The case for Changing the Fastest Finger First Model in Home Support

1. Executive Summary

The HSE’s Fastest Finger First (FFF) model is currently used to allocate home support

hours to authorised providers. While intended to create a more efficient and

streamlined referral process, the model has instead resulted in significant structural

problems across the home care sector. FFF generates inefficiencies, undermines

choice and person‑centred care, and contributes to growing waiting lists – issues that

arise from system design rather than provider behaviour.

Under FFF, referrals are issued simultaneously to all approved providers or all providers

selected by the client from a list presented to them, who must respond within seconds

to secure an allocation. Providers are required to accept 70% of referrals to remain

authorised, even though they typically secure only 11–25% of those they accept.

Referrals arrive with minimal information and include rigid, non‑negotiable visit times,

preventing providers and clients from arranging care that reflects real capacity or

personal needs. This results in unnecessary waiting lists and contributes to avoidable

admissions to residential care or increased reliance on family carers.

The model prioritises speed over suitability. It creates a competitive environment based

on reaction time rather than quality, appropriateness, or training. The lack of alignment

between client needs and provider skillsets also undermines staff development, as

specialist training cannot be matched to referrals in the current system. Furthermore,

FFF is incompatible with the emerging regulatory framework for home support,

particularly the requirements for provider‑led care planning under the Home Support

Providers Bill 2025, due to come into full effect in 2029.

3A more effective and person‑centred alternative already exists. Consumer Directed

Home Support (CDHS), in operation since 2018 in parts of Ireland, enables clients to

choose their provider and agree visit times that work for them. CDHS evaluations show

high client satisfaction and cost‑neutrality relative to traditional home support.

However, low visibility, inconsistent availability, and the absence of clear national

guidance have kept CDHS underutilised.

As Ireland moves toward a Statutory Home Support Scheme and a new regulatory

model, the current allocation system is no longer sustainable. Phasing out Fastest

Finger First and replacing it with a client‑choice model, possibly an expanded and

standardised CDHS, offers a practical, evidence‑based pathway toward a modernised

home support system that promotes dignity, flexibility, and better use of resources.

42. How the Fastest Finger First Model Works

2.1 What is Fastest Finger First?

Fastest Finger First (FFF) is the model used by the HSE to refer home care packages and

allocate home care hours to authorised home care providers.

2.2 Fastest Finger First Referrals

Within the FFF framework, the HSE refers service requests to all approved home

support providers simultaneously via email.

1 Referrals state the exact time that visits

need to take place and the client’s general location but have limited or no information

about a client’s care needs, family support network or other background information

that would help inform efficient and person centred delivery of home care.

2.3 Provider Response to Fastest Finger First

The HSE can send a referral at any time during business hours. Approved providers are

required to accept 70% of HSE referrals or risk being removed from the Authorisation

Scheme. However, HCCI research found that providers will only win between 11% to

25% of the referrals that they accept.

The provider who responds first is awarded the allocation, regardless of their actual

capacity, suitability, or the preferences of the service user. Providers often have

seconds to respond, meaning most providers have a staff member dedicated to

accepting referrals.

1 Clients approved for home support are typically presented with a list of approved providers in their area.

They can choose to select as few or as many as they wish. In practice, many clients are advised by the

HSE to select most or all the providers in their area to increase the chances that their package will be

accepted. Where we say “all providers” in this paper, it is this process that we refer to.

52.4 Client Impact of Fastest Finger First

FFF means that home support clients typically have little to no choice in which provider

delivers their home support and often minimal input into their care plans. The rigid FFF

model also results in clients not being allocated a provider – instead joining the waiting

list for home care, entering residential care or placing a high burden on family carers.

This is because the referral states the exact time of the visit, which clients or providers

cannot change. For example, if a referral says 7.30am and the provider can do 8am, it is

not possible for the provider to adjust the referral. Instead, the client enters the waiting

list.

