Dr. Joanne McCarthy:

I will start and others can come in if they wish. That is a question people always ask. We hear of these large numbers of organisations. To reply to the Senator I will go back to go forward. The first point to remember is that 90% of the funding goes to a very small cohort of service delivery organisations. The number the Senator is talking about is not that large. Some €1.9 million goes into the voluntary sector part of the disability programme and 90% of that goes in one particular way.

There are opportunities for looking at service design. For example, a new rehabilitation strategy was published a year or two ago focusing on the clinical side of rehabilitation. Part of it refers to the community side, which would bring organisations such as Epilepsy Ireland and others together to examine ways of sharing services, planning for the need for community-based services and then going to the HSE for funding of that need. There is opportunity for that but the Senator should not forget that most of these organisations are bringing in significant resources. First, they are co-funding services so how do we build that into the mix? We cannot afford not to let Epilepsy Ireland use its own resources to deliver services. Second, they have a significant amount of expertise that will not be in the system if we do not protect it. All these organisations have major links with the European associations and research groups. That level of expertise and added value must be valued and brought into the system.

Without a doubt, that conversation needs to start but not just at the point of amalgamations because we would lose the co-funded nature of many of these services and their significant added value in terms of expertise, specialism and the touching base with families and communities. When we have that conversation it needs to be in that much broader context. That is where I would start. I do not know if anybody else wishes to contribute.