The ageing nature of Ireland’s population has created increasing demand for home support services. In Ireland there is no statutory entitlement to receive formal homecare or home support. However, the Health Service Executive (HSE) does provide publicly funded home support services and commissions external or private providers to provide these services. While there is no statutory regulation of home support services in Ireland, legislation is progressing in this area. The General Scheme of the Health (Amendment) (Licensing of Professional Home Support Providers) Bill 2024 was published in May of this year.
Compliance under the new legislation
The Health Information and Quality Authority (HIQA) will be charged with monitoring compliance by public, private, and not-for-profit home support providers. When introduced, the new legislation will require home support providers to hold a licence from HIQA before they can operate. Those holding a licence will also need to comply with Ministerial regulations which are due to be made under the legislation, and with national standards of care to be developed by HIQA.
The Department of Health projects that, once the Bill is enacted, it will take three years for the new system to become fully operational. This three-year implementation period includes a 12-month commencement period and a 24-month transitional period. During this period, Ministerial regulations and HIQA’s national standards will be developed and formalised. HIQA expects to go to public consultation on these standards later this year.
Further details regarding the new legislation are provided for in the Scheme. The following elements form the core of the legislation and should be considered carefully by relevant operators and stakeholders:
- Registration requirements: In order to be granted a licence, it is intended that the Chief Inspector of HIQA will need to be satisfied, among other things:
- With the applicant’s fitness to provide a home support service
- That the applicant can meet the cost of the appropriate policy of insurance, and
- With the applicant’s financial capability to provide home support services
- Licencing: HIQA may attach conditions to a licence. Licences will remain valid for three years, after which point they will need to be renewed.
- Inspections: The Scheme allows for the inspection of home support service providers to assess compliance with regulations and standards and for the service of a compliance notice as may be required.
- Appeals and Enforcements: The Scheme also allows for appeals and enforcements of certain decisions of HIQA.
Industry concerns
Stakeholders have raised concerns about how this statutory home support scheme will be supported, including:
- How it will be funded: The Minister for Health stated in March 2024 that the Department of Health was examining a range of funding options. These options are based on reports that the Department commissioned from the Economic and Social Research Institute (ESRI) and the European Observatory on Health Systems. Home & Community Care Ireland (HCCI), the national membership organisation for managed home support providers, in a report published in April 2024, considered a range of options. These included full state funding through general taxation, co-payments from service users, and long-term care insurance.
- Recruitment and retention of staff: HCCI has proposed that social welfare law be amended to incentivise more workers to enter the sector. This approach would also aim to incentivise those already in the sector to work more hours per week, without fear of losing their social welfare benefits.
- Exclusion of certain types of home support service: Stakeholders who responded to a survey by the Institute of Public Health indicated their concern that home support services provided by individuals directly employed by a service user, among other types of arrangements, are excluded from regulation. Similar concerns were expressed during pre-legislative scrutiny of the General Scheme of the Bill on 19 June 2024. The Department of Health explained that a balance needed to be struck between regulation and the exclusion of a small number of arrangements that were felt inappropriate for regulation, or where regulation would be too onerous.
Comment
While the anticipated home support legislation is not yet in force, there have been some recent developments and continued engagement from the wider sector. Stakeholders and Government officials are considering the practical challenges facing the new statutory scheme, including funding and recruitment. The recent pre-legislative scrutiny of the General Scheme of the Bill allowed many of these concerns to be discussed. It will hopefully inform the development of the Bill as well as the associated Ministerial regulations and HIQA national standards.
For more information on the impact of the new legislation on your operations, please get in touch with a member of our Healthcare Sector team.
The content of this article is provided for information purposes only and does not constitute legal or other advice.
