Colm Burke (Fine Gael)
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I welcome the Minister and very much appreciate him taking the time to deal with this matter which concerns a cost analysis undertaken in the HSE of the provision of home care services. I raise the issue because, on the one hand, the private sector is being criticised severely for the charges it requires people who need home help to pay and, on the other, is being compared with the HSE in that regard. However, what is not being taken into account are the costs incurred by the private sector which includes insurance costs, organisational costs and the cost of renting premises.These are part of the costs the private sector incurs in providing home care to people around the country. A private provider may charge a contract of €22 or €24 an hour for the service. From that, the provider may pay €12.50 or €13 an hour to a carer. However, there are many other costs which they incur which must come from that overall figure. On the other hand, when the HSE provides a service, the cost of administration is not taken into account. The HSE does not have to pay rates, and insurance is covered by an overall insurance policy for the country. We have never seen a breakdown of the cost analysis of home care provided by the HSE.

While the private sector gives advice to the HSE as to how services should be run, the HSE refuses to take on board these recommendations. However, one now finds those in the private sector are recruited by the HSE to provide exactly the same services the private sector told the HSE it should not deliver to those who require home care. Has a cost analysis been done on how much it costs to provide an hour of home care if the person is employed through the HSE? If not, are there plans for such a cost analysis to be carried out? We need to do it now because we have a growing number of people living longer who will require additional home supports. Over 637,000 people are over 65. In 12 to 15 years, that figure will be over 1 million people. We must develop the home care package and ensure we are getting it in a cost-effective manner. I am not convinced that is happening.

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Colm Burke for raising this matter. He has been pushing for reform of the health services and has been supportive of my portfolio.

The HSE has sought to maintain, and where possible to expand, the range and volume of services available to support people to remain in their own homes, to prevent early admission to long-term residential care and to support people to return home following an acute hospital admission.

Home support services were a particular area of focus in budget 2018, with an additional €18.25 million allocated to them. The resources available in 2018 bring the total budget for the direct provision of services to €408 million. The HSE's national service plan provides for a target of some 17.094 million home support hours to 50,500 people. Home support services are provided either directly by the HSE or through voluntary and private providers. Service provision is identified through a needs assessment undertaken by a HSE professional for the purposes of identifying the person's needs and suitable service which will support the person to continue to live in his or her own home as independently as possible. The average cost per hour paid by the HSE to service providers encompasses all costs relating to service delivery, including the employee's salary, paid leave, employer's PRSI, travel, administration, training, etc. All providers who meet the HSE standards incur costs in addition to the direct cost of the salary of the worker. Such costs are essential to the operation of the service to the required standards.

In the absence of regulation of the sector, the HSE has put in place formal arrangements with external providers to deliver publicly funded home supports to the standards and requirements of the HSE.The HSE has, therefore, tendered on a number of occasions for providers of home support services so as to create an "approved provider" list in each of its geographic areas. The criteria to be successful at tender includes adherence to a level of standard of service provision as well as cost of provision of the service. In general, costs to the HSE per hour will range between €20 and €25, inclusive of pay and overheads, and will also depend on when the individual service is being provided. The utilisation of external providers delivers essential additional service capacity across the system without which many older people would not be able to remain at home.

The costs of delivery of service has increased due to general cost increases and to increased delivery of non-core hours of service at weekends, bank holidays and late evenings together with the costs of delivering an increasingly skilled workforce caring for older people with higher levels of dependency who would otherwise require long-stay residential care. The HSE has implemented increased contract hours for its directly employed staff in 2014 and is now in the process of offering improved contract hours in 2018.

In conclusion, it should be noted that the Department is developing a new statutory scheme for the financing and regulation of home support care services. This will be an important step in ensuring that the system operates in a consistent and fair manner for all those who need home care services.

Colm Burke (Fine Gael)
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I accept fully what the Minister of State is telling me but has the HSE or the Department ever sat down and done a detailed cost analysis within the HSE because we should not be comparing like with like in respect of the private sector and the HSE? I believe that the cost of the HSE delivering the same service as that delivered by the private sector could be up to between €30 to €35 per hour. Those are the figures I am getting. Nobody has actually sat down and done a decent cost analysis. Could the Department give consideration to a pilot cost analysis to see exactly what it is costing and how we can deliver more hours for people who require home care in a cost-effective manner right across the country?

Finian McGrath (Dublin Bay North, Independent)
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I will bring the Senator's concerns to the Minister because we are talking about public money and I accept the Senator's valid argument. As I said previously, the total budget in 2018 for the direct provision of services is €408 million. Regarding the point about hours, at the moment, the HSE hourly rate will range between €20 and €25, inclusive of pay and overheads. I accept the Senator's point regarding the other figures he mentioned. There should be some sort of independent assessment to find out the facts of the case. I will put those points to the Minister and come back to the Senator.