The pandemic has highlighted deep cracks in the social care system, and throughout the crisis, domiciliary care providers in the UK have been able to rely upon a robust regulatory compliance framework.
The same does not apply in the Republic of Ireland. Currently, healthcare regulation covers residential nursing services and hospitals, but does not yet extend to domiciliary care.
Due to this lack of regulation, prospective home care providers in the Republic of Ireland can open without registering with HIQA, the healthcare regulatory body. There are no annual or unannounced regulatory inspections for home care services, although home care providers contracted to deliver home care services by the HSE (the Health Service Executive, provider all of Ireland’s public health services in hospitals and communities across the country) may undergo periodic HSE audits.
The lack of domiciliary care regulation is not the only challenge that Ireland faces. While around 62,000 people are currently receiving home care support in Ireland, it is estimated that there are approximately five and a half thousand people waiting, equating to around 1.5 million more home care hours needed.
On both sides of the Irish Sea, the importance of being able to employ efficient home care services has never been more evident. The Home Care Coalition (HCC) is a group of 22 Irish charities, not-for-profit organisations and campaigners, established with the aim of ensuring the implementation of an adequately resourced, person-centred statutory home care scheme across the country. It has stated that the shortfall in home care provision is resulting in many delayed discharges from acute hospitals.
This means there are many patients ready to return home who find themselves unable to do so, because there is little or no home care support available to them. The HCC says this is adversely impacting waiting times for hospital admission in accident departments; beds are occupied by patients no longer needing them, reducing availability for those who do. Therefore, system reform and increased availability of home care and support services is urgently needed.
The Irish Government
These deficits in care provision have not been lost on the Irish Government. Sláinte Care, its 10-year healthcare reform programme aims to provide ‘the right care, in the right place at the right time’. A key aspect of the reform is the shift of care out of acute hospitals into the community and into a person’s home, where safely possible.
In April 2021, the Irish Government approved drafting of legislation for home care regulations. HIQA has been heavily involved, calling for a ‘full root and branch’ review of the home care sector and for Government engagement with all stakeholders, before the legislation is drafted. It has promised that new regulation will follow a needs-led, person-centred, human rights-based approach, in line with the overarching aims of the government’s national healthcare reform programme and with existing healthcare regulation.
Regulation and professionalisation of the sector go hand in hand
It is likely that regulatory frameworks, similar to those that nursing homes follow will be replicated for the home care sector.
Currently, as in the UK, the health sector as a whole is experiencing staff shortages. Low rates of pay, lack of incremental pay scales and pension, minimum annual leave allowances and lack of opportunity for further training and career progression may lead staff with potential to flourish in the domiciliary care setting to vote with their feet, choosing to move into the hospital sector, or out of healthcare altogether.
To ensure a steady supply of skilled staff therefore, the home care sector would benefit from the professionalisation of its health and social care workers, including the formation of a registration body, access to professional development, and the creation of clearly defined career pathways.
So, where to start? In short, the answer lies in regulation and compliance. Many home care providers have joined with HIQA and the lobbyists in the call for regulation, and aim to be “HIQA-ready”, since all the evidence points to the fact that they will be subject to regulation in the near future.
Regulatory change is around the corner
Therefore, any provider who has an eye to the future should be prepared for change.
Instilling a culture of compliance and best practice is vital, if providers want to attract and retain the best staff to provide person centred, needs-led care of the highest quality. Therefore, having robust policies and evidence-based procedures that incorporate current best practice is the only way for providers to ensure they are getting it right -and will be regulation-ready.
How do you create robust and effective policy when there is no regulator in place?
The question is: how can you create a suite of policies and procedures that provide a platform from which your service can deliver outstanding care?
You could employ a subject matter expert, which could be both time consuming and costly.
What about investing in a policy library? In the UK, where there is definitive regulatory landscape, that might be an option.
In Ireland, HSE policies may be referenced or adapted by home care providers, where contracts with HSE exist, but these do not always fit the home care environment.
I believe the solution is to invest in a content management system that specialises in providing bespoke policies, procedures and management toolkits for the care sector in the Republic of Ireland.
A solution? QCS…
Quality Compliance Systems (QCS), which provides content, guidance and standards to over 140,000 users across 5,000-plus organisations in the UK, has developed such a platform for the Irish home care sector.
The system contains 104 policies, care plans benchmarking and risk assessment tools. The content, which has been written by the Republic of Ireland’s leading knowledge experts and customised for the web, is fully scalable. In other words, it can be accessed quickly and easily on a wide variety of devices. This is particularly useful to homecare staff, who do not spend a time in an office. Should they need to refer to a policy, or want guidance on best practice while caring for a client in their home, they can easily access the information they need on their tablet or mobile phone.
Most importantly, QCS’s offering is much more than a content management system. It is also a best practice learning platform, which seeks to foster and accelerate learning in specific areas, for example, care of a person with a stroke, dementia, or with responsive behaviours.
Furthermore, managers can monitor understanding by checking that care workers have read the best practice learning points that they have been issued with.
Finally, QCS recognises that policies can be difficult to understand.
Not only does its team of experts ensure that the texts are written in user-friendly language, it has also translated them into several different languages and showcased them in a number of different media, including articles, webinars and podcasts.
For those who are keen to get ahead by laying the groundwork for a new era of regulation, equipping staff with QCS’s bespoke suite of policies and procedures is an excellent place to start.
This article was first published in the Social Care Professional Ireland