Cuirim fáilte roimh an Aire Stáit, an Teachta O'Donnell.

If it is in order, can I say a few words at the start?

Yes.

I thank the Acting Chair and the House for their time today to discuss this Bill. We had a constructive discussion in the Seanad on Second Stage. This Bill is an amendment to the Health Act 2007. As I said previously, for the first time, the Bill will introduce regulation of home support providers, who will be regulated by HIQA and the chief inspector. The Bill will give the chief inspector a range of powers and will make it an offence to provide a home support service without being registered. The chief inspector will be responsible for monitoring and assessing compliance of registered home support providers. The new system of regulation for home support will ensure the public can be confident that the services provided are of a high standard and will bring Ireland in line with best international practice.

The Bill was published in December of last year and passed by the Dáil on 20 May. It went through Second Stage in the Seanad on 16 June. I thank all the Seanadóirí for the constructive debate on the Bill on Second Stage. The context is that, as well as regulating home support providers for the first time, the Bill is a key, integral first step in the development of a statutory home care scheme that has been provided for in the programme for Government. I look forward to a constructive debate with Members on the proposed amendments to the Bill and am looking to progress the legislation.

I thank the Acting Chair for his indulgence. I am here with officials. I acknowledge the great work they have done. It is an indication of the seriousness with which we take this legislation and how important it is.

I move amendment No. 1:

In page 5, between lines 22 and 23, to insert the following:

“Report to Houses of Oireachtas

3.The Minister shall, within 12 months of the commencement of this Act, report to the Houses of the Oireachtas on creating a framework for child and adult safeguarding in the health and social care sector in the context of this Act, to expand and strengthen safeguards for children and adults to prevent the risk of abuse and harm.”.

I thank the Minister of State and his officials for coming to the House.

It was proposed on the Order of Business that we would conclude the debate on this legislation today. That is the political reality we live in. There is an urgency on the part of the Government to get through its programme and it commitments in legislation. There were no objections to the Order of Business, and, therefore, we have to work on the basis that we will conclude the debate on the legislation this evening.

The amendment states:

The Minister shall, within 12 months of the commencement of this Act, report to the Houses of the Oireachtas on creating a framework for child and adult safeguarding in the health and social care sector in the context of this Act, to expand and strengthen safeguards for children and adults to prevent the risk of abuse and harm.

We do not need to look back at history to know about the abuse of children or adults. We know that it went on in institutions, in State care, in private care and in private homes. There is not a day when we do not pick up a newspaper and read about the tragedy of the violation of people, be they children or adults, in placed in which they expected to feel safe. People expect to feel safe in their home. They have a legitimate expectation of trust and care that they will be safe from harm and abuse, but, sadly, that is not the case. I always bring that thought to legislation. It is something I am hugely committed to. I have personal experience of this matter. One thing about this Parliament is that we see things from where we stand and from the experiences we have had, and we bring that to the table. We all have different experiences. We are exposed to different sets of circumstances. Fr most of us, our experience of life prompts us to move on in politics.

I am conscious that this will be my only opportunity to speak on the amendment. As a result, I will outline some of the reasons for tabling it. Elder abuse remains widely under-recognised and under-reported. It takes place in many homes and in many forms. Many of us will have heard complaints about hospitals and nursing homes, but, as I said, abuse can take place in private homes. There are many forms of abuse, be it physical, emotional or sexual abuse or coercive control. Safeguarding begins by noticing and listening, particularly to older people, and responding when something does not seem quite right. We are familiar with a certain feeling we get about things. Sometimes we might not be able to put it into words, but people get feelings about things. When that happens, they need to be checked out. Older adults in particular must be supported and cared for in a way that respects their preferences, independence and dignity. It is essential that the new regulatory framework be put in place - I will talk about that in a moment - in order to protect both home care providers and service users. Everyone involved when it comes to a care package needs to be protected. That is really important. We have an opportunity and an obligation to create a system that prioritises dignity, flexibility, service user and client choice and personal safety.

The statutory home support scheme committed to by successive Governments is clearly still an objective in respect of which we will all try to work collectively. I know it is not possible at this juncture to roll out the complete suite of what the Government anticipated, but I am glad to see that this is still an ambition of the Government. I acknowledge that. We know that most people want to stay in their homes. Where they do, we need to support them. Central to the legislation must be the service user. I looked at the Minister of State’s significant contribution on Committee Stage in the Dáil. One of the key things he kept emphasising is that, at the end of the day, it is about the service users and their priorities. I acknowledge the significant contribution the Minister of State made in the Lower House.

