Improving residential homes for intellectually disabled people, as recommended by the State's health watchdog, will cost an extra €57 million this year, the Health Service Executive warns.
The watchdog, the Health Information and Quality Authority (Hiqa), should be required to take account of the HSE's lack of resources when issuing reports critical of individual homes, a cash-strapped HSE told the Department of Health.
The suggestion is made in correspondence from the HSE to the department, seen by The Irish Times. It highlights the rapidly escalating cost of raising standards to the level demanded by Hiqa.
Since 2011, the State has had a policy of moving people with intellectual disabilities from large institutions to smaller, community-based centres, and the number in “congregated settings” has dropped from over 4,000 to 2,800.
Pressure
The pressure on the HSE to accelerate this trend has grown since Hiqa started monitoring the sector in 2013 and uncovered widespread failings in the standard of care.
The HSE told the department it has achieved as much as is possible in “decongregating” from existing resources, and what is now required is a targeted investment programme with multi-annual funding.
One arm of the State - Hiqa - was demanding immediate action from homes to comply with inspections, while another arm - the HSE - had not been given the resources to address these issues, he said.
In a letter to the department in July, HSE national director for social care Pat Healy sought "certainty" about its projected overrun on spending on disability services, then estimated at €15 million.
Mr Healy said if the department was not able to provide this money, it should make the “necessary arrangements” with Hiqa so the watchdog’s findings “have regard” to the level of funding provided by the Government.
Letter
In a further letter last month, Mr Healy again raised the issue of “serious challenges and unfunded cost pressures” arising from Hiqa inspection reports.
He said an extensive change programme was under way to address the deficiencies identified by the regulator, which cover areas such as resident safety, governance and staffing.
However, many of these involved extra spending and it had also been necessary to provide replacement residential places.
Hiqa has threatened up to 20 centres with closure over persistent non-compliance.
