Mary Butler (Waterford, Fianna Fail)
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I welcome the opportunity to discuss statutory home care with my colleagues across the political spectrum. We may not always agree with each other, but I know we are all committed to helping people who need a high level of health and social care service to live at home for as long as it is possible and safe to do so.

Home support is an essential service for thousands of people each day across the country. Under my remit, the State is supporting approximately 56,000 older people to receive home support every day — that is over 70,000 people a year. The service is highly valued by people who need it, and their families, because it enables older people to live independently and with dignity in their own homes for longer. Rehabilitative home support also enables many older people to return home following acute hospital admission, avoiding delays for the hospital system and avoiding admittance to long-term residential care. In 2020, we made two important commitments relating to home support in the programme for Government. We committed to introducing a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care, and we committed to increase home care hours.

In my four years as Minister of State, I have worked tirelessly towards delivering on both of these commitments, and we have seen results that are making real changes for people in this country. When I started in this role during Covid-19, the priority was to make sure that people were able to get the services they needed in a safe way. We also learned very early on that keeping people in their own homes was safer for them in terms of containing the virus. This meant that delivering on increased home care hours was my absolute priority at that time. To that end, I secured the largest-ever increase in the home support budget from 2021 onwards. This was an increase of €150 million, nearly 20% more than in 2020. To put that in perspective, when Sláintecare was published, the State was investing approximately €403 million in home care and home help for older people. This is now called home support. This was to deliver about 16.2 million hours in 2017. Sláintecare called for an additional €120 million in funding over five years, by the end of 2022, which would have brought this to €523 million. The budget increases I secured meant that we had already exceeded this target significantly by 2021. I then secured further increases every year and now the budget stands at approximately €730 million for 2024. We exceeded our target of delivering 22 million hours of home support in 2023 and will exceed it again in 2024.

We are already delivering 590,000 more hours than we were at the same time last year. Not only does this mean that more people are getting the care that they need, but the average number of hours that people are getting has risen during that time. We have also seen the waiting lists reduce from a high of more than 9,000 people at the start of 2020, to under 6,000 people today. Some 2,956, or 52% of people are already receiving some support but are waiting for additional hours. The remaining 2,715 are waiting for new packages, which have been funded. The additional investment is also working to ensure that people are staying at home or able to return home with support after being in hospital. The number of people who are delayed coming home from hospital because they are waiting for a home support package has been reducing over recent months, with only a reported 37 people in that position across the country at the end of April. My aim is to get that figure down to zero. While there are many reasons for changes in behaviour, it is also clear that the number of people in residential care has also remained static over recent years, as we have increased home support hours.

The number of people in the fair deal scheme is still not as high as it was in 2019. There are some 23,000 people in residential care when the 2018 capacity review expected that there would have been more than 30,000 by now. The proportion of people aged 65 years and older in residential care has also reduced significantly, from 4.1% at the time of Sláintecare to 2.8% now. All indications are that what we are doing to increase provision is working. There is more to do, and I acknowledge that. I would like to see the waiting list reduced to a very low level and will continue to ensure that there is funding to support this. However, we are battling strong headwinds in terms of challenges with recruitment and retention in health and social care, which we are seeing internationally. I recently met other European health ministers, and I can assure Members that we are far from alone in finding it difficult to recruit people into this essential sector.

I would like to take this opportunity to recognise the hard work of carers in delivering this unprecedented amount of care and thank them for their commitment and the care that they deliver in the homes of older people up and down the country every single day. Improving conditions for care workers to reflect the intrinsic value of what they are delivering for all of us, is a priority for me. My expectation is that when we show that we value this type of work it will attract more people to the sector and help them to build fulfilling careers. In March 2022, I established a cross-departmental strategic workforce advisory group on home carers and nursing home health care assistants. It set out to examine, and most importantly, propose solutions to, the challenges in front-line carer roles in the home support and long-term residential care sectors. The group was chaired by the Department of Health and comprised representatives from seven Government Departments, the HSE and HIQA. The group consulted extensively with the key stakeholders to identify practical steps to take to address the recruitment and retention issues.

The report of the advisory group was published in October 2022. It contained 16 recommendations – which I fully endorsed – spanning the areas of recruitment; pay and conditions of employment; barriers to employment; training and professional development and sectoral reform. An inter-agency group was established to drive their timely implementation. The group’s most recent meeting took place in May of this year and my Department will publish the latest progress update this week. I am pleased to say that significant progress has been made in implementing the recommendations. As Members will be aware, close to 63% of home support is provided on behalf of the HSE by some 100 private organisations, approximately 20 of which are not-for-profit organisations. A new HSE authorisation scheme, which governs the payments to providers, and terms and conditions, was agreed in August 2023. I secured a significant rate increase, so that the scheme is now based on a core rate of €31 per hour for providers. This works out at an average rate of more than €34 per hour, taking into account weekend premiums, etc. The authorisation scheme delivers on commitments for sectoral reform, such as payment for travel time for home support providers, paying carers the national living wage at a minimum, and bringing legacy rates in line with the new revised rates of funding, ensuring fairness in the sector.

This is the first time that all home support workers delivering care are entitled to receive payment for their travel time. Thanks to the collaborative effort of stakeholders and the HSE, these measures will directly benefit home care workers and ensure they are fairly compensated for the valuable work they are doing.

The advisory group’s ninth recommendation has also been fully implemented. The statutory instrument authorising the issuance of 1,000 employment permits for home support workers was signed in December 2022. These permits will be for full-time positions with a minimum salary of €27,000 per year. Some 917 permits have been availed of to date.

Promotion of vacancies to jobseekers was one of the recommendations of the advisory group. Work in this area continues apace. The Department of Social Protection proactively encourages jobseekers to take up employment and job matching. Throughout the first quarter of this year, there were over 2,000 healthcare vacancies promoted to nearly 170,000 jobseekers and 18 healthcare specific events took place. In 2023, healthcare vacancies were promoted to over 680,000 jobseekers and over 60 healthcare sector recruitment fairs took place.

The Department of Social Protection is also working proactively with the EURES network to promote opportunities available in Ireland. EURES Ireland is working on recruitment projects with 15 healthcare companies, including large groups which provide residential and home care services to the elderly. These vacancies are promoted by EURES advisers across the EU and EEA. CVs have been received and forwarded to companies from countries such as Spain and Italy.

As well as improving conditions and promoting vacancies, we have examined how technology can be used to support the delivery of services to people who need home support. The HSE has commenced the procurement of a digital case-management platform and e-rostering system for home support services and the nursing home support scheme. This is a significant reform for the sector. A digital platform will facilitate standardisation of the pathway from application to the allocation and provision of home support. It is expected that the new system will be rolled out nationally in 2026.

A telehealth project run by community healthcare organisation, CHO, 5 and Ireland East Hospital Group was approved for €1.5 million of funding under Sláintecare integration innovation fund. CHO 5 will run a pilot project of 70 clients awaiting home support and the hospital group pilot is for 25 clients on the delayed transfer of care list. The project will run for two years with appropriate governance and oversight. It will include smart wireless devices which are integrated into homes. These devices ensure both personal and environmental safety, and home monitoring. There is a 24-7 expert care, phone-based team, which oversees the safety and wellness service. This team provides comfort calls, where prompts can be given regarding medication, nutrition and activity. There is a digitally inclusive adapted tablet to support social interaction and family members have access to an app, where the complete day story is available. They will receive calls from the team if there are unexplained changes to the normal day. The aim of the fund is to test innovative models of care and provide a proof-of-concept with a view to mainstreaming successful projects through the annual budget. I am confident that all of the ongoing reform that we are delivering through the HSE to increase the delivery of hours and improve conditions will continue to provide people with the care that they need in the home.

The demographic challenges that we are all aware of mean that we will have to continue to increase services and increase the average number of hours as the system becomes increasingly capable of delivering more intensive and complex care at home. However, the delivery of home support hours is only half of the picture. The programme for Government contains a commitment to a statutory scheme based on high-quality, regulated home care. It is clear, therefore, that the first step towards any scheme is to ensure that home care is regulated and that there are quality standards in place that services can be inspected against. It is essential that no matter where or how care is provided, everyone can be assured that their provider meets minimum standards of quality, safeguarding and governance.

My Department is progressing the development of a regulatory framework for home support providers. This will consist of primary legislation for the licensing of providers, secondary legislation in the form of regulation, which sets out minimum requirements, and HIQA national quality standards. The Health (Amendment) (Licensing of Professional Home Support Providers) Bill 2024 general scheme was approved by Government in May and my officials attended pre-legislative scrutiny last week. I look forward to the report of the committee and to bringing the Bill before the Oireachtas this year.

In the meantime, the Department has developed draft regulations in anticipation of the enactment of this legislation. There has been extensive consultation on these regulations, including public consultation and I would like to thank all those who contributed to the ongoing development of the regulations. HIQA has also begun work on drafting standards for home support providers, which will go out for public consultation in 2024.

The point has been made that the delivery of regulated home care is not the same as the delivery of a statutory scheme. I agree with this, but we cannot have a statutory scheme without a regulated system of care. I might note to colleagues that the fair deal took many years to develop and that was in the context of improving the fairness of existing systems that related to a sector that was well-known at the time. The home support sector is very different; it has never been subject to any kind of scheme or to the kind of oversight and regulation we are looking at now. Unlike residential care, there is potentially a very significant proportion of privately commissioned services that we do not currently have any insight to.

The introduction of licensing, regulation and inspection is something that I expect the sector to manage, but I acknowledge that it will be a fundamental shift for those services which will take some time to absorb. It is paramount that we do this carefully so that there are no undesirable impacts on the care that people are receiving in their homes or on the people who are delivering that care.

The possibility of introducing a statutory scheme has received a great deal of consideration both by myself and my Department. Officials in my Department and I are on record as saying that is has been a hard nut to crack. What I have learned since starting my examination of this is that there are as many different views of what a statutory scheme for home care is as there are members of this House. For some it is about a right to care; for some it is about a financial support scheme. For some it is about giving everyone access to the same amount of free care; for others it is about giving the most care to those who need it the most. For others, it is about enhancing the statutory framework with regulation. What I am crystal clear on is that the system that we have is working well, is expanding and improving every day, and is free at the point of use. At this point, I am not prepared to jeopardise any of that. I am also clear that all of the work that I, my Department, the HSE and the service providers are doing to improve and reform the sector is necessary and will be essential to any version of statutory home care.

