Dr. Catherine Day:

As I do not represent any organisation, I will make a broader comment. We were asked first to perform a factual assessment of the situation. The reason we recommended mapping the services was that we felt there was not a good overall understanding of the services that were needed and what it really cost to provide them. That is why we raised in our report the question of the ballooning deficit. It was simply being put to one side as though it did not exist. We recommended the mapping of the services because we need to know what the extent of those services is and the State needs to indicate how many of the services that are needed it is willing to provide for.

The State must then decide whether it should provide for them through the public system or whether it should contract out to the voluntary sector because it feels there is a positive value in working with that sector.

The question about the large number of organisations came up and we looked at that as well. We did not make a recommendation to consolidate because we feel that, in many cases, proximity to service users is part of the extra that the voluntary service adds. The reason we recommended that the State should have a rolling list of services that it commits to fully funding is because then it would be possible to be clear with people about what services would be provided. We made the point that, for example, one could not prevent a group of concerned parents from setting up a voluntary organisation if they felt they could help in some way but, equally, they could not have an expectation that the State would fund whatever they decided was needed. This why we need clarity in terms of what services are required by the population and how much of those services the State is prepared to provide.

In the context of the negotiations with the HSE, we are not starting afresh; we are coming from an historical position. We are coming from a situation whereby the HSE wants to provide the services but has a limited amount of public money. Instead of looking at the services that are needed, it and, to a certain extent, the organisations are looking at it as being a case of "Well, we are here because we are here and we need to be funded to continue." We felt that this was not a sustainable situation and that what we needed was to be clear about which services are to be provided and by whom. The full cost must then be paid, particularly if one considers what might happen if, to use the expression used earlier, the voluntary sector "throws back the keys". If the latter happened, the would have to step in and provide those services. One needs to look at the cost of that and decide whether it is better value for the public purse to do it through the voluntary sector - taken in the round, not only financially but also in terms of the quality of the services that are offered - or whether it is not sustainable because the voluntary sector does not have the capacity to do it. If the latter is the case, then provision must be made, from a budgetary perspective, for the public sector to provide it. What we were trying to recommend in our report was that the factual basis needs to be established. As a result, we suggested that the Departments of Health and Public Expenditure and Reform look at the deficit situation, put a figure on it and then work out how it will be absorbed or what services will be cut if it cannot be absorbed. There is a need for greater clarity on the factual situation and then a strategic discussion about what services are to be provided and by whom. This needs to happen before one can put a cost on it.