Critical to the success of the legislation will be building on home support packages. That is critically important. However, they must be packages that empower clients to choose their providers, agree flexible visiting times, improve alignment between needs and skills and make for better use of capacity. Maintaining personal autonomy is really important as one advances in years. Waiting lists for home care services have surged. I do not need to lecture the Minister of State about that. We are all aware of it. Data released by the HSE shows that the number of people on waiting lists for home care for the first three months of 2026 stood at over 5,300. The HSE’s head of service for older people, access and integration said that nobody is waiting for funding to be allocated for home support, but the problem is that they are waiting for carers to be assigned due to shortages. That is the key point. It is not the money – that is in place, according to the HSE – it is the staff shortages. There are a number of reasons for this, including costs, training and the fact that it can be more expensive for people who are carers to live in cities. There are a range of complexities involved. The Minister of State has been looking at the recommendations of the strategic workforce advisory group, SWAG. That work is progressing, so I will not go into any more detail on it. The shortage of carers is presenting problems for many hospital patients who are unable to be discharged because they are waiting for carers to be found for them. That is not satisfactory when people are looking for acute beds. There are people in acute beds who want home care support but cannot get it. That is a challenge. The shortage of home care support is particularly challenging in rural areas. The Minister of State will know this as someone who represents an area that is split between urban and rural. It is totally unacceptable that people around the country who have been approved for home care packages are left languishing on waiting lists for months. Time, sadly, is not always on their side.

I cannot stress enough the importance of day care services. Senators on all sides have spoken about the importance of such services for the elderly. They allow many to live independently in their homes while receiving interventions, health monitoring, social engagement and interaction and nutritious meals. These are all very important for elderly people, particularly those who may live in isolated areas. The benefits are enormous, even if it is only two or three days a week.

Day centres are particularly important in rural areas. They provide crucial respite for families and care givers, preventing other issues and challenges. Day care services and home help can work hand in hand to allow one to age with dignity and respect, but, more importantly, on the basis of choice.

I acknowledge the significant work of the family carers across Ireland. When I reached out to them the week before last, I contacted Richie Molloy, a former independent councillor who is a strong advocate and who works for Family Carers Ireland. He told me about the number of carers who are in financial hardship, social isolation and poor health and who are having to shoulder the ever-increasing responsibilities with insufficient State support. That is according to the Family Carers Ireland report, The State of Caring 2026, which was published recently. That report paints a stark picture of life for thousands of people who are providing unpaid care for loved ones with disabilities, chronic illnesses and complex needs.

Why am I asking for the Oireachtas to create a framework for child and adult safeguarding? I am aware that progress has been made around children, but we need to make progress in respect of adults. There was something I picked up from the Minister of State’s previous engagement. He rightly pointed out there is an overlap between the Department with responsibility for children, youth and disabilities, under the Minister, Deputy Foley, and the Department of Health. What is appropriate for one must be appropriate for the other. When all that will happen and will be knitted together is another day’s work.

It is important that I make that point.

There is a lack of appropriate action. We need to develop this. Elder abuse overlaps other abuses, particularly with societal groups such as people with disabilities or people who do not have full decision-making capacity. "Capacity" is another very important word in this space. Do people have the capacity to advocate for themselves? Who is advocating for them? Do those advocates have a conflict of interest in their advocacy roles? Are there conflicts within families in respect of what the priorities are? Where does this leave the client? The service users are central to all of this and they need to be protected.

Abuse can be perpetrated by family members or strangers or in relationships where there may be a high expectation of trust. I spoke about that last point as I opened my contribution today. We are all entitled to an expectation of trust and we must be kept safe from harm. When I talk about harm, I am talking about an assault, ill treatment or neglect in the case of an adult or, indeed, a child. Harm to anybody is unacceptable and we must protect them.

We talk about issues like sexual abuse, financial abuse, conduct that causes physical or psychological harm, unlawful conduct that appropriates adversely or that may affect people’s property rights or personal rights, theft, fraud, embezzlement, extortion and conduct that causes people to self-harm. That last one is alarming and occurs when people feel that they have nowhere to turn and then inflict self-harm on themselves. Harm arises from any action, whether by a deliberate act or an act of omission, that may cause impairment that is physical, intellectual or emotional or impacts mental health and well-being.