There is much more we agree on here than we disagree about. We all want people to get the type of care that they want: enough care to meet their needs, confidence that the care they are getting is high-quality and safe and assurance that care is being allocated fairly – with no postcode lottery. Regulation and reform, including the introduction of a single tool for assessing care needs, is delivering on this already. We are considering how we might introduce a right to care, but examples from other countries have shown that when resources are constrained – as they are everywhere – this right appears to lead to a system that is very similar to the one we already have. This creates a risk that the care people get may be free, but they still only get as much as the system can provide and waiting lists are still long. Introducing an entitlement then potentially introduces a risk of litigation when service needs are not met, and we would not want a situation where access to care is determined by reference to litigation rather than care needs. It must be delivered on care needs.

We have conducted extensive research into the financing of home support, including the potential for co-payments. Many have called for the introduction of a fair deal for home support. I am a great supporter of fair deal, but it is important to remember that it is a system of financial assessment whereby those who can afford to contribute to their care do so in proportion to their means. Right now, the care offered by and through the HSE is free to anyone who is assessed as needing that care. I am yet to be convinced as to why we would want to change this.

When the concept of a statutory scheme was first raised, it was in the expectation that the cost of home support would continue to grow in line with its expansion and that this would become unsustainable. It was thought that some level of contribution would be needed in order to support that cost, which would have to be underpinned by a statutory scheme. Instead, we have increased the investment in home support by over 75% in the last nine years and we continue to provide this service for free.

There is still more to be examined in terms of options for statutory home care. I will be meeting with the CEO of the HSE to discuss these matters further. I have also asked my officials to prioritise an assessment of the options that are available to us, based on all of the work that has been conducted since I took office.

Again, I must emphasise that this will not affect the ongoing impetus for reform in the Department and the HSE. Any statutory scheme must be based on a regulated system, underpinned by strong data and evidence that utilise a robust single-assessment tool. We cannot ensure that services are being allocated fairly without a single or unified assessment system and IT systems that record and report on the underlying data accurately and quickly. This is why the single assessment tool, interRAI, and the HSE’s IT system for home support, are critical enablers that must be delivered and rolled out fully as soon as possible.

I am also fully committed improving a range of other policies and initiatives that will support people to live safely and well at home for as long as possible. The adult safeguarding policy for the health and social care sector is well advanced and will apply to people who receive home support as much as to people in institutions or other health settings. Home support works at its best when it is supplemented by other services. The triangle of home care, day care and meals on wheels supports – including dementia-specific supports – is a key factor in supporting older people to age well in their own homes. I have increased the allocation for these areas every year since the formation of this particular Government. Funding allocation for the meals-on-wheels service has now reached over €6 million from the €3.5 million allocated in 2022.

Day centres are a crucial part of social care provision in our communities, providing invaluable support for people who may, for any number of reasons, be experiencing isolation and loneliness. Currently, day care services are provided across the country in approximately 320 HSE and HSE-funded day care centres. Finally, I have worked towards implementing a further commitment in the programme for Government to establish a commission on care for older people. The proposal for the commission that I and the Minister, Deputy Donnelly, brought forward was approved by the Government and in the budget we secured €1.24 million to support the commission’s work. The commission on care for older people will examine the health and social care services and supports for older people across the continuum of care and make recommendations for their strategic developments. The work that is under way is delivering more hours than ever before, more funding than ever before, and better terms and conditions for all who work hard to deliver home supports up and down the country every day. However, I am aware there is so much more to do. The Government is committed to supporting healthy and positive ageing. I welcome the opportunity to debate this important topic today.

Patricia Ryan (Kildare South, Sinn Fein)
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When the Government came to power in 2020, its programme for Government promised a statutory home care scheme along with various other commitments for fair and affordable home care, removing inpatient charges and medicine costs. Further to that, in 2022 the Government committed to its implementation by 2023 yet here we are, more than halfway through 2024 and close to the end of the Government's five-year term, and what has it delivered? This scheme seems to be plagued by the same thing as the national children's hospital: delays and more delays. This is confirmation yet again of empty Government promises and platitudes with no substance.

Ireland's people are growing older, with the Institute of Public Health predicting the number of people over the age of 65 to top 1.5 million by 2051. If this Bill were to deliver on all the Government's promises, our older and ageing population could look forward to being supported to live in their own homes with equitable access to high-quality and regulated home care. We expected a fair-deal-type scheme tailored to suit the needs of the home care system, which would deliver universal home care and enable more people to age in place in their own homes, thereby relieving pressure on hospitals, but what we got is more akin to a licensing scheme for private providers than a fit-for-purpose statutory home care system. After four years, we have a scheme funded on private provision of care, contradicting the universal accessible and affordable home care scheme committed to in the programme for Government in 2020. This could not be further from the fundamental Sláintecare principles that more care should be delivered in the home, enabling people to age in place for longer. The care of our elderly cannot and should not be commodified by being reduced to a bottom-line, minimum-cost, maximum-profit issue. The move from the race-to-the-bottom, lowest-cost-tender model to an authorisation-based one is welcome. The pricing set by the HSE is still far below the level necessary to attract and retain qualified staff in the sector. However, regulating providers is not enough. We need a system that is statutorily funded, recognises different levels and complexities of care, and is something our present and future generations of elderly can trust will be there when they need it.

In 2021, a report into the regulation of home care by HIQA stated:

Every citizen of Ireland, or someone close to them, will need some form of support in their own home during their lifetime. As such, it is no longer viable to apply a directionless lens towards the provision of homecare. Rather, there needs to be a complete overhaul of the homecare sector.

In its recent progress report on statutory home care, Home and Community Care Ireland referred to the home care sector as the Cinderella of the healthcare system due to the lack of progress and the Department of Health's failure to give timelines for the scheme's implementation. This is unacceptable so many years after Government promises and commitments were made and, it would appear, quickly forgotten. The Government has effectively dropped the ball on this. The scheme as it stands is, at its best, a licensing scheme for providers. It does nothing to deliver desperately needed reform and highlights the lack of joined-up thinking and communication between Departments. It is light years away from the complete overhaul HIQA has called for.

Our ever-increasingly ageing demographic needs to be acknowledged. The foundations for statutory universally accessible and affordable home care system that is fit for purpose need to be put in place now and not later. Action now will ensure our future older generations - that means the Minister of State and I - can look forward to being able to age in place in our own homes for as long as we are able to, hopefully supported by a genuine public health and social care system. As Sinn Féin spokesperson for older people, I am well aware of the current failings of our home care system. Thousands are on waiting lists for home care. Some 3 million home care hours were lost in 2023 due to staff shortages. Elderly people are languishing in hospital because home adaptations have not been done. Elderly cancer survivors are caring for their sick spouses because there is no staff to deliver the home care package and all because of a HSE recruitment embargo. These are the harsh realities being faced by our vulnerable senior citizens because the system as it stands is dysfunctional at best. What is needed is a statutory home care system to deliver accessible, fair and affordable care, giving people the opportunity to stay in their homes knowing the supports they need are there for them and they will not be forced into residential care by default.

I know the Minister of State has said she prefers to see people ageing at home and I take that on board. We need a system that lives up to the expectations of the promises and commitments in the programme for Government. This Bill does not even come close to that. We, in Sinn Féin, would deliver as set out in our document, Priorities for Change in Health and Social Care. We are committed to delivering the right care at the right place at the right time. This means putting measures and supports in place to allow older people to age in their homes for longer, modernising the home supports scheme and making it a statutory scheme to enable more complex care to be delivered in the home where needed. We would prioritise development of public home care services, widen the remit of nurses and other essential health professionals to deliver more and better services in the home, and reduce pressures on acute hospitals at the same time. In essence, Sinn Féin would deliver a home care scheme that would be fit for purpose, accessible and affordable, and above all, provide a statutory right of access. The Minister of State mentioned in her speech earlier that it was important during Covid to keep people home and keep them safe. I thank her for that and I take that on board, but I have asked several times in this House for a Covid inquiry. To date, we have not been given a date for such an inquiry. Would it be possible to get one?

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I think we are all in agreement that home support is so important. It can provide assistance with a wide range of activities and allows people to live at home as independently as possible whether they are ill, frail or disabled. It helps with washing and personal care and so on. I wish to say at the outset that not all disabled people need or want home care support. Many do not require this service. In fact, they require a personal assistance service, which is something different, in order to enable them to live independently.

There has been a growing crisis in home care support over the last number of years. The demand for home care is growing considerably and we can see an increase year on year in the number of people being approved for hours and being allocated home care. The disability capacity review shows that the growth in ageing of the disability population is likely to drive increased demand for home care services much further, as is the fact that people are living longer and are going to need more care in order to live at home. The failure in home care provision is compounding further the pressure on our hospitals because the lack of alternatives in community care has left thousands of people in hospital longer than they should be.

For the same reason many disabled people are also left to languish in nursing homes, not somewhere they chose to be but there was no alternative because the care was not available in addition to the accessible housing. Many people cannot return home because no carer is in place to provide the care they need once they return home.

The Government seems to have thrown in the towel over the programme for Government commitment to implement a statutory home support scheme over its term in government. Instead, it is talking about introducing a Bill which is entirely about licensing and regulation of the market for private home care providers. At a recent health committee meeting on 19 June to commence the pre-legislative scrutiny of this Bill, a principal officer from the social care division in the Department of Health who was asked whether the Bill delivers statutory rights to home care answered that it does not. She went on to confirm that it is about licensing and regulation, but does not cover affordability, access, a statutory right or any of those issues. When asked how advanced a Bill to deliver statutory home care was, the principal officer replied:

To be clear, I did not say a Bill is in development and did not mean to imply it is. There is preparatory work for a Bill that will happen at some stage, once it has been determined exactly what the content of it will be.

We are now four years into the term of a Government that committed to deliver a statutory right of access to home care in its programme for Government, and yet it is not even at the stage of having a Bill in development. It is a safe bet at this point that by the end of the Government's term we will not have a statutory home care scheme in place as it had committed to implementing. It looks like the best the Government will deliver is licensing and regulation of the market of private home care providers. In 2017 the then Minister for Health, the current Taoiseach, committed to the introduction of a statutory right to home care. When he was questioned about it in 2020, he said the scheme was almost ready. We are now four years on and it seems the Government is nowhere near ready.

The failure to deliver its programme for Government commitment to a statutory home care scheme is pushing older and disabled people into hospitals and nursing homes or into early admission into long-term residential care when they could be cared for in their own home if that is their wish. The Ombudsman's Wasted Lives report stated that the implementation of this scheme is necessary to address the current bias in favour of placing people in institutional settings.

A large number of people have been assessed as needing home support and are waiting very lengthy periods due to the lack of carer availability. Hundreds of these people are experiencing delayed transfer from acute settings. There are no carers available because the Government failed to plan for a sufficient workforce. When the changes to pay and conditions were introduced, no additional money was provided for that. In an act of sleight of hand by the Government, the number of home care hours provided was reduced to pay improved rates and conditions for the staff. I absolutely agree with improved conditions and rates of pay for staff, but unfortunately older people and disabled people pay the price for that by having their hours of care reduced. It has left many family carers to carry the burden on their own. I am constantly contacted, as I am sure all Deputies are, by families who do not have sufficient carers.

