Professor Roy McConkey:

The Deputy made an important point regarding how funding is delivered to people with disabilities. We rely a great deal on what is called block funding. For people in congregated settings, for example, the service provider will get an amount that is then averaged out among 20, 30 or up to 50 people. Therefore, the averaging out of the funding means that people with high needs are underpaid, while those people with low needs are overpaid. Many economists will recognise this situation as an inefficient way of doing this. The solution, therefore, is to try to do an assessment of people's needs to allow for direct resource allocation to meet the particular needs of each person. Those could be personal care needs, social inclusion needs, etc..

Many jurisdictions have moved to exploring options for individualised funding being made available. However, many service providers would see this as being a big threat to the maintenance of their existing systems. Those systems have been set up with the assumption that providers will get a year-on-year increase on whatever amounts they have received historically, which those organisations would argue provides for better planning. Of course, what is being done in that current model of funding is perpetuating a model of service that we may wish to get away from.

Some of the innovative providers are starting to explore how they could create services in which individual allocations are all added together to provide the outcome of the moneys that are needed to sustain that service. There are examples around Ireland where this is happening.

There is a need to look at value for money in regard to whether we are overpaying for some people who are getting more care than they need, or underpaying for those people who need much greater care. Mention was made of nursing homes, which is a big problem in the North of Ireland as well. The danger is that people are placed into nursing home care who could live in a community setting, with support from personal assistants, at a much cheaper cost than what is being paid for nursing home care. However, it is convenient for the bureaucracy to keep putting people into those sorts of settings rather than having to redesign services that are more responsive to people's needs. That is the challenge that Ireland needs to take on board, along with other countries as it is not unique to Ireland.