Tim O'Malley (Limerick East, Progressive Democrats)

I wish to begin by thanking Senators for moving this motion and for giving me this opportunity to clarify the issues raised and to make clear my unequivocal belief that the home help service is the cornerstone of public care provision for older people. The aim of the home help service is to enable people to remain at home, where appropriate, who would otherwise need to be cared for in residential care. It is an essential support to family and informal carers. Home helps form part of a wider community team and the Government is deeply aware of the important role that this service plays in supporting older people, in particular, to remain in their own homes for as long as possible.

I would also like to take the opportunity afforded by the motion to acknowledge the hard work and the commitment of carers in the home and in the voluntary sector and to say that we are making every effort to support them as much as possible. I also wish to acknowledge the valuable service provided by home helps themselves. In no way is their work unrecognised by Government — in fact there have been significant developments in the service over recent years including a major initiative to regularise the employment conditions of persons providing home help services. In a short period of time, the service has evolved from family members or neighbours providing support on a voluntary basis to today's situation where home helps, as employees, have the same statutory rights as other workers.

Home help comprises a range of services which may be provided to a single individual or to a household, including household and domestic support and emotional and personal care issues. Home helps provide a continuum of such support to clients, particularly as clients' needs change over a period of time. By its nature, it is a flexible service which responds to clients' needs and it is targeted at people who have been assessed as having high and medium dependency. As a result, the level of service required in individual cases will fluctuate from time to time. There must, of course, also be effective prioritisation within the service. Assessments are undertaken at local level and are carried out predominantly by the public health nursing service or by the voluntary service provider where arrangements have been made for the service to be provided through voluntary providers.

Most of us would prefer to remain living at home when we get older rather than going into long-stay care. No less than 28% of residents in long-stay beds are in the low to medium categories. This represents over 5,000 people and it is difficult to believe that many of these could not have been cared for at home if the right level of supports were in place. Clearly, long-term residential care will always be required in the health system but such places should be more appropriately allocated to patients with a higher dependency who can no longer be cared for in their own homes and communities. It goes without saying that community supports are needed if older people are to remain in their own homes or within their own community for as long as possible.

Internationally, other countries are putting in place community supports which give older people more control over the services delivered to them. Indeed, the experience is that families do not reduce their care-giving but rather maintain it if they see that there is some support for their more dependent relatives. The result of this in other countries is that residential care generally is not increasing and in some countries is reducing because of better home supports. It appears that we are short of the norm for home care provisions by OECD standards while we appear to be at the average for residential care. This is completely the wrong balance and must be changed. Given that people want to remain in their own homes, it is heartening to note the research that states that those who do so live on average two years longer.

Demand for home help services is increasing and this is attributable to a number of factors. One factor is demographic — our aging profile, although this is less acute than many of our European neighbours. In Ireland, our age profile means that approximately 6,000 additional people come into the over-65 bracket every year and there has been a proportionately higher percentage increase in the more dependent over-80 category.

Currently in Ireland, I believe that we can do even more to offer support to high dependency patients who want to remain at home. The Government is committed to developing the various community and home support schemes so that people and their families have a viable alternative to long-term residential care. There is no doubt that these supports will give people greater control over their own lives and will allow families to continue with their care. The Government is working to ensure that residential care should not necessarily be the first option when people need long-term care.

In a broader context, the Government is very conscious of the changing demographic profile of our population, with more people living longer lives and the consequential greater demand for services, both community-based and residential. The Mercer report on the future financing of long-term care in Ireland, which was commissioned by the Department of Social and Family Affairs, examined all issues surrounding the financing of long-term care.

Following on the publication of this report in 2003, a working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established. The objective of this group is to identify the policy options for a financially sustainable system of long-term care for older people, including respite care, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme. This group will shortly report to the Tánaiste and Minister for Health and Children and the Minister for Social and Family Affairs.

Additional funding of €5 million was made available in the 2005 Estimates for the home help service. In September 2005, an additional €6.6 million was allocated to target services for older persons and in particular, to address the priority needs across the country with regard to home helps, bringing the total budget to approximately €120 million in 2005. This figure should be compared with the figure of £12 million, which is approximately €15 million, which was allocated to this service in 1997.