In one instance, an elderly woman was confined to bed and required two carers at a time to lift her using a hoist to change her. Sometimes only one turned up. Sometimes none turned up. She actually spent one weekend where she had no carers at all. She ended up not eating or drinking so that she would not soil herself because otherwise she would have been left lying in this for some time.

I know of another woman who has locked-in syndrome and cannot move anything other than her eyes. She has a home care package in place, but her mother told me it has never been realised. There are three visits a day requiring three carers at a time because it requires the use of a hoist. They never know when one carer or two carers will turn up or even when none might turn up. They do not know from moment to moment how many carers will be there and if there will be sufficient carers. That is not fair on that family.

It was inevitable that this crisis would get worse because home care staff were included in the recruitment freeze. The authorisation scheme introduced last summer is a step in the right direction. It moved away from the low-risk cost tender model. However, the pricing set by the HSE under the new system is not sufficient to cover the new cost of travel time and hurts the ability of the sector to continue paying above-average rates of pay. It is further damaged by the continued pay gap between section 39 and HSE service providers. Importantly, it only deals with older persons' services and does not apply to disability services which means that more complex care is less attractive for providers. In November of last year during the debate on a motion on home care workers and home support, the Minister of State with responsibility for disability, Deputy Rabbitte, said:

The HSE is currently progressing the development of a new disability service procurement framework with the expectation of finalising the framework in quarter 1 2024. Any amendment to the disability service home support rates will be considered in the context of the procurement exercise...

We are now at the end of quarter 2 of 2024 and I ask the Minister of State to update us on the status of that and if it is almost completed.

The Government promised a statutory home care scheme and failed to deliver it. At best it will get the health (amendment) (licensing of professional home support providers) Bill 2024 passed, which will license and regulate home care providers. The Bill does not provide for or chart a path to universal access. It does not meet the expectations set under Sláintecare or in the programme for Government. Home care is essential to reducing pressures in hospitals, discharging patients on time and maintaining independence for people who do not need nursing home care. Sinn Féin would deliver a statutory home care scheme centred on access to give people the choice to remain at home instead of moving to a nursing home.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Devlin is sharing time with Deputy Flaherty.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I welcome the opportunity to examine plans for a statutory home care scheme. Supporting people so they can remain living in their own home is a fundamental policy for Fianna Fáil. We have consistently increased budgets for the provision of care in the community through day care centres, meals on wheels and home care. We know that for most people home is the preferred location for care. The home support service is therefore an essential service for thousands of people across the country.

Today in Ireland, approximately 56,000 people will receive home care which enables them to live in their own homes and communities for as long as possible. Last year, 22.1 million hours of home care were delivered, providing vital wrap-around support to help older people to age well. In 2020 the overall funding available to the HSE for older people was €1.97 billion, in 2024 the overall funding available will exceed €2.6 billion.

The home support service is highly valued by service users and their families because it enables older people to live independently and with dignity in their own homes for longer. It also enables many older people to return home following acute hospital admission who otherwise would remain there or would be admitted to long-term residential care. Since budget 2021 the Minister of State, Deputy Butler, has secured an additional €228 million in funding for the home care support service. I know from my own experience in Dún Laoghaire the wonderful work carried out by the home care support service. In particular I want to recognise the work carried out by service providers such as Shankill Day Care centre and Beaufort Day Care centre in Glasthule.

The meals-on-wheels volunteers and home care assistants are the backbone of the service and we could not manage without them. As a society, we will need to examine the strategic and policy implications of an ageing society and how we will deal with the challenges and opportunities it will bring. While it is wonderful to see people living longer and enjoying their well-deserved retirement, the State must support them.

The objective of the 2017 statutory home care scheme was to introduce regulation to the sector and ensure people have a right to enjoy consistent service levels and to live in their own home where appropriate. While there has been progress on home care, there have been setbacks to the full implementation of the scheme. In many respects the scale and scope of the scheme and the work and funding that would be necessary were underestimated by the last government in 2017. There is no doubt the challenges of Covid-19 and the cost-of-living crisis were further setbacks. I support the principles behind the statutory home care scheme but in order to deliver its objectives, a whole-of-government approach will be required to prioritise the necessary cultural change and allocate the funding required.

I welcome the Minister of State's statement today that it is a priority for her, but that there is more to do. I thank the Minister of State, Deputy Butler, for her efforts in securing additional funding for the sector and for her engagement in prioritising the need to support older people.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I join my colleague in commending the Minister of State, Deputy Butler, on her steadfast commitment in this area. I know it has been the defining principle of her career to date. She has put the care, protection and well-being of our elderly and the people who made this country what it is to the forefront of her raison d'être in political life and she is to be commended on that.

She is an outstanding advocate and passionate speaker at all times, and a great defender of our elderly population. We greatly admire that and take great pride in the fact that she is a member our party. It is a steadfast principle of this party that we will first and foremost protect and set out to safeguard at all times the elderly people of this country. Notwithstanding that, it remains a huge challenge. As many speakers said and as the ESRI report sets out, we are thankfully getting older. I am getting to a stage in life when people tell me I will live to a great age. I think about it, and I am getting a lot closer to that age than I was.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We are all going in the same direction.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I have a vested interest in ensuring we have safeguards in place for older people. We are, thanks to advances in medicine and the tireless efforts of staff in the HSE, living a lot longer. We want to continue living in our own homes and our own communities. We want to be surrounded by siblings and grandchildren. That is the least anyone can aspire to in a modern and progressive Ireland.

There are challenges in home care, as many people have said. The biggest challenge is probably the delivery of the service in rural Ireland. It is a pronounced challenge. It is a lot easier to operate and deliver home care in a large urban setting where the travel time is less and it is easier to get staff. It is a defining challenge for us in this sector, and I see it in north Longford and Leitrim, an area Deputy Martin Kenny is familiar with. It is extremely hard for these service providers to get staff to do it. In many instances the staff are being rushed through. They come in and may be there for 20 minutes or a half hour and are then rushing to their next appointment. It is difficult and frustrating for the care recipient and is one of the greatest sources of angst. In many cases it does not allow them to build up a relationship. In many instances the only contact people in an isolated rural area have with the outside world is with the carer who comes for that half hour in the morning and hopefully later their meals on wheels as well. It is important and that is why the Minister of State's efforts in statutory home care are to be commended. We need safeguards in this scheme, and we also need a minimum standard of care that people can expect. It should not be a case that people should be happy with whatever they get. We have a large number of private operators, and it has to be said nobody set up a private operation because it was an altruistic endeavour. They are doing it because this is lucrative and there is a lot of money to be made in this area. We need to police it and ensure they are delivering the service we expect, but more important, the service elderly people deserve.

My colleagues also spoke about meals on wheels. It is a fantastic initiative and a great link with communities. In many instances it might be the only contact with the outside world. It is probably a damning indictment of rural Ireland that we have evolved to the point where your only contact is the van coming down the boreen with two people to deliver your dinner. In many respects we have to wonder whether the progress we have attained in this country is all it is cracked up to be when we see something like that. That is why it is so important to safeguard it. I commend the many people who volunteer to work in meals on wheels. These are people who do not just take on a delivery role; they are a point of contact with people. They talk to people and will do extra for them even though I am sure it is not part of their job description. They will take away a letter that needs to be delivered or drop a message into town for them. That is to be commended.

There is no doubt the Minister of State has made substantial progress in this area. As we come to the twilight hours of this Government, we need to say we did good work in the area of home care. It is far from finished and there is a lot to be done. One of the biggest challenges, and the one we need to crack, is the delivery of home care in rural Ireland because it is challenging at the moment.

Seán Crowe (Dublin South West, Sinn Fein)
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Adequate home care provision allows older people to live with dignity and respect in their own homes. Additional supports also contribute to, and are vital for, independent living. The Government has often repeated there is a commitment to introduce a statutory scheme to support people to live in their own homes and Government members cite the fact that it is in the programme for Government. Like others, I want to see it in legislation and being budgeted for, rather than in meaningless statements in the Dáil or Seanad. When parliamentary questions are put down on home care packages, we hear the same line again and again. This is not a new idea. The Sláintecare report was specific about ending the overreliance on market mechanisms to deliver new healthcare services through the expansion of public nursing homes and home care. That programme for Government is almost due for renewal and we have seen precious few results, despite the usual flurry of activity and noise the Government believes is just as good in many cases. A public consultation was held, and a pilot even tested almost two years ago. We are supposed to believe that recruitment to key posts is ongoing, even though the work of the strategic workforce advisory group itself has been hindered by the recruitment freeze in the HSE. We are told time and again that the Department of Health is still researching funding models. Genuine fears were expressed yesterday by Alone that this will only be a replication of the fair deal scheme, which it described as being inappropriately bureaucratic and unfair in such a situation. This is all to be published or done in coming months and the next election has to be held by March 2025. There are not many months left for this element of the programme for Government to be introduced.

The health committee is currently discussing the licensing of professional home support providers. Rather than ending the overreliance on market mechanisms, it would do the opposite by designing the home care regulatory system around the private market, further embedding privatisation. It is a charter for privatisation even though the health committee heard yesterday that delivery of an equitable statutory scheme will not be possible while there is an overdependence on private sector providers. This is another sector of the health services effectively privatised, forcing people who worked all of their lives to either fork out the money or turn to families who may not be in position to provide care themselves or afford that care.

Without access to affordable residential care or care in the home, people are forced into a hospital system that cannot afford to accommodate them and is unsuited to their needs. The awful phrase "bed blockers" is often used. Too many people are stuck in hospital beds when appropriate care can be delivered elsewhere. Hospital stays should be an option of last resort when people just need a little help to live a semblance of an independent life in their own homes. It should not be the last resort. Thousands of delayed discharges of elderly patients are creating bottlenecks in our hospitals each year because people have nowhere else to go. It creates a knock-on effect through the services, leading to cancelled appointments and surgeries because of a lack of beds. It is the worst lack of joined-up thinking. It also represents an abandonment of our duty to our older and more vulnerable citizens that it is often beyond the ability of many families to afford home care.

If we want to pay more than lip service to independent living, delivering care in the home, universally and free at the point of access should be one of the highest priorities for Government. Ireland has an ageing population, as others have said. We are lucky that our loved ones are living longer, but this presents its own challenges. We have to be proactive and plan for greater demand into the future rather than scrambling and failing to provide what is needed today. We must do better for our older citizens and ensure they have prompt access to home care. Leaving them waiting for support could have a detrimental impact on some individuals and is not right or in any way fair. The Government must stop burying its head in the sand on this issue, and finally prioritise older people and those with disabilities to ensure they get the support they deserve rather than simply trying to privatise anything that stays still long enough, just as it did with nursing homes and dental care. There is a lot more to do.

