Tom Clonan (Independent)
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I thank the Minister of State, Deputy Butler, for attending. Given the date that is in it, I hope it will not be a case of there being no love lost between us at the end of the proceedings. I hope to enter this interaction with a solutions-based focus. The reason I am raising this Commencement matter is the problem in recruiting and retaining personal assistants, which I am sure has been brought to the Minister of State's attention. Personal assistants help disabled citizens and the elderly, as part of a home care package, to get them out of bed and live independently and with dignity. Based on my family's experience, there seems to have been a kind of collapse in these services from around 2021. The traditional providers, such as RehabCare and Home Instead, which I mention in a general sense as providers under the existing model, are unable to recruit people. I am conscious that Minister of State, Deputy Rabbitte, the Minister of State, Deputy Butler, and the Minister for Health have made millions of extra hours available, but the problem is that we cannot get the carers and personal assistants where needed, in people's homes.

Let me outline one of the solutions. The big corporate agencies, including RehabCare, do a great job but there is a one-size-fits-all model predicated on funding going directly to them from the HSE. Ideologically and philosophically within the Department, there is an agreement that we should move towards personalised budgets for families and carers so we can manage our care needs ourselves and do so flexibly. There are several service providers – for example, Home Care Direct and Áiseanna Tacaíochta, the ÁT Newwork – that act as a kind of link between families and carers, and a selection of personal assistants are available to them. On average, the agencies receive between €30 and €35 per hour in funding from the HSE for the carers. Typically, the carers who work for the big traditional providers get paid about €11 or €12 per hour, and that is why it is hard to recruit and retain them.That amount is barely above the minimum wage. However, the brokerages can pay carers up to €21 or €22 per hour, making them a more attractive proposition. In our house, for example, Eoghan's personal assistance hours for going to college are provided through Home Care Direct. We have no problem getting personal assistants - they are the most amazing people from South Africa and Romania – whereas his home care package, for want of a better expression, is provided through the traditional route and is failing. We have people who have become part of our extended family from Somalia, Nigeria, the Philippines, Korea and China. Without exception, these carers are wonderful people. They are not the problem. The problem is the model of provision. The Minister of State can revert to me if she needs further detail on this matter.

What is missing is a service-level agreement, SLA, between the HSE and brokerages like the Áiseanna Tacaíochta, AT, Network and Home Care Direct. The HSE national change and innovation unit and its national compliance unit have been working on this matter, but they have been doing so for over a year. They could come up with an SLA within weeks that would go a long way towards solving this problem and would have an immediate impact on people like my son and on those who are forced to remain in hospital after surgical procedures instead of returning home to live with their packages. There would be no cost involved. It is just a question of trying to get the HSE to draw up an SLA.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Clonan for raising this matter. It is my first time taking one of his Commencement matters. I am delighted to do so. We will meet again at 5 p.m. to discuss the Shona Project, so we will speak twice in one day.

The HSE provides a range of assisted living services, including personal assistance, to support individuals in maximising their capacity to live full and independent lives. The HSE National Service Plan 2022 outlined the HSE's commitment to deliver 1.7 million hours of personal assistance services to 2,587 people. This reflected an additional 120,000 hours of personal assistance services in 2022 to expand and enhance supports for people to live self-directed lives in their own communities. The most up-to-date statistics on the delivery of personal assistance shows that service remained steady during quarter 3 of 2022 and was above target by 4.4%. However, the Senator is correct, in that there are ongoing challenges in recruiting staff for disability services and the delivery of personal assistance services. These challenges are being experienced across a range of disciplines and grades in all areas of the health services, including primary care, mental health services, older person services and acute hospitals.

I wish to outline what I did last year with the provision of home care, specifically for older people but also for people with disabilities, mental health issues, etc. I was in an unenviable position as Minister of State, in that, despite having a full budget to provide all the hours we needed - €660 million - last year and an increase to €700 million this year, we had a shortage of staff. Some 56,000 people will receive home care today. Unfortunately, 3,200 people are waiting for home care. It has been funded but we do not have the staff to deliver it. Some 2,900 people have partial as opposed to full care packages.

I put in place a strategic workforce advisory group. It worked with my departmental officials. We engaged with all Departments and stakeholders across the public, private and voluntary sectors. There were 16 recommendations, all of which I took on board. I will set out some of the key ones.