What does all of that mean? In this amendment, I have asked and simply sought:

The Minister shall, within 12 months of the commencement of this Act, report to the Houses of the Oireachtas [only to report to the Houses of the Oireachtas, and not today, but in 12 months] on creating a framework for child and adult safeguarding in the health and social care sector in the context of this [Bill], to expand and strengthen safeguards for children and adults to prevent the risk of abuse and harm.

This Bill is one of many that present us with an opportunity to be proactive, to advocate and to be vigilant. We have the opportunity. So often, there is a situation where, after the event, we say we got it wrong and then ask what went wrong. We are the Legislature. We are Seanad Éireann, the revising Chamber for legislation. We are not here just to talk for the sake of talking. We are here because we believe in things. Things need to happen and things need to change.

I am not looking for a magic wand. I know the arithmetic of this House. It is all very well to stand up and say that this is the way we should be doing things, but the Minister of State will then read from a script or whatever and say he cannot do it for various reasons. I know the Minister of State has a bank of experts, advisers, policy people, the Attorney General, the Office of the Parliamentary Counsel, policy development officials and all of that. I will tell the Minister of State what I am really asking for. I will first thank him and the House for allowing me the opportunity to focus on these key issues. This amendment has given me that chance. It has put this scenario, which is one of many, on the record of the House.

I simply do not know what the Minister of State's final position will be on this proposal, having listened to the contributions and engagement by me and maybe others. I ask that we be proactive and alert and commit to some form of legislation. I say this because a framework is merely a framework. It is a very loose term, and I chose it because I thought it might be less adversarial and easier to get over the line. I do not think that is going to be the case, however. What I am really suggesting, and I hope the Minister of State will be in a position to say this will be the case, is that we can have a roadmap to strong, robust legislation that protects people in care, be that in their homes or in State or private institutions. We have an obligation to do this, and it is a must.

I thank the Minister of State.

Sula dtabharfaimid seans don Aire Stáit freagra a thabhairt, ba chóir dom a rá go bhfuil curaidh dhomhanda inár measc. Before we go any further, I welcome some distinguished visitors to our Gallery. These are the members of the Cabe Academy of Irish Dance, who are world champions, from Castleknock in County Dublin. I see that they are after bringing in the world championship trophy with them. They are very welcome to the Seanad. Tá fáilte romhaibh ar fad. I call the Minister of State.

I thank the Acting Chair very much. I thank Senator Boyhan for a very comprehensive overview of safeguarding.

I would like to address this matter in the context of the points the Senator raised. There were a number of things. I have a briefing note, which I will go through, but I will give some structure in terms of an outline.

Within the Bill itself, section 21 amends section 101 of the principal Act. I am referring specifically to the insertion of a new section 101(4)(f):

the policies to be maintained by a registered home support provider to ensure the safety and quality of the services provided by the provider, including in relation to safeguarding, medication support, infection prevention and control, risk management and quality assurance ...

This means that there would be a specific requirement under the Act itself, and in the context of this Bill, that home support providers would have to maintain policies on a number of areas, including safeguarding.

The Senator raised two elements in this context: adult safeguarding and safeguarding for children. In terms of adult safeguarding, the Senator will probably be aware that under the Children First Act 2015, safeguarding policies are already in place for children. The relevant agency here is Tusla. In terms of adult safeguarding, the situation that obtained when I came into this role was that there was a commitment in the programme for Government to publish a national policy on adult safeguarding for the health and social care sector. We published that policy last December and the Government approved a policy framework. It is the first of its type in this area. Once again, it is something I worked on intensively with the officials. In addition, the Government has approved the development of legislation to underpin the framework. At the moment, the Department is working on a general scheme of a safeguarding Bill. We hope to bring that to the Cabinet before the end of the year. I think that will dovetail into the Senator’s 12-month period. In the time the Senator is talking about, we expect to publish the general scheme of a Bill on adult safeguarding in the health and social care sector, which will come into line with the existing safeguarding legislation and policy for children as set out in the Children First Act 2015.

The policy framework itself includes legislative and non-legislative commitments that will significantly expand the existing supports and protections for adults at risk of harm across the social care sector. In terms of structures, the HSE will be responsible, but the delivery of adult safeguarding will operate independently of the operational side of the HSE. This is something I am strong on, and we will be incorporating it into the legislation. HIQA will have the remit in terms of independent oversight and monitoring of adult safeguarding. Furthermore, in the context of the home support Bill, there will be equally independent oversight as well. We held a stakeholder forum very recently, on 3 June, to discuss and engage on the implementation of the policy framework. The HSE’s chief social worker is leading the development of the implementation plan, which will come to the Department.