Róisín Shortall (Dublin North West, Social Democrats)
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Last week on the Order of Business I raised with the Taoiseach that seven years ago, as Minister for Health, he gave a commitment to introduce a statutory right to home care. Given the failure of that Government and the current Government to follow through on that commitment I asked for a debate on that issue today.

We have a debate, but it is not on the statutory right to home care. It is on statutory home care provision, which is a very different matter. What we are talking about today is regulation, and while regulation is important, it is not the issue. The issue is that people were promised a statutory right to home care, and neither this Government nor the previous one has delivered on that.

This issue was first brought to my attention by Brendan Courtney a number of years ago, because Brendan and his family found themselves in a situation where his father needed care. He was becoming increasingly disabled due to illness and he needed care. The family wanted to care for him at home, and they discovered they were not supported in doing that because funding for home care was not available. They were all prepared to put in the time and effort to do that but they needed support from the State. The only support the State could provide was nursing home care, under the fair deal scheme, but that is not what they wanted at all and Brendan did a lot of work to bring attention to this matter.

We know that older people want to stay in their own homes for as long as possible, and we know that from a health and well-being perspective they do best in their own homes, yet the State will not support that choice or that optimal arrangement for older people. Instead, over recent years since the fair deal was introduced, older people have been directed into nursing home care. They are being funnelled into nursing home care in the absence of adequate support for them to stay at home, and that system is not serving the interests of older people. Indeed, I cannot help but think it is a system that serves the commercial interests of the nursing home sector, and that is not what we should be doing.

Home and Community Care Ireland recently provided an insightful timeline about this issue, going back to 2016, eight years ago, when the programme for Government of the day committed to introducing a statutory, legal right to home care. The following year, the then Minister for Health, Deputy Harris, advocated strongly for that and said he was going to introduce such a statutory right. In 2017, Department of Health officials said they were working on a legal entitlement, along with regulation of the sector. In 2018, there was an extensive consultation on this and a large number of responses were given, which were predominantly in favour of introducing a statutory right to home care, making it at least a level playing pitch in order that we would not force older people into nursing homes but would look out for their best interests. In 2019, we were told by the then Secretary General of the Department that a statutory entitlement was an absolute priority and that it was going to be introduced shortly. In 2020, Deputy Harris, as Minister for Health, said the scheme was nearly ready. We heard the other day from officials that work on the regulation only started in 2020, so I do not know what the then Minister for Health, the current Taoiseach, was talking about in saying the scheme was nearly ready, because clearly that was not a true statement. In 2020, Deputy Butler, as the new Minister of State with responsibility for the matter, committed to implementing the statutory scheme by 2022. Here we are, two years later, and we are really no nearer to having that legal entitlement to home care. Much has happened since then, but there was not a clear commitment. Last year, the commentary from the Government changed to being about regulation of the largely privatised market for home care, but there is very little talk anymore about a statutory right to home care and that is where the difficulty arises.

If we have learned anything, we should have learned from the experience of Covid, the appalling situations that arose in nursing homes and the appalling numbers of deaths that took place in them because of congregated settings. At the time, the then Taoiseach, Deputy Varadkar, said in reply to me in the Dáil that we needed a new model of care and that large-scale nursing homes were clearly not in the interests of older people. At the same time, the then Minister, Deputy Harris, said the large-scale commercial nursing home model was not fit for purpose. Here we are, four years later, and virtually no progress has been made on developing a new model of care for older people. This is in spite of the fact all the advocacy groups, such as Sage Advocacy, Alone and many others under the umbrella group of advocacy organisations, have looked for a statutory right to home care. They want a new model that is about supporting older people in their own homes and looking at alternative housing models with support in order that people can stay at home and thrive in their local community. We are no nearer to that. The regulation is important, but why has the Government not delivered on the promise that has been made for so many years?

Fergus O'Dowd (Louth, Fine Gael)
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This is a very important debate and I congratulate the Minister of State, who is an advocate for the care of older people. She has a difficult job and she fights her corner, and I will certainly always stand up for her in that respect. I have great admiration for her.

The care of older people is critical, but the way they have been treated is appalling. If we look at the facts that Alone put into this debate with a report regarding people who are at home and need their homes to be adapted for their care, the Government allocated €97 million for that in the budget for this year but it is going to cover only 13,000 home adaptation packages, whereas in 2010, 13,500 were covered. There is a huge issue with funding to keep people in their homes. We should keep them in their homes physically because the environment is suitable, with the professional care they need, and keep them out of acute hospitals. Home care is especially important because where it works, there is a significant reduction in the number of acute hospital presentations by people who are elderly or have a disability. According to the Irish Independent this week, only 44% of elderly people discharged from our acute hospitals go home. A total of 22% go into nursing home care and the rest go into the homes of friends or relatives who look after them.

There is a huge issue here. It is an unmet need, and the Minister of State is going the right way in saying the care that is needed into the future should be free at the point of contact. A person should not have to put his or her house into hock to get home care. Most of these people have worked all their lives. They have reared their families. Why in the name of God should they be lumbered with additional penalties because they are getting older? We should support them 100%. I am opposed to charging individuals who, unfortunately, need this care. The tax burden should be equalised and social welfare contributions over the course of one’s working life should meet those future needs in order that the cost will not fall on any one individual who is unlucky enough to be unhealthy in the context of having a significant disability or illness and having to stay at home. Keeping people in their homes is of great benefit to individuals, their families and their communities. They will be in a place they know and love and where they are cared for. Putting them into a nursing home is the last thing that should happen to anybody. It should be almost impossible to get into one because the quality of care should be such that services are provided in the community.

Denmark is a model for this, to the best of my knowledge. I asked the Oireachtas Library and Research Service to do some work on this issue for me. Home care is free at the point of delivery in Denmark. Most of Denmark's nursing homes have been closed because people are looked after at home. Their needs are met there and it is where services are delivered. The number of acute hospital admissions in Denmark is down because John or Mary, for example, is not going into an acute hospital late at night at the weekend. They do not have to go into acute hospitals because they are being looked after at home and their needs are being met there. An awful lot of the people who, unfortunately, will be lying on trolleys in our hospitals in the future will be elderly people who should be at home and should never have been in those hospitals. If we can intervene at an earlier stage, we can support them. I believe that is what the Minister of State wants. It is what I want, too.

There are lots of issues with privatisation. The proportion of people in privately run nursing homes is 85%. Only 15% are in publicly run institutions. We must take over nursing homes, like the one in Lucan Lodge that can no longer be managed by the private company. I do not see why the State should not go in there, take it over, do the deal and provide the quality service that is required. We need a policy of State-supported and State-run services, with the quality of services the State can provide. Every private nursing home has, on average, three times more healthcare assistants but only one third of the nurses needed. When nursing home owners say they are not making money, I do not believe them. They certainly do not have the qualified staff they need, whereas there are such staff in public sector services. They criticise the public sector for excellence in care and that is a reality we have to face as well.

I know my time is short. Can I take more time, a Cheann Comhairle?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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You can keep going if the other Deputy does not come in.

Fergus O'Dowd (Louth, Fine Gael)
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I am only at the beginning of a five-minute speech that I may not have.

Let us look at analysis, best practice and facts. Let us look at Denmark and the northern economies, the so-called socially committed states. I do not have a problem paying more tax if I get the services I need and they are of benefit to the community. I hold that view firmly and strongly.

If we really think about it, the value we put on older people in our society is unacceptable. If one has an abandoned home and the roof is gone, the Government will provide a grant of €70,000 to replace the roof so someone can live in the house. If one has a home, with a roof, that has been vacant for two years, the Government will provide €50,000 to put the house right and make it liveable. However, those with a disability who want to adapt their home to meet their needs can get a maximum grant of €30,000 provided they do not earn more than €30,000. For those earning between €30,000 and €60,000, there is a reduced level of grant available to allow them to stay in their homes. What the hell are we doing as a State? Clearly, we are not looking after old people the way we should.

I am critical of the Government on a point relating to elderly persons in nursing homes. John and Mary can keep all of the income they get from renting out that house. What does that mean? It means we are putting all of the benefits behind anybody but the elderly or disabled person who needs them. People have to stand up and fight like hell for their rights because that is the battle ahead. The number of older people is growing. Since 2010 the number of people aged over 65 has increased by 60%. We are living for longer and we are living better lives, but obviously the needs of people with acute and long-term illnesses have to be met. What Government will do it? Who will decide that? I support the Minister of State in what she is doing but these questions should be at the top of everybody's agenda for this general election. What are you doing for older people? How do you show you care for them?

Let us take the example of nursing homes, to which Deputy Shortall referred. More than 8,000 people in Ireland died of Covid. Sadly, I see it is becoming rampant again. I know Covid is not as infectious as it used to be but people are dying. There were deaths this week due to Covid. If 8,000 children died four years ago due to Covid, there would be an inquiry and there would be change. We would get ready and we would learn the lessons. It is not about holding people accountable; it is about getting the truth. However, because they were old people, nothing is happening. I am critical of the Government on this. Time and time again we hear that a Covid inquiry is imminent. Where is it? Why is it not here? Why do we not learn the lessons? Why do we not care enough? It is the job of this and future Parliaments to show we will learn the lessons. There will be another pandemic but we have not learned any lessons from the last one. We leave too much to officialdom, civil servants and all of that. There is a care, concern and love of older people and children at the heart and guts of society. Babies and young people are the most vulnerable. I am lucky; I have a new grandchild. His name is Séamus Fergus O'Dowd. All of those guys over there should watch out - there is another O'Dowd. He is two days old and I hope he will come to this House in 18 years. By Jesus, will he fight like hell for what he believes. I will make sure he will.

We have to show our care and our love. We have to really step up to the mark. That is our challenge. I say with all of the passion in my soul that I believe that is what we have to do. If everybody here is lucky enough, they will reach my age. I am 75 years of age now. If I am lucky I will live another ten, 15 or maybe 20 years. If we are lucky, we will reach that age. We want to make sure we are looked after and that the taxes we paid in the past, our families and their commitments will be valuable. We want to ensure we will be held in the esteem that older people are not being held in now.

I know the resources of Government are finite but, my God, people who have worked all of their lives, reared their families, looked after their grandchildren and given their all to the State should not be left in the situation elderly people and people with disabilities are being left in now. I rest my case. If the Ceann Comhairle wishes, I will take his job so that I will be in the next Dáil. If he wants to make that offer, I will definitely do it, and I would be pretty tough on these issues. I thank the Ceann Comhairle for his indulgence.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I think the Deputy should keep his seat warm for that grandson of his if he is going to give performances like that.

