Dr. Catherine Day:

One arrives at a complicated situation for many reasons that build over many years. While it is dangerous to simplify, I will do so nonetheless. There is not a good understanding of the value of the positive contribution made by the voluntary sector. It was present in Ireland for a long time, but it has evaporated. The need to impose cutbacks during the financial crisis was interpreted not in a partnership way but in a command and control way, to adopt the wording the HSE often used with us. Unfortunately, we found that the emphasis had almost shifted to the financial side. That meant that the quality and range of services being made available to service users tended to be squeezed out. For that reason, we have recommended that there be a new start. In some parts of the HSE there was a tendency to amalgamate the voluntary sector with the public sector. That is why we are recommending that the separate legal status of voluntary organisations be respected. Their permission is needed to involve them, rather than presuming that certain services will be made available through them.

We have looked at how this has happened in other EU member states, most of which have a similar background in having voluntary health and social care services provided partly through faith based organisations and partly by means of philanthropy. Unless there is a new respect for the role, nature and difference of the voluntary sector, it will be hard to fix this problem. Now that there is a new CEO in the HSE and a new HSE board - there was no board for most of this period - perhaps there might be an opportunity to fix it. We hope our report will make a contribution to it. We would like the forum we have recommended to be convened quickly in order that our ideas can be discussed. It may transpire that they are not the best ones. There are many people in voluntary organisations and the HSE who have good ideas about how things could be improved, but those voices do not seem to be getting through. The idea is that the forum would enable them to meet and hammer out ways to improve things.

Everybody understands public money is limited and has to be spent wisely. It seems to us that people in the voluntary organisations are fully cognisant of the fact that they have to be accountable for public money, but they also believe many things could be done better. There is a need for a change in attitude and culture. We hope the changes at the top of the HSE provide an opportunity and a moment to bring that about. Having been at the head of the European Commission, much of what we have heard during this discussion reminds me of when the Commission had to change its attitude from one of arrogance to one of consultation and involvement. It was a difficult process. The people at the top level understood it was not possible to continue with the old way. As a result, the message came strongly that a change in attitude was needed. That is part of our message. We think it is important for the future that there be such engagement and involvement.