I will go back to the central point the Senator raised, which was elder abuse. Any form of abuse is unacceptable. Elder abuse can happen in any environment. In the policy framework we published last December, we have covered all aspects except for self-harm. That is not included. It is a specific, separate body of work that the HSE is undertaking.

Everything else, including coercion, financial, physical, emotional and sexual abuse, or any other form of abuse, is covered in that space.

I take the Senator's point. I would never put words in his mouth, but the word he was looking for may have been "instinct". If you have an instinct about something happening, you roll with it. If I am correct, that would summarise the position, and I accept that.

On home support hours, I am working with the HSE. We have seen a decrease, albeit not a huge one. The numbers are not going up. It is very simple. We have given additional funding to the HSE to recruit 257 additional home support workers. That is the key to bringing down the home support waiting list. We want to see the HSE recruiting for vacant posts. It is a matter on which I am actively working with the HSE.

The Senator made reference to decision-making. We obviously have the Assisted Decision-Making (Capacity) Act and the decision support services. It is very difficult for older people who may have myriad issues. They have to feel that one thing is safe. That is why we are looking for joined-up thinking. We are bringing through the home support Bill. That is the first step in statutory home care. More particularly, it will regulate the sector. Adult safeguarding legislation is being prepared. That will underpin what is in the framework on adult safeguarding. It will be in line with what is currently there for children, through the Children First Act. We expect that the general scheme of the legislation will go to the Cabinet before the end of the year, which will link in with the 12-month timeframe to which the Senator referred.

I accept what the Senator has put forward and the spirit in which he is putting forward. However, we are progressing in that space in a structured manner. For that reason, I will not be accepting this amendment. I take on board the sentiments the Senator expressed with his usual eloquence.

The Minister of State's opening statement was circulated. It runs to a page and four or five paragraphs. The final paragraph refers to the development of this regulatory framework. Does the Minister of State see that lovely term "regulatory framework"? The framework was in the amendment. The document states that the development of this regulatory framework has been a key priority for the Government, which is great and positive, and represents an integral part of the ongoing development of the statutory home care scheme - we are all for all of that - as committed to in the programme for Government. The document states that the Minister of State looks forward to a productive debate. We have had the productive exchange or engagement, but I am none the wiser from all of it. The development of the framework is welcome and a key priority, so we are all singing off the one sheet, except that the Minister of State cannot accept the amendment.

I hear what the Minister of State is saying. I have known him a long time, and I know he is a man of his word. He is committed in this space. I do not particularly like using the term "in this space". Everyone is using the word "space" at the moment. Anyway, I hear what the Minister of State is saying.

Am I right, to be clear, that the Minister of State is committing to the publication of the general scheme and the legislation within the next 12 months? I hope that will be the timeline and that it will set out clearly the issues that we have covered. Am I right to understand from the Minister of State's engagement that the home care support Bill will progress at some point? Do we have a timeline for that?

The Senator is correct that we are hoping a general scheme for adult safeguarding legislation for the health and social care sector will go to Cabinet before the end of the year. We are working intensively on that. We will seek the Seanad's assistance, and the legislation will be enacted once the President has signed it. There will then be a lead-in period. There will be a year for HIQA to get ready for the legislation. Within a two-year period thereafter, HIQA will have a full register of home support providers up and running. After that period, home support providers will not be able to operate without being on the register.

The Bill is coming through, and that will take 12 months. We are going to then have a transitional period about which the Minister of State spoke eloquently at committee. He was pressed on that point by various members. He said that the reality is that there will be a transitional period. There will be phasing as new people come in. There are other sideshows going on to address the shortage of carers and all of that. There is a three-year timeframe.

I heard what the Minister of State said. I am conscious that the Order of Business has given the approval to complete this business here today. That is out of my hands and out of the Minister of State's hands. It is not of my making or his. The options are clearly simple. We either do not accept the Minister of State's position and call a vote, and have everyone race up the stairs for the same usual exercise that has gone on for many years, or we clasp two hands in good faith and try to do something. I am opting for the latter option. I am happy to work with the Minister of State, as I am sure are the other Members of this House. We could tighten the timeframes, but that is a matter to do with Whips and how the Government organises its parliamentary business, and I respect that. It is important that we keep focused on these matters. Clearly, the Oireachtas committee can revisit the issue at some other stage. I thank the Minister of State for his engagement. I also thank the Seanad for the opportunity to raise these issues. This is a public forum and a very important place. We are on a pathway. It is important that we have this debate.