Róisín Shortall (Dublin North West, Social Democrats)
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He could be in another party.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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These are statements on statutory home care. The problem, as most speakers from the Opposition have made plain, is that we do not have statutory home care. That is the issue. What we have is a system where much of the care is provided by private providers and which is not working very well for most people. I have examples of that the length and breadth of my constituency. I continually have people who have a relative in hospital coming to my office. The relative wants to get home from hospital but cannot do so because a home care package has been put in place but nobody can be recruited to provide it. That is one of the main issues we see.

In the Minister of State's opening remarks she stated that additional money was being put aside for home care and people would get better salaries. One of the issues is that people do not feel they will have the permanency of employment they would have in other sectors. They will not be able to go out and get a mortgage on the strength of being a home care worker. They will not be able to set out a plan for their future on the basis of being a home care worker. That needs to change. It is one of the key things that needs to happen. It can only change if we have a proper statutory home care service which is provided and stood over by the State. That is what the Government does not do and what it seems to be moving away from. At the end of her remarks, she stated there was a lot of disagreement and some people wanted this, some people wanted that and some people wanted the other. We do not care what some people want. What we need is a service that is provided for people. The Government has the responsibility to make up its mind as to what that the service will look like and to deliver that service. We have waited years and years for that service. Coming in here at the eleventh hour, when this Government is near the end of its term, and saying people do not really know what they want is not an answer. That is not appropriate for a Government that has been in office for four and a half years. It simply is not good enough.

I continually come across people who are in very difficult circumstances, who have an elderly relative who has dementia or some other health issue. Indeed, the people advocating on behalf of dementia services were over in Buswells Hotel earlier today. I saw the Minister of State over there. Many of them, when they have issues with home care services, discover that they are getting half an hour three times a day but not at weekends. They need to get some help at the weekends but families are told to hire that in and pay for it themselves. The previous speaker talked about families should not have a burden put on them to pay for it themselves when they pay taxes all their lives, but that is exactly what they are being told to do right now by the HSE providers of home care services. "If you want more hours, go pay for them yourself." That is what they are being told. The service is already there because it has been privatised and a private company is providing that service, so people are told to go to them and hire in the extra hours. That is simply not appropriate either.

We also have a great many people with chronic disabilities. They may not be very elderly, they may be in middle age, they may have multiple sclerosis or various conditions. There are serious problems in trying to get assistance and packages put in place for them. It comes to the same thing, that they cannot recruit staff. That is what we hear all the time from all the providers whether they are in the public or private sector. They cannot recruit staff. They find that one section is stealing the staff of the other. The ones in the private sector sometimes get staff, train them up and have them working for them. Then they are hired by the HSE and the private sector provider cannot get them back. We have this crisscrossing over and back. It is all down to the same problem, namely that we do not have a proper service that is uniform and that we can stand over. The Government has promised a statutory home care service for a very long time.

There has been much mention of nursing homes and the difficulty in keeping people out of them. Absolutely, people should have services provided to them in their homes for as long as possible. I have dealt with many nursing homes. In my experience, the services that are provided in many of our nursing homes are second to none. People are very well looked after. That needs to be said as well. It is not always a bad experience. Often it is a good experience whether the nursing home is public or private. People are often very well looked after. That said, the vast majority of older people do not want to be in a nursing home. They want to be at home. They want to be with their family, with friends coming in to them and they want to have the services to do that. The cost on the State of providing adequate home care services for them to do that is a fraction of the cost of long-term care in a nursing home. We recognise that. Adequate investment at the early stages in the correct service to provide home care will save money for the State in the long term by keeping people out of long-term care in nursing homes.

I also want to mention the women, mainly, who provide home care service and who are the heroes in all of this. They often go far beyond what is required from them and what they are paid for. They get half and hour with somebody and sit for another hour, have a cup of tea and talk to the person and become a friend to them as much as a service provider. They need to be acknowledged, the great work they do. The problem we have here is that we have statements on something the Government has absolutely failed to provide and that is where the Minister of State needs to step up to the mark.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Next is Deputy Gino Kenny, who is sharing time with Deputy Paul Murphy.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Yesterday, representatives from Alone were before the health committee speaking about the home care sector. One of the contributors said that a statutory home care scheme was first mentioned in this House in 1968. I looked back and that is correct. A scheme like this was first mooted back in the late 1960s. We have been talking about this for a considerable amount of time and it still has not been done. It was promised in the programme for Government but has still not been put in place. We will all agree that home care is extremely important. I was a home care worker for a long time prior to this and I know how important the work is in terms of keeping people out of acute medical situations and keeping them at home. People do want to stay at home but they have to get the service and the hours that make it sustainable. There is a lot of demand for home care and it will increase over the next 20 years because people are living longer. That is a good thing. However, if the services are not there it becomes arbitrary, and that is not a good thing at all.

Like nursing homes, home care providers are largely run for profit. The Minister of State has not acknowledged that once this is the case, there is an imbalance. I am not saying private care providers are all bad. That is not the case. A model of profit before people is all wrong. That is not being ideological about it. Home care and nursing care should be run by the State because that is better and more economical. It is just better generally. We have to look at that imbalance. Home care should not be about supply, although there are supply issues. It should be about demand. It should be enshrined in legislation that anybody who needs home care will get it in time. If they get a good intervention in time, the outcomes are great, not only for that person and the family but for society as a whole. That needs to be enshrined in legislation. If it is not statutory, it becomes arbitrary and people will lose out, which is not fair.

Paul Murphy (Dublin South West, RISE)
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How a society treats and takes care of its older people says a great deal about the values of that society. The way that older people are currently treated does not reflect well on the basic values that underpin our current for-profit, capitalist society. It is a society and an economy where care work is massively undervalued and under-provided. Where it is provided, it is on a for-profit basis, as Gino outlined, often with very high levels of exploitation of those who are providing it. These are older people who in most cases have worked their entire lives, have produced a huge amount of wealth and have paid taxes. They now find themselves effectively abandoned by the State. Some are effectively compelled to go into nursing homes when it is not the most appropriate thing for them or what they want to do. A major burden is placed on their families. Families want to do everything they possibly can to care for their elderly relatives but there is serious pressure. A significant amount of unpaid labour is also taking place in our society, 1 billion hours of care work a year, saving the State €2 billion. People are not treated with the respect they deserve.

The answer is very simple and has been recognised by the Government previously. It is to have a statutory right to home care, for us, as a society, to provide appropriate home care free at the point of use, paid for through general progressive taxation. It is a political choice not to do that. We live in a wealthy society. We will have a surplus of €65 billion over the coming years. However, as has been outlined in this debate, we have seen delay after delay in development. This scheme was in the 2016 programme for Government and was originally targeted for implementation in 2021, yet here we are in June 2024 with little progress. In 2020, the then Minister for Health, Deputy Harris, claimed there was a scheme nearly ready and said that a new Government, whoever the Minister for Health might be, should be in a position to bring it forward quite quickly. A parliamentary question was tabled by the former Taoiseach, Deputy Varadkar, about a week ago, asking for an assurance that the general scheme of a statutory home care scheme Bill be published in 2024 and inquiring as to the reason progress has been slow in the past two years. This man was Taoiseach for the past two years, so presumably he should know why progress has been slow. If the scheme continues at its current pace, never mind this Government, it will not be implemented within the next Government either. It must be prioritised and backed with sufficient resources. Initially, the statutory entitlement to home care was at the very core of what the Government would talk about but now it is often not mentioned in Government contributions in the Oireachtas.

Funding has been rarely mentioned in the past four years and funding options have not been developed.

The consequence is the picture we see, namely the effective abandonment of many older people. Family Carers Ireland says that 74% of those surveyed report that the individuals they support do not receive sufficient formal support. We obviously know we are heading into a situation with more and more older people, so we need to resolve this urgently.

Bernard Durkan (Kildare North, Fine Gael)
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I hate to introduce rancour into any debate, particularly this one, but, as regards reference to the reserves that everybody has their eye on at present, let me remind the House that we had reserves in the recent past. They lasted two days when the run came on the banks. That is how much we can rely on reserves. They are there for a purpose and have to be kept for - if we intend to go on-----

Paul Murphy (Dublin South West, RISE)
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To bail out the banks. Is that what the Deputy is thinking of?

Bernard Durkan (Kildare North, Fine Gael)
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No, it was not to bail out the banks; it was to live up to our commitments. We, as a country, had borrowed beyond our capacity. I am sorry; the Deputies opposite can run away from it anytime they wish.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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What has this got to do with the debate?

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Show Deputy Durkan the respect of allowing him speak without interruption.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Ceann Comhairle. I reiterate that everybody has their eye on the reserves. That is how long the reserves last. They are reserves because there is a need for them in an emergency.

In this situation, we need a service - that is correct - but there is a vast difference between the service in the 1950s and the service now and what it entails. In the 1950s, we had large-scale unemployment, many people working in their homes, families working from home and so on. There were many more people available to help out in providing this much-wanted service than there are now. Now, whole families are at work for many different reasons. That is the way things are now, so we now need to develop a situation which continues seamlessly from the moment the person requires care and attention, either in a nursing home or in his or her home. That needs to be introduced in a way that is supportive and conscious of the degree of need in each situation. There are vast differences in that as well. In some cases the person only wants a conversation, a cup of tea, a bit of companionship and so on. That is important too in isolated areas in both urban and rural settings. It also means, however, that there are other situations that become more serious over time whereby people have a particular condition that gets progressively worse and they require a graduated level of service that contemplates the level of their need and how best to address it.

It can be done. Contrary to what many people said a number of years ago, that it will come at a relatively low cost, it will not. Everybody says it is a good idea, but it will cost. We have to be conscious of that fact and provide for it as necessary, otherwise it will not happen. We may pretend that this is a cheap way to deal with everything in lieu of hospital care. It is not because it requires travelling around the countryside and urban areas by a very dedicated team who have a personal knowledge of the patients they are dealing with. They have to travel once, twice or sometimes three times a day, depending on the condition. When they are committed to that, it is important from the point of view of the patient that the patient can rely on the availability of the service without interruption. That is the nature of the situation. The person, the individual, is vulnerable and needs that little reassurance in order to ensure continuity of the service and its seamlessness from the time the patient first requires it and on into the future for as long as necessary, just the same as hospital services and nursing home services are needed.

There should be a continuation of and some link with the nursing homes, whether they be public or private. If the State wants to provide public homes, I think it is the same thing, but there would be a knowledge arising from the link-up between the home care services and the nursing homes that would be available to nobody else, with the exception of a hospital. It would be important to have an overall view of the strengths and weakness of the services daily, if necessary. Where a glitch appears and a case is found where the staff are not able to turn up for a whole pile of reasons, and whether or not the patient's condition and how to respond to it have changed, there needs to be a central location like a nursing home that can provide an emergency response in the event of it being required and at the same time can take the patient into the institution concerned for short-term respite, a few days, a week or whatever the case may be, in order to get over the difficulty that has presented. It will work better that way and there will be a better return for its money from the State's point of view. It will be better for the running and the quality of the service from the State's point of view and the patient's point of view. There will be a wider knowledge among a wider group of people as to what is required in any particular area.

