There are no proposals to cease funding to any agencies providing health and personal services to people with disabilities. Section 39 of the Health Act 2004, empowers the Health Service Executive (HSE) to "give assistance to any person or body that provides or proposes to provide a service similar or ancillary to a service that the Executive may provide". Employees of Section 39 organisations are not public servants, are not subject to the standard salary scales for the health sector, are not counted in public service employment numbers and are not members of a public sector pension scheme. This provides Section 39 agencies with the freedom to exercise greater flexibility in respect of staff recruitment, deployment, pay and conditions.
The Service Level Arrangement or Grant Aid Agreement between the HSE and service providers governs the funding relationship between the relevant bodies. This agreement framework provides governance which links funding to a quantum of service and provides for these services to be linked to quality standards, with continuous monitoring to ensure equity, efficiency and effective use of available resources.
As part of this process, all Section 39 agencies are monitored via regular review meetings with HSE Management at Area and Regional level. These review meetings address financial reports, human resources, activity data, planning, review of agreed performance indicators and compliance with quality and standards etc. It must also be noted that Section 39 organisations may be involved in a range of other activities, which are not funded by the HSE.
The Government's plans for the reform of the health services, including the disability services, are set out in Future Health: A Strategic Framework for Reform of the Health Service 2012 - 2015. This document recognises that in order to improve services for the population and achieve the overarching objectives of the reform programme, we need real changes in the structures of the health system. Future Health describes the Government's plans for structural reform and outlines the phased approach which is being taken.
The Minister's key concerns in terms of structural reform are to promote good governance, avoid duplication and ensure a strong regional focus in managing performance and delivering value for money. The first phase of the transition process is aimed at: introducing revised governance and management structures, including the appointment of new national directors, in the HSE; the establishment of hospital groups on an administrative basis; revising the structures for delivering primary, social and mental health care to improve integration of services at the local level following a review of the Integrated Service Areas; and establishment of the new Child and Family Agency. I am happy to report that good progress has been made on these issues.
The second phase will involve the development of a formal purchaser / provider split and the establishment of the new structures to replace the HSE. As indicated, the plans for structural reform are not confined to hospital services and primary care, but will also apply to the social care sector.
Future Health commits to the development of a social and continuing care system that maximises independence and achieves value for the resources invested. This includes the reform of disability services in line with the findings of the Value for Money and Policy Review of Disability Services. Among the measures to be introduced as part of the reform process are the introduction of a standardised framework to commission services from both public and non-public providers; individualised budgeting to bring about a closer alignment between funding and the outcomes for individuals; and a robust regulatory regime to ensure quality and safety.