Winter is nearly upon us and that means only one thing, sky rocketing numbers of people on trolleys in our hospitals and political announcements of Winter Initiatives. Numbers have already been high this year but the IMO are now predicting that we will break the 1,000 barrier this winter for people on trolleys waiting for treatment.
The previous record was set in March of this year with 714 people waiting on trolleys at any one time.

In order to address this problem, yes more acute hospital beds are needed, as well as the relevant clinical personnel but perhaps the biggest way of relieving this problem is by providing sufficient support in the community for people to be discharged in a timely manner.

In the recent budget, €20 million was announced to tackle waiting lists in the weeks running up to Christmas and to pay for the HSE’s winter initiative program, to cater for growing demands as the weather deteriorates.

Also in the budget, close to €40 million was set aside for securing additional homecare packages and transitional beds, to assist in moving patients out of hospitals when their acute phase of treatment has concluded.

Both these actions are to be welcomed but because of serious capacity issues within the home care sector, an increase in home care provision for hospital discharges will probably mean less home care for deserving cases in the community. The fact is, if we really want home care to play a fuller role in the health care continuum and specifically in alleviating the pressures in our acute hospital sector, we need to take a longer-term view and look at how we can develop a sustainable and enterprising home care sector capable of bringing significant benefits and savings to society.

So what does a vibrant home care sector look like? Firstly, and perhaps most importantly, it needs to be a place where people want to work. A place where people receive decent wages and have the opportunity to advance and make a career. A place where carers are truly valued for the tough but vital work they do. We need to stop paying lip service to the great work carers do and put our money where our mouth is. Of course, many home care companies will be resistant to this wanting to maintain their bottom lines. The best way to combat this attitude is to ensure carers have options such as self-employment or maybe carer coops?

Secondly, it needs to be respected by health care professionals and users alike, as a real option for quality care. Presently, residential type care is seen as a safer option for hospital discharges primarily because it is regulated. Considering home care is generally delivered one on one it should have been regulated before our nursing home sector. Regulation of the sector will go hand in hand with a statutory underpinning of the sector and will help integrate the home care sector closer with the acute and residential sectors ensuring that there is more joined up thinking on meeting the needs of our older and disabled populations

Thirdly, it needs to be a sector embedded in local communities, fostering local community support and activity. Demand for support in the community is ever increasing from our older and disabled population and if it is to be met, we must activate and use community assets that are already in place. We need to attract into home care, people who are embedded in their local communities but presently not providing care. Local home care provision can also be an important economic stimulus for local communities.

Fourthly, it needs to embrace technology and new ways of doing things. Yes home care is all about the personal touch but adopting technology doesn’t have to mean the loss of the human touch. Technology should be all about enabling the care workforce to spread their empathy and caring more widely and more efficiently. This includes AI, big data analysis, remote monitoring, robots, telehealth and social networks. All these can play a role in allowing people stay independent in their own communities for longer.

Fifthly, it needs to offer service users choice and to empower them to make those choices that best suit their needs. Providing people with choices in how their home care support is delivered and empowering people to make those choices where possible is vital to drive quality and improve outcomes as well as efficiencies. What this means is that we will have to make sure that services fit peoples needs rather than what often happens presently, of shoehorning people into existing configured services. More of a movement towards personal budgets is one way to increase choice.

Finally, it is a sector fully integrated with the acute and residential care sectors, all with a joined-up coordinated plan for delivering the best healthcare when and where it is needed.

Home care has the potential to contribute so much more to the health and wellbeing of our citizens than it does presently. In order for it to do this, we need to loosen the shackles that presently are holding it back and really invest, support and nurture the sector. Home care hands politicians that rarest of political indulgences, giving people what they want, while saving money at the same time.