I appreciate the opportunity to appear before the committee. I congratulate Deputy Ó Fearghaíl on his appointment as Chairman of the committee. I pay tribute to his predecessor, the new Minister of State at the Department of Health and Children, Deputy Moloney. During his time as Chairman of the committee, the Minister of State was extremely supportive of our work. We wish him well in the Department of Health and Children, where he has responsibility for the areas of disability and mental health.
In our presentation, we are going to be critical of the Health Service Executive in a number of ways. I hope we will do so in a respectful and careful way. There are other agencies which are also involved in the area of health. The HSE has relationships with the Departments of Health and Children and Finance, and with the Oireachtas.
I wish to deal with three core areas. The first of these relates to the amount of funding that is or is not available in respect of disability services. The second area is the partnership or relationship between the voluntary disability sector and the HSE. The third area relates to authority or governance issues vis-à-vis the HSE and the Oireachtas in respect of disability funding.
Of all the different areas of Government activity, and in the context of the national disability strategy, that relating to health is the most important for people with disabilities and mental health conditions. If people cannot get out of bed in the morning, access physiotherapy services, obtain appointments, etc., they are not going to be overly interested in other matters. That puts the committee and its members in an important place with regard to progressing the national disability strategy.
Under the national development plan, current total spending on disability services is over €2.5 billion. The DFI is concerned because the HSE has indicated that it is seeking to achieve what it terms "efficiency savings" of 1% per annum from the overall allocation of €2.5 billion — some €25 million — and diverting it to the other overspend areas within its budget. Furthermore, this year's allocation of €50 million of multi-annual funding from the 2004 package has not been released. It is our view that this money has been earmarked for investment in other areas. I am not confident people with disabilities will benefit from that funding this year. Taken together, it would mean €75 million voted by the Oireachtas is more likely to be diverted elsewhere this year.
Many disability organisations continue to fund-raise to provide necessary health services which the HSE has a statutory remit to provide. At the same time, the executive is attempting to draw this sector into new contracting arrangements which it states it cannot respect. It is not in a position in all cases to respect the independence and autonomy of the sector. That runs counter to Government policy and common sense.
We are making this case with a clear expectation people with disabilities will have access to the comprehensive range of health and personal social services that they need. We draw on two sources in that regard. The first is that, as human beings, people have a right to their dignity being vindicated by being able to reasonably expect basic health and personal social services will be available to them when they need them. This is about vindicating people's human rights and their dignity to get on with life in the State; it is not only about services. The second is the commitment of the Government and the social partners to implementation of the disability strategy set out strongly in Towards 2016 and An Agreed Programme for Government, which states "Government is determined to continue to prioritise the interests of people with disabilities over the next five years through a series of significant measures".
We are concerned about the downturn in the economy. Disability is enough of a difficulty or vulnerability for an individual without the fear, burden or concern that there may be a slowdown or cutbacks. The background to this issue is Part 2 of the Disability Act 2005 which provides for independent assessments of needs. The State says it has a huge job to do. The health needs of every person with a disability must be assessed in a statement and services provided progressively over a number of years. That is a statement the job is starting. It is difficult in that context for any of us to contemplate that we will not continue to make progress.
Last December we had a hard landing in the budget. In the three previous years a €50 million multiannual package was provided. On top of this, €20 million was provided in 2005, €35 million in 2006 and €40 million in 2007. Therefore, an additional €95 million was voted by the Oireachtas for disability services. This year €50 million was provided to honour a commitment given by the then Minister for Finance in 2004. That is a massive slowdown in the move to provide additional funding.
Disability is strongly embedded in the policy implementation cycle, which we very much welcome. A vision is set out in the national disability strategy, Towards 2016 and An Agreed Programme for Government to enable people to get out and about and earn a decent income. Commitments are set out in Towards 2016 that there be will "a constructive relationship with stakeholders in relation to progress on the Strategy as a whole". The NESC and Comptroller and Auditor General reports push for greater collaboration and working in partnership.
