Alice-Mary Higgins (Independent) | Oireachtas source

I welcome the Minister of State and commend Senators Burke, Hopkins and Richmond on the Bill. It is a very positive and necessary step forward and a really constructive proposal. I previously had the opportunity for a number of years to work with Older and Bolder which was an alliance of older persons' organisations across Ireland that worked with groups such as the Alzheimer Society of Ireland, carers, active retirement groups and Age and Opportunity. Of the many common issues, a key area of focus for us was health and home care. I had the opportunity to be part of a national campaign called Make Home Work which specifically addressed and highlighted the need for quality, predictable, sensitive and appropriately regulated home care in Ireland.

The Law Reform Commission report of 2011, which followed on from that campaign, is very substantial. It is an excellent report and I welcome that it has so heavily informed the Bill and the proposals put forward. I also commend a number of the important elements within the Bill which are very sensitively and well done. I commend the Bill for looking at companionship plans and because it takes such care to look to the principles of independent living. For far too long, we have had a system whereby older persons have been placed in residential care and, as a result, are placed out of the public mind and removed from active engagement in society. As well as them losing in terms of their participation in society, society has lost out by the removal of so many older people who have immense experience, insight, ideas and engagement. Home care has a huge role to play in ensuring independent living. I also welcome the principles of privacy and dignity which are very important. I would like the Minister of State to address our national positive ageing strategy and our fulfilment of our UN obligations in that regard. Those principles are crucial.

I share the concerns expressed by my colleagues in the Labour Party and Sinn Féin about the quality of terms and conditions for those working in care, not just the question of pay rates but also the question of genuine pathways to progression, security of contract, predictability and management of contract. We should ensure that working in care in Ireland is something that people can commit to. We need to ensure that those persons described by Senator Kelleher who choose to do this with great care and sensitivity are not being asked to offer that up but are valued and have a pathway to a career in delivering quality care. It is important that there is progress towards an employment regulation order to accompany any such Act. The pathways and precedent are there and it is very important.

I will touch on something that was mentioned around the tendering process. I share the concern at the moment, which the Minister highlighted, that only 30% of our home-care services are being publicly provided. We need to really look at strengthening public delivery within this model. We need to look at the quality of training and recruitment in the HSE to ensure we have a huge cohort of care providers so that they are directly accountable for the care that is delivered in homes in Ireland. They should not simply be regulated but also accountable within the HSE. That will set the model which we expect and demand from any other providers in the sector, whether they are voluntary, community or private.

When I was with Older and Bolder we went into residential care homes and talked to older people about their preferences. The strong and clear preference is for people to be cared for in their own home. We have seen funding chipped away very seriously. Units of time of 15 minutes, 30 minutes and 20 minutes have crept in and are absolutely contrary to the principles of dignity. We talk about companionship plans because it is important that someone can sit and have tea and speak to somebody. That is part of it. The Bill is very positive. Unfortunately in recent years the working practice has been moving in the wrong direction. I have heard so many cases of people who move from two hours to one hour, who find they are on the clock, and are having a rushed bad meal. I urge the Minister of State to take immediate high quality action in those areas. The research is there. As I said, we engaged in campaigns on this seven years ago. There is a substantial body of work. I urge that this be moved forward speedily.

As a note of caution, I will bring up, as I often do, the Comprehensive Economic and Trade Agreement, CETA. There are proposals to introduce new investment court systems under which the introduction of new regulations that compromise profit can be subject to a claim of compensation. It is absolutely imperative we get the regulation in place now while we have the freedom to do so and while it does not come with an additional potential price tag as a result of companies taking cases because of the introduction of absolutely reasonable health care focused regulation. It is imperative we do that. Unfortunately, as my colleague has mentioned, some of the companies working in this area have approached it with a view to increasing their profits at all costs. We have seen companies fighting payment of staff who move from one home to another.We have also seen them fight, for example, holiday pay for staff. There is a negative trend in how home care is delivered, and it is important that this Bill and the regulatory and other orders progress and that speedy action be taken to address that trend.

My very last point is that health care needs, as mentioned by the Minister, must be paramount. It is very important that any further conditional review ensure that no obstacle is put in place that may discourage a vulnerable person or his or her family from accessing or seeking home care supports. Regarding the question of contribution of payment and entitlement, it is important we do not end up creating barriers to a service which must remain determined by health care need.