63. Impact of HSE’s Fastest Finger First Policy

3.1 Administrative Inefficiency

Administrative teams across all types of providers spend considerable time responding

to allocations they seldom secure. The FFF model also leads to repeated reallocations

when providers who secure care hours are unable to fulfil them, causing delays for

vulnerable clients. These inefficiencies are inherent in the system’s design, rather than

reflective of providers’ intentions or actions.

3.2 Loss of Choice and Person-Centred Care

By favouring speed over suitability, the FFF model undermines the HSE’s duty to provide

person-centred and equitable care. FFF overlooks service users’ preferences, and

providers are pressured to accept care packages without adequate information or

preparation. This situation arises directly from the allocation criteria set by the HSE.

3.3 Competition on Speed not Quality

FFF causes intense competition based solely on response speed rather than the quality

or appropriateness of care. It also leads to competition on technology, as providers

with more advanced systems become better equipped to response quickly to referrals.

This unhelpful competition is inherently part of the FFF model.

3.4 Waiting Lists and Unmet Need

FFF’s inflexibility results in people entering the waiting list for home support, even if

there is carer availability in the area. A FFF referral includes a fixed visiting time, e.g.

8am. There is no scope for either the providers or the client to change this. This means

7that even if the provider has capacity an hour earlier and the client is agreeable, the

client will still enter the waiting list because FFF is an inflexible model that does not, in

practice, allow any changes.

3.5 Staff Morale & Training

Schedulers and other back-office staff devote considerable time to monitoring and

accepting referrals they are statistically unlikely to secure. Home care workers are

disincentivised from taking on additional training because FFF is incapable of matching

a client with dementia to a carer with specialised dementia training.

3.6 Future Regulatory Compliance

FFF is very clearly incompatible with the Home Support Providers Bill 2025 and the new

regulatory framework that is due to come into effect in 2029. Regulations will transfer

responsibility for care plans and needs assessments onto the provider. This requires a

far more considered referral process that takes account of client choice and preference,

provider capacity and staff training. Further conflicts between FFF and regulatory

compliance are outlined in HCCI’s submission to the pre-legislative scrutiny of the

Home Support Providers Bill.2

2 HCCI. Submission to Pre Legislative Scrutiny on the General Scheme of the Health (Amendment)

(Licensing of Professional Home Support Providers) Bill 2024

84. A Better Alternative – Rolling out a Client Choice Model for

Home Support in Ireland

4.1 Client Choice Models in Home Support

Ireland’s prescriptive home support model is outdated and increasingly an international

outlier as other jurisdictions engrain choice based models in their home support

services. Client choice is central to home support in the UK, Australia, the US and many

European countries.3 The HSE offers client choice in some parts of Ireland, but as this

section explains, there is poor awareness and uptake of this option.

4.2 HSE’s Consumer Directed Home Support

Consumer Directed Home Support (CDHS) is a model of HSE funded home support that

gives individuals and families significantly more choice and flexibility in how their care is

delivered. It has been in operation since 2018.

4.3 How Consumer Directed Home Support Works

Instead of the HSE arranging the provider and scheduling, a client chooses an approved

provider and coordinates times with the provider that work for them. For example, if a

client has family care on the weekend, they can use CDHS to allocate more care during

the week or if a provider is extremely busy between 7am and 8am, the client and

provider could arrange to deliver care at a later time. Under the FFF system, this type of

basic flexibility is almost impossible to arrange.

3 Irish Medical Times. ‘Consumers’ Set To Get More Say On Home Care.

94.4 Current Availability of Consumer Directed Home Support

CDHS is already in operation in some parts of the country. However, CDHS is not well

advertised and the HSE do not maintain a list of locations where you can access it. This

means that, in most cases, a person must already be aware of CDHS and has to request

it rather than it being a standard option for all applicants.

Further, the HSE does not maintain a record of how many applicants avail of CDHS. An

evaluation of CDHS showed broad satisfaction with CDHS and reported that it was

generally cost neutral compared to traditional home support.4 The evaluation made a

number of recommendations including increased awareness and implementation of

CDHS as a choice for home support applicants. However, the evaluation has received

little political or policy consideration and the recommendations have not been

implemented. CDHS remains a small, underutilised service.