I have always believed that 50 patients can be dealt with much more effectively and efficiently in a residential situation than 50 patients spread across the country in an urban or a rural setting. Particularly in an urban setting in today's world, the provider of the service can spend an awful lot of time in a traffic jam, at traffic lights or at a multiplicity of traffic jams and traffic lights because the country is busy, and that is a good thing. However, we have to plan for it as we find it. This means that we must take into account the number of cases the individual or the individuals have to deal with, the number of individuals who have to deal with it and the quality of the service without in any way diminishing the quality of the service or creating a problem for the person for whom the service has been provided. We must also look at it from the point of view of the ability of the service provider to attend to the totality of someone's requirements on an ongoing basis. People will ask for a guarantee. If we can give the guarantee, by all means let us do it. We should do it. However, it has to be done on the basis of a precise identification of the costs and a meeting of the costs, a precise identification of the number of people required in order to pick up the high-quality service and a precise knowledge that this can be a replacement for the old nursing home care service, which is expensive insofar as the patient is concerned in most cases and unwieldy.

Many people have difficulty getting involved in the service, even though it is subsidised and so on. It is hard to iron out the details and hard to iron out the crinkles in the details and, as a result, there may be factors that may delay the conclusion in a particular case to such an extent that it becomes a debt that hangs on like the old death duties we had in this country once upon a time. They were not of any great help to either the State or the people concerned. It was only when they were abolished that that particular burden was taken from over the heads of a great many people, again in both urban and rural Ireland.

This is an important debate. We need to recognise the extent to which people become dependent on the provision of such a service into the future and, as a result of that, the necessity for those of us in this House to be able to say now and insofar as we can ascertain that we have put in place a service that we have quantified in terms of financial and personnel requirements - both are related - and, for the foreseeable future, that we have a system that will work and continues to work and meet the challenges.

I compliment the Minister of State, who is here in the House, on the work she has done in this particular area and on her knowledge of the area, which is obvious in the situations she has met with and continues to meet with all over the country.

Ruairi Ó Murchú (Louth, Sinn Fein)
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No Member will speak in this debate who is not in support of the provision of statutory home care as a right on an equal pegging with the provision of nursing home care. We have all dealt with many families who are seeking to get the right care package in place to ensure their loved one does not have to go into a nursing home any earlier than necessary. We need to ensure that what has been promised in regard to statutory home care provision is put in place as soon as possible.

I take this opportunity to raise once again what happened in Dealgan House, Dundalk, where at least 22 people died at the onset of the Covid pandemic. The families of those who died in that nursing home, along with many other families, are looking for a rights-based inquiry and, as the Minister for Health, Deputy Stephen Donnelly, referred to, a mechanism to provide people with closure and justice. That remains to be done. We need an update on where we are at with a Covid inquiry. We thought there would be something up and running at this point.

In the context of rising levels of Covid infections at this time, it has been brought to my attention that there are cases of nursing home staff stopping relatives from visiting their loved ones. We all understand the need to ensure care and protection are an all-time priority but consideration should be given to something like a care partner scheme to facilitate, in such circumstances, nursing home residents being able to have visits from family members. It should be possible to maintain that connection by ensuring an adequate level of care around the use of personal protective equipment, etc., on a similar level to what is done by staff who work on the premises.

An issue that sometimes arises in acute hospitals is that there is almost a pressure applied to families to put their loved one in a nursing home. It has been mentioned by many other speakers that we need a holistic system that provides an adequate level of home care. There is no one in this Chamber who has not had an issue with adaptation grants, whether it is that they are taking too long to process or the thresholds are too low. We need to be able to deliver for people where there has been a change in their circumstances to enable their loved one to stay in their own home. I have worked with the Minister of State, Deputy Rabbitte, on delivering a solution in this regard. We need a better system that can deliver for people across the board. That is absolutely essential. I do not know how many times we have been waiting on the results of a review or report and have been repeatedly told it is with the Minister and will be published soon. Across the board, we need a holistic approach, with a set of tools we can provide to people. We must look after our citizens, particularly those who have already lived a full life, paid huge levels of tax and played a major role in building the State up to what it is today.

Regarding statutory home care, when we engage with stakeholders, they generally have a fairly good word for the Minister of State, Deputy Butler, regarding her commitment to its delivery. However, they sometimes point out that there needs to be Government follow-through and that we are behind time when it comes to delivery. The question is when we will see the legal entitlement to home care delivered. The other question is how it will be done and the payment model that will be used. We need it to be done as soon as possible, while also dealing with whatever anomalies there are in regard to valuations and so on. We need it to happen as quickly as possible. Promises were made in the past. We thought the scheme was nearly there but it has not happened yet. There is an absolute onus on the Government to make sure it delivers on its commitments. We must ensure we look after people as best we can and, for those people it suits, provide adequate supports to enable them to live in their own home. Those supports are absolutely necessary.

Peter Fitzpatrick (Louth, Independent)
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Ireland has an ageing population. Life expectancy in this country has risen by two years for women and 2.5 years for men since 2008. With an average life expectancy of 84.1 for women and 80.5 for men, Ireland is now above the European average. Central Statistics Office, CSO, projections indicate that by 2030, there will be more than 1 million people aged 65 and over in Ireland. It requires planning and allocation of resources to meet the increased demand for both home-based and nursing home care.

At present, 80% of nursing home beds are in the private and voluntary sectors. Demand for home support continues to increase. According to age and population statistics, we will need an additional 1,500 beds annually for the next ten years. Instead, there has been a loss of 500 beds in the past year alone. The disruption to families and the heartbreak caused to older residents forced to leave the place they call home are immeasurable. Waiting lists for home support have become a feature of the service and are now primarily associated with an increasing capacity issue related to the availability of care staff.

The difficulty in accessing home support for older people is, after housing, one of the biggest issues raised by people in my constituency office every week. In County Louth, there are significant difficulties getting full home care packages for those who need them. They may get partial packages. People I have spoken to in CHO 8 say it is difficult to get home care assistants to travel to north Louth. The eircode lottery not only affects initial home care waiting lists but also how many hours of care are delivered to a client. As a rule of thumb, areas in Dublin have shorter waiting lists than rural areas, and areas with a high proportion of directly delivered HSE care have longer waiting lists than areas with greater involvement of the independent sector.

A significant issue at present is that smaller nursing homes located in rural Ireland face closure as the fair deal subsidy is failing to match rising costs. Each individual nursing home must negotiate its own fair deal arrangements. Currently, public nursing homes run and staffed by the HSE receive 62% more per person per week than is given to private nursing homes. Some public nursing homes receive substantially more under the fair deal scheme, even though the public home may have fewer services for those living there.

Ireland lacks an equivalent statutory scheme for the home care sector. While the programme for Government commits to introduce a statutory scheme to support people to live in their own homes, there has been little to no headway in delivering it. The statutory home support scheme, which aims to introduce a regulated home support service with a new model of funding and service delivery for adults over the age of 18, has been in development since 2018. The delivery of the scheme is pivotal to the growth and sustainability of the home care sector. Delays are preventing strategic planning. In June 2020, the then departing Minister for Health and current Taoiseach told the Dáil the scheme was nearly ready. In December 2020, the Minister of State, Deputy Butler, targeted quarter 1 of 2021 for the introduction of legislation and 2022 for the implementation of the scheme. Legislation to regulate home support providers has yet to be published and other aspects of the scheme have also been delayed or are stalled. Putting the scheme in place requires regulation, funding and reform of service delivery.

It is hoped to ultimately integrate the home care system with the nursing home care system in order that individuals can transition from home care to nursing home care much more easily, if the need arises. Referring to a potential funding model, the Minister suggested at the Home and Community Care Ireland conference in October 2023 that co-payments would be necessary. Others favour a social insurance model similar to that used by several of our European peers. Implementing the scheme raises challenging political questions. It will require significant political capital, as well as human resources, to drive through its implementation. The marginal increases in funding in the past two budgets are concerning. By the HSE's own admission, demand for home support increases by 4% each year. By that reasoning, anything less than a 4% increase in funding represents a cut to home support in real terms. That is evidenced in the HSE's national service plan for 2024, which shows a cut in the number of clients and targeted hours of home support delivery compared with 2023. Funding will likely be the most contentious issue but setting out a clear funding model is critical for the future sustainability of the sector.

A statutory home care scheme is a vital development for the future of care for older people and adults with disabilities. The current misalignment in funding between disability and older person services is creating a two-tiered home care sector that risks seeing disability home support provision being left behind.

Repeated delays to the scheme do a disservice to clients, home care workers and providers and have added instability and uncertainty to the sector. Furthermore, other reforms are dependent on the development of this scheme and the home care sector remains hamstrung until it is placed on a statutory footing.

The Sláintecare report recognises that, in the absence of an entitlement to home care services, many people pay out of pocket for private home care services, and that this should be addressed by ending the over-reliance on market mechanisms to deliver new health care services with the expansion of public nursing homes and home care. Yet the home care Bill 2024 relates entirely to the regulation of providers of home care services, which of course is required, but it does not address access to services or affordability. The Department of Health's home support reform team should be equipped with more resources so that the five different work streams of this scheme can be developed in parallel, instead of in tandem, one at a time.

Rather than restoring balance within a truly public health system that is universally accessible and free at the point of use, this Bill would actually reinforce privatisation by structuring the home care regulatory framework around the private market. The expectation within the sector was an improved version of the nursing home support scheme that delivered equitable access to home care. The reality is that seven years later we have produced a licensing scheme.

Access, staff recruitment and retention do, however, remain an ongoing problem not only in the home care sector, but across the health system as a whole. To get a sense of the scale of recruitment that Ireland needs, the European Centre for the Development of Vocational Training forecasts there will be an additional 119,000 personal care worker job openings in Ireland in 2030 compared to 2018. The goal in all of this is to streamline the process for the individual and their families and to ensure continuity of care. Yet, on any given day, approximately 100 people - plus or minus 25 - experience delayed transfer of care due to the unavailability of a home care worker to deliver a home care package. While the well-documented recruitment crisis contributes to this issue, the method of commissioning home care exacerbates it. When a patient is deemed fit for discharge, the hospital discharge team must wait and hope that one of the home care providers has a worker available to support the patient’s transition from the hospital. This approach highlights a strategic failure in hospital discharge planning. Considering the cost of keeping a patient in the hospital, which is €7,203 per week, the risk of hospital-acquired illnesses, and the impact on accident and emergency department overcrowding, it is crucial to view home care providers as partners in the discharge process and to provide them with the frameworks necessary for strategic discharge planning.