I am not going to press the amendment on the basis that the Minister of State has given a commitment to the effect that he is working on the issue. I will leave him with one request. Please keep the focus on the home care packages. Over 5,000 people in this country are waiting. They want to live in their homes by choice. They want to be empowered and supported at a vulnerable stage in their lives. They may be younger people with a disability or special need. They may be vulnerable parents, worn out and exhausted trying to care for their loved ones. It is a very distressing situation. No family is untouched by some experience of this matter.

I thank the Minister of State for his engagement. I thank his officials and staff for their engagement. I hope that we can keep it on the radar and retain focus, and that we can work collaboratively to advance some of the key issues that I have sought to advance here today.

I thank the Senator for his contribution and collaborative approach. Home support hours are a key priority for me and the Government. I want to bring the numbers down. They are coming down, but not at the rate I would like. The key element here is that we need to recruit more staff within the HSE. As I said, another 257 are funded and that work is under way.

I have regular meetings with the HSE, along with my officials, specifically around delivering home support. Some areas of the country are different from others. There is no homogeneous outline. Above anything else, home support will, dare I say it, be a key element of the statutory home care scheme and its operation. We have to increase the number of people in the area. It is a considerable body of work.

The Senator made reference to the word "pathway". We have a pathway, which includes the home support providers Bill and adult safeguarding legislation in the health and social care sector. There will then be the roll-out of the regulation. We will then move into the whole area of statutory home care itself. It is about ensuring that we have that momentum. The day-to-day activity is about people availing of home support hours. That is, and continues to be, an absolute priority for me and the Government.

I move amendment No. 2:

In page 6, between lines 3 and 4, to insert the following:

"Review of rates of pay and conditions of home care workers

4.(1) The Minister shall, not later than 6 months after the commencement of this Act, carry out a review of the rates of pay and conditions of home care workers in the public, not-for-profit, and private sectors, which should also examine career structures, rostering practices, mileage costs, and recruitment challenges.

(2) As soon as practicable after the completion of the review under subsection (1), the Minister shall prepare a report, in writing, of the findings of the review and cause a copy of the report to be laid before each House of the Oireachtas.".

As indicated on Second Stage, we are supporting the Bill. We think it is important that this sector is regulated, particularly as our most vulnerable citizens are dependent on care. Regulation is important, which is why this Bill needs to move forward as quickly as possible. The situation is that we do not have enough carers. We have more than 5,000 people awaiting care, either to have their hours filled or to have additional hours allocated ones because their needs have increased. We do not have enough carers. The ones we do have are rushed off their feet. They are rushing from service user to service user and are not able to spend the required time with anyone. This leads to people being put to bed at ridiculous hours in the evening or not getting up until very late in the morning, which has a huge impact on the quality of life of our older and disabled people. Some of the latter are young people or children.

There are blackspots that need to be addressed. I sought support for someone in the area of Cavan in which I live. I contacted the HSE and several private healthcare providers. None of them had anybody available in that area. The Minister of State indicated that there will be increased recruitment by the HSE. I welcome that. He said last week that there is no recruitment embargo, which contradicts what I was told by the HSE locally. There is no visible recruitment campaign happening. Many of the people who work for the private operators would prefer to work for the HSE because there are better pay and conditions on offer.

The Minister of State referred to increased recruitment by the HSE, which is very welcome, but I fear that it will just take staff from the private sector and that we will still have a deficit in provision for the people who require care. We need to recruit immensely in order to ensure that we provide care for all the people who require it. Whether they are in the public sector, the private sector or the not-for-profit sector, all of those workers deserve to be treated properly. The only way to recruit people into this sector and to retain them is by offering proper pay and conditions. That is not happening, especially for those who do not work for the HSE directly. Many of them do not get travel expenses. They drive on roads that are in shocking condition. The people to whom the call often live down long lanes in quite isolated rural areas. These workers' cars constantly have to be repaired as a result, and they are left out of pocket in that regard.

