Joint Committee on Enterprise, Trade and Employment debate -
Wednesday, 19 Jun 2024

Members who are participating in the meeting remotely need to be within the Leinster House complex. Apologies have been received from Senator Marie Sherlock and Deputy Louise O'Reilly. Today's discussion is on IBEC's Better Care, Better Business report. Carers play a vital role in our society. The support and care they provide helps to facilitate much economic growth. Carers and those in need of care face several employment-related issues, such as with career development, connectivity to the labour market and access to training. The committee is pleased that we have the opportunity to consider these matters further with representatives from IBEC, Dr. Kara McGann, head of skills and social policy, and Ms Nichola Harkin, head of legal services.

Before we start, as we always do, I wish to explain some limitations to parliamentary privilege and the practice of the Houses with regard to reference that may be made to another person in witnesses' evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege. Witnesses are again reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction I may give.

The opening statements have been circulated to members. To commence our consideration of this matter, I invite Dr. McGann to make opening remarks on behalf of IBEC.

Good morning. IBEC welcomes the invitation by the joint committee to discuss the IBEC Better Care, Better Business report. The importance of care is a growing and universal issue, not only for individuals and families, but for the business sector and society in Ireland. For too long, care work has been invisible work, largely hidden and unmeasured, and as such, often undervalued, yet the economy would cease to function without care, as it makes possible much of the paid work driving the market economy. It is essential work, critical to the social infrastructure on which societies and economies are built. As such, there is a need for a fundamental change in how we value care and caregivers. While acknowledging the breadth of issues surrounding care, IBEC deliberately chose to focus on this report on long-term care and the carers who are providing care and support for our family members or loved ones with additional needs, a chronic illness, physical or intellectual disability, mental ill health, palliative care needs, or age-related frailty. Our blind spot regarding these carers is having a significant and growing impact.

Without strong care structures and supports to meet the needs of the growing number of individuals needing care, those providing care and those juggling work and care, there are likely considerable repercussions for the labour market, economy and society. Employers and Government have a vital role to play in addressing the challenges surrounding long-term care. There have been several positive developments surrounding care, such as improvements in carer's leave entitlements, the introduction of the long-term carer's contribution scheme to support family carers qualifying for the State pension, improvements to income disregards for carer's allowance, and an increase in the hours a person can work while caring. However, despite an increase in investment, it is under-resourced and fragmented. Carers and those in need of care are not sufficiently or consistently supported.

Despite commitments from the Department of Health to introduce a new statutory home support scheme, there is still no statutory entitlement to receive formal home care or home support. The Government has under-delivered on targets with over 40,000 home care hours left undelivered on a weekly basis and an additional 6,000 individuals who have been approved for funding remaining on the waiting list for care because no care workers were available to provide this. Waiting lists for home care and other social services demonstrate a considerable existing gap between the demand and supply of adequate long-term care services, something that is at risk of widening if significant investments are not made.

There is a knock-on impact too to the broader health system and on hospital beds as there are delays in discharging patients due to a shortage of available carers for approved home support packages or as people await funding approval for home support hours. This will have consequences for Government commitments in the programme for Government and Sláintecare, which promised the right care in the right place at the right time and to enable older people to remain living as independently as possible in their own home for as long as they can. Without change, this cannot be achieved.

This issue is gaining greater urgency given Ireland’s ageing population, the increase in disability and chronic illness. While older people represent only one cohort in need of care and support, the world’s population is ageing and Ireland’s population is ageing faster than elsewhere in Europe. Those aged 65 and over are projected to increase to one in six by 2030. That means that at some point, most of us will be caregivers or will need caregivers. However, the professional care workforce is aging too with 42% of home support care workers aged over 60 and coming up for retirement in the next few years. Countries like Ireland that rely on both local and international workers to address shortages in the recruitment of professional carers will be under significant pressure to fill roles. It is believed we will face a global shortage of 10 million health and care workers by 2030, which will coincide with estimates of an increase in the demand for home care - a precarious situation and one that will result in a greater reliance on working carers, that is, individuals who are juggling employment with caring responsibilities. To keep pace with existing and future demand for long-term care, a sizeable expansion of existing services and a re-imagining of long-term care in Ireland will be required.

