I very much welcome this Bill. It is long overdue, as we badly need to have a statutory regulatory framework for home care support in this country. There is a glaring need to have minimum standards and a licensing regime for providers. Others have referenced the scandal we saw within the nursing home sector last year and in many previous years. We do not really have any idea of the quality and standard of the much-needed care that is taking place within peoples' homes. This Bill will, for the first time, allow for licensing inspection and enforcement of minimum standards. It is important to say that how the ministerial regulations will be set will be critical to the success or otherwise of this legislation. I am particularly mindful of the timeliness of this now, given that the approximately 28 million home care hours provided across the State in 2022 will almost double in about 18 years by 2040. The reliance on home care support packages across the State with an ageing population means getting this legislation right is going to be critical. Before I talk about my concerns about the Bill and indeed about what is not in it, I am conscious that 100 staff in Coolock from Northside Home Care Services are currently on strike because of their failure to be recognised within the section 39, section 56 and section 10 pay deal that was agreed 18 months ago. It is wrong that they have been excluded. We should decide whether they are part of our health service. The reality we have known for some time is that when we try to get services on the cheap, we end up in very serious and dangerous territory in healthcare. We need to make sure that these workers who are going in and out of people's homes day in, day out are afforded the dignity and respect of proper pay. SIPTU has also balloted for industrial action with a 95% vote across counties Donegal, Clare, Cork, Kerry and other counties because of long-standing failures to meet proper working conditions in the sector in those particular organisations. Regarding the Bill itself, today we are talking about a statutory regulatory framework for providers. A critical part of the jigsaw is the statutory right to be cared for within one's home. As we all know, there is a statutory right to access public hospitals in this country, but there is nothing regarding care within our homes. That has to be a critical part of ensuring people get the care, dignity and service they are entitled to and deserve within their home in future years if the Government is serious about moving care out of our acute hospital system and into the community. I also have a concern about what I see as the growing marketisation of the home care sector. For a long period of time it was very much based on the co-operative model. It was based on voluntary providers and community-based providers providing home care assistance within communities. That is now slowly changing, and we are seeing corporate entities come into the market and it is not so different from the nursing home sector in terms of their ability to swallow up smaller operations. In terms of some of the requirements set down in this Bill, there is a very real question for the Government regarding what kind of model of home care support it wants. Does the Government want it to be driven and delivered by large corporate entities, or does it still want to accommodate that community-based model? That is a question I would like the Minister of State to answer today because failings in how the Government has responded over many years with regard to the nursing home sector paved the way for the mess that happened last year. I know there are some changes now within HIQA with regard to having to declare the ultimate beneficiary. That is important but it is not enough because we have to be mindful of who is ultimately going to be controlling the market or the sector for home care. Another key thing is the financial support to be made available to HIQA, not just to administer the licensing but also in terms of the inspections regime. There are also the exemptions within this Bill, particularly with regard to personal assistance and those other carve-outs which are very concerning. We know there are about 200 home care support providers in Ireland with up to 29,000 staff. I do not want to see in five years that 200 figure go down to 50 or below, but it could because of the administrative requirements envisaged within this Bill. The key question, which is outside this Bill but is very much for the Minister of State in terms of deciding the budget, is whether sufficient funding will be allowed for in the tendering process for this additional administrative requirement? If there is, the Government can ensure the survival and, indeed, the thriving of the many home care support providers at the moment. If there is not, we know the direction of travel and we are going to see a much smaller number of very big entities. We also know that the 29,000 people who are providing home care support at the moment are not enough. There are massive shortages in certain parts of this country, including Cork, Kerry and parts of Limerick. Some 900 people are waiting for home care support in Cork and Kerry alone. Some 4,945 people are on a waiting list, as of June of last year. That is a huge amount of unmet need. The cost of keeping people at home is relatively low compared with the alternative, which is that if they do not get support and care, they end up in a nursing home or they are readmitted to hospital. We must do much more to ensure we attract people into these roles, and that comes down to pay and conditions. I spoke about the strike that is happening at the moment, and the ballot for industrial dispute. It also comes down to the hours that are worked and making sure that people get proper transport and other allowances. It is also about reaching out to the many people, in particular women, who are outside of the labour force. We often talk about the unemployment rate in Ireland being about 4% or 5%, but the potential labour supply in this country is of the order of 16% to 18%. I refer to people who would like to work but cannot do so because of structural circumstances in their lives, whether it is a lack of childcare, a lack of transport or because they are caring for an elderly parent or relative. There are people who would like to work and we must figure out a way to bring such people in particular into a sector like this. For example, they could work part time or full time. We need to tap in to the untapped resource that exists. I am concerned about how much in this Bill we are not hard-wiring into primary legislation but instead delegating to ministerial regulation. I refer in particular to the consent piece and the access piece into people's homes. It is important to work out the detail on that. That is something that should be debated here on the floor of the Dáil and the Seanad, as opposed to confining it to ministerial regulation. The second key issue relates to the qualifications of home care providers. Very serious questions were raised during pre-legislative scrutiny of this Bill on the desired minimum training and education, but the Bill does not provide any clarity on this. It would be worthwhile to hardwire this into the legislation. There is always a danger of there being a loophole with the exclusions. I understand why exclusions are put in place; we do not want to completely strangle or muffle a system. However, the reality is that if a provider has four clients or fewer, they should be regulated as well.