We need to address this issue in the context of a recruitment campaign, retaining existing staff and offering proper pay. I support the Bill. It is not bringing about the statutory home care scheme that was promised a number of times. I know the Minister of State says that the latter is coming, but we have been waiting for a long time for it. This is not about entitlement for service users. There is an opportunity to look at an industrial relations framework for this sector and to have an employment regulation order to guarantee certain pay and conditions. If we have low rate of pays, we undercut quality. In addition, there is a lack of continuity. Different carers come to people all the time, which is sometimes very confusing, especially older people who may have dementia. We want a high-quality service. That is something people are entitled to. We just need quality assurance. We need properly trained people, obviously, but we also need people who have compassion and empathy too.

The gaps in provision are putting a lot of pressure on families and family carers in circumstances where additional help is required at times. There is a lot of isolation and loneliness, which we need to look at too. Others are being forced into nursing homes because they cannot get the care necessary to allow them to stay in their homes. We heard from Senator Collins last week about her mother, who could not get care in her home. We need to shore up the sector and ensure that we have sufficient numbers of properly trained people who can provide the care that people require in their homes to allow them to maintain their independence and in order that they will not to have to fit in with a timetable because the carers do not have enough time on their hands.

I acknowledge the issue that Senator Tully, on behalf of Sinn Féin, has raised in the context of the amendment. This is an important issue that the Government is actively addressing. The delivery of high-quality home support is dependent on the efforts of people who work in the sector. I take this opportunity to acknowledge the great work that has been done by home care workers who provide support and assistance to people of every age who have a wide range of medical, conditions, abilities and needs and who are living at home. I agree with Senator Tully that independence is a huge factor in people being able to remain at home, both physical and mental independence. The mental aspect is often overlooked, but in the context of being in command of their lives and circumstances, whether they are young or old, I do not think people really change.

We continue to deliver on our Sláintecare commitments to increase the availability of care in the home and the community. We spoke about statutory home care. The latter goes back to Sláintecare, which is a cross-party policy. We brought a statutory home care scheme into the programme for Government, which I have been charged to work on. It is a process. As people are living longer, there is an inevitable increase in demand for home support. We should welcome the fact that people are living longer, but this brings challenges. There is no point in saying otherwise. Ensuring that we can attract and retain workers in this sector is therefore a matter of high priority for Government.

In 2022, SWAG, a multi-agency group to which Senator Boyhan referred earlier, was set up to examine issues relating to the recruitment and retention of healthcare assistants. The group produced a support containing 16 recommendations, many of which have already been delivered. The Department of Health is continuing to work with the HSE and other stakeholders and Departments to deliver on the remaining recommendations. I will shortly be launching a national survey of healthcare assistants that will provide us with important information on their healthcare conditions. The purpose of this survey is to allow healthcare assistants to outline their views. The results of this survey will be combined with the lessons from the implementation of the SWAG report to help us to identify our next priority for workforce development. It is important to highlight that much of the data that Senator Tully and Sinn Féin would like us to report on is not currently available or easily accessed, particularly in circumstances where service providers are not State-funded, which is estimated to be about a quarter of those entities that provide home support nationally. That figure comes from a recent ESRI study.

The information provisions set out in this Bill will provide HIQA with the power to collate and report on data of this type in order to inform national policy and planning. The relevant regulations must be made by the Minister before they can commence. This important task is being undertaken within this framework. The Government has delivered the SWAG report, which examined the relevant issues of healthcare assistants, and is working to deliver on its recommendations statutorily. By means of our upcoming survey of healthcare assistants and the regulations to be made on foot of this Bill being enacted, we will collate the data that we need to develop effective policy responses.

I accept the point the Senator is making in the amendment. For the reasons I have outlined, however, I will not be accepting it.

Amendment No. 3 in the name of Senator Clonan has been ruled out of order due to a potential charge on the Exchequer.

The Minister of State and his officials are very welcome. I think the amendment has been ruled out of order in error, because when we spoke about this last week, there was ambiguity.

Basically, the Bill says that providers with fewer than four clients do not have to be amenable to regulation, but they can continue to work and be paid.

As I pointed out last week, the HSE acts in an idiosyncratic and capricious way when it comes to funding for carer and personal assistance support hours. I know this from my lived experience over the past 20 years. There is a terrible power imbalance between parents and disabled citizens and those who sanction payment for hours. Each regional health area acts differently in this regard. In fact, each community healthcare organisation, CHO, has its own rules. The CHOs make them up by themselves. I have been told by disability managers, after an assessment of need recommended that my now adult son needed, let us say, 24 support hours, that he did not need that number. The attitude is one of the health services will give him ten hours and we will take what we are given.

