HSE 'concerned' about high cost of housing people with disabilities in commercial care

For accommodation services, the cost per person per year for this largely emergency care is roughly €420,000 per year with a for-profit provider, with such high costs generally reflective of situations which require a lot of staffing to support people who typically have intensely complex needs. File picture

The HSE is “concerned” about the high cost of placing people living with disabilities in private, for-profit residential care, an Oireachtas committee will hear on Wednesday.

Dr Andy Phillips, the HSE’s executive officer for the South-West, will tell the Committee on Disability Matters that the levels of commercial residential provision in the sector has “increased significantly” up to 14% of the total spend on such accommodation.

The Irish Examiner recently revealed the HSE is not in a position to say how much of its €2.2bn budget for residential disability services is being paid to commercial operators.

The rapid rise in the use of for-profit accommodation has raised concerns among advocates about the quality of care being provided and the system via which those placements are allocated.

At the Disabilities Committee, Dr Phillips is expected to say the rise in the level of for-profits “is linked to the lack of housing and capacity constraints associated with regulatory compliance on the HSE and voluntary sector”, adding that changes in the profile and complexity of the disabilities being supported “has also increased pressure”.

The HSE’s use of for-profit companies across disability services has increased massively over the past three years alone.

Overall funding for the five costliest for-profit companies (Nua Healthcare, Talbot Group, Resilience Healthcare, Galro, and Orchard Community Care) was €296m in 2024, up 129% from the €129m spent on the same services four years prior.

For accommodation services, the cost per person per year for this largely emergency care is roughly €420,000 per year with a for-profit provider, with such high costs generally reflective of situations which require a lot of staffing to support people who typically have intensely complex needs.

Dr Phillips is expected to tell the committee that the HSE has experienced “governance challenges” in recent years arising from “the mix of residents at locations coming from different parts of the country with separate individual oversight of their care”.

He will say that the health service is in the process of hiring specialist residential planning and review teams for each of the HSE’s six regions tasked with working “together for a singular view to achieve high quality of services at the most appropriate cost”.

A review of the for-profit accommodation currently in use will be used to guide a revised procurement framework for residential services “to ensure that we purchase services on a planned basis at scale... to achieve the best service and best value for money”, Dr Phillips will tell the committee.