Sentiment score: 0.18

I apologise. We all understand if there is an informal arrangement in place for looking after a relative or a neighbour, where it is only one person, but it is a business if a person is looking after three or fewer clients. I do not want us to be in a place in a number of years time where we are talking about the disaster of not regulating these entities. We are talking about people's lives. We are talking about people in a very vulnerable situation. In some situations they may not have very strong family support or they may have no family support around them at all. Who are we trying to safeguard here? We are trying to safeguard the person being cared for in their home and indeed the worker as well. That is critically important. To be frank, some of the workers involved last year were thrown under a bus. They were scapegoated and blamed for what took place in the nursing homes when, arguably, management and the owners got off scot-free. I have serious concerns about the exemptions. The other key concern is the classification or designation as a personal assistance service. There is a fine line between the two. I am worried that we would see organisations trying to classify themselves in that space and then being exempt from this legislation. At the end of the day we want to prevent abuse and exploitation of the person who is being cared for, and we also want to look after the worker who is providing that service. On the market and the cost of regulation, I spoke about the larger for-profit organisations that are effectively buying up voluntary and community-based organisations at the moment. There must be provision for the administrative burden in the funding provided to these organisations, through the tendering process. My last point relates to HIQA. In 2024, HIQA estimated that it would cost €1.1 million per annum to introduce licensing. In the first instance, we must get a commitment from the Minister of State, Deputy O'Donnell, that the comprehensive costs of licensing will be covered by the Department. I am sure it is much more than €1.1 million now. I have had serious concerns about the HIQA inspection regime, in particular with regard to nursing homes. We articulated that last year. We accept there has been an increase in the number of inspections and that is to be welcomed, but as I articulated earlier, there are concerns about how HIQA is going to enforce the licensing and how it is going to inspect and access people's homes. Ultimately, if licensing is not going to be a superficial act of these Houses of the Oireachtas, and if it is to mean something, we need to have a clear sense of what the enforcement framework is going to look like. In regard to nursing home registration, HIQA had to go to the District Court to seek the cancellation of a licence. I believe we need to do something stronger here. HIQA needs to be invested with greater powers to cancel the licence of a provider if wrongdoing is found. A much clearer message must be sent to the public that much swifter and more comprehensive action will be taken by HIQA if there are concerns. Right now, there is a belief among the public that we do not have an enforcement regime that will speedily respond when there are concerns and that too much time is taken. The reality is that abuses may continue to take place in the time it takes to make an application to the District Court. We must take more immediate action. We very much welcome this Bill. We want to see it move at a timely pace through this House and on to the Seanad. We need to see a substantial beefing up of the substance and content of the Bill for us to have the confidence that we will have a comprehensive and rigorous licensing, inspection and enforcement regime for home care support in this country.

Sentiment score: 0.11