on this issue. We need to regulate the sector. We need a Bill that does this. There are draft regulations that need to be fast-tracked and put in place. Once and for all, we need to deal with the recruitment and retention issues and put in place a fairer scheme, a fair rate of pay and a fair collective agreement that creates a level field that will allow us to recruit more staff into a crucial sector. More importantly, that will allow us to value the work these people do.

Patricia Ryan (Kildare South, Sinn Fein)
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I welcome the Ceann Comhairle back and wish him well.

Undoubtedly, the Minister of State is aware there is a crisis in home care provision. More than 40,000 home care hours are not being delivered weekly and more than 6,000 people approved for funding are still on the waiting list for care. The crisis is the recruitment and retention of staff. The root cause of this issue is sectorial employment standards. During the summer, I met with several groups representing the care sector and they all spoke with one voice in outlining the reason we are in this crisis. The representatives of some of those groups told me they met with the Department but they feel they were not listened to and that the meetings were just a box-ticking exercise, with no clear actions arising from them. The time for talking is over. It is now time for action. We need a root-and-branch reform of home care. We must value the people being cared for and this must start with valuing the work being done by those who care for them.

Where is the long-awaited pandemic bonus payment for the people who risked their lives and saved so many others? The sector is totally neglected and this needs to change.

While the crisis is bad now, there is a ticking time bomb of demographics. When I met with the national community care network, I was told that the average age of its 3,000 carers is 60 years of age. I have spoken to individual carers. They are overworked and underpaid and they feel undervalued.

We must make home care an attractive career option with opportunities for advancement and training. Home care workers must be added to the critical skills list for employment visas and permits. Each worker must have guaranteed hours and must be provided with payment for travel and subsistence.

Delivering proper home care would reduce the length of hospital stays, as Deputy Cullinane said, and reduce the risk of hospitalisation which would reduce pressures on the emergency departments and reduce delayed discharges. The State must step up to the plate. We need a two-pronged approach. The Government must address the recruitment and retention crisis but it is equally important that it advance vital regulation for the home care sector and make this legislation a priority. If the Government will not deliver a promised commission on care, Sinn Féin in government will.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Currently, there are over 6,000 people across the State waiting on home care support. It is an unacceptable situation. The crisis is getting worse and worse. In October 2021, 4,825 people were awaiting home care. In July of this year, there were 5,312. According to a reply to a recent parliamentary question I submitted, it is now at 6,255.

We as a party have been warning for a number of years about a looming crisis within the home care system. In responses to parliamentary questions I submitted, the Government acknowledged the demand for home care support has grown considerably over the past number of years and that factors such as the contracts of employment and employment terms and conditions being offered are a factor in the recruitment challenges faced by the sector. If the Government knows what the challenges are, why are they not being addressed?

The HSE is employing over 1,000 fewer home care assistants now than it was in 2017. Fianna Fáil and Fine Gael have failed to plan for proper home care to look after those in need and this failure is putting older people into hospitals and nursing homes when they should be cared for in their own homes. The lack of community care alternatives has left thousands in hospitals. Some cannot avail of early release from hospital because they have nowhere to go. When they go home, they have no one to look after them. Maybe they live alone or they live with an elderly spouse or sibling.

What we need is a pay agreement for the sector and the Government needs to make this happen. We need a proactive strategic approach to workforce planning across health and social care.

The Government must advance vital regulation for the home care sector and should make this legislation a priority. It must establish the promised commission on care to kick-start the modernisation of social care arrangements.

I will raise the home care cash grant with the Minister of State, Deputy Butler. I raised this on Questions on Policy or Legislation a few weeks ago. This places the entire onus on older people or their spouses to advertise for carers, to recruit them, to ensure they are adequately trained, to ensure that all aspects of the employee's entitlements are adhered to such as PAYE, leave and work permits, where applicable, and to include this on their home insurance. The Minister of State, Deputy Butler, suggested on that occasion that I was confusing this with the personalised budgets. I assure the Minister of State I am not. There is a home care cash grant. I sent the Minister of State information on this after that Questions on Policy or Legislation session and I am awaiting a reply. It shows exactly the correspondence from the HSE to the person in question, of course with the person's permission, and it is referred to as the home care cash grant. It is used by the HSE in some areas. It is not appropriate. It is not fair on the older people. It is a danger. I have outlined the issue and I would appreciate a response to it.

Martin Browne (Tipperary, Sinn Fein)
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Last year, when the Covid lockdowns were in effect, I raised the issue of a young man with muscular dystrophy. He was in receipt of minimal home care assistance at the time. I was told that despite being promised more care hours, they would not be provided due to shortages of healthcare workers in the south-east. Of course, Covid was used as a primary excuse here and yet here we are again speaking up for the many people who this Government has let down continuously because of its failure to plan for a significant workforce or to address long-term pay and conditions. As a result of this ongoing inability of the Government to address this, 1,561 people in community health organisation, CHO 5, which includes south Tipperary, and 461 in CHO 3, which includes north Tipperary, are waiting for a home care assistant despite being approved.

Repeatedly we are told, when facilities such St. Brigid's in Carrick-on-Suir or the Dean Maxwell in Roscrea are closing, that care in the home is the direction the Government wants to focus on. It is fair enough to pursue the goal of more care in the home. What is not fair is to close those important community facilities without having the alternatives in place and yet this is what we see from this Government - closing St. Brigid's in a secretive manner, preparing for the closure of Dean Maxwell but not having any alternatives in place locally. Instead, the Government makes people travel for the care they need or locate it miles away from their locality and their families. The Government makes plans without investing in the alternative. That is why almost 10% of all older people approved for home care have no carer.

