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Minisiter for Mental Health and Older Person, Mary Butler, launched the first meeting of the cross-Departmental Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants on 3rd March 2022.  Minister Butler has launched this Group in order to explore the issues which are resulting in the challenges facing this sector and to identify solutions for those challenges.  Minister Butler highlighted, specifically, recruitment and retention as being the main issues and that, although ample funding is available for provision of services, there is an inability to recruit new healthcare assistants (HCAs).  We are also experiencing a substantial loss of HCAs from the sector.  This has resulted in, as of the end of December 2021, 5322 people in the community left waiting for a carer to meet their needs.

The Advisory Group is made up of officials from:  Department of Enterprise, Trade and Employment, Department of Justice,  Department of Further and Higher Education, Research, Innovation and Science, Department of Social Protection, Department of Children, Equality, Disability, Integration and Youth, Department of Public Expenditure and Reform and HSE, HIQA and SOLAS.  The Advisory Group is committed to making a set of recommendations to Minister Butler by September 2022.  (Government press release available at: ).

As it was noted in the above press release that the Advisory Group would be engaging in meetings with relevant stakeholders over the next two to three months, the Alliance of Healthcare Assistants in Ireland (AHCAI) requested an invitation to make a submission in order to ensure that the voice of the HCA be heard.  Minister Butler invited us to meet with Government officials from her Advisory Group and this meeting took place online on Monday, 11th April.  AHCAI also submitted a written submission.  The Government officials from the Advisory Group have confirmed that, while the issues facing this sector are complex, they are working to a tight timeline and are committed to finding solutions.  As more information becomes available we will ensure that you are informed.  Below is a summary of our written submission.  All evidence provided regarding the sector was research based.

Summary of AHCAI Written Submission to Minister Mary Butler’s Advisory Group, 11th April 22:

Section 1:  Why are we experiencing the current crisis:
Here we highlighted the changes in our population and how the fact that we are all living longer means that there are more older people in need of care.  In addition, because as we age we are more likely to experience chronic illness, this is also a factor in why more people need more care.
We then highlighted that because this sector is getting so busy, this creates very stressful working conditions for the HCA, especially in the community.
We highlighted the differences in work contracts between the public and private sectors in particular issues regarding sick pay, holiday pay and pension schemes.  We also referred to the differences in whether or not travel expenses are covered when working in the community.
We also noted the difficulties with flexible contracts where, as a HCA, you do not know from week to week how many hours you will be working and how difficult this makes it to budget, plan or maintain any kind of work – life balance and that it is very difficult to maintain motivation levels.
Finally in this section we noted the lack of recognition for the role of the HCA across all sectors of society, including the media during coverage of the Covid pandemic.

Section 2: Can we change the way we care?:
We reviewed our society’s reliance on institutional care and referred to reports by different Government organisations which called into question our use of institutions for care not just for the older population, but all age groups that need care for whatever reason.
We spoke about different housing projects that provide supported independent living which could be rolled out more widely if the role of the HCA was recognised and developed.
We highlighted the possible implications of the Assisted Decision Making (Capacity) Act 2015, which will lead to even more people needing care in the community.
Finally in this section we spoke about the positive developments which will assist more people to live independently for longer including case studies on different housing projects around the country, developments in assistive technology which lead us into the final section…

Section 3:  The changing role of the HCA:
We highlighted the difficulties in assessing the role of the HCA and that this was mainly due for two reasons:  lack of a specific job description and the unregulated nature of the role.
We highlighted again the issues that are faced by the HCA and developed those issues further.  Research conducted in 2018 showed that staff turnover was directly linked to: pay, length of time working for current employer, training, access to continuing education, managerial support, supervision and mentorship and stress levels are work.  This particular report showed the satisfaction with the role was high but if these factors were not addressed recruitment and retention would remain a problem.
We called for the need for regulation for the role of the HCA and that this would result in it being seen as a profession that is respected and valued.  Regulation would ensure establishment of a career pathway that is recognised in terms of pay and conditions.  Regulation would ensure a clearly defined job description and it would also encourage school leavers to see it as a career in itself.
We also spoke about the fact that it is expensive for the HCAs to undertake major awards with QQI which are required for the role and yet there is no career development afterwards and how this is directly linked to a lack of motivation in the sector overall.

Section 4:  What would regulation of the HCA help to achieve?:
Here we highlighted that developing the role of the HCA would ensure recognition for the role with appropriate pay and conditions and career opportunities but also how this would help the healthcare system overall and indeed society by ensuring that more people could live at home and maintain their independence because the HCA would be available to provide that care.
We demonstrated that with further education the HCA would be able to highlight the complications of chronic illness before they require hospital admission thereby ensuring that acute beds remain available to those on waiting lists awaiting in-hospital procedures.
We showed how the issue of delayed discharges could be solved again if we have more HCAs available to provide care.
We highlighted how so many HCAs coming through the system now are digitally literate and could assist with technology which will assist people to live at home for longer.
We highlighted how well the HCA gets to know those in their care and how important this will be when the new legislation comes in regarding the Assisted Decision Making (Capacity)Act 2015.
We also highlighted how development of the role would enhance the HCAs ability to work with all the other health disciplines and would ensure an exciting career ensuring job satisfaction.

Within the meeting on 11th April we also highlighted that the role of the HCA can be very challenging emotionally and that there is no support system for the health and wellbeing for individuals in this sector.  We felt that this was something that should be addressed in any exploration of the role.

We hope that you feel we have highlighted the main issues faced on a daily basis.  We do feel our voice was heard and that Minister Mary Butler genuinely wishes to resolve the challenges, not just to meet the needs of those in need of care, but also to develop a career path for the HCA that is attractive and is fair.  If there is anything you feel you would like to highlight, please do.  As soon as we are made aware of any developments, we will bring these to you.

Thank you very much,

Clare Doyle





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