The recent publication of the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants, was welcome but at the same time leaves a lot of questions to be answered. The focus of my subsequent comments are mainly with regard to home care rather than nursing homes

The first and most striking point to be made, is that while the report is basically about how to make caring a more attractive career, views directly from carers themselves were not sought at all, only the views of their employers who obviously would have their own agenda, not necessarily in tune with carer’s wishes.

An employer’s aim will naturally be to increase the supply of cheap labour without effecting their margins. A case in point from the report, is the recommendation to remove carers from the visa ineligibility list. I think there would be very few carers who would like to see cheap labour coming in from outside the EU, before providers significantly increase their rate of pay.

In addition to ignoring direct input from carers, the report didn’t consider any input from outside traditional providers and stakeholders. The fact is, it is the status quo that has brought us to this state of play where caring is an unattractive career. Would it not have been useful to consult with a wider spectrum of viewpoints and models, to try and get a different perspective on the issues?

There seems to be a lack of immediacy in the report, with many of the recommendations medium term solutions rather than something to address the significant issues now.

Many of the recommendations also have a feel of tinkering around the edges when possibly what is needed, is a wholesale restructuring of our social care sector. The level of resources certainly within home care would seem to be sufficient, so should we be looking at a complete redistribution of these resources?

For example, presently in home care the demand side is treated as homogenous with everyone needing the same governance and hand holding when this is patently not true. This leads to a huge amount of resources going towards corporate overheads and governance when this isn’t always needed. We all know that the primary reason for the shortage of carers is poor pay. Could some of these lost resources not be redirected to carers through cutting out the middleman and not providing governance to the same levels where capacity exists with people needing support and their families?

There is nothing in the report about fostering more choice for families and carers and opening up the existing commissioning system which bestows a malignant monopoly on corporate providers, so that a wider ecosystem of provision models exists.

Looking at some of the specific recommendations in the report, recommendation 5 is about having providers pay for travel costs and travel time. This would be a positive move so long as the HSE could be certain that funding for this got fully to carers. In the existing tender, providers put in costs for travel in their pricing but virtually none of these funds have been paid over to carers.

Recommendation 6 seems to be a complete cop out, talking about inviting providers to give a commitment to pay as a minimum, the living wage. Surely that should be a red line and obligatory for any provider receiving state funds for home care?

Recommendation 15 concerning personal budgets has the potential to be the most effective recommendation in the report and also have the most immediate impact. However, this is only so if we are talking about true personal budgets, where the person receiving support has real control over what their care and support look like and not a watered-down version where there is a token transfer of control. Personal budgets where people have to use their funds with specified corporate providers and align with pre-set rules and governance, are not personal budgets. True personal budgets allow people decide by whom, when and how support is delivered. Real personal budgets allow people to take the risks they see as reasonable. Real personal budgets allow people live the lives they want not what the system wants. Real personal budgets fit in with people’s desires not the other way around forcing people to fit into a pre-ordained system.

It's a pity the report didn’t look at Minister Rodheric O’Gorman’s recent initiative to mandate the setting up of a child minders registry which would then allow families to contract directly with childminders using state funds rather than having to use a crèche. Something similar could work very well for older persons facilitating the roll out of personal budgets

The real impact of personal budgets as far as the report is concerned, is that they have the potential to get more funds to carer’s pockets and give carers more involvement in their work, thereby making caring a more attractive career.

Demand for home care is only going in one direction and if we are to meet that demand in the future, we are going to have to look beyond the existing status quo of them and us and one size fits all. The future of home care is local, community based and personal.