Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I welcome this opportunity to address the House on the hugely important role that section 39 and section 56 organisations and their staff play in our health and social care services. I welcome everyone in this Gallery to hear this debate.

Next week, a number of section 39 and section 56 organisations may begin a strike. This matter is highly important to me and to the Minister, Deputy O'Gorman. I recognise the potential impact that any industrial action will have on the lives of those who avail of services provided by section 39 and section 56 organisations. The sustainability of these organisations is a multifaceted problem affecting multiple arms of the State. The sector is experiencing critical dependencies around the competitive ability to recruit and retain staff. This has been highlighted by the sector for numerous years. Many Departments have funding relationships with these organisations. The matter at hand will affect the Departments of Justice, Education and Housing, Local Government and Heritage. It will have ramifications for the Departments of Social Protection and Further and Higher Education, Research, Innovation and Science.

The coming weeks will constitute a benchmark moment for this sector. I am grateful for the attention that has been paid to this escalating issue by the Taoiseach, the Tánaiste and the Ministers for Finance and Public Expenditure, National Development Plan Delivery and Reform. This is one of those rare instances where all parties involved in discussions are effectively on the same side and wish to see a resolution reached that is satisfactory to all. To achieve this, a balance has to be maintained in respect of the impact on Exchequer funding. As always, there are limits to our spending ability.

To provide a little more context, I will briefly outline the situation. Officials from my Department, the Department of Health, the HSE and Tusla attended a number of engagements with trade unions under the auspices of the Workplace Relations Commission, WRC, in recent months. In July, that process culminated in an offer being made to unions. My Department and the Department of Health made a combined offer amounting to a 5% increase in funding for pay, effective from November 2023 and with 3% backdated to April 2023.

In addition, a commitment to re-engage with trade union representatives following further public sector pay agreements was also offered. This was an important move. Union representatives rejected the offer. As we now know, unions representing section 39 and section 56 workers have announced that their members in a selection of employer organisations will take indefinite strike action, commencing next Tuesday, 17 October. Actions will involve health and community workers in a variety of grades and in multiple locations across 62 voluntary service provider organisations. Any industrial action will negatively affect the people who use these services. My officials and those in the Department of Health are available to engage with employers and unions. The hope is that a suitable solution can be reached to avert any industrial action. In the meantime, the relevant agencies – Tusla and HSE – have been asked to engage in contingency planning with the employer organisations that will be affected by industrial action so that any impact on those who depend on these essential services can be managed to the greatest extent possible.

I am conscious that similar considerations arise in respect of other sectors across government, adding to the complexity in seeking a resolution for any specific sector. As highlighted, staff recruitment and retention challenges comprise a critical factor affecting the sustainability and stability of section 39 and section 56 organisations and their ability to deliver services on behalf of the State. These challenges are mirrored in many of the health and social care professions across the country.

My Department is engaged in ongoing dialogue with involved agencies and the Department of Public Expenditure, National Development Plan Delivery and Reform. Indeed, I understand my officials are meeting their counterparts in that Department around now to discuss these issues once again. It is recognised that a solution to the current situation will involve additional investment into these sectors, securing their sustainability and stability. These discussions are continuing. Until they are concluded, it would not be appropriate for me to comment further. Suffice it to say that the sustainability and stability of health and social care sectors are a concern for me and the Government, including the Minister, Deputy O’Gorman. We recognise that the ability of voluntary organisations to pay their staff is highly dependent on State funding.

Regarding section 39 organisations, these voluntary organisations deliver a range of health and social care services to communities around Ireland. These include: residential, day and ancillary services for people with disabilities; mental health services; palliative care services; addiction services; and other health and social care services provided in the community. They also include a wide range of community initiatives that improve older people’s lives, maintaining a sense of community and combating loneliness and isolation, while also providing practical services such as meals on wheels, laundry, basic essential repairs and much more. These types of supports in the community are extremely valuable. Voluntary organisations frequently make up a large part of the service delivery landscape – for example, delivering between 70% and 80% of disability services in the majority of community health areas. Staff of these organisations perform the same roles as public sector staff but may receive lower pay.

