The debate around this is very important. I generally welcome the Bill, which is important. Safeguards for users and providers are important. That it covers the care of both the elderly and those with disabilities is the crux of this. However, there are issues around provision and standards that we need to keep an eye on as well as the availability of home help hours and home care hours. We have censuses and we have them for a reason. They allow the State to plan for what is coming down the tracks. Everyone knows that we have an increasing age profile in our population. By 2030, we will have over a million people over the age of 66. County Laois is estimated to have between 13,000 and 14,000 people over that age. According to the 2022 census, 11,978 people were over that age. That is four years ago. We know that the population overall of the county has increased and certainly the population of the elderly in the county has increased. Rural isolation is a problem in Laois and we have big rural areas across the Slieve Bloom Mountains and Slievemargy to the east and west and to the south of the county down to Ballaghmore and places like that, back across to Erril. Loneliness and isolation are damaging both mental health and physical health. I have dealt with a number of cases where there is a shortage of home care hours. People are what is called waitlisted and they will get word that they are entitled to hours and the HSE is granting hours but it is not in a position to provide them. I have to say this to the Minister of State because his party has been in power for 15 years. The emphasis has been on private nursing home care but, in general, people want to be at home. Nursing homes should be last resort and only if they really want that and if the level of care required requires them to be in a residence. Private nursing homes have been the number one Government option and they have mushroomed. We have seen the scandals in County Laois, in The Residence for example, not too far from my own house. We have seen the Drumneen situation and that is an unfolding story. We have seen difficulties in Kilminchy Lodge. Some private nursing homes have been good and Ballard Lodge was one but, unfortunately, it has been closed due to HIQA. This was one that had good reports and good satisfaction from residents and families was being reported. We need to enable people to continue to live independently and to do that there are a few basic requirements. Homes being adapted to meet people's needs is obviously important. I want to pay tribute to the housing section of Laois County Council. In my experience, any money that is granted is matched by the council in terms of alterations for stair lifts and extensions and making a house wheelchair accessible. That is really important. The provision of day care centres is important. It is important that people go somewhere one or two days a week to have a meal with other people and meet their contemporaries and have a social event, etc. The meals on wheels service is really important. That is the other part of it but the most important element is the home helps. They are the four legs of the stool and if one is taken away it will keel over. That is the best way of saying it. We also recognise the right of the people to have a level of care in their own home and to continue living there. All of these provisions are far less expensive than nursing homes or acute hospitals and the preferred option of the majority. I want to highlight that I deal with cases where people are being discharged from hospital, but the home care package is not in place. I have had to intervene and I recall one case where an elderly woman was being sent home on a Friday evening and there was absolutely nothing where she was going home to. The ambulance was on its way with her and was subsequently turned around and brought back. She would not have survived over the weekend without the appropriate care. She did not have what she needed in her own home at that stage. There needs to be proper joined-up thinking between the hospitals and the home care services and that needs to be sorted out. We need to be sure that we have the home care package that the person needs when he or she goes home. I also want to address the issue of the stopwatch approach where 15 minutes is given for this and 15 minutes for that and the person has half an hour. We have home helps racing around in rural areas. Laois is a sizeable rural county and I have outlined some of the extensive rural areas in the county. If people are racing from one place to another, they are not able to provide adequate care. There is not time to carry out the tasks. There needs to be flexibility to allow the home care workers, as they are now being called, to provide that level of care. Very little can be done in half an hour. We all know that sometimes in our office we can get very little done in half an hour. It could take an hour or an hour and a half to deal with one issue. The same applies for a home help going to look after an elderly person. We need to be mindful of that. Another issue I want to address is the quality of the employment. There is a labour shortage in the sector, but we still have a lot of people who are not employed or under-employed. I find it very frustrating that some of them are not trained to provide the level of care. I know from my time on the Committee of Public Accounts that HSE employees are cheaper in the long run and in the short run than staff provided by private companies. Private companies providing care and they are doing a good job but less than 40% of care now being provided directly by the HSE and that needs to be looked at and that needs to change. Those directly employed by the HSE have better terms and conditions and we need to make sure that they are upheld. The quality of jobs in the sector is really important. It is important that all people have a proper living wage whether they are employed by the private sector or public sector. Travel times and travel costs in rural areas need to be looked after because a home care worker might be visiting seven or eight people in a day. It is also important that we have trained and vetted staff, because the safety and well-being of the service user has to be paramount. There is a need for clarity regarding how home care will be funded. There is a Bill coming and we need to make sure that this can be paid for and that the people who need it, regardless of whether they can pay for it, should not be prevented from getting home care. On the Bill itself, the overall provisions relate to registration, which is a positive move for the HSE, voluntary and private providers and a chief inspector of social services. In England the social services departments are very local. They are based in the local council areas, which is very interesting. They organise home helps and home care and they have huge powers. We do not have that here. The State will have to examiner whether the big HSE model is the best one for doing it. Does that need to be separated out? I do not know. I do not want to create another quango. I am not going to tell the Minister of State to do that. I am all for reducing. A lot of these bodies are needed and I am not going to get into the populist argument about doing away with quangos. However, the question of who provides this needs to be examined. The regulation of providers and the minimum requirements and standards are really important. The Bill has provisions for the inspections of businesses and homes, including private homes. That needs to be very sensitively handled, as do the interviews with service users and home helps plus the families. That could get into a really tricky area. Without running away with ourselves, I think we can see that would need to be handled in a very careful way because you could get bogged down very easily in that, but, obviously, it is important that there are interviews with the service users. I urge caution on the exemption for the providers with four or less clients. I will not come down on it completely-----

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-----but it is an area that may need to be looked at. I know what the Government is trying to do. It does not have to do away with the informal pieces that are there. I think Deputy Charles Ward is okay with my taking another minute or two. As regards the informal care and what the Government is trying to cater for there, I do not want to kill that off altogether, but it may need to be examined. I am not totally sure about that. It makes sense to have informal arrangements. Overall, I welcome the Bill. The Minister of State has heard what I said about the labour shortage. That is directly related to the quality of the jobs. The HSE is the cheapest way. That has been proven. If the Minister of State looks at the figures, he will see it. The last I saw, I think the private providers were €34 an hour or thereabouts. That is two years ago now. What is important here is that we increase the number of people in this. Surely within that 5% who are unemployed at the moment we can find some people who can be trained up to provide care in their local communities. We need to be able to keep this local. A few people driving across the county, from Ballylinan over to Camross or somewhere like that, will not work. We need to be able to keep it within local areas. It does not work otherwise for the home helps. I hope the Minister of State will look at that area.

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