Thursday, 28 November 2019
Ceisteanna ó Cheannairí - Leaders' Questions
This is an important issue. Voluntary organisations that provide services on behalf of the HSE do so on a contract basis under either section 38 or section 39 of the Health Act 2004, as the Deputy outlined. Such organisations provide a broad range of services across the health system, including large acute care hospitals, specialist hospitals, disability services, hospice care, mental health services and addiction and rehabilitation services. Community-based support groups focusing on social inclusion support and advocacy may also operate under these sections.
Service arrangements are in place between the HSE and all service providers, which clearly set out the obligations of the organisation, the services for which they are engaged by the HSE and the funding that has been agreed for that. The HSE is monitoring, on an ongoing basis, the financial position of organisations funded under the service level agreements. The current service level agreement process provides a forum for such organisations to discuss any issues or difficulties with the chief officer of the relevant community healthcare organisation.
The Minister for Health is aware that some section 39 organisations have raised concerns about financial sustainability with the HSE, including a number of organisations in the disability sector. The HSE has assured the Department of Health that it is committed to working intensively with such organisations to support them as appropriate to address such issues in the context of the service level agreement process. Where it is identified that a genuine issue is arising that may impede the effective and efficient delivery of services by sections 38 or 39 social care service providers, any remedial action will need to be considered by central Government, as a resolution cannot be addressed within the current health Vote resources.
In May this year, the voluntary hospice group wrote to the Minister for Health asking that all section 39 hospices be redesignated as section 38 organisations on the basis that hospices provide core services not provided by the HSE. I have been involved in that conversation with the Minister for Health. As of now, there is no established procedure for transitioning from section 39 status to section 38 status. There are obstacles to overcome while determining how a mechanism could be created to facilitate such a transition, which include additional costs to the Exchequer, employment ceilings and conditions attached to transfer as well as legacy and governance issues.
This is a real debate. Dr. Catherine Day produced a report, which I understand is with the Minister at the moment. He is likely to implement its recommendations but it is important for him to have the opportunity to outline that in the context of the related issues. This issue is getting serious Government consideration.