Oireachtas Joint and Select Committees

Wednesday, 19 June 2019

Joint Oireachtas Committee on Health

Voluntary Organisations in the Health Sector: Discussion

Photo of John DolanJohn Dolan (Independent) | Oireachtas source

I thank all of the delegates. There is no doubt that, to coin a phrase, the independent review group has done the State some service, as will become manifest and for which the three representatives need to be thanked, as do those who are providing the support they receive in doing that work. My colleagues have made several useful and interesting points. To put it mildly, we have excavated a range of concerns and issues.

My first question is a speculative one for Dr. Day. Are public bodies and the political system threatened by the voluntary sector as an equal partner, a conscience and critical friend? How might the broken-down relationship be put back together? What are the first three steps or the key pieces of that process?

There is an idea of health being a resource for living and well-being, something that supports people in being out and about, rather than simply being cared for in a health setting. This point was touched on. Is this being considered as something valuable in what I would call the investment, rather than the cost, made from the public purse? I will put it in industrial relations terms. Could this be the productivity element that will bring us from deficits and under-funding?

Reference was made to other EU countries that had got it right. To get us to use Google in the right place, about what states are we talking? Mr. and Mrs. Google are our saviours.

In effect, the faith-based organisation sector was one of the spurs for the independent review group in starting its work. It is interesting how it has moved from it. I have in mind the idea of charity status and the Charities Act. For charitable purposes is a concept that dates back hundreds of years, long before the Republic, the Free State or anything else. It comes from an altogether different world view when kings were appointed divinely. Now we have the notion of public benefit which the Constitution sets out in secular language. It underwrites the connection between the old-fashioned terms of charity and charitable with public benefit. The Constitution also includes fundamental freedom provisions. Reference was made to a point about a group of parents. The Constitution refers to the right of people to form associations and unions. It does not give them the right to send in invoices to be returned as paid within 30 days. That is understood. Can the review group representatives offer some thoughts on whether that could be a way to bridge the traditional concept of faith-based or charitable purposes with public benefit or the public good?

I will come down to more testing or immediate issues. The new head of the HSE was before the committee smartly after he was appointed. He brought with him a letter he had written on 14 June. Two things in it interested me. The first was the statement that the director general held the line absolutely on the budget he had been given. We know that the footnote is that every year we have seen the budget broken such that the State has to come in with a Supplementary Estimate. We now have the idea that this cannot or will not happen or that it could happen but will not happen. My second point is allied to the first. The director general stated the HSE had to earn the trust and confidence of its funders. I put this point to him on the day. He is suggesting people who are not receiving services, whether they are disability or elderly care services, will have to wait until a public body earns the trust and confidence of another public body. I simply do not know what words to put on that statement, but it is a serious place for public bodies in which to find themselves. From our point of view and that of the people we want to serve, that leaves them well and truly out in the cold and there are many of them. There are deficits and unmet needs. We also have the Irish Fiscal Advisory Council giving us a financial weather forecast. Let us also bring it in. There is considerable competition in public spending. The issue arises as to whether the base of €60 billion has to be looked at or whether we keep looking at the portion on the edge that is considered to be extra funding.

I turn to the disability organisation representatives. I am someone who lives on both sides of these tracks. That is my position in the here and now, not only in the past. I will attend a board meeting tomorrow of the Disability Federation of Ireland, of which I am chief executive. I will attend our annual general meeting. We are dealing with a 20% deficit in funding this year, as are others, because of reductions made earlier this year by the HSE, about which I am not moaning, as we all know it. I have it also in being involved in the Seanad which is a great privilege and honour. It is a valuable position to be in.

Section 38 and section 39 organisations provide ancillary and essential services. Perhaps some of those present know this off by heart. I have in mind two organisations, Ability West and the Brothers of Charity, both of which are based in Galway. One is a section 38 organisation, while the other is a section 39 organisation. I defy anyone to put the thickness of the paper I have in my hand between either of them. That is one of the great lies in all of this. Do the disability organisation representatives wish to comment on that matter?

The current narrative emerged during the past couple of decades. It was different in previous decades, for example, when I started work in the Irish Wheelchair Association. At the time, we might have met the Minister if he or she came to open something and do whatever else. I am paraphrasing, but the Minister would say to us that when the Government got some money, we would be looked after. It got money and we know exactly where we are today. Something has shifted in the past 20 years. That is one of the conundrums. The narrative now is that there are too many organisations with inefficiencies and that there is duplication. The view is disability services are getting almost €2 billion annually.

My next comment is for the committee. We need to have some analysis or receive some response smartly from the three connected entities in the public arena, namely, the Department of Public Expenditure and Reform, the Department of Health and the HSE.

We know the Department of Public Expenditure and Reform is always busy elsewhere. I cannot see, however, how it, with any honour, could refuse to be part of this conversation with this committee and others. I am sorry that my colleague, Deputy Bernard Durkan, is not here. I found some of the things he said confusing. I am coming to a conclusion after these points. Deputy Durkan stated that he respected the voluntary sector for what it does. He continued by saying that as a country we were happy to accept the services provided in the past and now. I will put this point to the voluntary organisations. As somebody who has grown up with and has a great grá for voluntary participation in this republic, I find it hard to hear what Bernard said.

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