Of particular focus to IBEC’s report were working carers and the structures, care solutions and professional care sector supporting them to balance work and care. Estimates of informal carers are conservative as many people do not identify themselves as carers but rather partners, parents or children of loved ones with a particular care or support need - some in employment, others not. Census 2022 identified over 299,000 people providing regular unpaid care, that is, carers aged mainly between 40 and 64 years. We know that most of the long-term care is provided by women and this is borne out by the 77% of recipients of carer's allowance, 81% receiving carer's support grant and 83% of those on carer's benefit, all of whom are women. This also means that consequences of gaps in support will impact women to a greater level with a knock-on effect to their labour market participation, pay, pension and the gender pay gap.

Findings of research carried out by Amárach for IBEC on working carers - those combining informal care with paid employment - echoed findings in other research studies. Working carers were challenged by their dual responsibilities often feeling they were not doing a good job either at work or at home, struggling with finding and affording the right supports or services and often having to consider difficult choices around their work and care-giving responsibilities. Most respondents agreed it was hard to get everything done or to balance work and care. Over a third mentioned the negative impact of caring on their ability to do their job and on career progression. Respondents coped at different times by taking paid or unpaid leave, reducing working hours, frequently missing work or leaving the workplace entirely. Supports were deemed inadequate and the resulting strain on mental health and finances hampered their well-being.

We believe addressing this potential crisis of care will require action in four key areas. Supporting those in need of care will require increased funding and availability of appropriate home support hours and packages, which avoids the postcode lottery in accessing care. We are talking about a continuum of care that provides real choice and quality options, and supports users in leading active, healthy and dignified lives and a statutory home support scheme to finance home care like the fair deal. While legislation, regulations and standards are believed to be at an advanced stage, they need to be urgently implemented.

Second, addressing supports for carers will require the delivery of a fully funded carer's guarantee with a core basket of services like emergency respite care, training and crisis support, which needs increased funding and better integration as it is currently fragmented and inconsistent. A review is required of all support schemes, eligibility criteria and means tests as they are deemed inadequate, restrictive and not fit for purpose.

Third, we need to address recruitment and retention in the care sector with a national campaign to promote the value and profile of careers in care. This must include career paths, development and professionalisation like the work done around early learning and childcare through things like additional funding to the skills training funds in SOLAS and increasing the capacity of healthcare traineeships.

A review of the eligibility criteria for State benefits, particularly the hours versus days approach, is required to ensure we are not preventing people from remaining connected to the labour market and to support more carers into the workforce.

Finally, we need to future-proof our workplaces by creating a culture that supports the growing number of working carers and keeps them connected to the labour market with formal and informal flexibility to avoid the isolation and financial challenges that occur if one must give up working. Some employers have engaged with the likes of Family Carers Ireland and its Caring Employer programme to support and empower working carers.

The challenges facing the care sector are multifaceted and complex but are not insurmountable. By working together, Government, industry and stakeholders can develop effective solutions that ensure the sustainability and quality of care services in Ireland. We must acknowledge the need to act and invest now for working carers and those in need of care while addressing the issues causing staff shortages in health and care services. I thank members for their attention. I look forward to their questions and to our continued dialogue on this critical issue.

I watched Dr. McGann's presentation from my office and thought I would come down in person. It is such an important issue so I thank Dr. McGann for the presentation and for this document. It has many really though-provoking commentary and recommendations. I will focus on recruitment and retention. I should explain by way of background that I am a proud trade union member and someone who campaigned for years to organise workers across the care sector. I did so because there is a significant issue regarding terms and conditions for those workers. Would the witnesses acknowledge that the pay rates in the sector simply are not good enough when it comes to recruiting people?

Recruitment and retention constitute a much wider issue than just pay rates. As we set out in the report, what we need to really address in the challenges in recruitment and retention is the professionalisation of care as a profession. We mentioned things like the national campaign to promote the value and profile of carers and care and a review of the eligibility criteria for State benefits. It is a much wider issue. I do not think it is as straightforward as simply saying it is an issue of pay. We know that collective bargaining does exist in the HSE and there are still recruitment and retention challenges in the healthcare sector across the board so I do not think it is as simple or straightforward as just saying it is about pay and if we resolved that issue, the other challenges would simply go away. We need to look at this from a much broader perspective. As our report states, employers have a role to play in that but so does the Government. We need a whole-of-society approach. It is not a simple fix, unfortunately, and, therefore, we cannot expect it to be fixed by simply dealing with one element. We need to look at this across the board. Dr. McGann may have more to say on that.

