Seanad debates

Wednesday, 22 June 2022

Nithe i dtosach suíonna - Commencement Matters

Home Help Service

10:00 am

Photo of Timmy DooleyTimmy Dooley (Fianna Fail)
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I welcome the opportunity to raise what I believe is an important issue and I am pleased the Minister of State with responsibility for this area is here. He does not need me to tell him about the difficulties that exist in our acute hospitals and the significant delays people have in getting access to bed capacity. Much of the elective work is now delayed because of the crisis in accident and emergency departments. Some of that relates to the inability of patients to move from the care facility, which is the acute hospital, into either a step-down facility or back home. Therefore, there is a passage through the system for many.

I have identified what I believe is one of the very considerable difficulties that exist. It is the inability of the HSE or many of the other service providers to be able to hire home care assistants. From his constituency work over the years, the Minister of State will have had people come to him seeking more home care hours to be made available by the State. In order words, they want the State to put money aside to enable people to be cared for in their home and for them to allow them to live out their lives there. That used to be a problem but that is not the problem any more. The money is in place for the service but the problem is the service providers cannot get staff to fill those hours. Many more people could be living out the latter days of their lives in their own home if there were care assistants available to them.

I have met many care assistants and I do so on a regular basis. Some of them are now leaving the service. The only reason they are doing so is that they are not being properly looked after financially. The wages are poor but many of them are prepared to do the job because it is flexible work. What is killing them in the current climate is the cost of travel. The profile of the Minister of State's constituency is not that much different from mine. A carer might care for a person who lives ten or 15 miles from where the carer lives and visit that person at 8 a.m. By 11 a.m. the carer has to be with another person somewhere else. By 2 p.m. the carer has to be with another person. By 5 p.m. the carer has to be with another person and by 9 p.m. the carer might be back with the person he or she visited first that morning.

Carers may travel more than 100 miles, or sometimes 200 miles, in a day depending on the profile of the people they look after. It is not sustainable for those people to be asked to continue to do that work at the rate they are being paid for mileage. It is abysmal. They just about got by when diesel and petrol was somewhere between €1 and €1.12 or €1.13 per litre. It is now €2.13 per litre. These are people on very low incomes in the first instance. They provide a phenomenally valuable service. Without them many more people would be in the care of State, putting a further burden and pressure on the acute services, further lengthening the wait time in places like University Hospital Limerick, UHL.We saw from the HIQA report the appalling display of service available to patients. If we do not intervene at the home care assistant level, the problem is going to get worse. As the price of fuel continues to spiral out of control, and we accept that is outside of our control, these people will not be able to keep their cars on the road and continue to travel and do the great work they are doing. I am appealing to the Minister of State to look at every line item in the budget of his Department and try to find an appropriate amount of money to make it possible for these people to do their work. Their low wages can be dealt with through the normal labour relations mechanism. I have argued about this before and will again. However, there needs to be an urgent intervention putting in place a few extra cent to make it possible for them to do their phenomenal work.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Dooley for raising this issue which is raising its head all over the country. I have seen it in my constituency as well. As part of the broader Sláintecare reform of our health and social care system, the Government is committed to reorientating the model of care towards primary and community care. In furtherance of this objective, in budget 2021 my colleague, the Minister of State, Deputy Butler, secured additional funding of €150 million for home support. This is supporting the development of a statutory home support scheme as well as the delivery of 5 million additional hours of home support. The funding secured in budget 2021 to provide the additional 5 million hours has been maintained for 2022 and preliminary data indicate that at the end of April 2022, some 6,902,191 home support hours had been delivered nationally to 54,949 people.

Against this background, the Minister of State is aware that some home support providers require their front-line employees to pay for the travel costs they incur in the course of their duties, and I thank Senator Dooley for raising the matter. While the HSE pays for the travel expenses incurred by healthcare support assistants whom they employ to provide home support, providers in the voluntary and private sectors do not always do so, nor is there any obligation for them to do so when contracted to provide services on behalf of the State by the HSE.

