Tuesday, 2 July 2019

Questions (48)

Martin Heydon


48. Deputy Martin Heydon asked the Minister for Health the progress on implementation of the recommendations and findings of the report of the independent review group established to examine the role of voluntary organisations in publicly funded health and personal social services; and if he will make a statement on the matter. [27965/19]

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Oral answers (6 contributions) (Question to Health)

The voluntary sector plays a key role around the country in the delivery of health and personal social services. The origin of many voluntary organisations was to provide a service at a time when the State did not. The value of their contribution is immense but given the variety of arrangements, all formalised at different times in the State's history, it is right that we review the relationship we have with organisations in the voluntary sector and the key role they play, and that we make sure the relationships are fit for purpose in the future and provide the very best service for all service users. I ask the Minister to comment on the independent review that was carried out, its recommendations and their implementation.

I thank Deputy Heydon for this important question. The report of the independent review group established to examine the role of voluntary organisations in publicly funded health and personal social services was published by me in February this year. It makes 24 recommendations covering areas such as the governance of voluntary organisations; dialogue, engagement and contractual processes between the State and the voluntary sector; ethos, asset ownership and public capital investment; and broader issues related to health system development.

The recommendations are grounded in two key overarching findings. First, the report recognises, as does the Deputy, the important contribution voluntary organisations make and concluded that they should continue to play an integral role in the delivery of health and social care services. Second, it found a high level of mutual interdependence between the State and voluntary organisations and called for the development of a stronger relationship based on trust and partnership.

I fully agree with and endorse the findings. Voluntary organisations have an important role to play in the delivery of health services. I have already signalled my commitment to further strengthen the relationship between the State and voluntary organisations but I also think I have an important role, as does the Government and the Oireachtas, in setting out policy. It is a relationship that must mutually respect the responsibilities of each other.

As a first step, I have given approval for the establishment of a new dialogue process between the Department, the HSE and other relevant health agencies and representatives of voluntary organisations in the health and social care sector, as was recommended in the report. My Department is currently designing this process, including its terms of reference, membership and other practical considerations, and will be engaging with voluntary sector representative organisations in that regard.

I believe that this new dialogue process can provide a forum for engaging more effectively with voluntary organisations on key policies and initiatives. I also believe it can provide a forum for taking forward other recommendations in the report such as those relating to governance, but perhaps more importantly, it can provide the platform for developing greater levels of trust and partnership across the system. This must be a two-way process with recognition of the respective roles and mutual dependencies of both sides.

There is also a broad range of other recommendations in the report that are under consideration. The good news is that many of themes align with the Sláintecare programme and will be taken forward in that context. Some require collaboration with other Departments such as the Department of Public Expenditure and Reform and that work is ongoing.

I am conscious that we have remarkable voluntary organisations such as KARE in my constituency. The Minister is aware of it, as it is also involved in west Wicklow as well as Kildare. It was established in 1967 by parents and friends of children with intellectual disabilities who wanted their children to be able to live at home and to go to school locally. KARE is a fantastic organisation that has since seen the development of two great schools in St. Anne's in the Curragh and St. Mark's in Newbridge. I was a member of the board of management in St. Mark's for some time. They provide a very good service. I am aware of the challenges they face on an ongoing basis. What the Minister said is very important about the future relationship between the Department, the HSE and voluntary organisations such as KARE. The Department, the Minister and Members of the Dáil are responsible for setting policy and we cannot abdicate that responsibility.

I recently attended the KARE AGM and I was struck by what many of the service users said about their desire to live alone instead of in group houses in the community. In order for them to be able to do that it requires multi-annual funding and long-term planning. I note there is a key policy recommendation on multi-annual funding.

The Minister of State, Deputy Finian McGrath, and I support Deputy Heydon in that regard. I am aware of the very good work of KARE in the Deputy's constituency and in mine, and the very good work of so many voluntary organisations across the country which are an integral part of the health service. We could not do without them. They were providing services long before the State bothered to do so. My Department did not exist until the 1940s. We had a State without a Department of Health because we were reliant on the voluntary sector and the church. In addition, some of the largest hospitals in this country are also voluntary. I respect the role of voluntary hospitals. Many countries have them, but they must modernise, be more transparent and open and they must provide a seat at the table for public policymakers and representatives of the State.

In the excellent report we are discussing, Ms Catherine Day made some good recommendations about having a public interest director or whatever we wish to call him or her. We can and must respect the voluntary ethos, which I very much do, and the good work that is being done, but there is only one forum that sets public sector policy and health policy and no ethos should prevent people from accessing healthcare. That is the type of discussion we need to start having with the sector in terms of how we can help by providing certainty of funding and multi-annual funding and how they can help us by making sure we can implement public policy.

The Minister is dead right. At the heart of the issue is addressing service level agreements and making sure they are fit for purpose. In many ways, that will involve the agreements being reviewed and simplified so that they focus on service provision as much as possible. I come across issues in my constituency all the time, which I have raised with the Minister of State, Deputy Finian McGrath, regarding challenges for school leavers with intellectual disabilities when they reach the age of 18. I am thankful that KARE is not among them, but we have voluntary organisations around the country that are constantly in deficit. Recommendation 8.8 in the report is to assess if an organisation is adequately funded in the first place and if there are better ways to manage its budget. If an organisation is in a constant cycle of deficits year-on-year, it will never get out of the cycle. Such organisations are then hamstrung and cannot provide the service we need.

Recommendation 8.3 relates to official recognition through a charter of the legally separate status of the voluntary sector reflecting its public service role. Ultimately, it is about due recognition. The report produced by the review group chaired by Ms Catherine Day is excellent. It is a great opportunity for us now to drive on, show the voluntary sector that it is a dual relationship, that we are interdependent on each other and we must work together in order that we can better provide a service for people in the future that is fit for purpose.

I agree with Deputy Heydon that it is an excellent report. I thank Ms Catherine Day, Ms Jane Grimson and Ms Deirdre Madden for doing that body of work. In the report we heard from the voluntary sector that the organisations do not mind complying and providing information but they object to the level of bureaucracy and want us to make it simpler, in particular for smaller organisations, and not constantly ask them for the same information in multiple formats. We must reduce the bureaucracy and form filling while making sure that we have the right level of oversight as well.

I accept that we will have to address the funding issues. The Minister of State, Deputy Finian McGrath, and I will have to look at the legacy issues with Government colleagues. I am sure Deputy Heydon will agree that alongside any funding there must be reform. I refer to such things as personalised budgets. I do not believe the provision of disability and social care services is likely to be confined just to block grants, but will be more about personalised budgets and empowering the person with a disability as well. Like any conversation with any interest group we will have to speak about appropriate levels of funding and certainty of funding but also how we reform and modernise the delivery of the services.