4.5 Benefits of a Client Choice Model

Implementing and scaling a client choice model would modernise and align our home

support service with international best practice. Benefits include:

• More patient centred care.

• More client choice and respect for client preference.

• Better alignment of needs and skills.

• Greater flexibility in scheduling.

• More efficient use of existing capacity.

4 Amanda A Phelan, Alice Duggan, Deirdre O’Donnell, and Fealy Gerard. Evaluating A Consumer-Directed

Health Care Pilot For Older People In The Community.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6846500

10• Reduced administrative waste.

• Improved market fairness and resilience.

• Alignment with future regulation.

• Cost neutral initially, with scope for savings from improved efficiency.

115. Recommendations

HCCI supports the phasing out of the Fastest Finger First model of home support in

favour of a model that prioritises client choice and person centred care, with referrals

based on the level of training and provider capacity. Recommendations to support this

include:

• Commit to phasing out the Fastest Finger First model.

• Introduce and scale a client choice referral model nationwide.

• Publish clear eligibility, access, and operational guidance for CDHS.

• Publish data on CDHS uptake, eligibility and coverage.

• Develop a platform for clients to compare home support providers.

• Embed client choice into the home support regulatory framework that is

currently in development.

126. Conclusion

The Fastest Finger First model was introduced with the intention of streamlining home

support referrals but its design has led to systemic inefficiencies, unmet need, and

barriers to person centred care. This paper highlights many challenges that have

emerged from FFF: loss of client choice, waiting lists and administrative burdens. These

issues stem from the structural design of home support, not provider behaviour.

Ireland’s ageing population and the growing complexity of home support needs requires

us to develop a referral system that is modern, fair and aligned with international best

practice. The clear conflict between FFF and the new home support regulatory

framework, that will be fully implemented by 2029, puts a hard deadline on when FFF

must be phased out.

FFF is also in conflict with the principles of Sláintecare and the Statutory Home Support

Scheme. There is scope to investigate reform of the system through both programmes

of reform (as well as through the Commission on Care for Older People).

5

Consumer Directed Home Support offers a proven, cost neutral pathway to a more

responsive and effective system. The HSE should immediately prioritise further

evaluation, awareness and roll out of CDHS.

In the long run, a client choice model, whether CDHS or another commissioning

method, should become the default option for allocating home support packages. As

5 The Commission is charged with examining the health and social care services and supports provided to

older people across the continuum of care and with making recommendations for their strategic

development. Subsequently, a cross-departmental group will be established under the auspices of the

Commission to consider whether the supports for positive ageing across the life course are fit-for-

purpose and to develop a costed implementation plan for options to optimise these supports.

13well as improving patient outcomes, this would reduce reassessments, inappropriate

allocations and administrative waste – thereby strengthening efficiency and budgetary

controls.

Reforming the referral model is not simply a technical adjustment; it is a necessary step

toward ensuring that every person receiving home support can access care that is

appropriate, dignified, and centred on their preferences. By committing to phase out

Fastest Finger First and scaling a client choice model nationwide, the HSE can create a

home support system that is sustainable, equitable, and genuinely person centred.

                                                                —ENDS—

FOR FURTHER INFORMATION CONTACT: dionne@hcci.ie or 086 201 0980

About HCCI

Home & Community Care Ireland (HCCI) is the voice for home and community care providers across Ireland.  Our mission is to drive policies that sustain the sector, guaranteeing the highest standards of care for people — whether services are publicly funded or privately sourced — and uphold the well-being of our workforce.  We are committed to honesty, integrity and evidence-led policy. 

Our vision is a future where every adult in Ireland has a statutory right to home care and where solutions in the community are thoughtfully designed to support people.  At HCCI, we not only advocate for care — we champion a system that respects and empowers every person it serves.