I thank members for inviting us before the joint committee. After more than four decades of providing a unique and successful type of support to people with special needs, Camphill Communities of Ireland is facing the real prospect of having to cut its services for the first time. There is even a question mark hanging over the future of the organisation's operations. Camphill Communities of Ireland serves more than 275 people across a range of ages, most of whom are full-time residents in 17 locations. Funding issues with the Health Service Executive, which remain unresolved despite negotiations dating back to 2004, threaten the sustainability of the Camphill model under which the organisation provides secure home environments for residents in its urban, suburban and rural locations nationwide. If these issues are not resolved, there is a real prospect that many of the 275 people served by the organisation will have to transfer to care organisations that are considerably more expensive to the State and do not provide the unique volunteer-based, life-sharing model of Camphill.
Camphill Communities of Ireland is now very frustrated at what it sees as a stonewalling attitude in the HSE towards dealing with this ongoing and protracted situation. At a national level meeting in December of last year between the HSE and a delegation of a number of people from Camphill Communities of Ireland, it was stated bluntly that one community simply could not survive past 2015 without additional funding. To date, very little has changed. In that particular example of an urban Camphill community which supports 20 people with special needs, 16 of those who live there are full-time residents. The recommended funding, according to the HSE's target rates and published in its own value-for-money review of disability services, is in the region of €1.2 million. The funding received is between 49% and 58% of the value-for-money figures. The differences arise depending on whether the recommendations are assessed on an estimation of support need or on staffing levels, each relating to the residents. There is also a variation when a calculation is made, taking into account a contribution from the disability allowance of the residents. In the example community, when compared with the funding provided by the State in 2008 - which more or less met the needs of the operation - there has been the equivalent of between an 8% to 14% cut in funding since 2009. Camphill is not necessarily asking for the full recommended assumed rates according to the HSE's value-for-money report. It would likely be able to sustain the community at a funding level of between 65% to 70% of the target funding levels highlighted in that report.
The Camphill Communities of Ireland operation is a relatively small component of the matrix of service providers for approximately 8,000 people with special needs in residential services in Ireland. Its principles also differ in that the concept is based on the principles of Rudolf Steiner and are underpinned by the acceptance of the spiritual uniqueness of each human being. When the organisation was established in Gorey, County Wexford, in 1972, almost all of its workers were long-term vocational volunteers known as "co-workers". My colleague, Mr. John O'Connor, is seated to my right and is a vocational volunteer co-worker. Such co-workers lived as part of the community and provided 24-7, family-type care for residents. Modest living expenses are shared and many co-workers have raised their own families within these Camphill communities. They have traditionally been helped by short-term co-workers or volunteers such as students from Ireland and abroad who take the equivalent of a gap year to work with the organisation. Small numbers of local volunteers are also involved. In all three elements there is a large component of altruism. The culture and diversity, not to mention friendship and companionship, that co-workers bring to the lives of people with special needs cannot and should not be underestimated. The vocational volunteers provide a vital and fundamental role within Camphill but sadly long-term volunteers are diminishing.
With 505 people now in the total workforce, the organisation has seen a 9% increase in worker numbers in the past two years while funding has decreased significantly over the same period. Within the total, the number of paid employees in the past six years has increased by 25% and between 2009-2013 wage costs for those employees have increased from €2.4 million to €4.2 million which has placed severe pressure on financial resources that are diminishing.
Virtually all of the organisation's income is from the public purse. When the operation was established, it was paid in the form of initial block grants to meet minimum estimated needs, to be topped up if necessary. In the early 1990s the system was changed to a capitation fee basis, which is a more transparent way of funding. Initially, new funding worked out well even though Camphill communities were typically receiving capitation fees of approximately 50% of those paid to other organisations in the same field. The high altruistic nature and element of those who work in Camphill communities means that the wage element of a community can be as low as 45% of total costs when compared with a typical 80% in more mainstream organisations. It is accepted that the savings to the State from the activities of Camphill communities are currently in the region of €5 million annually.
At present there are 274 co-workers. The number of co-workers has remained fairly constant though the proportion of short-term volunteers is rising. This is partly because it has become more difficult to attract long-term co-workers to the Camphill lifestyle. The situation is exacerbated by the increasing number of long-term co-workers now reaching retirement age for whom a small top-up provision to their State pension has also to be made. On the other hand, the numbers of fully paid employees in the communities has risen steadily. The declining number of long-term co-workers is part of the reason employees will only work more conventional hours compared with the 24-7 input of co-workers.