The HSE admits that issues such as the contracts of employment terms and conditions are a factor in the recruitment challenges faced by the sector. Sinn Féin wants a health system that is planned in a way that supply and qualification meet demand so that we have a service that people can depend on. That is why we are calling for the establishment of a commission on care to bring together social care sectors and stakeholders to modernise the home care sector and better align the range of care services. We need to see the establishment of a high-level workforce planning group to deliver accountability and joined-up cross-Government planning for training, recruitment and retention of health and social care professionals across the sector. If the Government thinks that carers and home care workers will magically appear without this level of planning, the problem that already exists under its watch will only get worse and it is the people with the most need who will suffer.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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It is 15 years since I first engaged with politicians in relation to the issue of home carers and home helps. I was representing them at the time and we warned politicians that there was a crisis coming in home care because of the terms and conditions of employment and because of the privatisation which, as the Minister of State, Deputy Butler, will be aware, fired the starting gun for the race to the bottom.

There is nobody in this House or anywhere else who will dispute that home helps and home carers are good value for money. They are exceptional value for money but when one spends that money in the private sector there is always a premium to be paid to the shareholders, to the owners etc. When one spends it on not-for-profits or directly employed home helps, every shilling that one spends goes into home care delivery. The privatisation model has not worked. It has let down the home helps, it has let down the home carers, it has let down the people who are dependent on their care and it is letting the taxpayers who are funding it down. It is not good value for money. It is only when one recognises that it is not good value for money that one will be able to make the necessary changes.

I will mention the case of two twin boys in my own area. They are wheelchair users. They are eight years of age. Their mother is at the end of her tether. She is desperate to get some assistance. I have tabled parliamentary questions on the issue. I have engaged with the HSE. They tell me simply that the staff are not there, but what do I say to their Mam? What do I say to her? She is at the end of her rope and all she needs is some of the most cost-effective, best value-for-money intervention that the health service can provide. That should not be beyond the Government. The Government has ignored the calls from the trade unions and the advocacy groups and now we find ourselves, yet again, in a crisis that was entirely avoidable.

I commend An Teachta Cullinane, not only for this motion but for all of the work that he is doing. I urge the Minister of State to take on board what is in this motion and the practical suggestions made.

Johnny Mythen (Wexford, Sinn Fein)
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Home care is one of the most essential parts of looking after the well-being, mental health and welfare of our treasured older citizens and those living with disabilities.

Many people who require this service are coming out of hospital. Coming out of hospital is a very worrying time for anyone, but doubly so for older people who may be facing mobility challenges. It is proven that home support is the best way back to independence. The elderly fully deserve this service at their time of need.

I take this opportunity to mention the families of individuals waiting for home support too. For them, home support comes as a lifeline, a time for respite when they can be reassured that their loved ones are getting the care they need in a safe and professional manner.

I have spoken about the desperately long waiting lists for home support in County Wexford in this Chamber on many occasions. At the start of this year, there were 644 families waiting for new home support services and 227 waiting for increased provision in County Wexford alone.

The waiting list figures for home support services in County Wexford are so dire that a review had to be conducted at the end of last year. I tried to get my hands on that review with little success but eventually succeeded in securing a copy through freedom of information. The main finding of the review is that the fundamental issue is staffing. This is not a surprise considering low wages, ever-changing working conditions and the current cost-of-living crisis. This is why I support the motion in the strongest manner possible, specifically the calls for career pathways and a workforce planning group with fair employment standards and proper remuneration benefits that match the valued work the home support workers provide. We need a pay agreement for the sector with direct Government regulation and intervention. The Government must appoint a commission on care to modernise social care arrangements.

I ask the Minister of State to follow up on the review conducted in County Wexford. Recommendations were to be implemented throughout 2022. What is the update on this? What actions have been taken or are being implemented in Wexford? The Minister of State has a long way to go to get home support services up to standard. The comprehensive motion outlines how we can get there. I urge every Deputy in the House to support this excellent motion and act quickly on the issue of home support services.

Mark Ward (Dublin Mid West, Sinn Fein)
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There is a crisis in home care that has been brewing for many years. We are now no country for older people. Fianna Fáil and Fine Gael are failing our older people. We have reports that there has been an increase of more than 10% in the number of older people on waiting lists for home care assistance, with figures of more than 6,000 this year. What is shocking is that almost 10% of all older people approved for home support have no carer. This is because past and current Governments have failed to plan. This lack of planning by the Government speaks to its priorities. People who have worked their entire lives are being left behind and let down badly. There are hundreds if not thousands more who have funding but only receive partial support that is far below what they and their family need. When we hear of our young people emigrating in record numbers, many of whom are healthcare professionals, can we really blame them when this is the future they can expect? We need a proactive strategic approach to workforce planning in health and social care. We must improve working conditions to help with the retention of staff.

There are knock-on effects. The lack of community care alternatives has left more than 7,000 people delayed in hospital, including more than 1,000 people who could have gone home earlier if they had a carer. In the midst of a hospital bed emergency, we have people in beds who should be at home and we have people on trolleys waiting on those beds. We can rectify this with proper home care delivery. Sinn Féin has a plan to fix this, as my party colleagues have outlined. We need a pay agreement for the sector and the Government needs to make sure this happens. The Government must advance vital regulation for the home care sector and should make this legislation a priority. We must also establish the promised commission on care to kick-start and modernise social care arrangements. Our communities deserve much greater public investment in the home care sector in the years ahead so they can get and receive the right care in the right place at the right time.

Something that really bothers me is the phrase "bed blockers". I hate when it comes up. A woman in her 70s contacted me to say she was told her husband was a bed blocker. He has been in hospital for a long time. He is unwell. In her words, he is looking to come home and die with dignity. He has not been allowed to do so because he has been told he is blocking beds. He is not blocking the beds. It is the system that is blocking the beds.