On behalf of the Social Democrats, I welcome this Bill to finally regulate home care services. The Social Democrats have long advocated for a statutory right to home care and this regulatory framework is an important element of that. As it stands, home care services remain unregulated, despite the vast majority of home care hours being funded by the HSE. While State-provided and State-funded home care is subject to HSE standards and policies, that is no replacement for statutory independent oversight. Unlike the nursing home sector, HIQA has no role in regulating services. For instance, it does not set standards, monitor compliance or register providers. This regulatory vacuum has prevailed for far too long despite the potential risk to service users. In reality, there is no barrier whatsoever to entering the home care sector. If a provider is not receiving State funding, there is no obligation for them to comply with HSE standards and policies. Given that millions of hours of home care are privately funded each year, that should be a cause for real concern. This Bill to regulate services is therefore long overdue, as is a statutory right to home care. We can all accept that residential care is rarely anyone's first choice. Most older people prefer to stay in their homes and the State should support that. Remaining in the home can allow people to retain their independence. It is associated with better health outcomes and is much more cost-effective than residential care. More importantly, every person deserves a meaningful choice in how and where they live. Home care provides that choice. It provides the respect and dignity that we all aspire to towards our older years. The current model of long-term care in Ireland, with its over-reliance on nursing homes, denies too many people any real say in where they live. In 2023, Sage Advocacy published a report on long-term care in Ireland from a human rights perspective. One of the key issues identified by Sage was the infringement of people's right to liberty. Why? It is because there are insufficient long-term care services in the community that would enable and support people to remain in their own homes. I would like to take a moment to commend Sage Advocacy on the incredible work it does in this space. This is not just theoretical. The lack of home care services in some parts of the country means that nursing home residents are not prioritised for home care. That further compromises their liberty, as they have to remain in a nursing home setting against their wishes. Sage found that many of these residents would require relatively little assistance to live in their communities but the support simply is not there. The easiest option, and often the only one seriously pursued, is therefore for them to remain in a nursing home. Without the necessary services in the community, nursing home care is presented as a fait accompli. When it comes to waiting lists, at any one time thousands of people are on a home care waiting list. They have been assessed and approved for home care but no carer is available. At the end of September, 5,392 people were waiting for home care, up from 4,805 at the beginning of 2025. In the waiting lists there are significant regional disparities, with particular black spots, as we have heard, in Donegal, Mayo and rural parts of Cork. The worst performing integrated healthcare area, IHA, is Cork South Lee. It consistently has the highest waiting list in the country and accounts for over 40% of the entire south-west region home care waiting list. Although this is not captured in the data provided to TDs by the HSE, we know that some older people are waiting over a year for home care services. With this level of unmet need, it is particularly galling that there is no action plan to tackle home care waiting lists. It is all well and good to pontificate about the importance of home care and moving away from the State's over-reliance on residential care but what is this Government actually doing to make that a reality? Demand is not going to taper off, it is only going to rise. A 2025 ESRI report found that between 2022 and 2040, annual home care hours would need to increase from 28.7 million to between 44.9 million and 54.9 million. At the higher-pressure end of that projection, that is a 91% increase. I acknowledge that the number of hours provided by the HSE in 2025 exceeded expected activity by 1.46 million hours but that has not had a substantial impact on waiting lists. The target of 24 million home care hours for 2025 was too low to begin with. The 2026 target also lacks ambition at 26.7 million hours. We also know from ESRI estimates that over 7.6 million home support hours were privately purchased in 2022, accounting for 26% of all home support hours provided that year. Clearly, there is a huge level of unmet need in this country. In the absence of a statutory entitlement, large numbers of people will continue to pay out of pocket for expensive private home care. From my observations of constituents who have come to me with these issues, it is often at the end of a conversation, when we are talking about the other pressures in their lives, that they also mention they cannot get the care they need for their father, for example, who is at home and needs support. It is when they come to me with other issues. There is also a massive amount of unseen pressure that is simply not reported by people. A statutory right to home care, despite this Government's stated commitment to introducing a statutory home care scheme, remains undelivered. Delivery of this key Sláintecare reform has been allowed to drift for almost a decade. In 2017, the current Tánaiste and then Minister for Health, Simon Harris, committed to a statutory right to home care. That very same year, the current Minister for foreign affairs and then Minister of State for older people, Helen McEntee, said the statutory scheme and necessary regulations would be delivered in two to three years. In 2019, the Secretary General said that a statutory entitlement was an absolute priority for the Department of Health and was going to be introduced shortly. In 2020, when the statutory scheme was originally earmarked for delivery, the new Minister of State, Deputy Mary Butler, committed to delivering it by 2022. In the years since, the statutory scheme has largely been sidelined. As of last September, the Department was still researching different funding models more than five years after it was supposed to be delivered. The Minister of State may deny it but it is quite clear that the statutory scheme is not a priority. In the latter part of the previous Minister for Health's tenure, he stopped talking about the statutory scheme almost entirely. Any requests for updates were met with stock responses about the importance of progressing regulation. The new Minister has continued to stick to that narrative. I accept that progressing regulation is important but if it was so important to the current Minister and her predecessor, why are we only taking Second Stage of the Bill now in 2026? While regulation is an important step on the road to a statutory scheme, it is a far cry from delivering the radically different model of long-term care that is so desperately needed, which was promised after Covid. The reality is we still only have a statutory scheme for nursing home care and not home care, which is discretionary. In 2026, the system still incentivises residential care, despite the clear preference of many to be cared for at home. Why is this disparity still not addressed? I sincerely hope that the delivering of a statutory right to home care has not been put on pause until the work of the commission on care concludes. That is not to say the work of that commission is not important but we do not need another report to tell us that a statutory scheme is required. We just need a Minister and Government willing to deliver it. On the