Róisín Shortall (Dublin North West, Social Democrats)
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4. To ask the Minister for Public Expenditure and Reform the engagements he has had with the Department of Health and the HSE in relation to funding proposals for the new HSE Home Support Tender 2023; if additional funding has been requested from his Department to implement the recommendations of the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants; if additional funding will be provided to the Department of Health to implement a new home care tender ahead of the current arrangement ending in June 2023, following another extension of the existing tender; and if he will make a statement on the matter. [22301/23]

Róisín Shortall (Dublin North West, Social Democrats)
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The issue I raise concerns home care and staffing in nursing homes. We can only describe this as a crisis that exists in particular in regard to home care, where there are very long waiting lists and it is largely due to very poor terms and conditions for staff working in this important area. The funding of the package to improve conditions seems to be lying with the Department of Public Expenditure, National Development Plan Delivery and Reform. There is a delay in making the necessary funding available and I want to know what the Department's intentions are in that regard.

Patrick O'Donovan (Limerick County, Fine Gael)
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I thank the Deputy, on behalf of the Minister, Deputy Donohoe, for raising this very important issue. The Government is committed to promoting care in the community for older people so they can continue to live in their own homes for as long as possible. Home support is an increasingly important part of the supports the Government offers to older people and will continue to increase in importance into the future, as our ageing population grows. The overall policy intention and provision of services are in line with Sláintecare. The home support service is funded by the Government to deliver a volume of service each year as approved in the HSE national service plan, which is subject to the annual Estimates process.

As is the case for all Government Departments, the 2023 Estimates process involved detailed engagement between the Department and the Department of Health on the overall funding provided to the health sector. As part of budget 2023, the Department of Health made an allocation for the provision of home care support from within the available additional funding to meet the cost pressures being experienced within that area. Beyond this budget 2023 engagement, the Department has had no further engagement with the Department of Health in relation to funding for the new HSE home support tender for 2023. As with other areas of health policy, the Minister for Health has policy responsibility, in the first instance, for the provision of home care support. Within this context, the HSE is responsible for developing the private home care provider tender with engagement from the Department of Health. Therefore, any further queries in relation to the home care service or the status of the tender process should be directed to the Minister for Health in the first instance.

While the Minister for Health has policy responsibility for this area, the Minister for Public Expenditure, National Development Plan Delivery and Reform understands that the 2018 tender framework for the provision of home care support services was initially valid for a period of just over two years from September 2018 to 31 December 2020. Since 2020, the HSE has extended the framework a number of times, with corresponding rate increases. The most recent extension of the framework was at the end of 2022, initially to the end of April 2023. This extension increased the rate by 2.5% on tier 1 rates and by 3% on tier 2 rates. The HSE has proposed a further extension of the contract arrangements to Friday, 30 June, to allow time to finalise tender arrangements. No final decisions on the tender content have been reached.

Róisín Shortall (Dublin North West, Social Democrats)
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I do not think the Minister of State can absolve the Department of all responsibility in this regard. There is a funding requirement involved in this. While I am not sure if the Minister of State is aware of it, at the moment there are 6,500 older people on waiting lists for home care. They have been approved for it, and it is difficult enough to get approval for it, but they are on a waiting list because there are no carers available. Equally, there are many people in hospital who are ready to be discharged but they are waiting for home care and the staff are not available.

This is largely due to poor terms and conditions within that sector. The model the Government is pursuing is not the model I would favour. It is largely and increasingly privatised in respect of both home care and nursing home care. That is a mistake, but we have that system now. That is the model the Government is working to, and it needs to be funded properly. The funding requirement is set out very clearly in the strategic workforce plan that has been drawn up. Several Ministers, including the Taoiseach, have committed to funding it, so when is the funding going to be made available by the Department of Public Expenditure, National Development Plan Delivery, and Reform?

Patrick O'Donovan (Limerick County, Fine Gael)
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As the Deputy is aware, it is not appropriate for a Minister, in the context of existing commercial discussions, tendering processes or anything of that nature, to discuss them on the floor of the Dáil. As I said earlier, the HSE has proposed a further extension of the contract arrangements to Friday, 30 June which is its prerogative as the lead agency on this.

As I said at the outset, I am not trying to absolve myself or the Department of anything. It is simply a fact that when voted expenditure goes from this House to line Departments, it is for the Minister with responsibility for that area to set out, through the Department's policy framework, how he or she proposes to spend it.

It is worth pointing out that home care support spending has risen by 58%, from €443 million in 2019 to €700 million in 2023. These are not insignificant amounts of money, notwithstanding the level of demand that exists. Further discussions involving the HSE and the Department of Health, in terms of the completion of the tendering process, will naturally form part of the budget 2024 process which will be commencing, as I said earlier, after the summer economic statement is published.

Róisín Shortall (Dublin North West, Social Democrats)
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I reiterate that there is a real crisis in relation to getting sufficient staff to provide what is a critical social care service. Those difficulties were recognised in the strategic workforce plan. There were 16 recommendations made, principally in relation to pay and conditions. The plan recommended a living wage and paying people for their travel time which, incredibly, is not in place at the moment. The recommendation is for a payment of €34.44 per hour, and the cost of implementing that would be approximately €90 million. What is being suggested is that the Department of Health has only €50 million and that there is a shortfall. These are validated figures. Grant Thornton went in and looked at the books of several providers. There is no question but that the figure of €34.44 is a valid one but what has been offered is €28. That goes nowhere near meeting demand. The Taoiseach said in March it was his intention to implement all of those recommendations and what is missing now is the funding from the Department of Public Expenditure, National Development Plan Delivery, and Reform. The Department needs to step up.

Patrick O'Donovan (Limerick County, Fine Gael)
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As already stated, as a former Minister of State in the Department of Health, the Deputy will appreciate that it would not be appropriate for the Minister of Public Expenditure, National Development Plan Delivery, and Reform or for a Minister of State in his Department, in the middle of contractual discussions relating to the continuation or extension of contracts, the hiring of additional personnel or whatever is required for the service, to volunteer an opinion on behalf of the Department that ultimately holds the purse strings. My Department is not the one with the policy role and it does not lead the implementation of policy in this area.

I totally understand the concerns expressed by Deputy Shortall, as does every Member of the House, with regard to how the lack of home care is affecting people in our constituencies. Some of us actually feel this more personally than others. However, it is a matter for the Minister for Health, in conjunction with the HSE, to outline how they propose to spend the allocated moneys that are voted from the Dáil, why they might require a Supplementary Estimate and so on. There is a process for that and there is also a process in the context of the Estimates. I hope that once a conclusion is reached with regard to contractual arrangements on 30 June that this will form part of the discussions for 2024.