The home care sector for older and disabled people is presently in crisis, as evidenced by rising waiting lists for home care packages, widespread discontent amongst carers and inadequate and poorly spent funding.
With demand for support increasing rapidly in both the older persons and disabilities sectors, we need to look at new ways of commissioning care and new ways of delivering care. Otherwise, home care will never play its full role in our health sector, which considering care at home is most people’s preference, would be a travesty.
So how do we unlock this potential? The best way I know is through providing real choice and control to the people that matter, those receiving care and their families and advocates.
This means moving towards Consumer Directed Care also known as Personalisation and specifically what are termed personal budgets. This is happening in many other jurisdictions such as Australia, Canada, US and our neighbours the UK.
Indeed the UK government has recently unveiled plans to increase the number of people with personal budgets from 23,000 to closer to 350,000, a real recognition of the power of personal budgets to drive quality and efficiencies.
A personal budget is a sum of money made available to the person needing support to spend in the manner they feel is most appropriate for their needs and with the provider they choose. It transfers control from the State to the person needing care and their family.
We have seen some limited use of personal budgets in Ireland but Minister Finian McGrath’s Task Force on personal Budgets in the disabilities sector is aiming to increase the use of personal budgets.
A move to the use of personal budgets in Ireland may well be problematic as it is a departure from the existing status quo where you have incumbent providers providing care on behalf of the HSE. Personal budgets remove control from them and places it firmly with the person needing care.
In the disabilities sector one of the main barriers to personal budgets is the difficulty in unbundling funds from existing section 38 & 39 providers. Existing providers are resistant to any of their existing clients being allowed to opt for a personal budget without them getting a replacement client. This is putting artificial barriers in the way of people who want more choice. If this issue isn’t rectified it means people wanting to opt for a personal budget will have to wait for their existing provider to find a replacement client or else have access to new funding.
In addition, if you are lucky enough to get a personal budget, it often just becomes an extra burden on top of families who already have enough to cope with, as people are forced to become employers and deal with all the resulting legislation. However other solutions now exist which alleviate many of these burdens.
On the older persons side, it is the HSE who need to relinquish control and trust older people and their families as the best placed to decide what their care and support looks like and with whom their funds are spent.
Presently the HSE commission care every 3 to 4 years to a limited number of approved agencies. This reduces choice for families but also results in the serious capacity issues we are witnessing because agencies aren’t making caring an attractive career for carers.
We need to move away from fitting people into existing services that have been organised and funded, to fitting services into what people want. The state needs to start to view itself as an investor and not a buyer. An investor looks to liberate innovation at the personal and local level. Investment is not management, it is making sure resources are funnelled to the best people to make decisions, solve problems and subsequently create solutions.
Personal budgets need to build on what already exists in the community and not become just a more convoluted way to spend funds.
Ireland can become a leading proponent of personal budgets if we embrace them. If we don’t allow vested interests slow down their adoption. If we ensure families are supported in adopting them. If we ensure personal budgets mean real choice and not just more of the same but in a slightly different guise.
The upcoming home care tender for older persons is a real chance for the HSE to begin the introduction of personal budgets. Let’s hope they grasp it.