The reason I introduced this amendment was to be absolutely explicit and remove any ambiguity that "a person who provides a home support service to fewer than 4 persons as described in paragraph (a) shall be paid with public funds in a similar way to a registered agency and shall not be precluded from payment as a self-employed carer." It is not adding any extra cost to the Exchequer; it is just clarifying a matter. That is why I believe the ruling out of this amendment was an error.

All of these things, as Senator Boyhan referred to earlier, knit together. This time last year, on 25 June 2025, I introduced a comprehensive Bill on personalised budgets to this House. I worked with a corporate legal firm to do so. It was the first time in the history of the State that a corporate legal firm – one of the big internationals – worked with the Office of Parliamentary Legal Advisers, OPLA, to draft legislation. That major legal partnership came to me and offered me the use of a legal team, pro bono, for almost two years. The team did all of the research. It looked at every system internationally and every single consultation that this and previous Irish Governments had done, right up to and including the Action Plan for Disability Services 2024-2026 by the former Minister, Deputy O’Gorman, and the former Minister of State, Senator Rabbitte. When I presented the Bill to the House and argued its merits, the Minister, Deputy Foley, delayed it for 18 months. It is delayed until Christmas Day. I have seen in the Order Paper that it will be read again on Christmas Day. Should I come in after my dinner or will it happen before I take the turkey out of the oven? The legislation I drafted is in line with every single policy aspiration of the Government.

If we have personalised budgets for disabled citizens, like my son, how will those funds be dispersed? That is why I am saying, like Senators Boyhan and Tully, that this should be person centred rather than administrative systems centred. Disabled citizens and older people should be able to choose the carers or support providers themselves. That should not be within the purview of an administrator in the HSE. When a lot of those administrators and disability managers move on, they move into the private sector. There is a revolving door in that regard. That is why they recommend in that way. I have had cases where HSE managers have told me to use a specific service and no other, and then I discovered that the people operating that service are former colleagues of that person.

I introduced this amendment to be absolutely clear that no self-employed care provider or personal assistant would be denied access to public funding as a result of their not being amendable to regulation, as set out in the Bill. Last week, the Minister of State agreed that the intention of this legislation was not to exclude those people from payment, but I fear that, as a result of the little bit of ambiguity here, it could be used as a way for the HSE to shoehorn disabled citizens and elderly people into availing of the services of large agencies and for-profit providers, which pay carers very low wages. The carers who come to me are earning €13 or €14 per hour despite approximately €35 per hour being allocated. It is the agency that takes that money. That is the reason I tabled this amendment.

I know that the amendment has been ruled out in error, one that revolves around the ambiguity I am trying to address. Whoever ruled it out of order thought that these providers would be paid in addition, but that is not the case. It is envisaged in the Bill, as confirmed by the Minister of State last week, that they would be paid anyway. I cannot see how this amendment would levy a charge on the State if it is already provided for in the legislation. It has been ruled out of order. I do not know whether the Minister of State would have supported it had it been allowed. I ask the Minister of State, when he and his officials are drafting the final legislation, to see whether there is any way they could include even one line to remove that ambiguity and ensure it is clear to anyone in the HSE that they cannot refuse to give public funding to someone on the basis that they are self-employed and not part of a large agency.

I thank the Minister of State for his patience.

The Senator’s amendment has been ruled out of order but I will speak to the section and the particular points he raised. I looked at this in great depth because I wanted to cover everything. I will read out the note and then I will cover a number of points thereafter.

I thank Senator Clonan for raising this matter. All exemptions included in the Bill have been carefully considered to ensure that there is no adverse impact on services that are not intended to be captured under the current regulatory framework. In relation to the matter the Senator raised, section 69B(2)(a) provides that where a person provides a home support service to fewer than four people, they are exempt from the requirement to register. That is in the Bill. The exclusion was carefully considered in order to ensure that the regulatory burden placed on providers was proportionate to the size of the service being provided. These small services are typically single operators working on a one-to-one basis with service users. As I said on Second Stage of this Bill, I was in Wales for St. Patrick’s Day and took the opportunity to meet its minister with responsibility for this area. In Wales, the regulation is four persons or fewer. In our case, it is fewer than four persons. The exemption also seeks to exempt personal assistance services where service users directly engage with a personal assistant. These arrangements allow the service user to direct the way in which their services are provided, which upholds the principles of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD.