When we looked into it and spoke to people in the sector, looking at development, career paths and professionalisation of the sector to attract staff to the area and retain them will be hugely important. There is no opportunity here to allow people to learn on the job. Two level 5 QQI qualifications are needed for a potential carer who may not have been in a classroom for quite some time or might not have had a good experience in the education system. To be faced with having to start there as opposed to the UK model where people can do skills for care programmes and are able to cover the equivalent of that QQI level 5 certification once they are regulated is another strand of the piece. I am not dismissing pay but it is probably a broader church than that.

I acknowledge Dr. McGann and Ms Harkin are saying that they are not dismissing pay. Let me stress that I think there is a lot of really good stuff in this report and I welcome the fact that IBEC has come in but pay is a huge factor. It concerns me slightly.

I would like IBEC to at least acknowledge that pay is a significant factor. Could the witnesses do that?

What we are saying is we need to look at this in the round and we cannot put too much of a focus on any one factor. Another factor we have referenced in the report, which is a real issue around recruitment and retention, is the eligibility for social welfare payments for those on carer's allowance. While it has been increased in order that carers can work a maximum of 18.5 hours, they cannot earn more than €450. We are saying across this report that we need to look at everything. We need to look at all of the issues and challenges, including the things that are coming up around recruitment and retention. We do not want to simply state it is a quick fix or it is a straightforward matter of pay. We have looked at this in great detail-----

There are also challenges within the structures, with the HSE tendering for home care providers in this space. There are challenges around what is in that tender, what that looks like and what that is made up of. To some degree, there are constraints around that as well. Absolutely, it is a factor. It is one of the things-----

I thank Dr. McGann. It has taken the witnesses six minutes to acknowledge that but I welcome that Dr. McGann has said pay is a factor.

I will tell the witnesses my experience of dealing with private sector pay providers. They refuse to recognise trade unions. They sack people who become active in trade unions rather than deal with them. If you take the private nursing home sector, I would struggle to name more than one nursing home that actually recognises trade unions. This begs the question: how are workers in this sector actually supposed to negotiate a pay rise?

It is one of the factors. We are not saying that pay is not a factor; we are saying it is one of the many factors. What we are saying is it is not a straightforward fix; that if one element of the challenges faced in recruitment and retention is dealt with, then it is not just an easy fix. If you look, as I said, within the HSE, collective bargaining and trade union recognition exists in the HSE but there are still recruitment and retention challenges there. We can see that it is not an easy fix or the sole factor here. Obviously, we have been in this committee room before talking about trade union recognition and the adequate minimum wage directive. In IBEC, we are working with ICTU and the Department on transposing the adequate minimum wage directive. We have been in here talking about that on previous occasions.

Yes but you have members of IBEC who refuse to recognise trade unions. There are members of IBEC in the care sector who are happy to dismiss people for simply joining a trade union, and asking to be represented and to be able to negotiate their pay. I have asked a fundamental question. Respectfully, again, how are workers in the care sector supposed to negotiate a pay rise when they are denied trade union representation? It is a serious question.

What I would say is that when the Senator says there are members in IBEC who do not recognise a trade union, ultimately freedom of association and disassociation is a constitutional right in Ireland. There is the freedom to recognise or not recognise a trade union in Ireland. That is a constitutional right that we have protected here. The other thing I would say is if there are individuals who have been dismissed as a result of trade union recognition, there are really strong supports for them in the Unfair Dismissals Act. It is automatically unfair to dismiss someone for trade union activity.

That is because it is not worth taking them at the minute. That is the reality but I do not want to go down that particular rabbit hole because it would take us away from what the witnesses are here to talk about.

Again, I will note that Ms Harkin has not answered the question with regard to the really badly-paid workers in this sector. In fairness, fair play to Dr. McGann on acknowledging the fact that €13.10 per hour is an appalling rate of pay for looking after our loved ones and trying to keep them at home. It is the elephant in the room here. For example - and I want to be proactive here - I think what would really help in the care sector is an employment regulation order, and to actually put in place a floor of decency with regard to pay, conditions and career paths. We do have EROs, as the witnesses know. Would IBEC support the development of an ERO as a means of tackling the chronic underpay and poor conditions in the care sector?

