There are many issues I could raise, such as the national maternity hospital or redress for mother and baby homes, but I wish to raise the inability to recruit and retain staff across the public health service. It is now reaching a crisis point. This is particularly the case in the crucial area of home care services. Despite the increased allocation of hours by the Government, people dependent on the service are actually receiving cuts in their hours due to staff shortages.

I give the example of Kevin, who suffers from multiple sclerosis. Kevin needs help getting into and out of bed and feeding himself. He had carer visits four times a day but, just over a week ago, he was given two days' notice that he would have no more visits due to lack of staff. In his own words, he felt that he was being left to die. The situation changed after he went public, and the hours were reinstated. That is an extreme example of what people are facing, but many people dependent on these hours are losing them due to staff shortages.

When you consider the pay and conditions for home care workers employed by agencies funded by the HSE, it is very easy to see why people are leaving or not taking up these jobs. The norm for agency staff is a minimum wage of €10 per hour with a zero-hours contract, no sick pay or pension, and the constant stress of getting from one client to the next. They have to provide their own transport and do not get any allowance for doing so. A carer in Dublin, for example, might have two to three clients in an hour. If carers use their own car, they have the problems of traffic and parking fees. Many of them use buses. The reality of their travel costs means that they actually earn below the minimum wage. In rural areas, they are being forced to speed and take risks on country lanes.

The HSE pays these agencies €30 per hour per client. If a carer sees two to three clients in that hour, that is €60 to €90 for the agency and €10 for the carer. Why does the HSE not directly employ these workers? It used to do so until the decision nearly to privatise these services. It should directly employ these workers on a decent wage with a travel allowance, sick pay, a pension etc. These workers provide a crucial health service for which they need certain qualifications. They are not just being overlooked; they are being undervalued. They are being abused and treated like dirt and certainly not treated like the heroes they are. They were the ones on the front line who went door to door and client to client and lost money during the height of the pandemic because families were afraid they could bring the infection into their homes.

First, there has been a dramatic expansion of resources for home care hours. I think the Deputy would have to acknowledge that. There were 5 million hours last year in respect of-----

It is not having any impact.

It had a huge impact last year in terms of reducing the number of people waiting for home care packages. There is a critical skills and ineligible occupations list review of sectors of the economy that we need to liberalise in terms of getting work permits and so on. The review has not so far recommended the removal of the occupation of care workers or home carers from the ineligible occupations list. The issue is that we have to work with those who are providing these services in terms of the conditions and improve them. The big concern at the moment is the issue of securing enough people to work in the service itself.

To be fair, the Minister responsible secured additional resources in the budgets last year and this year. The issue is securing enough people to work in the service. The Minister of State, Deputy Butler, is working now in terms of engaging with the stakeholders involved on all sides and looking at the workforce challenges in terms of home support and nursing homes. It is a critical issue for those who need the care. It is also a critical issue for hospitals in terms of the alleviation of pressure on them and flow through the hospitals. As a result of the additional hours last year, the flow through the hospitals last November and December was very efficient and effective and had a clear impact. The issue is skills shortage.

I am not disagreeing with the Deputy. We do have to look at terms and conditions in respect of home care workers and the Minister is working with a workforce advisory group to engage and deal with those challenges and improve on them because, across the board, caring is an area that does need to be improved and enhanced.

The fact of the matter is that in recent times workers from the private home care sector have been going into the HSE because the jobs are better paid, they are respected more and they get a pension and sick pay etc. In addition, people are not taking up the jobs in the private sector because of the conditions. It is a fundamental issue facing the healthcare service across the board. Last night we discussed the Sinn Féin motion on ambulance services and learned that the annual spend on private ambulance services rose from €2.1 million in 2011 to €10.1 million in 2019. How much are these private companies getting from the State to serve clients and people who need support in their homes? They are getting €30 an hour. The Secretary General of the Department of Health was offered a salary of €400,000 a year, which works out at approximately €200 an hour. That salary was not implemented but I presume the head of the HSE is on something similar. What a contrast that is with the pay of agency workers on a minimum wage, doing the work they are doing, having to travel in the way they must travel and paying for parking and petrol or bus fares. Will the Taoiseach move to employ these people directly in the HSE?

First, 75% of those working in the home care support sector are working part time. As I stated, last year the Minister secured additional funding of €150 million for home support and the HSE national service plan sets a target to provide 24 million hours of home support.

Would it not be better to employ them through the HSE?

That is throughout 2022. At the end of September, some 15 million home support hours had been provided to more than 53,000 people. There is an enormous programme in place that is being resourced by the Government through the HSE and it has grown significantly beyond previous years. However, that, in turn, has created pressures in terms of availability of people to provide the home supports. For the moment, in terms of employment permits and so on, home care does not satisfy the conditions and the groups reviewing this believe we should first look at terms and conditions as they apply to home care workers and that is what we are doing to see if we can improve those terms and conditions to improve recruitment domestically.

How can that be done when these workers are being paid by the private sector?