This exemption is further supported by 69B(2)(c), which exempts providers who have service arrangements with the HSE to deliver personal assistance services. The Department of Children, Disability and Equality is progressing a broader programme of work to develop a vision and strategy of specialist disability services for 2030 that will include considerations, particularly around governance arrangements, across the disability sector more broadly. That Department is also advancing the development of a policy framework on supports for community living, which will include consideration on the role of the personal assistant. The outcome of this work will inform future policy and legislative considerations for disability services.

The home support authorisation scheme is how the HSE commissions tendered home support from approved providers. The scheme opens periodically to allow prospective new providers to apply to become approved. The scheme requires providers to meet certain criteria. This legislation seeks to introduce regulations for home support services. Matters relating to HSE-commissioned home support services are to be further evaluated during the design of the statutory home support scheme. It is committed to in the programme for Government. We are going to look at that in depth.

The Senator raised a specific point about personalised budgets. I have no doubt that the Senator has a greater knowledge than I of this area. It is something that is personal to him and he understands it well. A personalised budget demonstrator pilot was established in 2019 on a cost-neutral basis. In May 2025, the demonstrator pilot commenced its evaluation phase, which is expected to conclude shortly. It is being led by the National Disability Authority. The evaluation will provide insights into the barriers and facilitators to rolling out personalised budgets on a large scale. It will, therefore, inform next steps. There are, therefore, personalised budgets within the disability sector.

Under the pilot scheme people with disabilities can get a budget and determine the person they want to engage to do that service for them. To clarify the point, the Bill here just deals with the regulation specifically. I wanted to look at this and to be totally without any form of ambiguity. This legislation deals with regulation. The issue of how home support is commissioned by the HSE is something we are going to look at in greater depth as part of our design of a statutory home care scheme. We give that commitment. It is not even a commitment but something we are going to do. There is that pilot project for personalised budgets for people with disabilities and an evaluation run by the National Disability Authority. That is due to conclude shortly and we await the outcome of that review.

I hope that brings clarity to the points the Senator raises.

I thank the Minister of State.

When is it proposed to take Report Stage?

Now.

Is that agreed? Agreed.

When is it proposed to take Fifth Stage?

Now.

Is that agreed? Agreed.

I thank everyone for their contributions. This is significant legislation. It is a landmark Bill in that for the first time ever we will be regulating home care providers. That will give added confidence to the people who use the service, who are the most important people of all, about the high quality of the service. I acknowledge all the work done by home support workers and providers and by the people who are doing it for family without being paid. They do phenomenal work. This legislation has now gone through both Houses of the Oireachtas and will go to the President to be signed. It is an integral part of, and the first step in, the commitment in the programme for Government to design a statutory home care scheme to allow people to stay in their own home for as long as possible, if they wish. It is hugely important that people remain independent. This home support providers Bill is a first step in that direction and I thank all Senators for their great work. I look forward to continue working with them on a range of matters, with the development and design of a statutory home care scheme as a key focus.

I will be brief because I am aware it is the end of a long day for many of us. I wish the Minister of State well. The way he conducts himself and his business makes matters easier to deal with. I wanted to acknowledge that because it is a significant part of the success of navigating this Bill through the House. That is a credit to the Minister of State personally and I thank him for that. He has made a number of commitments, which I look forward to. I will be tracking them, as he doubtless knows. I make a final plea because while we have this Bill and more promised legislation, there are more than 5,000 people waiting for home care packages this evening. They must always be to the fore of our thoughts, our policy and the provision of necessary resources. I certainly give the commitment that I will be back on my feet in a month or two with a Commencement matter asking the Minister of State to make a statement on the number of people looking for a package. I hope the figure will be down to 3,000 by then rather than up to 10,000. I wish the Minister of State well. I look forward to tracking the commitments he has given us.

I thank Senator Boyhan. It goes without saying I acknowledge the officials in the Department.

Absolutely.

A lot of it goes unseen. They are a huge part of any work done by Government. I wanted to put that on record.

Hear, hear. Well said.

I compliment the Minister of State and his staff on the passing of this significant legislation. As he said it is the first step on the way to a statutory home care scheme. I wish him all the best with it. It is really good people can have the assurance they are all on the same footing. I wish the legislation all the best and congratulate the Minister of State. I know how committed he is to the future of this and I am sure there is other legislation coming to us shortly in a similar vein.

When is it proposed to sit again?.

Tomorrow, at 10.30 a.m.

Is that agreed? Agreed.