Kara referenced the issue around private care providers providing care on foot of tenders from the HSE so as a sector, there are budgetary constraints there. There are also challenges around the uncertain nature of the work. If somebody is hospitalised or someone has an appointment, there are challenges there with regard to hours. All of these things need to be considered. We are not saying "Yes" or "No" to any particular thing around that but I would say there are challenges around the budgetary constraints in the sector. The Senator mentioned individuals who say they have been dismissed by virtue of trade union activity and it is really important to highlight there are existing very strict rules around protection of trade union membership.

The compensation Ms Harkin is talking about only counts until such time as they get another job. If they get another job the following month then they are only entitled to one month's compensation. Let us be clear about this. The existing legislation is not fit for purpose.

I want to bring the witnesses back because I am down to the last couple of minutes at this point. They have not answered a couple of key questions. The first key question is, how are badly-paid workers in the care sector - which the witnesses have rightly highlighted has huge recruitment and retention issues - supposed to negotiate a pay rise when IBEC members refuse to recognise trade unions and refuse to collectively bargain with them? I am aware of the constitutional issue. I do not want to talk about that. I want to ask the question, how will these workers get a pay rise?

-----who do not wish to recognise a trade union. What I would also say is - as we have been in this room before talking about the adequate minimum wage directive and the transposition of that directive - we are working, under the auspices of LEEF, with our colleagues in ICTU and the Department on the transposition of the adequate minimum wage directive. We are looking at what I think was a really useful report of the high-level working group on collective bargaining with regard to promoting collective bargaining in industrial relations in Ireland, and we are working really closely with ICTU and the Department on looking at how we can transpose the adequate minimum wage directive and implement the recommendations of the high-level working group report. It is not what we are here to talk about today but I think it is important to note that.

Our other point - and Kara can feel free to jump in here - is this is a really wide issue. We need to look at this in the round. We cannot make it a straightforward issue of stating that if we fix one element, recruitment and retention is simply fixed. I have said before that within the HSE there is trade union recognition and collective bargaining but there are still recruitment and retention issues in the HSE and the health sector overall. We know it is a broader issue and that there is a lot at play here. In the report, we have set out a number of ways we believe these recruitment and retention issues can be addressed. We are not saying they are the only ways-----

I again apologise for interrupting but I am down to the last minute here and IBEC has not addressed the fundamental issue at the heart of so much of the recruitment and retention crisis, which is the appallingly low rates of pay. The witnesses have, in fairness, acknowledged the rate of pay for a private home help of €13.10 per hour which, I will put on the record here, is an absolutely disgraceful rate of pay. For me, it is a shame because IBEC has got an awful lot of good points in this document but it is avoiding the elephant in the room, namely, low pay and the fact that IBEC's members refuse to negotiate with trade unions and refuse to commit to an employment regulation order that would actually take concrete steps to tackle this issue. It is a huge shame that IBEC has not acknowledged that and has not even had the courage to encourage its members to engage with an ERO process.

I need to apologise as I am going straight from here to a Commencement matter but I will say to the witnesses that I will watch back the rest of the proceedings. I thank the Chair for his time this morning.

In reflecting on that conversation, it is welcome that IBEC is entering into this sphere. To have longer lives is one of the great achievements of humanity and we are not maximising that potential or supporting it in an optimal way. I have noted many of IBEC's suggestions. It highlights Iarnród Éireann, which seems to have taken a very flexible approach to allowing part-time working, meeting with its family carers, knowing their needs and adapting the workplace. How widespread is that practice? The corollary is what employers are going to bring to the table, which IBEC says should be a big tent. That is the first question.

A number of employers see this as a key issue as part of their workforce. They may have a multigenerational workforce and we know that care can be sudden and unexpected, so it can really span the workforce generally. Many employers focused in on that during Covid, when it was spotlighted in a way it had not been previously. While some knew of working carers within their organisations, it became more obvious that there were potentially more of them.

We have seen many employers engage with the Family Carers Ireland Caring Employers programme, which has a number of different structures, and others have gone it alone and worked on direct pieces in this area. Typically, they have engaged with people in their organisations and they have found that people who have caring responsibilities-----

The corollary of opening the debate on this is that IBEC needs to do a survey of its own members’ practices so we have a picture of that. I will put the question slightly differently. Would IBEC support a code of practice developed by the WRC that would create a model of flexibility for people who have caring responsibilities?

