Breakdown: cost of care unclear

The HSE does not know how much taxpayers' money it has paid out to private providers around the country specifically for homecare services in each of the past five years, the Sunday Tribune has learned.

Last week's Prime Time programme on RTÉ showed private homecare companies hiring untrained and unvetted home helps and homecare assistants.

Carers were seen threatening older people and force-feeding them, and allegations of stealing from clients were also made in the programme. The HSE has since announced plans for a review of service provision in the sector.

It has previously estimated that it spends about €340m a year on homecare, with 10% of that through private operators. But when asked for a breakdown of the total amount it has paid out to private homecare service providers over each of the past five years – as well as a total overall figure for each of these years – a HSE spokeswoman said this information was not available due to the absence of a national accounting system.

"The HSE operates on the 11 accounting systems of the former health boards, which do not have capability to capture costs in alternative views as per this request," she said. "The absence of a national accounting system has been debated at length, most recently at the public-accounts committee, where the incoming CEO conveyed the difficulty of providing sharp, crisp financial data on a range of care headings and programmes. The HSE has since been given approval to commence the process of procuring a national system."

She said while the pay costs of staff working in elderly care are recorded and would include physiotherapists, occupational therapists, social workers, public health nurses and other staff, the financial systems do not group these costs together into homecare packages.

"The HSE operates through a network of care providers, all of whom are listed by name in our annual financial statements, together with the funding provided to them," she said "Many of these providers provide services over a range of care programmes and are not specifically identifiable as 'providers of homecare for older people'. The HSE would have to undertake an analysis of all the care organisations and try to establish the amount of payments made to them which relate to homecare."

About 65,000 older people in the state receive homecare services either from the HSE or the growing number of private companies that have established businesses in the sector.