Camphill welcomes the efforts to improve the quality of residential care and actively engaged with HIQA throughout the inspection and registration processes which, although challenging, has been a positive experience. In fact, a HIQA inspector commented off the record that if they had a child with an intellectual disability that they would choose Camphill as the preferred model of service. However, Camphill is also meeting greater financial pressures as the regulatory process for residential disability services requires a substantial amount of administrative work, as well as more stringent fire and other safety and infrastructure changes. A significant element of its residential accommodation is now 30 years old or more, which brings extra financial burdens. All of this has also meant that long-term co-workers are increasingly pulled into administrative tasks rather than the life-sharing ethos of the Camphill ideal. In order to address this issue, Camphill has had to support these roles through employment which has led to increased costs.
When the HSE conducted a value for money pilot study, it invited Camphill to participate so that it could address the funding issues. The study found very large discrepancies between the costs involved in the various agencies. Camphill was very much at the bottom end of the list on a cost per resident basis, so much so that it was in part nearly considered an outlier in statistical terms. The pilot has subsequently been rolled into a report on value for money and policy review for disability services. This report came up with a programme to achieve a 5% reduction in annual funding per placement from the 2009 level. Instead of the value-for-money review being used to address the huge discrepancies in the system, Camphill's funding was targeted to achieve the same cost savings as everyone else without the increases in funding that larger service providers had been granted in the Celtic tiger years.
Following many meetings with the HSE, at both local and national level, the delegates of Camphill say that they now feel absolutely frustrated at being ping-ponged from one level of the HSE to another with no movement on the funding issues. Camphill has been informed that the HSE may at some point in the future develop a needs assessment tool to work out the support needs of individual residents. Camphill supports the move as it would bring equity into what is a very skewed system at some unspecified point in the future.
Camphill says it has simply been blocked at almost every turn and, most recently, by the suggestion that a service improvement team led by the HSE, that would consist of individuals seconded from larger service providers, would inspect the way Camphill delivers its services with a view to highlighting how further cost savings could be achieved. Some co-workers have reached the conclusion that they must simply walk away from their vocation. If that happens, the resultant costs per resident will inevitably balloon compared with the very low cost of the Camphill model, even in a modern context of some employed supports. These are swollen costs that the Irish taxpayer will have to pick up. Such a scenario would be detrimental to the individual residents who consider their current Camphill placements home. Equally, the 17 urban, suburban and rural locations in which Camphill operates would also lose out because, in each case, residents and co-workers have integrated into their local towns and villages. Camphill's ethos has invariably resulted in extensive mutual support in those locations and communities have adopted the residents. This is integration in a very real and progressive way that clearly belies the tokenism of some institutional models.
In the face of the current programme of avoidance, Camphill has been forced to undertake a political lobbying exercise to try and bring some pressure to bear on the situation and to break an 11-year logjam. If lobbying does not succeed then a major shift looks inevitable. Such a shift would mean increased costs for the taxpayer and an undeserved end to four decades of hard work, goodwill and obvious achievements by thousands of voluntary co-workers who are sharing, and have shared, their lives with people with intellectual disabilities. Worst of all, however, is the fact that 275 people who have lived much more successfully than they or their families could ever have expected will face an unknown future and be wrenched from the love and care they have today. Camphill seeks real engagement with the HSE to redress the appallingly low capitation fees that have persisted at Camphill over the past two decades. In fiscal terms three of our communities are close to the edge and soon they will have to commence arrangements to transfer residents to the care of the HSE if a solution is not found in the very short term.
In addition, the rigours of the new regime imposed by the national standards for residential disability services need to be addressed in a very concrete way. Simply ignoring the problem will not aid the safe care of people with special needs. The HSE asked for costings for fire upgrades and other works. The costings were supplied more than 12 months ago.
To date, HIQA has inspected all but two of Camphill's communities. The issues identified require substantial funding to meet the requirements of the inspections. To date, no funding has become available. Ongoing maintenance of a huge raft of buildings is not currently included in any funding stream from the HSE. This also does not take account of the financial cost of purchases of new vehicles. A funding mechanism must be found to ensure safe homes and safe vehicles for the people we care for.