While the Government deserves credit for substantially increasing home support funding and establishing the Commission on Care for Older People, reform is essential if Ireland is to develop an aged care sector suitable to meet our changing demographics. Home care in Ireland has evolved without being supported by a comprehensive strategy for home care for older persons. Similarly, the Government’s commitment to a home first model of care lacks strategic backing. The commission requires sufficient resources to complete its work on schedule. In order to implement these reforms and to create effective home care policies, we need a data-driven strategic approach to develop solutions that could modernise the sector. Wholesale reforms are also needed in home care workers’ pay, benefits, training and career progression among other things. As demand for home care is set to grow substantially over the next number of years, it is essential that we put in place the appropriate systems for home care. The present system is letting down both the patient and the carer. We should strive towards a sector that has equal access to care and where waiting lists are kept to a minimum.

Richard Bruton (Dublin Bay North, Fine Gael)
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I welcome this debate and the work the Minister of State, Deputy Butler, is doing in this area. In my view longer lives is one of the greatest achievements of humanity but sadly it is too often portrayed as a period of decline or even of burden. We need to see this issue through a different lens. While I welcome the Commission on Care for Older People, I would have to say that again its emphasis on caring and the suggestion of decline is the wrong emphasis for our society at the moment. We need to look at ageing as a huge opportunity that we have not sufficiently developed. It is about the opportunities and of course there are some challenges with it too.

We have done a lot of work on this through the Fine Gael policy lab, of which I am vice chairman. About 500 people were involved in the survey and we held nine workshops looking at the types of challenge. What came out really strongly is that there is a virtual circle that we should be trying to promote, which is staying healthy, staying active, and staying connected. This promotes the individual's well-being and it minimises avoidable illnesses, which are the cause of a lot of the issues we are discussing. It reduces the frequency of treatment but more importantly it reduces the dependency of people during periods of treatment, which is where the huge health costs are incurred. We have not sufficiently looked back up the path to develop the sort of policies that are needed. I believe very strongly that we need a whole-of-government approach to this. This is not in any way to undermine the work the current Minister of State is doing but the reality is that most people reach retirement without the proper preparation. We have not developed the opportunities in the community that we need. There is not a fit between existing State supports and what would make family caring more accessible and deliverable. We have huge gaps in the sort of accommodation people need. There is very little between being in one's own home with no supports and being in a nursing home. This has been traced by numerous policy issues. We do not have sufficient emphasis in the health service on prevention and management of chronic conditions. We also have this issue we are discussing today around home care.

When we try to look at this issue of longer lives through a different lens it is remarkable what we find. The quality of life peaks at the age of 68 and it is not until people reach their 80s that they are back to a quality of life measure similar to in their 50s. This is a period of huge opportunity and well-being if it is managed right. It has been found that 50% of people would like to work beyond their contracted retirement age. This applies to more women than men. The rigidity of the retirement age is a huge obstacle to what we need to do. Other figures show that 40% of older people report isolation and 84% of men and 69% of women report no supportive friendships. These would be the sort of friendships that would help people cope with the challenges that come in their lives. With health, 40% of treatable conditions go undiagnosed so people build up complex health issues later down the track, which are then much more difficult to manage. Under claiming and the uneven distribution of the benefits that we do offer is rampant. There is an unspoken assumption in a lot of the policies that have been unwittingly developed that there is some female member of the family available to provide care. This simply does not fit in with the changing structures of family life.

We need to rethink this in many ways. The organisations that work with care people did a take stock, of which I am sure the Minister of State is aware. Across 15 pillars on which they measured progress, in ten of those areas Ireland ranked at D or less, which meant little or no positive impact. This is just the reality of the challenges we face. I believe a lot of it is because our silos have been too rigid and we have not adapted them to the changing nature of lives. When we talk to people their greatest fear is losing independence. That is the greatest fear people have when they are thinking about their future. The Minister of State may be aware that back in 2019 very good collaborative work was done between the Department of Health and the Department of housing. It came up with the idea that there are eight stages of assisted care between living in one's own home and living in a nursing home. These are various levels of support and assistance. There is a massive gulf in Ireland between level one and level eight.

At that time there was the hope that we could start to build it. To be honest, it got derailed by Covid and by other things. There was a great deal of insight in that report that we must go back to and seek to develop. We make it extremely difficult for people to rightsize. We do not offer the options. There are all sorts of hand trips in access to medical cards and means tests if people do decide to downsize. We are one of the countries that has the highest level of over-accommodation, especially for people over 65 and beyond. We typically live in larger homes than we need, which are often ill-equipped to changing needs. We have not developed the opportunities to change that and to allow people to shift to more appropriate settings.

I welcome in particular one initiative the Minister of State has introduced, namely, enhanced community care. That is a significant shift in the thinking of the Department and the HSE. The hope is there will be 96 of those networks, serving populations of 50,000. That offers the promise of progress but we must see more tangible indications of how this is impacting on people. I struggle to find indicators of how this is rolling out. The experience we had through the work we did was that there simply is not the flexibility on the ground for families trying to support someone with challenges or to respond to a sudden change in circumstances. The carer's allowance and benefit have a rigid number of hours a person must be working or not working. That makes it harder to have the sort of flexibility needed for families who are trying to support care to access those funds. We do not have anything like the domiciliary care allowance, for example, or the incapacitated child tax credit that are given to parents struggling with the challenges of children with special needs. We do not have the same sort of supports for families trying to cope with the challenges of an adult with needs. We must rethink some of those supports in order that they can become more compatible with families being involved, as well the proposals we are discussing here for the development of a statutory home care scheme.

I note the Minister of State has expressed some misgivings as to how easy this is going to be to deliver and whether we would dramatically improve the situation. We must take seriously the misgivings she expresses because she is working at the coalface. I do not balk at the idea of a small charge, a bit like the fair deal, but the reality, according to the ESRI's calculations, is that we would have to have 24 million more hours. The Minister of State has done extraordinarily well to build on the 10 million hours we had in 2012. We now have 22 million hours, which is an extraordinary achievement but it will be a challenge to provide another 24 million.

What we need to do is think more flexibly about reforms that would make a difference in the short term. I strongly believe there is a place for local care partnerships where people who are involved in care could register, access information, supports and flexibility, and where volunteers could provide additional support. That is a way people could be supported without dramatically increasing the obligations and, at the same time, the Minister of State can focus on long-term development.

We should force health insurers and pharmacies into being more active in supporting care in a preventative context. We must have much more screening for those conditions that are undetected. We must also introduce a dignity in care mark for all health settings. Sometimes it is inexcusable the conditions that people face when they are in an emergency situation and they go into certain settings. That is not hugely expensive to change.

The Minister of State should also seriously look at a home care development agency, not unlike what the Minister for Children, Equality, Disability, Integration and Youth is doing in regard to a child care development agency. This is a sector that must be developed in a coherent way. At the moment we rely on private sector initiatives to come forward and develop ideas and they get access to contracts. I acknowledge the progress the Minister of State has made in those contracts.

I have spent a lot of time working in the enterprise sector, where we have a myriad of agencies helping companies doing far less important work than caring for people in difficult years. We have lots of agencies offering both technical support and expertise. We must think in those terms. Again, it is something that would move on a phased basis towards the sort of objectives the Minister of State set for herself.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank Deputy Bruton for an insightful and profound contribution.

Michael Collins (Cork South West, Independent)
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The programme for Government has pledged to introduce a statutory scheme to support people to live in their own homes, providing equitable access to high-quality, regulated home care. This commitment is crucial, especially for our elderly population who often prefer to age in the comfort of their own homes. The Department of Health is responsible for developing the regulatory framework for home support service providers. Its goal is to ensure that all service users receive regulated care. The Department is currently working across four broad areas to fulfil this commitment: the regulation of home support providers; collaboration with the HSE to develop a reformed model of service delivery for home support; and the implementation of the recommendations of the strategic workforce advisory group. However, the Minister for Health's recent home care Bill, the Health Bill 2024, has been met with frustration and disappointment. The Bill focuses solely on the regulation of home care service providers and fails to address access to services or affordability. This falls significantly short of the promises made in Sláintecare and the expectations set in the programme for Government. The programme for Government had promised a statutory home care scheme as part of the Government's commitment to fair and affordable healthcare. This promise was made alongside pledges to introduce GP cards,to remove inpatient charges, and to reduce medicine costs. It was universally accepted in the Sláintecare report that a statutory entitlement to home care and community care, equivalent to the fair deal scheme for nursing home care, is necessary. Yet, seven years later, all the Government has managed to produce is a limited and underwhelming licensing scheme. This Bill has become entirely about regulating a market of providers, instead of providing a statutory right of access. The expectation was an improved version of the nursing home support scheme that would deliver equitable access to home care. This is widely recognised as essential to reducing pressure on hospitals.

The Sláintecare report also recognises that, in the absence of an entitlement to home care services, many people pay out of their own pocket for private home care services. This should be addressed by ending the overreliance on market mechanisms to deliver new healthcare services by the expansion of public nursing homes and home care. However, the Health Bill 2024 does the opposite, by designing the home care regulatory system around the private market, further embedding privatisation, instead of resetting the balance within a genuinely public health system with universal access that is free at the point of access.

This Government has failed to deliver meaningful home care reform, to reduce hospital waiting lists, to expand medical card eligibility, or to deliver an entitlement-based system of care. Fianna Fáil, Fine Gael and the Greens have turned their backs on the core community and home care reforms that underpin Sláintecare - if they ever believed in them in the first place. For example, in 2022 alone, nearly 3 million hours of home care promised by the HSE could not be provided, mainly due to a shortage of staff. This is a recurring theme where the HSE sets a target and then fails to meet it. In 2022, the target was for 23.67 million hours of home care but only 20.79 million hours were provided, despite more than 6,000 people being on waiting lists. The Cork and Kerry area lost out on 744,797 hours, followed by the south and south-western area of Dublin, as well as parts of Kildare and Wicklow. Approximately 6,500 mostly older people are on waiting lists, more than half of whom are seeking the service for the first time, with others in need of additional support.

In Cork alone, more than 700 people are on the list. This situation highlights the urgent need for reform in the provision of home care services. The State's approach is failing to meet the needs of our elderly population, who deserve to receive care in their own homes. It is time for the Government to deliver on its promises and to ensure all citizens have access to the care they need.

Care comes in many ways when people are ill. I would like to mention the critical issue of the pending funding for Cancer Connect in County Cork. This esteemed organisation has been instrumental in providing daily transfer for individuals undergoing chemotherapy or radiotherapy across Cork county. In a single month of 2024, Cancer Connect facilitated more than 730 journeys, underscoring the vital nature of its services. The operational funds for Cancer Connect have been predominantly sourced through local fundraising efforts. However, this method of financing is not viable in the long term and State support is imperative for the continuation of this incredible service.

