Oireachtas Joint and Select Committees

Wednesday, 5 October 2016

Select Committee on the Future of Healthcare

Citizen-Centred Health Care: Civil Engagement

9:00 am

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein) | Oireachtas source

Senator Dolan referenced Article 40, on the right to form associations. That article is the basis from which I made a good living and is an issue about which I feel very strongly. I would like to explore the journey from advocacy to service provision. I am not sure I share all the Senator's views on the role of the State in this regard but I recognise that there is a replication in the charities sector. Senator Dolan will correct me if I am wrong but it certainly seems to me, as an observer, that there is a problem of duplication to be addressed. Many of the criticisms of our health and social care services revolve around their silo nature whereby A does not talk to B, and B, in turn, does not talk to C. There are multiple charitable and voluntary organisations dealing in the same area. Without wanting to stymie their advocacy function, which is incredibly important, I would like to know what scope there is for co-operation between charities.

Senator Colette Kelleher spoke about the limitations that are sometimes placed on service provision. Without meaning to put words in anybody's mouth, I wonder whether that is because of the mechanism for service level agreements. I suspect people are given a tenner and told to do €50 worth of work with it. Again, there are multiple agencies and a great deal of replication because the governance and administrative systems have to be in place. That can create a difficulty. It seems some charities suffered more than others in terms of cutbacks because they simply did not have a buffer. Smaller organisations, in particular, have felt that pinch considerably. I am interested to hear any observations the Senator might have in regard to service level agreements. It is the model that seems to be driving most provision.

I am aware of the good work Senator Black does in the area of dual diagnosis. The Government sector, including the HSE, is not doing enough - if it is doing anything - to address the issues in this regard. There must be a link-in with mental health services. I am interested to explore the extent to which there is a difficulty in this respect given there is largely no recognition of dual diagnosis despite the general acceptance that it is an important issue which needs to be dealt with. I am wondering about the extent to which charities can shape policy, including, but not solely, in respect of the issue of dual diagnosis. Or is the policy of charities mostly driven by the funding that is available to them?

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