Analysis: Homecare funding always hardest hit

Patients are better off at home. Homecare helps them prosper and frees hospital beds

Homecare: Even the dearest homecare package costs less than a hospital’s €1,000-a-night stay. Photograph: Bryan O’Brien

Homecare: Even the dearest homecare package costs less than a hospital’s €1,000-a-night stay. Photograph: Bryan O’Brien


While the politicians continue their protracted haggling over a new government, the health service continues along familiar tracks.

As usual, spending is running well ahead of budgets, with an overrun of at least €350 million by the end of the year now being talked about.

Last year, the Health Service Executive received a €600 million supplementary budget but the Government’s position was there could be no more bailouts of this kind.

The new budgetary rules this year mean this money will have to be clawed back by either throttling expenditure by the end of the year (painful), begging for unspent money from other departments (unlikely) or running an overdraft into next year (dangerous).

The HSE is flagging its budget this year is not sufficient and has already restricted recruitment by insisting hospitals can only hire on a “one in, one out” basis.

With further cost-saving initiatives likely, the cutbacks in homecare packages are probably only the thin edge of the wedge. But, like previous cuts – notably, the replacement of permanent staff by expensive agency staff – they are worryingly self-defeating.

Homecare packages can be expensive for highly dependent patients, but even the most complex package costs far less than a €1,000-a-night hospital stay.

The extent of the problem is unclear. The Irish Times is aware of cutbacks affecting patients in south Dublin, Kildare and Wicklow, but the HSE was unable to say whether waiting lists have been created elsewhere.

One senior clinician in a hospital outside the greater Dublin area said six of his beds were occupied by patients for whom no homecare package can be found. “They have complex emotional and psychiatric issues. We are doing nothing for them here in hospital and they don’t need to be here.”

The patients affected are largely elderly, but also include other people with complex care requirements, such as psychiatric patients and those who have undergone gender realignment.

Meanwhile, home-help hours are being cut by 50,000 this year. It’s a familiar refrain. There is unanimity we need to do more to help patients live in the community. That is where most of them want to be, and it also frees up beds in hospitals for sick patients who need them.

Yet funding for home helps, homecare packages and other social supports have borne a disproportionate share of the cuts since 2009. Social care remains the Cinderella of the health system.