The key issue is that the voluntary disability sector is seen as a partner in the delivery of services, problem solving and trying to make everything work better with State agencies. That is clear at that level but I refer to the HSE and voluntary disability sector partnership which can bring a number of attributes to the table. We can muster community engagement and awareness, as well as voluntary fund-raising. All our boards comprise people who act in a voluntary capacity. A lot of other voluntary work is undertaken. The organisations bring a significant capital stock to the table, including innovation, expertise and ongoing strong relationships with people with disabilities. Many of them have people with disabilities embedded in their operation, management and governance.
The problem is that there is a major disconnect between this approach and the ongoing behaviour of the HSE. Recently, the executive published service level and grant aid agreements to which it would like the disability organisations and other external agencies to sign up under sections 38 and 39 of the Health Act 2004. The agreements look on the voluntary organisations as subcontractors rather than partners and provide for a control and dependency relationship rather than one based on trust and joint problem solving.
The Comptroller and Auditor General's report of 2005 states, "The continuance of a relationship with not-for-profit service providers as partners in service development and delivery would involve the State in actively working with organisations to strengthen their organisational capacity". There is a need more than ever for voluntary disability organisations to be supported to ensure their governance structures can respond to the growing challenges. The challenges are welcome in that they are all about greater accountability, transparency and improved service provision for people with disabilities, yet the 1% funding cut will, first and foremost, affect the back offices of organisations which need stability and strength to operate better as organisations and with others.
We would very much welcome regular and ongoing engagement with the HSE on an organisation to organisation basis in achieving greater efficiencies for the purpose of ensuring services for people with disabilities are enhanced and money is not diverted elsewhere. We worked hard with politicians to secure that money and will not hand it back too easily. The ongoing reform programme in the HSE continues to hinder the formulation of positive relationships with the sector. We have tried to engage at every level with an organisation consumed by its own evolving or revolving structures where the impact of the internal efforts to reform is distracting from sufficiently and consistently focusing on people with disabilities.
I refer to the issue of funding. New and enhanced provision for services increased strongly between 2005 and 2007 but came to a halt in budget 2008. Not alone did it stop but it receded, from a total of €95 million in 2007 to €50 million extra in 2008. This was a deceleration in the rate of growth of almost 50%.
The Minister for Finance made a decision in 2004 to set up the very welcome multi-annual funding programme. At the time the Minister stated in the Budget Statement that other disability services would continue to be dealt with as a normal part of the annual Estimates process. This has not happened in this current year. Today is 1 July and we have not seen one cent of the €50 million of the multi-annual funding being pumped down the line and providing services to people.
We are down €45 million on last year and there is no sign of the €50 million. The 1% cut is being introduced now which has the effect of taking €25 million out of services for disabled people. This committee is one of the right places to ask why it is possible that an executive agency under the aegis of the Department of Health and Children can unilaterally overturn not only the funding allocation remit of the Oireachtas but what is set out in the NDP. These 1% efficiency savings may be called that, but it must be made clear that this is a conscious and systematic removal of funding voted by the Oireachtas for disability services and allocation to other areas. I have no doubt it was well meaning but decisions were made and we expect those decisions to hold.
I emphasise that as well as the multi-annual funding, if the results of the independent assessment of need are ever to be implemented, there is a great need in the medium to long term and over the years, for significant extra investment in the disability area. The NDP allocated almost €19 billion for disability services out to 2013. From 2010 onwards, the annual increases making up that funding will be simply 2% per annum. Those projections were done before the NDP was published and were made on the basis of the Department of Finance forecast of an annual growth rate of approximately 5%. If that money comes through — we hope it does — it will be a modest amount and will not achieve what we want. We are also at a point where we are not even sure that this money will hold. There are a couple of clear problems which we invite the committee to consider.
The HSE has admitted to this committee that it has diverted funding to other services and it stated that decisions to reallocate funding were made by the senior management team at national level. We also know that the chief executive, Professor Drumm, has acknowledged that money earmarked for palliative care was spent elsewhere. Last December the Minister for Health and Children wrote to the chairman of the HSE with the instruction that development funds designated for specific projects in the health service were not to be used to address the financial deficits incurred.
