Home care services are critical to support older people to stay in their own homes and communities, to prevent early admission to long-term residential care and to support people to return to their homes following an acute hospital admission. These services may be delivered directly by HSE staff or indirectly through not-for-profit and private providers contracted by the HSE.
In 2012 as part of a quality improvement programme the HSE introduced a tendering process for new home care packages sourced from private and not-for-profit providers. This process was most recently repeated in 2016.
I understand that some not-for-profit providers who are funded by the HSE to provide mainstream or core home help services were operating a limited service for clients who wished to pay for additional hours. This approach appears to have happened in a small number of cases but it was raised with the HSE in the context of a legal challenge by a group of 42 private providers in respect of the planned 2014 tender for enhanced home care. The not-for-profit providers referred to in the legal challenge were almost wholly funded by the HSE at that time, and continue to be significantly funded by HSE to provide home help services. In circumstances where a client-funded element of service was developing, concern was expressed that such arrangements may constitute cross-subsidisation or could amount to state aid.
Agreement was subsequently reached between the HSE and representatives of the private providers. Under that agreement and to avoid any doubt, the HSE made it clear that the type of arrangement I described earlier was not acceptable to the executive and was to cease. If a not-for-profit provider wishes to develop the private element of its business, in the same way as a commercial entity, it may withdraw from HSE-funded home help arrangements. This is not an issue of the State not wishing to provide support or help, but a legal issue to which we must adhere.
