A recently published report by Home and Community Care Ireland has quantified savings of €2B over the 8 years to 2021. This translates into 18 million extra hours of home care and an additional 8,600 jobs.

€2B is a big number and normally when you are talking about making savings of this magnitude it means severe cuts to services as well as major pain for some section of society.

In this case no! What we are talking about is a win-win situation by giving people what they want. The power of choice and the ability to stay at home for as long as possible.

So how are these magical savings generated? Are they radical solutions needing root and branch reform? Are they reforms which haven’t been done elsewhere and as such there is a lot of risk involved?

No and No.

These savings are generated by implementing the types of policies already carried out in numerous other jurisdictions.

What is been called for is firstly, the introduction of open and transparent commissioning of the existing home care budget of €340M which would ensure better quality care at a lower price. In the absence of regulation in the home care market, this would be an important driver of quality by allowing patients to vote for providers with their feet.

Secondly, an end to the ring fencing of budgets for one type of care over another within the older persons budget and allowing instead patients to direct the spending of one over all budget for elderly care through their preferences.

Savings of €117M for 2014 alone are available if these measures are implemented. The Minister of Health owes an explanation to our older population why he is implementing frontline cuts that are having a devastating affect on their lives when he has two easily implemented and tried and tested solutions available as detailed in the report.

Home Care Plus

Home Care Plus welcome the recent U-turn by the government with regard the cuts to personal assistant hours for those with disabilities. However, we would call on the government to go further and also reverse the planned cuts to home help hours and home care packages.

Both these cuts are short term solutions that will cost the government more in the long term. We would contend that there are several other initiatives that could be undertaken before having to resort to cuts in frontline services.

For example, why not  look at the area of patient choice? The total budget of elderly care is roughly €1.2B with the vast majority of this (€900M) being ring fenced for residential care through the Fair Deal Scheme (FDS). This is despite the fact that people’s overwhelming preference is to be looked after in their own home.

We also know from HSE information, that 80% of people who accessed the FDS were never assessed for a home care package. In addition 16% of people in residential care are considered low dependency with a further 29% medium dependency. That’s nearly 50% of people in residential care that could be suitable for care at home!

Why not stop ring fencing funding for one type of care over another and instead let people choose how and where they want to be looked after. How much could that save and in addition you are giving people what they want!

Health cuts

The recent proposed cuts to the health budget are very difficult to accept when you take into account that there are areas which could be looked at before having to resort to affecting frontline services.

Cuts to frontline services should only be considered when all other areas such as administration, pay and wastage have been exhausted.

In the context of these cuts, is it fair that staff within the health service are getting pay increases through increments?  Is it fair that the HSE are paying up to 98% of the price of branded drugs for generic drugs? Is it fair that public hospitals don’t charge private patients for treatment in their hospitals? Is it fair that negotiations with hospital consultants still haven’t born fruit?

How much could be saved through changes in how the HSE is managed and run?

A recently produced report by the PA Consulting Group calculated that nearly €80M could be saved by opening up the market for care at home to all providers and making it fully transparent. That’s well over half the savings of €130M the minister is looking for.

We at Home Care Plus feel that the elderly and vulnerable should not have to shoulder the cost of poor management and the intransigence of interest groups defending their own interests at all costs.

Health Cuts

Home Care Plus are shocked at the recently announced cuts for care at home for elderly people. We feel that these cuts to front line service provision is the easy way out for the HSE rather than looking at inefficiencies in their internal organisation whether it be in terms of pay levels or administration structures.

The fact is that home care is the cheapest way to look after our elderly and numerous studies have also shown that it is their number preference of how they would like to be cared for.

It costs the over €1,000 per day for the HSE to keep someone in an acute hospital bed while to keep someone in their own home can cost only €185 per day. In addition they are getting one to one care from someone they know and have a relationship with.

If we want to make savings in the health budget, home help hours and home care packages should be increased rather than been cut. Home care keeps people out of expensive hospital beds and residential care. It also can ensure a more speedy discharge of patients freeing up much needed beds in the system.

This short term view decision making, will only increase the costs of looking after our elderly people the medium term.

HSE cuts, Home care

Currently in the UK there is an important move towards a personalisation agenda for the health care sector which is changing the way health care is delivered there. What is personalisation?

Personalisation means looking at care and health provision in a completely new way. It means looking at healthcare from the patient’s point of view and starting with the fact that everyone is unique and as such each person has different strengths, weaknesses, circumstances, preferences and aspirations.

With this in mind personalisation is all about putting the patient at the centre of assessing their needs and subsequently at the centre of the decision making about how, when and where they are cared for.

Traditionally our health service has been service lead which can mean that patients don’t always receive the care and support they need when and where they want it. They are also somewhat divorced from the shaping and construction of their care and support.

Personalisation is all about giving the power of choice back to the patient regarding their healthcare and lives in general. It means ensuring that information and support is available to enable patients make their own choices well informed decisions about how they want to live their lives.

Personalisation is about

1) Tailoring support to the individuals needs

2) Ensuring patients have access to information, support and advocacy to help them make good decisions about their healthcare provision

3) The importance of early intervention, prevention and re-ablement to ensure patients are supported early on and in a manner that’s is appropriate to them.

With personalisation people would be given their own budgets to spend as suited their particular needs and preferences. For those people not capable of making those decisions support and advocacy would be available from the state.

