I have ten minutes, and I am sharing time with two of my colleagues. I welcome the opportunity to contribute. We will support the Bill on Second Stage because the private homes support sector must be regulated, and families deserve basic assurances of safety standards and accountability. However, supporting a Bill is the not the same, as I am sure the Minister of State will agree, as applauding the Government's record, which I wish to turn to. This legislation is necessary, but it is also a stark admission of how little has been delivered and how low the Government's ambition has fallen. The Bill's purpose is to amend the Health Act to create a statutory regulatory framework for registration, minimum standards, inspection, enforcement and data collection for home support providers. It brings the framework for home support providers into line with the model used for designated centres, HIQA standards and an expanded role for the chief inspector, all of which I agree with. It provides for a public register of providers, including key details and conditions of registration, a prohibition on operating without registration with offences and penalties, inspection and enforcement powers, including compliance notices and court applications where serious risk is identified, data collection and publication in aggregate forum ensuring that we can finally see what is happening in the sector. In plain language, this is about regulating providers, but it is not about delivering entitlements for patients. Not only is there a commitment to a statutory home care scheme in the programme for Government, but it was included in the previous programme for Government, . This was to operate on a similar basis to the fair deal scheme. We still have no details of how that will work. We still have no details of who will be entitled to it or who qualify, what equity issues will be in play and when this will see the light of day. I suspect that we have not seen a statutory home care scheme in place or any movement on this issue because we do not have the capacity to deliver it. The Government should be straight and upfront with people. We know and all deal every day in our constituency offices with families who are waiting for home care or intensive home care packages. Some families and some people get them. Some get partial hours, which is not all the hours that they need. Others do not get any at all and are stuck on waiting lists. Two of my colleagues in Donegal, Deputies Doherty and Mac Lochlainn, have alerted me to serious problems in the county in accessing intensive home care packages. There is a long waiting list. We have patients and families who need urgent support at home, and they cannot get it. I suspect that is what happening here. Statutory home care is a game-changer. It means that there will be a statutory right or a statutory obligation for a person to have access to home care. That will place more of a burden and obligation on the State to provide that care. The Government, HSE and Department are not equipped to deliver it. It reminds me a bit of the Disability Act 2005 where the Government of the day decided rightly that we would confer a legal right for a child to access an assessment of need and that that assessment of would look at the health and education needs of each child. On the basis of the aggregate assessment of need carried out, the Department would then be able to plan and provide the appropriate resources, including speech and language therapists, occupational therapists, psychologists and so on. That never happened. Of course, what has happened is that people are waiting, waiting and waiting. Parents are taking the State to court. I have a concern that is what is holding back the Government on this. It is saying, "Hang on a second here", or maybe it is coming from the Department saying, "Let us be very careful about statutory schemes because that places an obligation on the State." However, the reality is that this is badly needed for many families. Everybody has the right to the best available care. A long time ago - well before Sláintecare - it was an accepted principle in the health care system that if it is appropriate for a person to be cared for at home that is where they should be. We have far too many people in hospital who should be at home, but they cannot be discharged from hospital because the home care supports are not available. I deal with this all the time as the health spokesperson for my party. I get queries in from all over the State relating to people who are in hospital and want to be discharged to their homes. Their families want them at home. It is the best place for them. They can care for them to a level, but they need additional supports to discharge them. They have additional needs, and they cannot get the supports. They are pleading with the hospital and community services. Sometimes there is not joined -p thinking between all those services but for the most part, the capacity is not there and the person cannot be discharged. If a person cannot get care at home, he or she ends up in hospital. There are major advances in health care. I am a member of the Joint Committee on Health, as is the Cathaoirleach Gníomhach. We are learning all the time of the advances in technology. For example, we hear about virtual beds, the principle of which is great. A person could be cared for and monitored, including their blood pressure, from home. Huge advances have been made where a person does not necessarily have to be in hospital to get certain care. Some people do, but there are categories of patients who can be cared for at home. The problem is that we cannot realise that potential because we do not have the capacity. What happens is that it is a postcode lottery, patients go on a waiting list, and they may or may not get the home care supports that they need. That is not what should be in place. That is not where we need to be. I have seen it far too often in healthcare, particularly under the previous Minister for Health and indeed, the current Government as well. Big promises are made that we are going to do all these wonderful things with Sláintecare being the biggest one. It was the big vision for healthcare, but then we do not see the practical delivery of it. We have seen it in so many areas of healthcare. Beds that were promised were not delivered. Staff that were promised were not delivered. Pharmacy agreements that were promised were not delivered. The Government made these big announcements and then left people high and dry. That is what was done with the statutory home care scheme. What is really frustrating is that despite two programmes for Government that promised a statutory home care scheme, and all of the years that have gone by, the best the Government has done is to say it will regulate the area, have a registry and make sure service providers are registered. That is great but it should have been done years ago. That it is taken so long for even this Bill to be brought forward, given the commitments we were given, is staggering. I imagine that most people probably thought this was already in place. That is something that is really basic. Of course all home care support services should be registered, of course they should be subject to regulation, and of course HIQA has to have the powers to look at these areas. For most people this is a no-brainer and they would have expected it to have been in place. The fact we are only dealing with this now is problematic, and we still do not have the statutory home care scheme, as I said. I ask the Minister of State to examine the difficulties in the north west. It is an issue that an Teachta Doherty in particular has raised with me. I have spoken to the head of the HSE on this and he has acknowledged that there is an issue, which is a staffing issue. I want to make a point on something I am concerned about generally in healthcare. When we are speaking about home care we have to accept that because of decades of a lack of investment in public home care, the vast majority of providers are now private. We have also seen this with nursing homes. At one point a majority of nursing homes were public but they are now private. The majority of home care is now being provided by private providers. I am not casting aspersions on the private providers, and the staff and the people do a good job, but we need to build up public capacity and we need to make sure we are getting value for money and bang for buck. We are paying premiums to private providers to provide services that should be provided through the public system, given that we have all signed up to the principle of a universal healthcare system, public healthcare and Sláintecare. This is what we have all signed up to but what I see is more and more privatisation and systems dependent on the private sector. We see it with dentistry. We have more private dentists than public dentists. We have more private nursing homes than public nursing homes. We have more private home care providers than we have public providers. This is wrong and we need to rebalance the scales. We need to invest in the public service. We are not going to be able to roll out a statutory home care scheme unless we have public infrastructure. I imagine there is even push-back against this from some of the private providers. The role of the State and the role of the Government is to make sure we can deliver on this. It is the job of the Minister of State and the Government to deliver on the promises made in this area. I do not believe the Government will be able to do it unless it builds public capacity. It has not built up public capacity which is why year after year it comes with Bills like this as opposed to a statutory home care scheme. It is simply not equipped or in a position to deliver it.

Sentiment score: 0.22