This level of funding shows the Government's commitment to the thinking and policies I set out earlier. However, we must continue to build on what we have achieved so far. We must continue and accelerate our investment in this key service if we are to meet people's real desire to stay in their own homes.

There is concern among carers generally that home help hours should not be reduced and it is clear that Senators share these concerns. I fully agree with this view, as does the Tánaiste and Government, and this concern has been made clear to the Health Service Executive. However, increased demand for the service may necessitate some minor adjustments in the provision of the home help service. Basically, this means that although a small percentage of clients may have the number of hours of home help which they receive reduced, this is counterbalanced by others receiving the service for the first time. Such decisions are made on the basis of need. In 2005, it is anticipated that around 7.5 million hours of home help services will be provided to the elderly with a further 1.5 million hours being provided for people in the disability sector and others. Funding has been provided by the Government to the Health Service Executive for this purpose. There will be no cutbacks in the hours committed to the home help programme this year.

The Government proposes to extend home based services through the introduction of home help packages. The home help system was introduced as a way of supplementing good neighbourliness and has now become a formalised support method. In general, it is provided between the hours of 9 a.m. and 5 p.m., five days a week, although there are exceptions. However, the care which people require is not limited to those hours. It is proposed that home care packages would run in conjunction with home help. Home help forms part of the home care package. It must be much more flexible and less prescriptive and capable of dealing with people late at night, overnight and at weekends, if required. If a disabled or elderly person is not capable of cooking meals, dressing himself or herself or putting himself or herself to bed, our home help and home care package must be able to facilitate support to do these things in the home.

Crucial to the effectiveness of the home help service is the staff concerned — the home helps themselves. In line with increases in investment in services in recent years, major progress has been made in enhancing the terms and conditions of employment of home helps who are employed in the health service. A collective agreement was finalised in August 2000 between the health service employers and the trade unions. This part-time home helps agreement represented a significant step in regularising the employment status of home help personnel employed by the former health boards and it is worthwhile setting out some of its components.

These included a commitment from both sides to the reorganisation and restructuring of the home help service. It noted that home helps would provide a continuum of care for clients, particularly as clients' needs change over a period. It proposed that an assessment of needs be conducted for each client, part of which would include the number of hours of home help service which would be provided to the client. This would be subject to regular review and monitoring. The agreement also noted that flexibility of service provision by home helps would be maintained. Under this national level agreement people working as home helps benefited from substantial pay increases and benefits.

The agreement regularised the pay and conditions of home helps in terms of pay, annual leave, premium pay and travel expenses. It recommended that contracts of employment be agreed between the parties and that guidelines be drawn up on the standardisation of working hours. Arising from the agreement, as and from 1 January 2001, home helps were transferred to the same pay scale which applied to non-nursing staff at that time. During the course of this process, an assimilation exercise was also agreed, which granted incremental credit to home helps, thus recognising previous service. That is not to say there are no outstanding implementation issues. However, all such issues, for example, contracts of employment, continuity of working hours and superannuation continue to be discussed between management and trade unions in accordance with normal industrial relations processes. I stress that, in overall terms, significant progress and enhancement of the terms and conditions of home helps are evident since the August 2000 agreement.

Since 2000, home helps have been included in collective agreements which apply to non-nursing support staff. Senators will be aware of the work of the public service benchmarking body, PSBB, which was established to carry out a detailed examination into jobs, pay and conditions of public servants and compared them with jobs of equal size in private sector. In tandem with this process the PSBB established a parallel process for craftworkers and non-nursing personnel, which included home helps. This is called the parallel benchmarking process.

The resulting agreement between health service employers and the trade unions — SIPTU, IMPACT and ATGWU — in regard to the support, formerly non-nursing, staff employed in the health services became known as "Recognising and Respecting the Role". This is a framework agreement for support staff in the health services which aims to contribute to the ongoing development of support staff and the services which they are responsible for providing. It sets down the modernisation and change required in the service, the achievement of which would result in pay increases for personnel.

The parallel benchmarking agreement which was concluded in late 2003 provided for three phases of pay increases to eligible personnel, including home helps as follows: phase 1, 25% from 1 December 2001; phase 2, 50% from 1 January 2004; and phase 3, 25% from 1 June 2005. Payment of the first phase in the form of a lump sum of €2000 to each whole time equivalent, or pro-rata thereof, was sanctioned for payment by the end of December 2003. This was an up-front payment.