This is one of many issues currently being explored by the cross-departmental strategic workforce advisory group. The Minister of State, Deputy Butler, established this group in March 2022 following a call for submissions from relevant stakeholders such as the Senator. The remit of the group is to identify and formulate recommendations to address strategic workforce challenges in the home support and nursing home sectors. Accordingly, the group is examining issues such as recruitment, retention, training, career development and pay and conditions of front-line carers in these sectors so that solutions can be found.

The group's deliberations will be informed by an evidence review of the role, function and supply of home support workers in four European countries, which has been commissioned by the Department of Health from the Health Research Board and which will provide insight into home support workers' employment conditions internationally. Stakeholder engagement is also central to the work of the group. As part of a structured programme of consultative engagements with key sectoral stakeholders, a facilitated workshop was held on 23 May. The group continues to liaise with these stakeholders to further explore the issues arising and will submit a report for my consideration by September 2022. The report will outline the group's findings and recommendations as well as an action plan for the recommendations' implementation.

Concurrently, the Department of Health is preparing a general scheme and heads of Bill to establish a licensing framework for professional home support providers. Secondary legislation setting out the minimum standards with which providers must comply in order to be licensed and HIQA national quality standards is also being developed. This will provide a robust regulatory framework for a sector which is at present unregulated, clarifying home support workers' rights and responsibilities. A public consultation on the draft minimum standards is under way and will close on 28 July 2022.

I think the Senator is looking for a stipend, effectively, for these great workers who are providing an incredible service. I would think the sooner we can come up with some solution, the better. Across the country we are all facing this. It is an issue we need to address as quickly as possible. It is not just a service these staff are providing but they are also saving a lot of extra hours in hospitals, nursing homes and so on. I would like to get this raised. I do not think Covid has helped. A lot of people have looked for other opportunities. We need to make sure this very important work is enhanced and continued.

Photo of Timmy DooleyTimmy Dooley (Fianna Fail)
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I welcome the Minister of State's response. While I know what the Department is trying to do, I am concerned that the issue will be lost in reports and more bureaucracy. The State has outsourced this service and does so with other services through section 38 and section 39 agreements. Clarecare in County Clare is an example. It was never given back the funding that was cut. There were plenty of carefully worded responses from Ministers at the time stating it was a matter for the voluntary body to figure out how it paid people and what they did and did not do. The truth is that when the cut came and the Department cut HSE staff, the cuts were imposed on the private sector operators as well but the money was never properly returned to the level it should have been. That is a separate issue I hope can be addressed in due course through ongoing dialogue and debate.

The issue I am raising now is the cost of travel, which has been exacerbated dramatically by the increase in the cost of fuel. It has doubled in cost. It is obvious that we do not have people to fill these positions. They are not prepared and cannot afford to do it. Immediate intervention is needed. Otherwise there will be more people on trolleys in accident and emergency departments because we will not have the bed capacity to address demand.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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Workforce challenges in the social care sector are international challenges that Ireland has in common with other jurisdictions. For example, in March 2022 the Scottish Government published a national workforce strategy for health and social care to address the challenges they face in Scotland. This Government is committed to addressing the strategic workforce challenges that exist in the home support sector in Ireland.

It should be noted that, notwithstanding these challenges, progress is being made in increasing home support provision. Overall service delivery has increased by approximately 17% year on year and the total number of people waiting for home support has fallen from over 9,000 at the start of 2020 to 5,068 by the end of May 2022. In providing clarity on the roles of service providers, home support workers, service users and family carers, the regulation of the home support sector will ensure the quality of home support services and safeguard service users. The work of the strategic workforce advisory group is progressing and the Minister of State, Deputy Butler, is confident the recommendations of the group will be effective in addressing the workforce challenges that we face in the home support and nursing home sectors.

Senator Dooley has raised the possibility of some stipend - I will not say a magic bullet - to address the increased cost of fuel. This is happening in all sectors. It is an emerging issue and we need to tackle it.