We are talking about caring. To move the dial, I know small businesses are under a lot of pressure but, at the same time, if this is as important as IBEC is saying and is crucial to the supply, would it not be the way to go to get a proper code? Then, when these requests come in from family carers, there is a standard against which to judge them.

I would note the formal and informal flexibility, both of which are very important. There is the formal flexibility of requesting part-time work, shortened hours, working from home or whatever it might be, and that is formalised in an arrangement. Equally, or certainly very important, is the informal flexibility of employee-to-manager understanding.

I suggest IBEC does a survey of the practices of its employers so we get a baseline picture of what is available and the direction of travel.

I will move on. I share IBEC's belief that we need statutory home care and the ESRI has estimated its cost at about €500 million. Will that be in the IBEC pre-budget submission? Is it looking for that to be done? IBEC will be knocking on our door in a few weeks’ time, no doubt, telling us its priorities. Will this be one of them?

It will absolutely be in there. We will be looking for supports around the carer’s guarantee and other elements in that whole long-term space. I want to mention one thing with regard to flexibility. We really want to see that culture of change among employers. We want to see employers recognising that working carers are part of their workforce into the future and future-proofing their organisations accordingly. That is to allow formal flexibility but also the informal flexibility where somebody rings up and says the carer is not in a position to turn up that day because of an emergency, and the employee might need to postpone work or work from home, and that is okay because our organisational culture says that is part of how we do our business. We think that is as important as the formal procedures in place and that employers definitely need to play their part in acknowledging that working carers are part of our future workforce and we need to support them if we are going to keep them in the labour market.

One of the issues about home care provision is that, currently, only some 40% is provided by the HSE itself and it outsources to the private sector about 60% of the workload. The issue of how this sector develops is going to be intimately involved with the negotiating position of IBEC. Personally, I favour a development agency, much as is now promised for the childcare sector. Like the previous speaker, I believe we will need an REA in the sector, just as we have had in the childcare sector, and we will need to develop the skills and the process of recruitment and apprenticeship. We will need to do a lot of things in this sector.

I recognise there are contradictions within IBEC's own membership. Some people who do not employ carers see it in a very different light and see this as cost-increasing and so on. Does IBEC have the structures to move this debate on? Something like 20 million hours are now provided by the State and if we move to the statutory option, we will be going up to 42 million, so we will be doubling the number of care hours, although that will obviously happen over time and we will not do it overnight. How will the private sector position itself within that? It is a massive job to double in scale, attract the workers and attract the skills. I would be interested to hear what IBEC's attitude is to the development challenge that it is effectively posing to us because it is saying we should double the provision.

There are a number of pieces to that and the Deputy mentioned a couple of them. It is worth noting that if we use waiting lists as a metric, where provision has been outsourced to private providers, they are getting very good results, if we look at it from that perspective. In one of the CHOs, it is 100% outsourced and the waiting list is down to seven, while in another, it is 85% HSE provision and the waiting list is at 1,200. The private sector is playing a part where there is a gap, with 40% of the delivery. However, in terms of how we approach this moving forward, it is about looking at all of the strands together. It is looking at the regulation of this sector, how we look at licensing and how we look at improving the regulation and professionalisation of the sector. It is looking at the development and career path so we build that into this piece as well.

It is looking at the access we have, so it is something that we need to grow.

That sounds very like a registered employment agreement, REA. It is going to regulate the training, the pay and conditions. It seems Dr. McGann is wiggling somewhat on the idea of whether we should move towards some sort of regulated employment sector, much like childcare has now moved to. Multiple interests are represented by IBEC. However, I cannot see a way forward that does not have IBEC coming to the table and saying "We are going to go from 21 million hours to 42 million hours". That is a huge development of this sector. We need to put it on a long-term footing so that people are attracted to the sector at twice the current scale. I do not believe IBEC can step back from it and say "That is for the Government or for someone else to come along."

Absolutely, but ultimately the obligation to abide by those terms and conditions is squarely on the employer. Training and professionalising the sector can be done without the need for an ERO. However, it is important to highlight that we are not saying employers have no role to play here. We are absolutely in agreement that employers have a role to play here and we are bringing employees along with us on this journey. As the Deputy said, we have a wide, diverse membership with employers at different levels and at different stages in this but we certainly acknowledge the fact that we need to bring employees along with us on this journey.