This personal budget would come about through an assessment of the persons needs by the state and could be paid in the form of a direct cash payment, held directly by the person or, where they lack capacity, by a ‘suitable person’ or secondly, by way of an ‘account’ held and managed by the state in line with the person’s wishes, that is to pay for community care services which are commissioned by the state, or as an account placed with a third party provider and ‘called off’ by the user in direct negotiation with the provider.

The person would be encouraged to draw up their own care plan in conjunction with the state and it would be reviewed on a regular basis to ensure that the agreed outcomes are being achieved and any changes responded to.

Personalisation would also allow people to vote with their feet helping to ensure that providers of healthcare services are competitive and supplying a top quality service.

Today’s article in the Irish Independent ( http://www.independent.ie/national-news/probe-into-topups-for-150000-charity-chiefs-3040011.html) is further evidence of the waste that goes on in the Charities and Not For Profit Sector. These organisations receive billions in funding every year from the state amounting to 10% of the states spending on health with little or no check on how that money is spent or benchmarking to see if the state is getting value for money.

It is frightening to think that the Minister doesn’t even have the power to compel these organisations to reveal if their chiefs have been receiving top up payments to their salaries or not.

In these times of financial hardship it is vital that there is complete transparency with regard this funding to ensure that the cuts to frontline health services are kept to a minimum.

In the UK they are moving towards a Personalisation agenda whereby funding is given to the service user directly to spend in a manner that is suitable to their circumstances. This ensures that providers must “compete” for funding and thereby ensure that their organisations are efficient and give great service to their “clients”.

If service user’s cant mange funds themselves, they can appoint a third party to do it for them that could include family members or the state.

Is this something we should be looking at in Ireland to ensure that health services are more patient centred and that services are delivered in a more efficient way?

Home care; Charities

Since our inception nearly 3 year ago Home Care Plus have been advocates of bringing in regulation for the home care sector. We feel that the home care sector is much more open to potential abuse by the simple fact that 95% of our work is done in one on one situations with vulnerable adults. The nursing home sector which has been regulated and comes under the auspices of the Health Information and Quality Authority (HIQA) is less open to abuse by the simple fact that there are people around.

The recent published report by the Law Reform Commission has starkly stated the need for this regulation as soon as possible.

The Minister has an agreed set of standards on his table drawn up by industry stakeholders that need to be given a legal footing and subsequently supervised by HIQA.

Standards and regulation are of course useless unless there is subsequent supervision and enforcement of these standards. The argument is often put forward that in our present financial state, the HSE and HIQA don’t have the resources to adequately enforce any regulation that comes in.

This issue is not unique to Ireland and one solution that other jurisdictions have put in place is to go down the road of accreditation. The Minister could insist that all providers of home care services whether to publicly funded patients or private clients must achieve accreditation by a selected international body such as CARF ( www.carf.org ) within a certain period of time. Supervisions could then be focussed on the providers who haven’t undergone the accreditation process or who achieve a low score on their outcomes thereby concentrating scarce resources in the areas where they are needed most.

Regulation was brought into the residential sector because of the Leah Cross scandal. We hope it won’t take a similar scandal in the home care sector in order for the government to bring in regulation.

Home care regulation, Law reform Commision

The announcement today from the HSE of possible drastic cuts to services to the elderly in an effort to secure savings and stay within budget by the end of this year are deplorable. Some of the suggested cuts include cutting home help hours by a quarter and reducing the availability of personal assistants to people with disabilities.

 The HSE presently spend €220M on home helps. Cutting this by a quarter would save them €55M. Much of this saving could be realised by better procurement practices.

Presently all home help services are provided directly by the HSE or not for profit organisations funded in many cases 100% by the HSE.

While the care carried out is of a high standard, by ring fencing the provision of home help hours to within the HSE and not allowing private providers to compete for the provision of this service, the HSE are not getting sufficient bang for their buck.

By allowing the private sector to compete for all aspects of care for the elderly a recent PA Consulting report calculated that savings of roughly €60M could be made. While the HSE refuted these findings there is no doubt that significant savings going towards the required saving of €55M could be made by better procurement practices.

Health Cuts, Home Care

Home Care Plus were delighted to host a coffee morning In Winnies Craft Cafe in Woodbine in aid of Blackrock Hospice yesterday. The morning was a great success with many of our clients coming along with their carers as well as local people living in the area.

Nearly €500 was raised for a very worthy cause and we would like to thank everyone who came along to make the morning a success.

Home Care Plus

Numerous studies have shown that older people want to stay living independently in their own home for as long as possible. Now a recent report commissioned by Age Action Ireland, “A Total Indifference To Our Dignity”, found that older people would prefer to stay in their own homes even if they are suffering abuse, rather than go into a nursing home. This is a terrible state of affairs.

The powers that be accept that healthcare should be moved into the community and away from hospitals and residential care but this wont happen unless significant resources are diverted away from the latter to the former.

In Ireland older people are entitled by law to hospital and residential care but they are not entitled legally to services that could help them to stay in the community such as home care, home help or grants for fitting out houses. This has to change and older people must be entitled by law to these community services. Not to do so, is blatant discrimination against older people as they are the sector of society that use these services most.

The Fair Deal for nursing home care was announced with great fanfare but this isn’t what older people want. Why not a Fair Deal equivalent for community services with the right to these services enshrined in law?

Home Help

Community Services