Recently there has been significant media coverage of HSE cuts to frontline services because of reduced budgets. This has caused uproar, with various interested organisations claiming that the most vulnerable in our society are been made scapegoats as they are seen as easy targets.

We all realise that the same money is not available now as at the height of the Celtic Tiger and while it is a pity more was not invested to improve frontline health services and less dedicated to increasing back office resources, we have to live with the fact that savings have to be made.

However, we at Home Care Plus feel that before cutting frontline services we need to examine efficiencies within the delivery of health services, to see where we can in fact improve services without increased expenditure.

One area that is a central plank of HSE policy going forward is the provision of home care. It also impacts one of the vulnerable sectors of society, the elderly.

Presently the HSE spends about €330M per annum on home help and home care packages. The vast majority of this is provided for by the HSE directly and not for profit organisations which are funded directly by the HSE. Private providers cannot compete for the vast majority of this spend leading to a severe lack of competition.

A recent report carried out by the PA Consulting Group for the Irish Private Home Care Association showed the total cost of care carried out by the HSE to be over €29/hour when overheads are taken into account. The private sector can provide this care on average at rates of €21/hour. This translates into a saving of nearly 30%. Applying this to the HSE’s current spend mentioned above would result in a saving of around €90M per annum.

In addition, the private sector generally works to higher standards of care with garda vetting, proper reference checking, training and supervision all being carried out by the main private providers.

The current HSE procurement policy for home help and home care packages is not transparent and it is most certainly not getting the best value for money.

This type of analysis could surely be carried out in other areas within the HSE. In these times of financial crisis, transparent competition is the best way to ensure you are getting the maximum bang for your buck.

Home Care

Home Care Plus attended the recent Pfizer Health Forum on “The Ignored Demographic” where numerous interesting contributions were made by both members of the audience and also the panellists.

What came across most forcefully was the desire of older people to be respected and to contribute in a meaningful way to society. Like any demographic segment, senior citizens are made of a wide variety of types of people and not just by sick people which is perhaps the popular image.

Irish society can learn a lot from some eastern societies where older people are respected and revered for the life experience they have. Our challenge is how to harness this vast well of experience for the betterment of society.

On daily issues there was a lot of disquiet over the lack of services for older people such as insufficient home help hours, lack of accessibility to additional services such as physiotherapy in nursing homes under the fair deal scheme as well as fear over possible cuts to the old age pension.

Specifically in relation to home help hours and also home care packages, the state presently spends €210M and €130M annually on both. Only approximately 20% of the budget for home care packages is open to private providers of home care to compete for. If private providers were able to compete for all the available budget, significant savings could be achieved allowing the state to get more “bang for their buck” and without increasing budgets give out up to 30% more care.

Presently about 12% of our population is made up of people over 65 and this is forecast to double over the next 20 years. No society can afford to ignore 25% of its population and expect to prosper.

Home Help

Primetime’s programme on dementia care in Ireland and the subsequent Frontline programme on elderly care, presented a very stark view of care for people with dementia and also care for the elderly in Ireland.

Both programmes painted worrying pictures of serious underfunding, inadequate services, the absence of official standards as well as a lack of vision for the future.

The case of the daughter abandoning her mother in an A&E ward as the only way of getting the state to face up to their responsibilities was particularly shocking.

We in Home Care Plus feel the introduction of regulation and supervised standards in the home care sector, is vital to ensure that patients are cared for in accordance with their needs and to international best practice.

Standardisation of access to state care also needs to be addressed to avoid post code discrimination.

On the issue of funding, one way for HSE to stretch their budget further in these difficult economic times, would be by simply putting the whole home help and home care budget up to tender, rather than automatically giving the work to internal HSE staff and not for profit organisations who might not necessarily be giving value for money.

Ireland spends more per capita on health than most of our European neighbours but what we need to do is ensure that budget is spent wisely.

Home Care