How Can We Improve the Quality and Efficiency of Home Care Provision in the

Absence of Regulation

National Healthcare Conference 2015

Social Care budget 2015 - €3B

Elder Care budget 2015 - €1.27B

Fair Deal Scheme - €948M

HSE Funded Home Care - €325M

Home Help - €195M

Home Care Package Scheme - €130M

Privately funded care - €20M

Older Persons Services

Home Care Market 2014

HSE

Not-For-Profit

Private

Home Help Home Care Packages

Private Customers

€142m

€53m

€33m

€54m

€175m

€107m

€63m€43m

HSE Funded

€20m

€195m €130m €20m

€345m

Structural Issues Holding the Home Care Sector Back

Unregulated - Scandals

Dominated by State – Purchaser and provider

Strategic Engagement

Funding Silos

Poor cousin of Healthcare Sector – Lack of Confidence

Poor Transparency and Accountability

Lack of Regulation

State Dominance

Strategic Engagement

Funding Silos

Weak Link

Transparency & Accountability

Waste

Examples of What is Wrong

5 Hour rule

Paying providers in advance of delivering care

One price for all cases

Regional monopolies - Lack of Choice and Clients not Empowered

Price based tenders

PHN’s over worked – assessors, supervisors, administrators, advocates

Solutions

Tender Structure

What Does Good Commissioning Achieve?

Drives quality provision

Brings efficiencies without affecting quality

Promotes cohort of quality providers

Promotes healthy & safe competition

Provides transparency and accountability

Brings fairness

Key Question

What Does a Good Commissioning

Process Look Like?

Internal Reference Price Model

Emphasises on quality

Licensing not contracting

HSE set internal price for home care Justified

Per Lot

Latitude for special cases

PHN assessment Outline

Hours

State contribution is ........ Tax relief

Private top up

Internal Reference Price Model

Client discusses with provider directly Care Plan

Customised price

PHN role - supervision and support where needed

Internal Reference Price Model

Advantages HSE know exact exposure

Promotes idea of contribution

Each individual case properly costed

Takes advantage of local conditions

Helps recruitment and retention

Drives quality through client choice

Promotes quality providers willing to invest

Move up acuity scale

Better integration with acute sector

Home Care Needs to Play a More Important RoleLet Money Follow the Patient – End Silos

Use Procurement as a Driver of Quality Provision

and Quality Providers

Commissioning Policy

Extensive

Transparent

Quality based

Summary

How Can We Improve the Quality and Efficiency of Home Care Provision in the

Absence of Regulation

National Healthcare Conference 2015