Approximately two years ago, the chairman and manager of Cancer Connect met with the Tánaiste, who was then the Taoiseach, in Cork to discuss the necessity for substantial State funding. Specifically, an annual contribution of €100,000 was mentioned. A commitment to this effect was also made in the Dáil. Regrettably, as of 18 June this year, Cancer Connect had yet to receive any portion of the promised funding, despite numerous public assurances by Government officials. I urge the Minister of State to provide clarity - if she cannot, she might pass it on to the Minister who can - on when Cancer Connect can expect to receive the pledged financial support, ensuring the sustainability of its essential services. I have contacted the Minister's office many times in relation to this, and am still awaiting clarity. The funny thing is it was openly publicised by a TD over a year and a half ago in west Cork that the money was there. It was announced it would get it. Imagine, the care people needed, they had to get it from their own families.

When Cancer Connect was set up, I was involved initially. It probably never expected to expand as it has. It has expanded and other countries are trying to copy the service. People are picked up from the door. For some people, it is a one-to-one service. More can be picked up by bus, taken up for chemotherapy, all organised in CUH, and brought back down again within a few hours. The service cannot continue without funding. It has been promised funding. Why has it not been given the funding? It is slightly different from the issue at hand, but it is all to do with health. I would appreciate if the Minister of State or someone could intervene and give Cancer Connect what it deserves. It cannot continue on voluntary contributions from the people of Cork county or west Cork. It has to get State aid and €100,000 is not a lot to ask for after having been in operation for ten years, if not more.

Thomas Pringle (Donegal, Independent)
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It is shocking there is no statutory entitlement to formal home care in Ireland or even a regulatory framework for home care services. Despite the Government committing in the 2020 programme for Government and Sláintecare to introducing a statutory home care scheme, it has yet to do so. Although this is incredibly disappointing, it is hardly surprising. Given we are coming to the end of the Government's term, it seems unlikely such a scheme will be introduced now. It is yet another promise broken by the Government and would make you wonder how serious the intentions of the three Government parties were in delivering commitments made at election time. The 2020 programme for Government is nothing but a list of undelivered promises at this stage, many of which the Government has completely ignored or actively U-turned on over the past four years. Unfortunately, statutory home care is one of the many forgotten promises and there are considerable deficiencies in home support availability, as well as a major shortage of care workers.

The majority of care provided in the home is undertaken informally by family members and others. In Donegal alone, there are almost 10,700 unpaid carers, which is 6% of the country's population, compared to 5% in 2015. Like the rest of the country, females in the county are more likely to be carers than males, with 60% of all carers female. As it stands, 8% of females in Donegal are carers and 5% of males. There are 139 carers under 15 years of age providing regular unpaid care in Donegal. The period between 2015 and 2022 saw some notable increases in the hours of unpaid care provided. The number of carers in Donegal providing 43 or more hours of care per week almost doubled from 1,688 in 2016 to 3,324 in 2022. This number has more than doubled nationally. Almost two thirds of carers were aged between 40 and 64 years and 15% were 65 years or over. It is clear there is a significant and persistent imbalance between men and women when it comes to unpaid work and caring.

Many are expected to do this without outside support and unmet demand for home support is at an all-time high. Last August, nearly 6,000 people were on HSE waiting lists for new or additional home support and a further increase is anticipated due to Ireland's ageing population. According to a report by the ESRI, the country's population will grow by between 14% and 23% between 2015 and 2030. People aged 65 years and over will increase from one eighth of the population to one sixth in that period. The number aged 85 and over will almost double. This means ageing carers as well. Our reliance on family carers is unsustainable. They require much more support and recognition than they are given.

I was encouraged to hear the Minister of State say the care offered by the HSE is free to anyone assessed as needing it and that she is yet to be convinced as to why we would want to change this. I am happy to hear this but we need to focus on the issues that persist. We should have home support services that enable older people and others to continue living in their homes and support informal carers as well. Nursing homes are full of people who would be able to live in the community with proper support, which would be much cheaper to deliver and better for them and their quality of life. Everyone deserves to live a life of dignity. We should support people to live at home in the communities by providing proper home care free at the point of delivery so everyone can avail of a proper and better home service.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I thank the Ceann Comhairle for facilitating me coming in having missed my earlier speaking time. I welcome the Minister of State coming in and making a statement on this critical issue. I acknowledge the work she has done since her appointment. We have seen a significant increase in the annual funding for older people to €2.6 billion this year, and €730 million per annum is being spent on home care. That is money well spent.

The majority of our senior citizens want to remain in their own homes. I urge the Minister of State to move at pace to bring about a model similar to the fair deal model that will enable people to get additional hours in their home. I speak from the experience of working with a family member currently looking for home help. Even the maximum number of hours pales into insignificance in terms of the level of care some people need.

Will the Minister of State ensure people who need home help hours get them? A big thing I notice in my constituency is people being approved home help hours and not having the people to fill those hours. On entering government, we made a commitment to reverse the dependency on private home care and to go back to hiring people directly by the HSE as home care providers. That is not happening. There is an overdependency on private providers and they tend not to want to do night-time or weekend care. Before bringing in any statutory package, the Minister of State needs to look at ensuring people who can stay in their homes with a certain number of home help hours, get those hours. I was dealing with a constituent from Moate last week. Her 93-year-old mother was approved five home help hours per week but cannot get the staff to do them. This is a big issue the Minister of State needs to tackle.

While speaking of statutory care, I want to take the opportunity to reference fair deal and the number of people unaware of the fair deal option. I am dealing with a family whose wife was in long-term nursing home care for sixteen months. She was entitled to fair deal but not encouraged to avail of it. Processing times are too long.

There are people who go into a hospital and have to be discharged directly into a nursing home. In certain instances, the costs in that period between discharge until the fair deal scheme is processed have to be paid from the family's own resources. The Minister of State is shaking her head but it happens in certain instances; I am dealing with it. To be fair, there are officials in her Department helping me overcome that. There are transitional schemes but not everyone is availing of or qualifies for them. There are families paying dearly as they wait for their fair deal application to be processed. I am highlighting to the Minister of State that flexibility needs to be shown in cases like this.

One of the saddest things I experienced when canvassing in the local elections was calling to houses in which people were living on their own. These are people who may not see others for days on end. They were unaware of services like a day care centre. I ask the Minister of State to write to each and every day care centre asking that it reach out to people in its community to make sure they are aware of this service. I raised a case previously in my constituency of a number of senior citizens in a village who were unaware of the local day care centre. I was told they had never applied, but they did not apply because they did not know. From the HSE's perspective, whose responsibility is it to ensure people, particularly those living on their own, are offered day care for a minimum of day per week, where they can come in, meet people and socialise? If the Minister of State takes anything from my contribution, I ask that it be this.

Mary Butler (Waterford, Fianna Fail)
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I acknowledge the input of all Deputies today. I thank all those who stayed to speak on a Thursday afternoon. We know the numbers are always a bit less on a Thursday afternoon but many Deputies contributed, which is very welcome.

The thrust of the conversation concerns older people, statutory home care and the provision of home care. I will not use the full time allocated but I will say a couple of things. As Minister of State with responsibility for older people, I am extremely proud that, in 2019, before I was in this role, Ireland became the first country in the world, to receive age-friendly status. That was achieved through the hard work of various organisations and the HSE.

When we speak of Ireland and our older people, it is important to mention that we have the highest life expectancy in the EU 27, as determined by the World Health Organization. These are not my words but those of the World Health Organization. Last Friday, I was in Luxembourg for a meeting with the Ministers of Health of the EU 27. Many of the challenges we have with staff and waiting lists affect the whole of Europe. There is a real shortage of nurses and health and social care workers. Every single Minister I met said this was an area in which they are really challenged.

Before I address the matters raised, I will acknowledge the outstanding efforts of front-line carers and all those who work right across our health and social services. They work extremely hard seven days per week, including bank holidays. They work split shifts where they work mornings and evenings. That must be acknowledged.

We hear some people say that not everyone is encouraged to go into providing home care supports and services. Home care supports and services must be regulated. The point has been made that the delivery of regulated home care is not the same as the delivery of a statutory scheme. I agree it is not and there is no ambiguity in that regard. However, we cannot have a statutory scheme without a regulated system of care. The home supports sector has never been subjected to any kind of scheme, with the oversight or regulation we are looking at now. Unlike with residential care, we do not currently have any oversight of or insight into a significant proportion of privately commissioned services. Similar to HIQA regulations, it is important we do not compromise on regulations. This legislation is extremely important.

In the context of statutory home care, I will repeat a little of what I said earlier because it is important. I want to see a statutory scheme. For some, a statutory scheme is a right to care. For others, it is about having a financial support scheme, ensuring everyone gets the same amount of care, giving more care to those who need it most or enhancing the statutory framework. It is important to note, as many speakers acknowledged, that since I took up this role four years ago, an additional 4 million hours of home care have been delivered. As I stand here, 560,000 people in the country are receiving home care. Some will receive that care this evening while others received it this morning. Some will receive care three times per day. A total of 70,000 people received home care last year. It supports people to live in their own home with the correct wrap-around supports. I acknowledge there are people waiting on supports. It is not a funding issue but rather a matter of providing enough staff. I welcome the 917 people outside the EU who availed of permits last year and this year to come here to provide home care. It is important we acknowledge that. We have had debates about people from other countries coming into Ireland. These people are coming here with permits and earning set money delivering home care, which is really important. We were able to deliver more home care last year because we had more people to deliver it.

Currently, the budget for home care is €730 million, which will provide approximately 22 million hours this year. For the approximately 70,000 people who will receive home care this year, I have done a huge amount of work on the issue of a statutory scheme and have given it an awful lot of thought, with my team. I am not minded to charge people for home care. When we introduce a statutory scheme, we will have to work out how that is possible. For example, if we introduce a scheme similar to the fair deal scheme for statutory home care, it will mean people will have to contribute. Families with a loved one in a nursing home pay on average between €300 and €400 per week on top of the supports they get from the State. We also would need an enormous number of additional staff to deliver home care. A statutory scheme can be delivered but we must be able to fund it and must have the staff to deliver it.

As Minister of State with responsibility for older people, I am not minded to charge people for home care. Home care means that you can get care in your home, similar to what we want in Sláintecare, that is, the right care in the right place, as close to home as possible. I will continue to work on this. I will do the regulatory piece first and work out the best scheme possible. The message I want to go out from this House today is that I am completely supportive of statutory home care. People should be able to get home care when they need it but I am not minded to charge them for it.