As well as pay increases under the parallel benchmarking agreement, non nursing personnel have also benefited from the following general pay increases under Sustaining Progress and the mid term review of Part Two of Sustaining Progress: 3% from 1 January 2004, 2% from 1 July 2004, 2% from 1 December 2004 and 1.5% on 1 June 2005. Further increases of 1.5% and 2.5% fall due for consideration with effect from 1 December 2005 and 1 June 2006 respectively. Sanction to payment of all these pay increases is subject to health service performance verification group being satisfied that the employees have complied with the modernisation and change agenda for the health sector.

Under the parallel benchmarking agreement, with effect from last June pay structures were streamlined; more than 25,000 support staff, including home helps, were placed within four bands for pay purposes, a reduction from the 11 bands which had applied heretofore. Recognising and Respecting the Role also contained specific provisions on the training and development of support staff. A discrete fund of €60 million is to be spent over the five years period 2004 to 2008 on training and development and thereafter a fund of €12 million per annum is to be provided. This underlines the commitment of the Government to address the on-going training and development needs of support staff. This training is being implemented through the SKILL project, an acronym for securing knowledge intra, within, lifelong learning.

The SKlLL project is a unique training initiative which is designed to address the needs and aspirations of support staff in the health service, including home helps. Its mission statement is, "To educate, develop and train support staff in the health services to the optimum of their abilities, in order to enhance their role in the quality of service to patients". The overall objective of the SKILL project is to allow individuals to undertake a programme of training, development and education. Participants in this programme will be enabled to progress through a predetermined structured framework encompassing personal and career development, training and educational opportunities. In this way, participants will be able to acquire new knowledge and skills, and will also receive recognition for their achievement, by way of accumulating credits and accreditation of prior learning, right through to the achievement of higher level academic vocational qualifications. The training and development needs of support staff, including home helps, will be identified through consultation with all stakeholders and in particular with each category of support staff, managers and users of the service.

The SKILL. project has the following twin objectives: first, to provide opportunities for support staff in the health services to acquire the skills and knowledge necessary to enable them provide excellent levels of service in the health services, and to provide support staff with the ability and confidence to adapt to the changing environment of the health services and, second, to provide an integrated framework within which support staff in the health services can pursue personal and career development. It is envisaged that the structured framework which has been designed for the SKILL project will be supervised and monitored by a recognised college and-or learning and education accreditation organisations. In other words, the training, development and education programmes provided to participants in the project will be required to comply with the standards set by the accreditation body. The overall SKILL. project will be divided into a number of work packages to develop and deliver programmes to specific groups of support staff, for example, the creation of a programme specifically geared towards the needs of home helps.

The HSE has confirmed this evening that the amount of hours delivered by the home help service will not be cut. The Department of Health and Children is in consultation with the HSE to get full and accurate figures on the number of hours delivered by this service in recent years. It is hoped that all this information will be collated within the Department shortly and will be published. The full-time salary for those involved in home help is approximately €27,000. Part-time workers are paid on a pro rata basis.

I appreciate that the motion is important both to those involved in home help and to the people who use their services. I am very conscious of the changing demographic profile of our population. More of us are living longer with a consequential greater demand for services. Significant developments in the home help service have taken place in recent years including a major initiative to regularise the employment conditions of persons providing home help services. In a short period of time the service has evolved from family members and neighbours providing support on a voluntary basis to today's situation where home-helpers, as employees, have the same statutory rights as other workers.

The Government is determined to continue its focus on supporting care in the community for older people. The home help service is a fundamental part of this support. I acknowledge that we do not have a perfect system and that more work needs to be done if we are to give people a real choice. We are targeting those most in need while also ensuring that the home help service is available to as many people as possible. There is, therefore, a continuing need for prioritisation within the home help service. I again stress that the Government is absolutely committed to the further development of the home help service. The very substantial increase in funding over the past eight years shows that commitment in concrete terms. For my part, I will continue to work assiduously towards ensuring that the service is improved and that older people can retain their independence and their place in the wider community.