HCCI Opinion on need for reform

of 'voluntary' sector care provision

April 2014

Public confidence in the 'voluntary' sector has been seriously damaged. Recent revelations surrounding REHAB and CRC use of funds as well as disclosures from the latest HSE review into top ups has left the public with a justifiable distrust of the sector.

The term 'voluntary' itself is also a misnomer and misleading to the public. The only people who are not paid in these organisations are the directors or trustees. In the instance of Rehab we have seen that even this isn't the case. All other staff members in these organisations are paid market rates.

While it is easy to find scapegoats, I firmly believe that in the majority of cases, the problem is not the people, but the structure they operate within. While it may seem odd to speak of market competition when talking about the vital services the health system provides, it is the lack of healthy competition, caused by monopoly type situations, that is the root cause of many of these scandals.

We cannot rely on the benevolence of ordinary people. We must provide incentives to ensure people are performing to the best of their abilities. Competition is a proven incentive to ensure top quality services. For too long, some organisations have operated free from the threat that their funding could be withdrawn. This has fostered complacency, leading to substandard care for their clients.

The perception that the 'voluntary' sector has some sort of monopoly on caring and empathy and can be trusted with blank cheques to provide care needs to be hit on the head

Take the home help sector of which REHAB Care are an important element, which receives roughly €60M in state funding as an example. This funding is received monthly and in advance, with virtually no subsequent direct control over how those funds have been spent.

In addition, competition is being impeded by the lack of choice offered to the client. For instance, if a person living in Clontarf is awarded home help hours, they have to use Clontarf Home Help whether they are happy with their service or not. In this scenario, there is no incentive for the care provider to strive to improve their services on a daily basis or to ensure they are giving real value for money.

We urgently need a paradigm shift away from viewing the patient as a passive 'service user' to ensure that they are given due respect and treated like any other informed purchaser or 'client'. Only by empowering the client to choose their service provider, can we ensure a higher benchmark for home care standards. What greater way to keep providers on their toes?

While accepting that a certain level of state provided care is important, the state's seeming insistence on maintaining the 'three pillars' of voluntary, private and HSE provided home care is baffling.

The fundamental issue should be providing a high quality service that represents real value for money regardless of provider.

v In the current situation, this can only be ensured through a competitive, transparent and non-discriminatory procurement process. Only by insisting on basic safeguards such as ensuring that all funding is dependent upon proof of service provision, and that patients are empowered to feel like clients, can we break the structures which have enabled the abuse of funding to date and take meaningful steps to improve the standard of home care in Ireland.

Michael Harty,
Home and Community Care Ireland