1100 michael harty final hcci national healthcare conference 2015
1. How Can We Improve the Quality and
Efficiency of Home Care Provision in the
Absence of Regulation
National Healthcare Conference 2015
2. Social Care budget 2015 - €3B
Elder Care budget 2015 - €1.27B
Fair Deal Scheme - €948M
HSE Funded Home Care - €325M
Home Help - €195M
Home Care Package Scheme - €130M
Privately funded care - €20M
Older Persons Services
3. Home Care Market 2014
HSE
Not-For-
Profit
Private
Home Help Home Care
Packages
Private
Customers
€142m
€53m
€33m
€54m
€175m
€107m
€63m€43m
HSE Funded
€20m
€195m €130m €20m
€345m
4. Structural Issues Holding the Home Care Sector Back
Unregulated - Scandals
Dominated by State – Purchaser and provider
Strategic Engagement
Funding Silos
Poor cousin of Healthcare Sector – Lack of Confidence
Poor Transparency and Accountability
12. Examples of What is Wrong
5 Hour rule
Paying providers in advance of delivering care
One price for all cases
Regional monopolies - Lack of Choice and Clients not Empowered
Price based tenders
PHN’s over worked – assessors, supervisors, administrators, advocates
17. Internal Reference Price Model
Emphasises on quality
Licensing not contracting
HSE set internal price for home care
Justified
Per Lot
Latitude for special cases
PHN assessment
Outline
Hours
State contribution is ........
Tax relief
Private top up
18. Internal Reference Price Model
Client discusses with provider directly
Care Plan
Customised price
PHN role - supervision and support where needed
19. Internal Reference Price Model
Advantages
HSE know exact exposure
Promotes idea of contribution
Each individual case properly costed
Takes advantage of local conditions
Helps recruitment and retention
Drives quality through client choice
Promotes quality providers willing to invest
Move up acuity scale
Better integration with acute sector
20. Home Care Needs to Play a More Important Role
Let Money Follow the Patient – End Silos
Use Procurement as a Driver of Quality Provision
and Quality Providers
Commissioning Policy
Extensive
Transparent
Quality based
Summary
21. How Can We Improve the Quality and
Efficiency of Home Care Provision in the
Absence of Regulation
National Healthcare Conference 2015
Editor's Notes
Improving economic times but important we ensure we are getting max out of existing resources before looking for more
Overview of Elder care sector and give some context.
Looks complicated but actually gives a good breakdown of home care funding.
Interesting to see that private sector only accounts for about 18% of total market and only 13% of state funding.
Want to look at the issues I think are holding sector back from playing its full role within the overall health sector.
Most obvious obstacle
Primetime scandals
Should have been regulated before residential sector
Dept. of Finance not wanting to create further entitlements
Short term view as HC could bring significant long term savings
EPS report calculated savings of €2B over 8 years – running sector more efficiently and allowing hc play a fuller role
Another major obstacle
Both purchaser and provider
Not healthy
Expensive - 30%
Move towards how residential care sector looks 20/80
State should regulate and supervise not necessarily provide
Role for the state but questionable if it needs to be of order of 80%
Need strategic engagement with state
Connected to State dominance is lack of engagement with stakeholders
Threat to the sector
Recruitment / retention
Beaurocratic obstacle
State loves silos, HSE loves silos.
Allows them to channel funds how they want rather than in best and most efficient manner
Create false demands i.e. residential care
Protects poor providers
Takes power away from client
No difference between HH and HCP
Antipathy of money follows the patient
Issue providers need to address
HC seen as weak link in continuum of care – not safe pair of hands
Acute sector first reflex is for residential care / step down
Need to promote cohort of professional operators willing to invest
Move up acuity scale
Organisations need Clear future = Investment with confidence
HC underutilised
One of most Important structural issue
Lack of
Section 39 funding prime example – no procurement process - €18M out of €60M
Organisations receiving funds from multiple sources – no tracking
Primetime scandals – 50% wastage
Place for all types of organisations but no service is free Debunk myth of voluntary or NFP
Lack of transparency and accountability lead to waste
With increasing demand and scarce resources cant afford waste
Eliminate waste before we ask for more funds
5 hour rule – 2 providers per case, anti social hours, multiple providers, undermines continuity, silos issue.
Paying in advance – no accountability, cant assume army of Mother Theresas out there – Primetime
Single price – companionship to late stage dementia commodity type care, incentivises cutting corners. More nuanced approach needed
Regional monopolies – no incentive to provide great care, vulnerable people with low propensity to complain in first place. Competition good in health as people make decisions on quality not price
Price based tenders – pushed down price of HC which pushes down wages and causes problems of recruitment and retention. Bedrock of providing quality care. Look at UK example.
PHN’s – supervision should be primary role
To paraphrase Bill Clinton “It’s commissioning stupid!”
Most important tool available to shape sector
Too important for just procurement department
More input from ground staff and stakeholders – designed by stakeholders
Structure based on price fine for commodities but elderly aren’t a commodity
Last tender 100% price!!
Should be based on quality and client choice
Yes want value for money but more sophisticated and nuanced way to get there than just blunt price route
Not about knocking down prices and encouraging providers to cut corners
Trying to bring about efficiencies through a blunt instrument like price is a fools game
Providers that are bringing real value added to table
Transparency by ensuring all funding goes through a procurement process
Fairness promotes partnership and collaboration lacking at the moment
Why lock out good new providers?
Taking into account training, supervision etc.
Some providers may need to upskill to enable them to do proper assessments
Selection from Approved provider list
Price maybe taking into consideration that provider has work in the area already
Improving economic times but important we ensure we are getting max out of existing resources before looking for more
