HSE is consistently failing in its care for people with disabilities

From costly and ineffective outsourcing to an inability to parse its own data — as it's all in a single Excel-based file — HSE failure isn’t an anomaly, it’s a pattern, writes Cianan Brennan

The latest revelations about the large number of children with disabilities in State accommodation more than 50km from their home fits into a pattern of a lot of money spent, poor planning, and poor record-keeping. Picture: iStock

THIS week, the Irish Examiner revealed that at least a quarter of children with disabilities residing in State accommodation in Ireland are living more than 50km from their home.

In this latest in a series of articles on accommodation for people living with disabilities, much of the new information follows similar trends seen across Ireland’s public services — a lot of money spent, poor planning, little bang achieved for the Government’s buck, and poor-to-the-point-of-negligence record-keeping on the part of the HSE.

The Irish Examiner had already reported that the number of children with disabilities living in State residential care had doubled in just two years, from 155 to 300, between the end of 2023 and April 2026, a 93% increase.

Yet, despite the ballooning health service budget seen over the past 10 years, the HSE is basically unable to say why such an increase in child disability placements has resulted in such a short time, bar noting that up to 60% of new referrals are co-funded with Tusla, the child and family agency. 

That is about as granular as the data gets.

Much of this information has been gleaned via the persistence of Cork East TD Liam Quaide, a former practising clinical psychologist with the HSE and the Social Democrats’ spokesperson on disabilities, who has been heavily focused on the performance of the HSE with regard to mental health and residential provision for disabled people.

It is worth looking back over some of what has come to light as, taken as a whole, distinct patterns begin to emerge.

Litany of failures in January, February, March, April, May, and June

In January of this year it emerged that the HSE could not say how much of its €2.2bn residential budget is spent on commercial for-profit accommodation for people with intellectual disabilities, despite knowing that the number of such centres had doubled since 2021.

There are multiple concerns over such corporate entities. While they certainly have a part to play, particularly in emergency and crisis situations, the fact remains that providing care for the most vulnerable people in society does not align well with the quest for profit.

On a very basic level, staff are far harder to retain in such institutions because they are of necessity paid less, less skilled, and, unfortunately, often less likely to stay. The continuity of care required by these patients, whose needs are so great, cannot be provided because put simply, the staff don’t stay.

There are three cogent facts regarding that particular issue: 

• The level of corporate care is increasing. 
• This care is generally a deal more expensive than that supplied by the State or Section 38/39s. 
• The HSE either doesn’t know or won’t say how much is being spent on for-profits.

There aren’t many private companies with a €2.2bn budget that can’t say what it’s being spent on. Or, if there are, they won’t be keeping a budget of that size for long.

Tony Murray with his wife Susan and their adult daughter Aoife who has an intellectual disability. Tony spoke to the 'Irish Examiner' in February about the 'Before We Die' group he set up, and has since addressed the Oireachtas disabilities committee. See links below. Picture: Moya Nolan

The reason given is that such organisations provide so many services to the HSE that it is not possible to differentiate residential expenditure from the rest.

'Before We Die' founder's view 

Dublin man Tony Murray — who, at 70, continues to care at home for his 44-year-old daughter, who has an intellectual disability — has a different take. He said: 

The thinking seems to be ‘if we can’t quantify this, then we don’t have to solve it. 

In March, it emerged that the HSE paid at least €306m to just five for-profit companies for the provision of disability services. Again, the extent to which residential expenditure accounts for that overall figure was not discernible.

In April, queries by Mr Quaide revealed that mental health services are being funded at less than half the HSE’s own requirements for a fully-functioning service.

The East Cork area covering Youghal and Midleton has just 1.49 staff per 1,000 population to work on its children’s disability network team (CDNT), less than a third the allocation for Cork City.

There are simply not enough staff to effectively deal with the complex needs of some of the children living locally.

State accommodation far from home

In May, it emerged that more than 600 people living with an intellectual disability are placed in accommodation outside their home county, and fully a third of them are more than 100km from home, a far-from-ideal situation to put it mildly. One mother of such a child, aged in her late 50s, predicted that when the four-hour round trip she and her husband must make each week to see their daughter becomes too much, they will simply drift from her life.

In the end, the mother suspects, their daughter will never see anybody.

Later the same month, we heard how the number of children referred to child mental health services doubled in 2025 due to a lack of resources.

Vulnerable people getting no therapy

Earlier this month, we reported that chronic underfunding and understaffing in mental health services means that intensely vulnerable people in approved care centres are receiving only a fraction of the support they should get — with some centres reduced to providing a bed, medication, and supervision only.

It goes without saying: This is not how things are supposed to be, and the HSE has acknowledged as much repeatedly. However, when asked about the age breakdown of the hundreds of child disability placements it provides, the HSE said that the practical functionalities of its reporting are “limited” by the fact a single Excel-based file is all that exists to that end.

A spokesperson added that staying on top of that information “would require a substantial additional effort and resources”.

So, we have €2.2bn being spent on disability residential care each year, care that costs hundreds of thousands of euro per person. In 2025 the most expensive placement totalled just under €1.02m. 

Much of the information about HSE care published in the 'Irish Examiner' has been gleaned via the persistence of East Cork Social Democrats TD Liam Quaide. Picture: Gareth Chaney

At the same time we have a service that cannot afford to parse the data of the children with disabilities it is paying to accommodate. So we don’t know what age they are, the nature of their disability, or the reason for their being accommodated away from home, often a great distance from home. All that money, and basic record-keeping appears to be beyond us.

Granted, some of these children will be profoundly disabled or have such complex needs that their being raised at home is simply not practicable. But it certainly won’t always be the case. And if there is no data to analyse, the situation can not be improved by way of a coherent strategy.

As Tony Murray and countless other older parents of adult children living with disabilities can attest, there does not appear to be any overarching plan for what will happen to their sons and daughters when the parents die or become incapable of providing care.

'Wait until it's too late and then chuck money at it'

The plan, inevitably, appears to be to wait until its too late and then chuck money at the situation. No one is served well by this scenario. It is a deficiency that seems to apply across much of Irish society, from our housing disaster to the HSE’s own continued use of expensive agency staff while being simultaneously incapable of paying its own frontline staff a fair wage.

Judging by these various stories, the lack of forward-thinking strategy regarding our most vulnerable citizens applies regardless of their age or the nature of their disability. It is long past time for that to change.