commission on care, I will make a couple of broader points about our elder care model, which I hope will be addressed by that commission. One of my primary concerns with the current model is the financialisation of services. Increasingly, care is being viewed as a commodity. We see this most aggressively in the nursing home sector, where 80% of beds are privately run. Increasingly, the nursing home sector is being financed by international investors. All the while, smaller community-based nursing homes, which should be supported, are on the verge of extinction. We also see this worrying commodification of services in home care, with just 36% of home care provided directly by the HSE in 2024. This move towards increasingly contracting out public services is often thought to result in efficiencies but the argument does not hold up. This is because most of those supposed efficiencies have costs, as we just heard from one of the Minister of State's colleagues. Those costs tend to be borne by workers, patients and service users. The commission on care should articulate a new vision for elder care, one where the State leads in the provision of publicly-funded integrated care delivered primarily in the community. All of this, of course, is the vision of Sláintecare. This new model should have a deliberate bias towards the home in sharp contrast to the current elder care model. Groups such as Sage Advocacy and ALONE have consistently advocated for alternative care options. Unfortunately, a major deficit in delivery has prevented the realisation of such ageing-at-home policies. I note that the EU care strategy - there was a national action plan for 2023-24 to respond to that strategy - looks at that visionary, end-to-end system of care, where we recognise that across the course of all of our lives, we all receive, and many of us give, care. That is where we need to be at. That is about radical reform, not this piecemeal progress. Returning to the Bill before us, I once again reiterate the Social Democrats' support. It is welcome that the Minister has taken on board concerns related to paediatric home care packages, which my colleague, Deputy Rice, and others raised with her last year. Children were omitted from the draft scheme but the Ombudsman for Children, HIQA and the previous Oireachtas health committee all recommended their inclusion. According to the ombudsman, over 650 children with complex needs are in receipt of paediatric home care packages. Providers of these services should be subjected to the same level of scrutiny as adult home care providers. I welcome that these providers are now captured in the Bill. I do, however, have concerns about other provisions, for example, the exemption from regulation, as we heard, of service providers with three or less clients. The pre-legislative scrutiny report recommended that all State-funded services should be covered by this legislation and the associated regulations but this was not accepted. This exemption presents potential risks for clients in terms of standards of care and protections. Equally, there are very real risks for workers in terms of exploitation and bogus self-employment. In particular, I have concerns about migrant workers who might be more vulnerable to exploitation when it comes to pay and conditions. I do not accept the Department's response that this exemption is needed to ensure the legislation is proportionate. I will raise a couple of points on the subject of workers. The biggest challenge facing the home care sector is the recruitment and retention of staff. In response to this looming crisis, the Minister of State, Deputy Butler, established the strategic workforce advisory group in March 2022. Six months later, that group published a report with 16 recommendations. For a while, there seemed to be momentum behind this group but that has stalled completely. The implementation group has not met or published a quarterly progress report since July 2024. Implementation just stopped without explanation, even though only three of the 16 recommendations had been implemented when the most recent progress report was published. A further three recommendations were paused due to the HSE recruitment freeze that was in place at the time. What of the other ten? At the end of last year, my colleague, Deputy Rice, was told that an updated strategic workforce advisory group report would be published following a survey of home care workers and healthcare assistants. You would have to wonder why this is only happening now. Where is the sense of urgency? While it is regrettable that implementation has been put on ice once again, I hope two issues in particular are finally addressed this time. The first is a real living wage for workers and not this Government's version of the living wage, which of course is not a living wage at all. The real living wage currently stands at €15.40 per hour. Anything less would show a complete disregard for these vital workers. This must also be accompanied by a commitment to maintaining parity with a real living wage going forward. Another pressing issue that must be addressed is the payment of mileage rather than travel time because that is a real problem for those workers, particularly in rural areas. Ultimately, this Bill is a step in the right direction, albeit a small one, which should have been taken years ago. Clearly, the provision of person-centred care is just not a priority for this Government. If it were a priority, there would not be this piecemeal approach to reform. Frankly, it is unforgiveable that almost six years on from the first Covid lockdown, we have made virtually no progress on developing a new model of care for older people. Reports have been published, evaluations are ongoing and a commission is under way but what has actually changed for people in receipt of this care? It is very little, more importantly, for those who are not in receipt of this care. The whole system of elder care is still weighted towards residential care, with the wishes of older people still seen as little more than an afterthought. Rights-based care will continue to be purely notional in this country without more radical reform. This Bill may be welcome but it represents the bare minimum intervention. I spoke with my daughter this morning; we had breakfast together after our Pilates class. She worked in the home care sector right after she left school a number of years ago during Covid. She loved the work. She loved being with people, providing them with care and providing them with the dignity and respect they need. She worked for a private home care provider under HSE funding. I started to tell her about this Bill and what is being done. She was passionate about it and wanted to share with me her experience, which I said I would share on the floor of the Dáil today. She said that as a worker in that space, the pressure you are put under to commodify care and simply move in half-hour slots between one service user and another and to try to provide them with dignity in that time was virtually impossible. When we talk about privatisation of care I am not saying there are not good people in those places who are trying to provide care. Quite the opposite, people get into that work because they want to do this. They want to provide care for people and provide them with dignity and respect in their most vulnerable time of need. Many of those business owners are trying to do exactly that. Ultimately, care cannot be commodified. In the AI space, we hear about this massive labour displacement that is coming. Do you know what you cannot automate? Care. We need to invest in it as a State and respect the work of care that has been largely undervalued by our society across the globe, mostly because it is done by women. That goes for paid and unpaid care. We need to start thinking about it differently, looking at it differently and start valuing it.

Sentiment score: 0.27