Building Momentum, the public sector pay agreement, has widened the gap between section 39 workers and other workers delivering equivalent services in the public sector. Notably, in the case of disability services, HSE and section 39 staff frequently work directly alongside each other in multidisciplinary teams, particularly on the children’s disability network teams. Their work is essential in providing services to many families and vulnerable people in society. The systemic sustainability and stability of organisations in the health and social care sector is, therefore, a significant concern for the Government. I understand these challenges and recognise that the ability of voluntary organisations to pay their staff and effectively and safely deliver services is highly dependent on the State funding they receive. Staff recruitment and retention challenges are not new or unique to these organisations, but I remain committed to effectively working with all relevant parties to resolve these systemic issues.

With the potential of industrial action next week, we face an urgent and difficult situation in seeking to resolve the pay claim from staff employed in the community and voluntary sector.

I know from my engagement with service users and families that the announcement that service disruptions will begin next week is already causing significant distress for many. We have a collective responsibility to exhaust all opportunities to avoid further anxiety and the impact of actual service disruptions. In that regard, I acknowledge the constructive engagement and openness of the staff representatives during discussions facilitated by the WRC. Unfortunately, these initial engagements did not result in a resolution but the Departments remain available to reconvene and we all know that a solution will only be reached through further dialogue.

As a Minister of State in the Department of Children, Equality, Disability, Integration and Youth, I find it particularly hard to accept the status quo. We are not just talking about figures on a spread sheet. These are real people with real lives. These are individuals and their families who are trying to keep the show on the road. Ultimately, these staff are supporting people with disabilities who, in turn, are trying to live their lives. Some will say there is a fear of contagion and of the impact this will have on other sectors. I look at it differently. I look at the contagion of care and fair wages for staff, a contagion of increased pride in the work being done by section 39 and 56 organisations, a contagion of equality.

When I was appointed Minister of State with responsibility for disability, one of the key issues I addressed was pay restoration for section 39 organisations. I secured and delivered the money for it in 2020 because it was the right thing to do. This stemmed from a time when financial emergency measures in the public interest cuts were made to the pay of public servants and when section 39 organisations were faced with difficult decisions due to reductions in their core funding. While it is understood that pay savings were made by certain community and voluntary organisations, the precise mix of pay cuts or other savings measures varied from organisation to organisation. To address this, a process involving the Department of Health, the HSE and ICTU was initiated at the WRC in 2018 to work through the complex issues involved and agree a process to consider the pay of staff in section 39 organisations whose employers had cut their pay. This resulted in funding being made available for pay increases for an initial 50 larger scale agencies within a total group of 300 agencies that met various criteria. Pay rises commenced in 2019 with an annual pay increase of up to €1,000. In December 2020, there was further engagement at the WRC, which resulted in funding being made available for pay increases for cohorts of staff in the remaining 250 agencies identified in 2018. They had to wait far too long. A payment arrangement consisting of three phases was agreed, with the first two payments made in 2021 and the third and final payment made in 2023.

Notwithstanding the efforts to address pay restoration in recent years, the Government recognises that sustainability and stability challenges persist in the voluntary sector, in both section 38 and section 39 organisations. The HSE and the Department are working to develop short, medium and long-term solutions to address recruitment and retention issues. I chair a working group on this issue, which meets regularly and is attended by representatives from the HSE and the Department of Further and Higher Education, Research, Innovation and Science.

I put on the record the fact that the official from the Department of Finance has left and that an official from the Department of Children, Equality, Disability, Integration and Youth has arrived.

The HSE also has a dedicated team working closely with individual organisations to address sustainability challenges.

Regarding WRC engagement to date, although neither the HSE nor the Department are the direct employers of staff in these organisations and therefore have no power to set pay rates or terms and conditions, both parties recognise the role section 39 organisations play in supporting and shaping the sector through the funding provided. The priority for both the Governmentand the HSE is to ensure that service users receive adequate services to live fulfilling lives in their communities. In recognition of the fact that recruitment and retention issues are affecting the ability of section 39 organisations to deliver services, my Department and the Department of Health made a combined offer to increase funding by approximately €54 million on an recurring annual basis to section 39 and section 56 bodies. The unions did not accept this offer and indicated that their members in a selection of organisations, including, disability services providers, would take indefinite strike action from Tuesday. Any industrial action will impact negatively on the people who use these services. I again urge the unions to return to the negotiation process. The employer organisations also need to be directly involved to avoid industrial action and the negative impacts this will have on service users.

