Dr. Catherine Day:

I thank the committee for the opportunity to discuss the report of the independent review group established by the Minister in 2017 to examine the role of voluntary organisations in publicly-funded health and personal social services.

Our terms of reference called for factual analysis, including of issues with faith-based voluntary organisations, consultation and recommendations on future relations between the State and the voluntary sector. This led us to establish an evidence base which included drawing on previous reports, of which there have been many, and to meet stakeholders on over 40 occasions. We undertook a public consultation, to which we received over 100 replies and many written submissions, and we felt it was important to compare the situation in Ireland with other countries, particularly other EU countries.

Our main finding is that the State and the voluntary sector need each other. The voluntary sector provides 28% of inpatient hospital beds and two thirds of disability services, while the State pays €3.3 billion a year to the voluntary sector to provide these services.

We recommend recognising this reality and making a new start through building a new relationship of mutual trust and respect between the parties. In our report we explain how and why we believe the relationship between the voluntary sector and the HSE has broken down and why it is necessary to find better ways of working together. In our view this should be done through State recognition of the role and value of the voluntary sector and by recognising its separate legal status. Equally, the voluntary sector must recognise that it is an integral part of the overall health and personal social care system with all the duties and responsibilities that arise.

We propose giving this recognition through a charter and a forum where the voluntary sector and the State can interact on a permanent basis.

We recommend a two-way process of consultation, early involvement, listening and learning to deliver a genuine partnership such as exists in several other EU countries. Drawing on wider EU experience, we recommend moving to a system whereby the State decides, in early and real consultation with the voluntary sector, on a list of essential services to be delivered to the public. The list should be based on full-cost pricing for the delivery of these services, with prices fixed nationally but with room for regional variation.

A first step on the road to this way of delivering services would be to improve data and to map service needs across the country. We recommend including a map of difficult-to-replace services to help ensure continuity of services in the case of withdrawal of key service providers. We recommend that the State should apply or fix national standards for commissioned services. Obviously, the list would require regular updating. Such a process would be more patient centred, providing greater certainty about availability and affordability of services and would have the benefit of moving the dialogue between the HSE and the voluntary sector away from the current overwhelming focus on funding to instead focus on the type of services to be delivered and their quality and outcomes.

In addition to hoping to put relations between the HSE and the voluntary sector on a new footing, we recommend separating the commissioning and service provider roles of the HSE and making the executive more accountable to the Minister and the Department of Health. We also recommend a stronger and more visible role for the Department, including ensuring more joined-up services for users and fostering greater co-operation between Departments and agencies to reduce unnecessary duplication. We also point out that the voluntary sector needs to modernise and improve its governance, to strive to avoid duplication and to accept it is part of delivering a national health service that requires it to take wider considerations into account.

With specific reference to the faith-based organisations that formed part of our terms of reference, we carried out a detailed analysis to establish how many there are and who owns them. That detail can be found in the annexes to our report in particular. In summary, we concluded that 14 of the 48 public and acute hospitals in the State are voluntary and that as many as 12 of them still have some degree of faith-based ownership or governance involvement. This situation is changing and new decisions are being taken. We foresee that the number of faith-based hospitals will reduce to four in the coming years. We looked at the mission statements of faith-based organisations, examined how they provide access to services and considered issues around ethos and decor and the range of services they provide. We made recommendations to the organisations and the State in the light of previous experience. For example, on the issue of co-ownership, we recommend that in future, the State should own the land and buildings of publicly funded hospitals. Where this is not possible, financing and governance arrangements should be agreed before funding decisions are taken.

To conclude, we met a wide range of very dedicated public-service-minded people in the course of our work. We thank them for their input. We also met with high levels of frustration in both the voluntary sector and the HSE. We believe that a new beginning is needed if we are all to benefit from the positive contribution of the voluntary sector as described in more detail in our report. Other countries have found ways of working with the voluntary sector in mutually beneficial partnerships and we believe this is possible here, provided a new relationship is developed based on mutual trust and respect.