The recent Winter Plan published by the HSE has made it clear that home care is going to play a much larger role over the coming months in combatting the COVID pandemic but perhaps more importantly, is going to play a larger role in our health sector overall, with a doubling of the home care budget mentioned in the plan.
This is positive for the sector and a real opportunity to show case all that is good about having a properly funded and fit for purpose home care ecosystem.
However, what we must guard against, is this increased importance becoming just a means to copper fasten the stranglehold of a limited list of approved corporate providers and the further embedding of just one model of home care provision.
The home care system cannot be about families having to adapt to a rigid pre-ordained system. It has to be the opposite, a system adapting to families varied needs in a more personal and human way. Increased funding must mean more choice, better outcomes and happier carers, not just fatter bottom lines.
One concern we would have with regard current and future discussions around workforce reviews, how increased funding will be spent and what the sector will look like, is that there seems to be very little direct input from carers and families into these discussions. Yes, providers will talk about surveys and consultations they have carried out with both parties but that is not the same as getting direct unfiltered feedback from both carers and families. The HSE and the Department of Health can’t fall into the trap of presuming provider organisation speak for carers and families. Indeed, provider organisations don’t even speak for all providers, with many both large and small providers, outside their umbrella.
Part of the reason we are not hearing the professional carers voice in rooms where decisions are being made, is that professional carers don’t have any national organisation to represent them. However, this shouldn’t allow provider organisations become the filter through which carers wishes are passed. Government must make efforts to reach out directly to carers to understand their concerns and needs. Facilitating the setting up of an independent professional carer advocate body could be one way to do this.
Understandably, providers have their own agenda but it is just that, their agenda to cement their position. Their thoughts on how to improve the lot of carers should be taken into account in any workforce review but not as Gospel, more an addition to direct views from carers themselves.
Take the issue of payment for travel. Any move by the HSE to pay for travel costs should go fully to carers and not suffer leakage to corporate administration. Likewise, initiatives to protect pay to carers affected by COVID by increasing payment to providers, will be severely diluted unless safe guards are put in place to ensure funds flow to carers rather than corporate overheads.
Home care provision is a lucrative business for private providers presently, yet despite this, carers are still very poorly treated as evidenced by the capacity issues the sector is facing. Any increase in home care funding must ensure those funds find their way to the frontline. The focus has to be about helping carers not companies. We need a relentless focus on making caring an attractive career.
The best way to ensure increased funding is efficiently used and distributed, is by offering choice to families and carers. Not the Henry Ford definition of choice of “You can have any colour car so long as it’s black” but rather a genuine choice, of families being able to choose from a wide ecosystem of provision models including corporate providers, local co-operatives, community organisations as well as smaller micro type providers.
The way to enable this choice is twofold. Firstly, by having appropriate regulation for different types and sizes of providers rather than a blunt one size fits all model. Safeguarding and governance should foster innovation not stifle it. Secondly, by having a commissioning process that promotes relationship type care over transactional type care, that promotes quality over price.
There will also be a need for complete and transparent information on the choices available to families so that they can make informed decisions about what model works best for them. Presently the only choice families have is from a list of uniform corporate providers offering the exact same solutions.
It’s positive that there are movements to enable home care play a more important role in our health sector after this pandemic but we need to ensure that families and carers are at the centre of those changes and contributing directly to discussions on change. Importantly, we must make sure that families and carers, are the ones that should benefit most from any increased funding.