Róisín Shortall (Dublin North West, Social Democrats)
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4. To ask the Minister for Health if he will provide an update on the new home care tender, following an offer of €31 being issued to providers on 25 May 2023; if this offer is based on the current living wage of €13.85 per hour; the details of the other elements of this offer; how this figure was arrived at; the means by which travel expenses will be paid; the rationale for continuing with the fastest-finger-first commissioning model; and if he will make a statement on the matter. [26967/23]

Róisín Shortall (Dublin North West, Social Democrats)
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A related topic is the question of home care. There is a crisis in home care. While the HSE provides home care with staff with proper pay and conditions, the reality is that in much of the country that essential service has been outsourced to the private sector. The people working in those services are at a serious disadvantage to those who are employed by the HSE. What are the various elements of the latest offer for home care workers in the private sector?

Mary Butler (Waterford, Fianna Fail)
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The existing tender for home support was extended by the HSE to 30 June. The process of developing the new tender is at an advanced stage. Engagement has been ongoing between the HSE and the provider representative bodies. The HSE published stage two of the process on the 25 May.

I am pleased the proposed indirect hourly core rate includes a number of significant reforms that can stabilise the market and improve the terms and conditions for workers. This rate is subject to the new tender, including provision for sectoral reform, including travel time, addressing the living wage and reforming legacy rates, as recommended by the strategic workforce advisory group.

The Deputy asked about the commissioning of services. In the first instance, the authorisation scheme will be client-centred. She often raised with me previously about the fastest-finger-first approach. It will operate on a client choice basis, putting the service users' needs first. How that will work in practice is the HSE will provide a list of providers requesting that the client indicates his or her preferred provider. If the selected provider cannot deliver the service, the HSE will issue an email alert to all community healthcare organisation, CHO, specific approved providers. The HSE recommends that email alerts issue at a standard time each day to facilitate providers in managing responses because we heard larger companies had more economies of scale in having more staff available to do this. The first provider to respond with confirmation of a named home support worker to deliver the service will be awarded the contract for that client. This process is adopted to meet the support needs of the client and in the interests of fairness to all providers.

Through the strategic workforce advisory group, we are able to deal with the living wage, the travel time and also the sectoral reform in relation to legacy rates. Many different legacy rates had built up over many years.

Róisín Shortall (Dublin North West, Social Democrats)
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I would like some specifics. I set those out in the question.

When the Minister of State talks about the living wage, is that €13.85 per hour, which is the current living wage? What arrangements are in place for increases to that living wage? There is a system for determining that and it is increased on an annual basis. Will the contract cover those increases? I would like confirmation of that first.

What about the question of continuity of income for staff? If a client goes on holidays or if is in hospital for a few days, what about the home care worker's income in those circumstances? Will there be continuity or will it be left to chance? What exactly is the Minister of State proposing to do regarding travel mileage?

If she could clarify the situation those issues first, I will come back to the commissioning model.

Mary Butler (Waterford, Fianna Fail)
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As agreed by Government, the national living wage will be set at 60% of hourly median wages in line with the recommendations of the Low Pay Commission. It will be introduced over a four-year period and will be in place by 2026, at which point it will replace the national minimum wage.

The first step towards reaching a living wage will be the 80 cent increase to the national minimum wage from 1 January 2023 to €11.30 per hour. This will be followed by gradual increases to the national minimum wage until it reaches 60% of hourly median earnings. In 2023, it is estimated that 60% of median earnings will equate to approximately €13.10 per hour.

Regarding the Deputy's question on the continuity of incomes, where we are talking about private companies here, they all will have their own terms and conditions with their own employees in respect of how many hours they are rostered for per week. My understanding is that travel time is being discussed at present

Róisín Shortall (Dublin North West, Social Democrats)
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Sorry, mileage.

Mary Butler (Waterford, Fianna Fail)
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No. It is travel time we are dealing with in this. We are not dealing with mileage as well.

Róisín Shortall (Dublin North West, Social Democrats)
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My question is about mileage.

Mary Butler (Waterford, Fianna Fail)
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Mileage is not included. Travel time is included at €2.99 per hour.

Róisín Shortall (Dublin North West, Social Democrats)
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That is really disappointing. In the context of us having a crisis in home care at the moment, does the Minister of State realise 6,500 people, mainly older people have been approved for home care but services are not being provided to them? We were discussing earlier the problems of people inappropriately arriving at hospital emergency departments. A major element of that relates to older people who do not have the necessary care at home. What the Minister of State is proposing is a far cry from what was recommended in the expert report.

The current living wage is determined to be €13.85 per hour. The Government is talking about bringing that in over a four-year period. The Minister of State is doing nothing about improving the mileage rate and she is passing the buck completely on continuity of income. If a client goes into hospital or if a client is away, who covers the cost of that for the person providing the service? This falls far short of the recommendations in the report that she commissioned and committed to implementing.

Mary Butler (Waterford, Fianna Fail)
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With all due respect, the Deputy was previously a Minister of State in the Department of Health. She understands that I am constrained by my budget. My budget is €723 million for home care this year, which is a significant amount. She mentioned failures but 56,980 people will receive home care today. A total of 3,524 new applicants are funded waiting for supports but 2,908 people are already receiving supports, but not the maximum hours advised. It is important to put that on the record.

With regard to the tender, we are dealing with legacy issues that have been there for many years. This is one of the issues that all the organisations brought up when I met with them. The Deputy asked me to meet an organisation from north County Dublin, and I did.

On travel time and the living wage, we have to work with the budget we have to deliver the hours we have.

I think we have made significant changes to the tender.

Róisín Shortall (Dublin North West, Social Democrats)
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We should reflect the reality of the situation. It is not a matter of what the Minister of State thinks. She committed to implementing the expert report that she herself commissioned. As the figures have been validated by Grant Thornton, there is no dispute about the costs. Why is the Minister of State not prepared to meet the costs of providing home care? Approximately 6,500 people are awaiting home care and that number has remained stubbornly high. Despite all those elements to which she has committed, it seems now that she is not prepared to follow through on ensuring they will be included in the new offer of €31. We cannot provide the services on the basis of those figures the Minister of State gave. She talked about phasing in the living wage. There is a figure for the living wage now, which will increase each year, and the Government needs to commit to doing that. This falls far short of what is required.

In respect of the commissioning model, what I hear the Minister of State saying is that she is putting the responsibility back onto the client to make the choice. The commissioning should reflect the level of need required but it is not doing that, judging by what she said. It is really disappointing that she has welched on this.

Mary Butler (Waterford, Fianna Fail)
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Targets rose from 18.67 million hours in 2020 to 22 million hours in 2023, while the delivery of hours rose from 17.55 million in 2020 to 20.78 million in 2022. As of 31 March 2023, 5.2 million hours had been provided in the year to date, and this was an increase-----

Róisín Shortall (Dublin North West, Social Democrats)
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Those figures are meaningless.

Mary Butler (Waterford, Fianna Fail)
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I did not interrupt the Deputy. This was an increase of about 250,000 hours on the same period in 2022. I thank Home and Community Care Ireland and Joseph Musgrave for their interaction with the HSE as we develop this tender. A huge number of hours have gone into putting it and the recommendations of the advisory group in place. I am delighted to say the statutory instrument authorising the assurance of 1,000 emergency permits for home care workers was signed in December, with 68 permits issued to date.