Yes, can I come back to that? The focus is very much on the means test which the Minister has raised successively. She raised it twice. Are employers using carer's benefit, which does not have those restrictions to anything like the same extent? Are they using that in a creative way? Carer's assistance is really for full-time care so those recipients would be detached from the workforce. The focus seems to be more on people staying attached to the workforce. I am wondering about the use of carer's benefit or the constraint in carer's benefit. Will Dr. McGann identify reforms that would make that more workable, to combine part-time work with caring responsibilities?

That comes back to the culture in the organisation and employers future proofing their workforce to make sure they are doing all those elements of flexibility where they can in order to keep that worker engaged. What I was alluding to with the hours versus days approach is, we hear from the sector that a number of people may themselves have care responsibilities so they are working part time and keeping benefits, the medical card being one that they are particularly cautious about. In conversations with them there is quite a broad church from different organisations-----

It is where a person can only work for three days of the week to retain benefits, whereas if a person worked the same hours over, let us say five days, those benefits are lost. It is a bit of an anomaly within the system that would free up more workers immediately. Talking to the workers themselves the sense we get is that most would take on up to three extra hours, which would release another million care hours into the system if that hours versus days approach within the social welfare system was adjusted.

Good morning to our witnesses. I thank them for their communications before the meeting. It is interesting that IBEC is here today because there was a debate again in the House last night regarding carers. One of the figures that was thrown out in terms of the cost of informal care to the economy every year, if the State was to pay for it, was a figure of €20 billion, which would be unsustainable. We can all agree on that from the outset. As was highlighted, there is still no statutory entitlement to receive formal home care. That is an issue of funding throughout the State and the State is looking at that. However, an issue that arose last night was the number of people, which in IBEC's submission was almost 300,000 people, providing informal or unpaid care, and the greater impact on women who generally tend to end up holding the bag in terms of care hours. There is an impact on jobs. We heard in previous debates about the difficulties in families where one partner cannot work, one partner is earning and one is not and the pressure that brings. What we are really seeing is the demographic challenges of an older and ageing population and people living longer. We have problems and the question is how to deal with them.

In terms of the outline presented, has IBEC looked at any research on how the Government fiscal and taxation policy could incentivise greater care participation? In other words, if a person is not working there is not much point in a greater tax-free allowance because he or she is not earning. However, the question relates to benefits that would try to help people who are staying at home. My sense is that people who are caring are double jobbing in a way, so that creates greater stress. They are also saving the State money if that care burden had to be moved on to the State. What can the State do in terms of taxation or greater tax rebates or funding to soften that blow and to recognise that there is a significant cost of care burden that the State is not being charged with?

Unfortunately, I do not have that answer but I certainly will revert back with that. It is not something we have looked at.

Deputy Matt Shanahan: Something like that would be helpful in terms of any submissions being made. Also, reference was made to statutory home supports and something similar to the fair deal. Has Dr. McGann any estimate as to the Exchequer costs as opposed to the health saving costs? If we want to propose something to the HSE it generally looks for a cost-saving to incentivise a change of activity. It does not want to add to the budget, therefore they ask for an explanation of how something will save money and then it can pay it. In terms of a statutory home support care scheme, the fair deal itself is struggling, family care is struggling and the care hours issue is a struggle. Where and how will we recruit these people? As others have already pointed out, what cost incentives are there to recruit people? That seems to be a big problem in terms of the actual cost per hour being paid to carers.

In regard to the fair deal piece, we do not have the exact figures. Again, I can come back with those. We are seeing people who cannot get access to homecare, finding themselves in nursing home care sooner than they would like or is actually necessary. The cost involved in that type of care versus homecare, is multiples of multiples. In terms of savings, if we had the homecare sector up and running and that fair deal approach within the homecare sector, the savings certainly would appear to be there in comparison with early entrance into nursing homes.

In regard to the sector itself and attracting workers into it, we have heard it described as a three-legged stool in terms of regulating the sector so that it is professional, because not anybody can do it. It should be recognised as a skill and as something very valuable. There needs to be a career path and career development that acknowledges, in many cases, carers who are providing very specialist care maybe to clients with dementia and complex needs. There should be a recognition of that. That could potentially be where we could look at different pay rates or different structures. How it is funded is obviously key but also how we look at developing, on the job, not just off the job.