A key recommendation was that we look outside the EU and secure work permits in that regard. On 1 January, 1,000 work permits went live for people living outside the EU to work in Ireland as healthcare workers providing home care. We know this approach works because we took it previously in respect of nursing homes. To date, 2,640 people from outside the EU have come to Ireland on permits to work in the nursing home sector.

Another recommendation relates to a point raised by the Senator. The HSE pays a rate of between €30 and €35 per hour to organisations that supply personal assistance hours, yet the worker only gets €11 or €12. The same situation obtains in home care for older people. One of the key recommendations was that, under the new tender being put in place with the HSE from 1 April to provide home care hours, the person providing the hours through a private company would have to be paid the living wage.That is the recommendation.

Martin Conway (Fine Gael)
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The time is up.

Mary Butler (Waterford, Fianna Fail)
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There is a half-minute left.

Martin Conway (Fine Gael)
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Apologies. I was premature.

Mary Butler (Waterford, Fianna Fail)
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They would have to be paid the living wage. They would have to be provided with mileage which the HSE workers get. Notwithstanding that issue, HSE healthcare workers are paid €16.50 an hour and mileage and still it struggles to recruit. We have rolling recruitment campaigns across the nine CHOs at the moment to try to encourage more people to become healthcare workers. I want to make caring a viable career option. I will send on a copy of the strategic workforce advisory group recommendations. They have been welcomed by all. The most important thing now is that they are implement. The biggest one related to permits. They went live on 1 January this year.

In regard to the Senator's specific case, there was a joint in-person workshop entitled Service Continuity and Capacity Recruitment and Retention between the HSE and representatives from the voluntary service provider organisations. The majority of specialised disability provision is delivered through non-statutory sector service providers. We know very well from lived experience how difficult it is to encourage people at the moment to see caring as a viable career option.

Martin Conway (Fine Gael)
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I apologise for interrupting the Minister of State's flow.

Tom Clonan (Independent)
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I thank the Minister of State for that. What she said about the permits is interesting because when my son's service collapsed in 2021 I tried to get a sense from the different care providers about what the issue was. Initially they thought it might have been Covid-related, which might have had a chilling effect. However that is definitely a positive development. That will help. To reiterate, the model offered by such groups as Home Care Direct is actually working. I know because we had no problem recruiting my son's carers. It is very flexible. The carers are very happy. They are all Garda vetted and qualified. That is provided through the Higher Education Authority but the HSE will not deal with them because there is no service level agreement. All that is required is for them to draw up the service level agreement and then this can be part of that landscape. It will have an immediate, positive effect. There is no cost implication for the Department. This is about trying get the HSE to draw up the service level agreement. If I can assist in any way in regard to introducing someone from the HSE I will. The HSE knows the key stakeholders. It is a matter of exerting some moral pressure in order to get this over the line. I appreciate the Minister of State's comments.

Mary Butler (Waterford, Fianna Fail)
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I thank Senator Clonan for the way he expressed himself today. We are putting a new tender in place at the moment. It was meant to be in place on 1 January but has now gone out to 1 April. One of the things we are doing, because this was not available for the care of older people previously, is looking at personalised budgets for the first time ever, within the tender. We are also looking at some e-technology supports especially for people with dementia. This is another thing we are exploring. We are trying to think outside the box. Another recommendation of the strategic workforce advisory group was to engage with the Minister for Social Protection, Deputy Humphreys. Many people who once worked in home care may be willing to go back to it. However, that might mean they would lose their entitlement to a medical card or social protection. We are trying to see if we can encourage people who worked previously to come back and do more.

In regard to the Senator's specific point about the service level agreement between the HSE and the provider who can be hired, I will certainly raise that with the Minister of State, Deputy Rabbitte. It has been raised before. It has been looked at previously. I found that by putting in place the strategic workforce advisory group we set out clear timelines which we reached. Now it is about ensuring that all the asks are not aspirational but that they are put into use. I am hopeful that if 600 or 700 people come in on permits it would almost clear the waiting list. For once it is not an issue in regard to funding. It is an issue relating to staff. I will have a copy of that report for Members this evening.

Martin Conway (Fine Gael)
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I thank the Minister of State. Senator Clonan raised an important issue. The response was positive and we appreciate that.