In an effort to mitigate this impact, the service providers affected have been asked by the HSE to ensure that they: identify priority cases that need contingency planning during the strike action; identify essential services that must continue during the strike action; link in with the relevant trade unions and seek derogations for particular priority staff who may need to be rostered to continue essential service provision; engage with trade union officials regarding developing contingency plans to minimise service disruption; and communicate with families regarding this strike action and potential disturbance to services. The HSE will continue to engage closely with services to ensure the impact of any service disruptions can be minimised to the greatest extent possible.

Since my appointment to this role, my overarching ambition has been to improve the range of disability services available to children and adults. I recognise the essential role section 39 providers play in achieving this. This year’s financial allocation for disability services demonstrates the Government’s strong commitment to building capacity in this area. I was delighted to announce earlier this week that an additional €195 million will be invested in disability services for 2024, bringing total investment to €2.8 billion. My priority for 2024 will be the enhancement of person-centred supports and services, supporting the progressive roll-out of the action plan for disability services, and the roadmap for children’s disability services. I am aware that the implementation of these strategies cannot come quickly enough for those awaiting access to services and their families. I am confident that the allocation for 2024 will allow crucial investment in important services. I will work closely with my ministerial colleagues, the HSE, voluntary providers and disabled persons organisations to ensure that this funding has a substantial impact in 2024.

I turn now to current Government discussions about section 56 organisations. Tusla, the Child and Family Agency, is legally responsible under the Child and Family Act 2013 for a wide range of services to support and promote the development, welfare and protection of children and the effective functioning of families, which include family support services, child protection services, alternative care services, birth information and tracing, adoption, children’s services regulation and Tusla education support services. A major contributor to delivering these services is the work section 56 organisations carry out. Tusla works with more than 600 section 56 organisations. These organisations deliver a broad range of vital services locally all over Ireland including psychology services, speech and language therapy, play therapy, bereavement counselling, general counselling, art therapy, provision of residential-care placements and services for survivors of domestic, sexual and gender-based violence. In addition, these organisations range from multinational operations with hundreds of employees to local community-based organisations with small cohorts of staff that are often dependent on volunteers. Section 56 bodies have seen funding increase from €138 million in 2014 to €206 million in 2022. That is an increase of almost 50% and is reflective of the increasing demand for services and the demands arising from recent societal challenges. Also included in this increase, is the addition of initiatives such as the children and young people's services committees national programme and area-based childhood programme, as well as the expansion of the family resource centre programmes. Previously, a €6.5 million increase in funding was provided to section 56 services to allow them to begin to address the sustainability and survivability crisis facing the sector.

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Further increases to funding include the €7 million paid to organisations under various Covid-19 measures during 2021; 11 additional family resource centres, FRCs, added to FRC programme at a cost of €1.76 million with additional increases in funding to other existing family resource centres; and dormant account funding for the FRC programme was secured over 2020, 2021 and 2022 amounting to €2.77 million.

Tusla relies on the delivery of services by a variety of section 56 bodies. These services are always prepared to be flexible and adaptable and open to the complex needs of children and families served by Tusla. In the event section 56 services ceased operations, the agency would be under tremendous financial and resource pressure to maintain these services for families. As has been the case in other settings, the State having to step in, in an emergency capacity to stabilise an organisation, has significant cost and risk implications and is an action of last resort.

Section 56 organisations have reported that due to the inability to compete as a recruiter, potential staff have declined positions in the advanced stages of recruitment. The recruitment and retention of staff in this sector has become a major challenge and is impacting service delivery and responses to additional demands. Attracting and retaining qualified and skilled staff who can provide the level of care required for children and families is vital within these services. The time and resources required to deliver a successful recruitment campaign have significantly increased for these organisations. Potential staff declining positions due to current salaries assigned to posts has been flagged by the sector and many service providers have been unable to increase salaries since 2014 rates. Being unable to recruit and retain staff is impacting service delivery for these organisations and compounding waiting lists.

In budget 2024, the Minister, Deputy O’Gorman, prioritised resourcing Tusla to fulfil its statutory responsibilities and support the most vulnerable in our society. This will increase Tusla’s allocation in 2024. Over the coming weeks, the Minister will be engaging with his officials and senior Tusla management with regard to Tusla’s business plan for 2024 which will determine how best to use this funding to achieve better outcomes for Tusla’s service users.

The Minister, Deputy O'Gorman, will be joining me as he is at a Cabinet subcommittee meeting at the moment. He sends his apologies that he is not here at the start of this debate but he will join us as soon as he is out of the Cabinet meeting.

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