The apprenticeships in Ireland do not start until level 6, while to work in care, you need two level 5 QQIs, so that is on-the-job learning. For someone who is coming back into care work after not being in the workforce for a period or who is trying to juggle that, it can be quite daunting whereas if such people are on the learning on the job, they are getting that exposure and that support in the role. It is more likely that somebody would be retained in that space, particularly-----

I want to ask about the other point that was made regarding the hours versus days. On paper, it makes sense but the difficulty is that if a person is in a technology workplace, it might be easier for someone to work from home or to log off for a few hours and catch up later on. If a company was employing people in a manufacturing or skills process, where they are part of a team, it is very hard to have people slipping in or out, particularly at very short notice. If a carer has not turned up, and that happens in the workplace, it would be very difficult to try to structure that in sectors. Has IBEC done anything to look at that? It is certainly not feasible or would be very difficult to achieve for some sectors.

It would be difficult in some sectors, however, we need to be creative. We need to be thinking that way and looking at our workplaces and how we are going to future-proof them with those particular challenges in mind. It may not be possible for every job to do it that way but there may be a different way that we can look at it. When we did the research and talked to people who are juggling that care and work element, what they were feeling was overwhelming pressure to try to do both while possibly doing both poorly. This added to stress and financial concerns. If we can manage it, we should keep these people close to the labour market in a way that when their caring needs have changed, they will be able to ramp back up again, if that is what they wish to do, and that they feel supported in so doing whereby there is a culture within the organisation that states this is not forever but this is how the organisation will support them in that regard. We have seen some organisations put in place employee network systems in order that people do not feel like they are the only person going through this. From what we have heard from carers themselves, it can be very isolating and can take a heavy toll on mental health. We need to be creative and come up with different ways and while we may not be able to deliver in respect of every role, there is a different way that we can look at this and we need to urgently prioritise that in our employment.

The average age of carers is also a problem, because it falls on the further end. These are people that are generally past their 40s, most are in their 60s and therefore are people who probably want to give up work themselves and not be taking it on. IBEC is trying to keep people connected to the workforce while many of them are already looking for the exit door to their own retirement. This may have relevance to the research and employer participation. There is a bigger social piece here in respect of how we are going to pay for this ageing demographic into the future. Unfortunately, when we look at countries like the United States, for example, there is a terrible two-tier system whereby those who have money pay exorbitantly for care and for those that do not, it falls back on whomsoever with a poor standard of care.

I thank the witnesses for their participation today. If the witnesses come back - and it could be in the IBEC submission - they could include more quantified costs for the initiatives they are proposing because ultimately, there is a cost to everything. There also could be a good cost-benefit analysis in respect of what is being saved in the residential care setting and what is delivered in increased productivity and labour participation.

I thank the witnesses for their presentation and am sorry that I missed it but I was in the Chamber dealing with another matter. A few things came up here. I am interested in the private retirement communities mentioned in the witnesses' publication. A whole list of step-down models was also mentioned in that regard. My impression is that we do not have a huge take-up on the retirement communities in Ireland as I only am aware of a very small number. Will the witnesses comment a little on why this is the case and why businesses are not building these communities? I would have thought there would be a demand for them, given that many people are living in very large houses with great value. By selling those homes and using the equity to purchase or lease a place in a private retirement community, they would be better off in many ways. I know of two or three of them in the country that are doing well but apart from that, there does not appear to be much take-up at all.

I do not know the reason they are not but I agree with the Deputy that we need a continuum of care that has a range of options for people in order that they have choice in this regard. A dignified and respectful way of engaging with the individual in need of care around choice is sometimes missing from the care conversation. While the care providers are doing magnificent work, some of the choices often are taken out of people's hands, be that for financial reasons or due to the options in their area. We hear from people in rural areas in particular, regarding the numbers of available carers locally and how those options can narrow very quickly.

We need to see greater options in terms of that continuum of care. Culturally, we may not have got our heads around it yet, but we need to start looking to other models in other countries. There are some good practices that we have come across in international research. Denmark, for example, focuses on deinstitutionalisation of elderly care. It focuses more on the home care step-down retirement village approach within communities, rather than institutional care in the first sense, unless it is warranted by a particular complex need. We have seen them come with a cross-functional team whereby it looks at the functional, psychological, medical and social resources or challenges that an individual might have, and approaches it from that perspective with a view to trying to match the type of care. It can start with rehabilitation to make sure somebody is physically able to stay in his or her home longer, all the way up those retirement village arrangements. I am familiar with a couple here that are magnificent arrangements for people, which keep that community focus and engagement for people as much as anything else.

