The reform of social care in Ireland is long overdue. For too long now, care in the community has played a secondary role to nursing home care. The introduction of the Fair Deal Scheme in 2008 put nursing home care on a pedestal in comparison to home care.

The scheme gave people a right to nursing home care and makes a significant contribution to funding it. The scheme is also demand lead and not budget lead like home care.

There have been numerous reports and discussions about reforming home care by introducing regulation, under pinning it with legislation and giving people a right to access it, however action has always been kicked to touch.

Despite the logic of promoting home care over nursing home care because it is cheaper in many cases and it is also generally people’s first choice to stay at home, progress has always been stymied.

I suspect the principle reasons for this are firstly, a fear from the Department of Finance to giving people another right to a demand lead service and secondly, a fear from the same department of undermining the incredible free work done by family carers throughout the country. Why pay for something if it’s available for free?

There might be a will and indeed a plan to implement reform in the Department of Health and the HSE but this counts for nothing, unless the mandarins in the Department of Finance are on board. Their focus is on Euro’s and future liabilities.

Unless the Department of Finance sees a clear economic benefit for funding home care, they will view it as a black hole with few real immediate benefits and no end of spending in sight.

Additionally, the openness of the Department of Finance to fund home care will be severely tempered presently because of Brexit concerns and COVID costs. They realise that post this crisis, the imprint of the State will be bigger and so why take on even more responsibilities and costs if not absolutely needed. Yes, social care is underfunded in Ireland but not to the extent that it is critical.

This is unfortunate, because the fact is, our society is changing. Families are becoming smaller and there are more childless couples and individuals, which means demographically, the provision of informal free care by family members, is declining with time.

If home care is to play its full role and be properly funded, a robust and detailed case must be made of the economic benefits that will flow in order to sway the Department of Finance. A case that shows clearly the savings to be had by relieving pressures on the acute sector. A case that clearly shows the savings to be had from keeping people out of residential settings. A case that shows clearly the economic and tax benefits of having more women free to join the workforce. A case that shows clearly the ability of home care to be a economic driving force for local communities.

I think the will is there in the HSE and the Department of Health to enable home care to play a larger role, but the key to ensuring a vibrant, regulated and well-funded home care sector, lies with the people who hold the purse strings.