A Vision for Change states that €25 million was allocated for each year 2006 and 2007 but €17 million was delivered in 2006 and €10 million in 2007. This amounts to a little more than half of what was allocated. There are real and very pressing issues about the gap between allocations and what hits the spot. It is unacceptable to us that resources allocated to disability and mental health should be diverted to other areas. If health issues are not addressed, the policy of mainstreaming and the whole intent of the national disability strategy will be in tatters; it is as simple as that.
An Agreed Programme for Government stated that the Government is determined to continue to prioritise the interests of people with disabilities in the next five years. For that commitment to be honoured, another commitment in the programme for Government, namely, that half of the disability strategy would be implemented by 2010, must also come into play.
A particular legacy issue with regard to funding is what we describe as core deficit funding. A range of organisations exist around the country in all areas of disability which are still doing their own fund-raising and providing their own funding to provide basic health and personal social services. To cut to the chase, unless that unsustainable situation is sorted out, new services cannot just be added on when the foundations are left shaking. This situation needs to be sorted out. Funding was allocated in the years 2005 to 2007, a total of €15 million in 2005, €10 million in 2006 and €5 million in 2007, went through the system. Last year's money was withdrawn and there is no allocation this year for that area.
I refer to a tabular statement in the documents presented to the committee which details eleven organisations showing that euro for euro, these organisations are putting in exactly the same amount as is coming from the HSE. Introducing new services without addressing the shortfalls in current services is a case of building on sand. Organisations and people are being taken for granted by the HSE in this regard.
It is essential to get the health and personal social services right to make the disability strategy work. It is a magnificent strategy and people and governments from all over the world ask how it was done. It is a great strategy but unless this area of health — in particular the personal and social services — is dealt with, it will crumble. Funding for disability services needs to have its own budget subhead or some other mechanism — whatever works — to protect the voted money. We will still complain that there is not enough voted but it is really galling that money voted does not go where it says on the tin and this is totally unacceptable. The funding set out in the NDP, which we consider to be modest in terms of the overall project, must be protected. Budget 2008 represents a deceleration of almost 50% in the rate of growth over the previous year. This was a hit we took last December. We do not need one again in the middle of the year but we are getting it. The €50 million multi-annual funding has not been deployed into the system and the 1% efficiency savings, to use a euphemism, must be stopped immediately. The HSE view that it has an overriding statutory obligation to balance the books on a yearly basis, is at odds with other statutory obligations or decisions. For instance, money is voted by means of the Finance Act, so somebody will need to figure out how to avoid these being at odds with each other.
There is a great need for the HSE to acknowledge through its engagement with the voluntary sector that the voluntary disability organisations bring a great deal to the table and that we are not simply subcontractors, there to tender when the HSE considers it needs a service provided. In a sense they are losing a considerable amount by not seeing the broader picture of community involvement. Members and staff spent last weekend trying to get the community involved in the Oireachtas. There is Government policy regarding active citizenship, community engagement, keeping people interested in issues in their country. People do that in day in day out through disability groups and so on. We want the HSE to start working with us on the basis that we are partners with them. We respect its statutory role. Those draft service agreements need to be rewritten from the point of view that it should respect the independence and autonomy of this sector. I draw members' attention to the fact that as voluntary organisations we have the support of the Constitution. I believe Article 40 states that people have the right to form associations and unions. That needs to be understood.
The HSE is not the beginning and end of the matter, but it is without doubt, in the front line. People see and experience its performance and there is no shortage of media interest in that. People do not readily see the connections and relationships between the HSE and a range of other actors, the Departments of Health and Children, and Finance, and the Oireachtas. Being critical of the HSE is popular today to the point of being a national blood sport. I do not wish to add to that kind of discourse. However, there are points well felt across the sector and they need to be made. I hope I have done that in a respectful way.
If possible this committee should further analyse and reflect on matters relating to the relationship between the Oireachtas and the HSE having regard to disability funding. It would be useful for the committee to find a way to prevent the HSE from effectively subverting the decisions of the Oireachtas in respect of voted funding for disability. We need to get delivery of what has been allocated. We will row again about what we need. However, right now we need to get our mitts on what has been allocated in this year's budget — that €50 million. As part of that we need to unravel these 1% cuts, which have been taken from what was committed in the budget.