I also have visited them and I was impressed with the quality of life and the reports I got from the residents. They were happy because they were no longer lonely. They had companionship, friendship, community and fun and their lives had changed completely. This was in contrast to living on their own and heating their own house, which they did not need. There is a business model there for the business community and for the State to get involved in, and we have more and more people that would welcome it. It was mentioned that they are in their own community. A person could be living in a town and a centre could be built in the town, which is not institutionalised but is sheltered housing in some shape or form. There are different levels to that and I have seen them in other countries as well but we do not seem to have the impetus here to make them happen.

The witnesses' submission also stated that caring is not an attractive career choice. I put it to the witnesses that what is happening now is that as more workers have more care demands placed on them, it is impinging on business. Business is perhaps beginning to see that we need to do something else and this is why this report is so welcome. It is having an impact on business. I saw what Irish Life and Irish Rail have done. We should encourage more businesses to go down that route, to look at what Irish Life and Irish Rail have done regarding flexibility and encouraging people to share with their employers the stresses they are under at home. Employers can then understand if somebody needs to go quickly or needs flexible time and can work something out. Is that something that IBEC is pursuing as a policy objective amongst its members?

It is an area that we have been interested in, and work had started pre-Covid and then stalled a little bit. We are now putting a lot of focus on it. We are trying to talk to employers on a range of different approaches, both in groups and, as recently as this week, through our podcast. This is to try to highlight good practices that are happening within employer organisations but also how a big change may not necessarily be required. For many years, we have had a reasonable accommodation passport for people with disabilities that we agreed with ICTU and Employers for Change.

We have implemented that and encouraged our employers to pick it up. Basically, it offers a formal conversation where someone can talk about the types of flexibilities or accommodation they may need to do their job. Those accommodations can be put in place in order that the person does not have to start all over again every time he or she progress in the role or gets a new manager. We have seen a number of companies take that sort of model to look at the flexibilities their working carers may need and put that in place so there is an understanding and a recognition and the working carers feel supported.

We have heard from some people that there can be a reluctance to disclose having a care responsibility. It seems to be twofold. One reason is some working carers may see work as a bit of an escape from care where they do not have to have a conversation about how their mum, partner or whoever it may be is doing. That is a factor for some. For others, there are concerns in respect of it impacting their careers. We need to make sure the workplace is creating a supportive culture. There is a famous quote about how there are only four types of people in life: those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need a caregiver. It will come to us all if we are lucky enough to live that long, which is a good testament. We have got to see that culture.

I have a final question. It was mentioned there will be a global shortage of 10 million healthcare workers by 2030. Does Dr. McGann have any figures on what the shortage in Ireland will be? Right throughout her publication and submission, she mentioned that even with money having been made available, there has been difficulty in getting workers. They just are not coming forward. This may be because, as Senator Gavan said, the rates of pay are too law or the roles are not seen as attractive or professionalised. It may be that the standards around the certification of training are not there, as Deputy Bruton alluded to. There is a lot of work to be done in that regard.

Due to Ireland being beyond full employment, to use the term which is used now, are there issues with bringing people in from abroad? I am always conscious when I say that. Our medics are leaving to get experience and so forth and we are bringing in people from other countries. In some ways, we can be impinging on their health services by bringing their nurses, doctors, and carers here. We deal with work permits in this committee. Will Dr. McGann talk about the issue of bringing people into Ireland? At times, there are language and cultural issues surrounding all that. Maybe Dr. McGann will comment on that whole space.

It was a really welcome change when workers in this space were removed from the ineligible list and are now eligible. Of the quota of 1,000 work permits put out, there has been an uptake of approximately 800 so far. It is working very well. There can be a particular challenge when workers also need a visa. Currently, those are two separate systems and it can obviously cause a particular delay in that space. We are hopeful that the single application model will come to pass in due course. It will be welcome not just for the care sector but for all sectors. That is definitely important. The Deputy is absolutely right; we will be competing with international workers who are mobile workers. We need to make sure Ireland is welcoming and supportive of them coming to provide this really important role in addition to our local workers who will fill that.

That concludes our consideration of this matter for today. I thank the representatives for assisting the committee in its consideration of this important matter. That concludes our business in public session for today. I propose that the committee go into private session to consider other business. Is that agreed? Agreed.