Regina Doherty (Meath East, Fine Gael) | Oireachtas source

I welcome all our guests. I appreciate the presentations they have made. Most of the questions have centred around the people in section 39 and section 39 organisations who are on very large pay. We do not mean to discount the work the organisations in question are doing. I acknowledge that the work they are doing did not arise from the few questions they were asked by my colleagues on the Committee of Public Accounts. I am well aware that they have been doing this work for many years. I want to put it on the record that we appreciate it.

In the last number of years, the HSE has ceased trading with a number of organisations that we are currently funding. I am not discounting the fact that they provide valuable services. Can the officials share with me some of the reasons this cessation of trading has happened? Reference was made earlier to the compliance of the hundreds of organisations that the HSE is currently working with. I assume these agreements are not confined to the financial arrangements - wages and salaries - of the high earners in those organisations. Can I ask how the HSE is measuring the level of compliance? Can the witnesses give me an example of some of the key performance indicators that would be within a service level agreement, for example, in the case of somebody who is providing residential care in the disability sector? The specific reason I ask this question is that has been brought to my attention lately that in a certain organisation which provides services in residential houses - it will remain nameless - the ratio of service users to qualified staff looking after those service users has diminished drastically in recent years. The number of responsibilities the service providers in the organisation are obliged to offer has increased drastically in that time, and not as a result of the extra hour and a half that is required under the Haddington Road agreement or the previous requirements under the Croke Park agreement. How do we ensure the services provided are of a standard that we would be proud of? How can we be happy that we are getting value for taxpayers' money in the provision of these services?

Senator van Turnhout mentioned earlier that many service users have the feeling that they are receiving charity and are genuinely under the impression that they have to fight, scream and kick for services. This was mentioned the other night by Suzy B, a lady for whom I have a great deal of respect. In light of the amount of taxpayers' money we are providing to taxpayers, I wonder whether there is a better way of providing these services. Is there a better way of providing information on how the taxpayer is funding these services, so that service users do not feel they have to fight for services to which they are entitled? They should not have to feel like they are receiving charity, because they are absolutely not receiving charity. While most of these organisations raise funds to enhance the services they offer to service users, it must be emphasised that this €3.2 billion is not charity - it is taxpayers' money that is being paid to taxpayers who are entitled to it. Is there any way we could reframe that? Maybe we could do so by making it clear each year in the statement of intent what we are spending this €3.2 billion on. We should list the services that are being provided for and the people to whom the services are being provided. That might seem like a public relations exercise, but I think it would be valuable.

I am keen to know about the service level agreement and the key performance indicators on an individual basis across the organisations that are providing these services. At a higher level, are we actually looking at the organisations that are providing those services? I appreciate that we have business relationships with them, from the HSE to the individual organisations. As Senator van Turnhout mentioned earlier, those business relationships seem to be rolling over even though they are tendered every year. If that is not the case, maybe the witnesses can explain how and why these services are tendered. Are there new entrants from a larger scale? The same people that are receiving large amounts of money - well in excess of €5 million - are providing the services year in, year out. Are there new entrants into the market? Are people leaving the market? I hate the term "value for money", but we need to ensure the millions of euro that are being given to these organisations are being spent wisely to provide proper services to service users.

I am referring to the ordinary people who are providing the services and who are earning absolutely nothing close to the ladies and gentlemen we have been talking about in the media in recent weeks. How do we ensure the average nurse or service provider working in a residential care house is being treated well and that his or her conditions of employment are as they would be if he or she were working in one of the organisations and directly employed by the Health Service Executive?