For years, the conversation around disability services in Ireland has centred on waiting lists, staffing shortages, and the struggle for families to secure basic supports. But beneath these well-documented problems lies a quieter, more profound shift: the rapid disability care privatisation of care for some of the most vulnerable people in the country.
New figures released to Social Democrats TD Liam Quaide show that the HSE paid at least €306 million to just five private, for-profit companies for disability services in 2025. That’s more than double the €129 million those same five firms received in 2020 — a 129% jump in just four years. Overall, the HSE spent roughly €526 million on around 220 for-profit providers last year. Those five firms alone account for more than half of that total.
The sums are staggering. But the real issue is what we don’t know.
Where is the money going in disability care privatisation?
Despite the scale of spending, the HSE cannot break down how much of this money goes to residential care — the most expensive and essential service for people with complex disabilities. In 2024, the HSE estimated its total funding for disability residential services at €1.7 billion, but it has repeatedly stated that it is impossible to isolate how much of that went to for-profit companies.
Quaide put it bluntly: “This still falls well short of transparency. It does not show how much relates specifically to residential services, how much relates to children as against adults, or what the exact expenditure was.”
Without that data, it is impossible for the public or politicians to assess whether the State is getting value for money — or whether vulnerable people are being housed in facilities that prioritise profit over care.
A decade of quiet expansion in disability care privatisation
Ireland’s disability budget has ballooned from €2.8 billion in 2024 to a projected €3.8 billion by 2026. Much of that growth has been eaten up by a handful of large for-profit operators. The top five — Nua Healthcare Services, Talbot Group, Resilience Healthcare, GAIRO, and Orchard Community Care — received €295 million in 2024. Nua Healthcare alone took €128 million, or nearly 45% of that pot.
Spending on these companies has grown far faster than the overall disability budget. If the trend continues, for-profit providers will soon dominate the sector just as they have come to dominate nursing homes — a development that has already sparked serious concern about quality of care.
As one HSE spokesperson put it, the agency “works in partnership with both not-for-profit and for-profit organisations to ensure the best level of service possible”. But critics argue that when companies are driven by shareholder returns, corners get cut and staff are undervalued — and it is the most vulnerable who pay the price.
The hidden cost of profit-driven care
This is not a theoretical worry. The for-profit nursing home sector in Ireland has been dogged by reports of understaffing, high staff turnover, and regulatory breaches. There is no reason to assume the disability sector will be immune. Roughly 16% of residential disability services are now provided by for-profits — a figure that has doubled in just five years.
What is missing from the public debate is any real scrutiny of whether this model works for people with disabilities. In a system where the State is the sole funder but private companies are the providers, there is a fundamental conflict of interest. Companies are incentivised to keep costs low and maximise revenue — not necessarily to deliver the best outcomes for residents.
Moreover, the lack of transparency means that families and advocates have no way to compare the performance of for-profit and non-profit providers. We know how much we are spending, but we have no idea what we are getting for it.
What needs to change
At a minimum, the HSE should be required to publish a detailed breakdown of all payments to for-profit disability providers, including the type of service delivered, the number of people served, and the average cost per person. Without this, the State is effectively writing blank cheques to companies whose ultimate loyalty is to their shareholders, not to the people they are supposed to care for.
Quaide’s Freedom of Information request has pulled back the curtain, but only a little. The €526 million figure is a starting point, not an answer. It is time for a full public audit of for-profit disability spending — before the disability care privatisation becomes a done deal. For more on how similar trends affect other public services, see Ireland’s Obesity Crisis Meets the Miracle Jab. To understand the broader context of for-profit care, read When kindness became a crime. For authoritative analysis on privatisation risks, visit OECD and World Health Organization.
