Tuesday, 17 December 2019
Section 39 Organisations: Motion [Private Members]
I move amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following: "acknowledges:
— the valuable contribution that voluntary organisations make across Irish society and in particular their integral role in the health and social care sector, where the State relies on these organisations to deliver core health and social care services through various contractual arrangements;
— the wider role played by the sector in social inclusion, community and rural development and youth and education services;
— the Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services, which recognised the continuing important contribution of the voluntary sector and recommended placing the relationship between the State and the voluntary sector on a new footing;
— the establishment by the Minister for Health of a new dialogue forum, in response to the Independent Review Group's report, with the aim of building a stronger working relationship between the State and the voluntary sector based on trust and partnership and to facilitate regular dialogue with the voluntary sector on future policy and strategic developments;
— that Ireland has ratified the United Nations Convention on the Rights of Persons with Disabilities and the United Nations Convention on the Rights of the Child, which place a duty on Ireland to ensure that children and adults with mental or physical disabilities should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate active participation in the community;
— the significant progress being made under the Transforming Lives disability reform programme, which aims to provide a more person-centred, integrated and cost-effective model of disability service provision; and
— that the Government has significantly increased investment in disability services since it came into office and the overall budget for disability services will exceed €2 billion in 2020, an increase of 31 per cent (€490 million) since 2016;
— over 2,000 voluntary organisations receive funding from the Health Service Executive (HSE), spanning almost all areas of health and social care, including acute hospitals, disability, mental health, older persons and hospice services;
— Sections 38 and 39 of the Health Act 2004 legally underpin:— the provision of services by non-statutory providers on behalf of the HSE (Section 38); and— the HSE fund Section 39 organisations to assist them in providing services to the population, and a majority of these agencies provide essential services to people with disabilities;
— the provision of services similar or ancillary to a service that the HSE may provide (Section 39);
— the issue of pay restoration for Section 39 workers has been the subject of intense engagement between the parties under the auspices of the Workplace Relations Commission (WRC);
— an agreement reached in October 2018 in relation to pay restoration for employees of these organisations provided for pay restoration in relation to 50 'pilot organisations' in the first instance, including the larger organisations that are funded in the main by the HSE;
— pay restoration for the 50 organisations commenced in April of this year, with further payments due in 2020 and 2021 as appropriate;
— the WRC agreement recognised that some of the remaining Section 39 organisations (estimated 250 approximately) are likely to have pay restoration issues and a process to address these will be agreed, and the parties will commence engagement on this issue during 2019;
— the call for pay restoration is premature as the WRC agreement did not guarantee pay restoration for every Section 39 organisation which receives funding from the HSE and that an agreed process is underway regarding the remaining 250 agencies; and
— Section 39 services and pay agreements extend beyond those that provide services for health and social care; and
calls on the Government to commit to:
— the full implementation of 'Sustainable, Inclusive and Empowered Communities strategy to support the community and voluntary sector in Ireland 2019 – 2024', which sets out a long-term vision for communities in Ireland and a general direction of travel for Government policy in relation to the community and voluntary sector for the coming years;
— strengthening the State's relationship with the voluntary sector through meaningful participation in the new dialogue forum between the Department of Health, relevant health agencies and representation from voluntary organisations in the health and social care sector;
— working within the parameters of the WRC agreement in relation to pay restoration for Section 39 agencies; and
— a continued whole-of-Government approach to improving access to and quality of services for people with a disability in line with the National Disability Inclusion Strategy 2017–2021 and Transforming Lives."
I thank the Deputies for raising these important matters and allowing us time to discuss them here tonight. Let me deal with some of the facts regarding this debate. First, I did not cause the banking crisis and I did not cause austerity. I went into government to support people with disabilities and also to support staff in section 39 organisations. I will outline my strategy and response later.
Voluntary organisations have long made a significant contribution to Irish society and in the past, offered care and support when the State did not. However, I believe this country has moved on from that time and there is now a high level of mutual interdependence between the State and the voluntary sector.
While the Government fully agrees on the importance of ensuring support for the role of the voluntary sector, the approach proposed in the Sinn Féin motion does not have regard for the significant initiatives under way to put the relationship between the State and the voluntary sector on a firmer footing. Therefore, the Government is opposing the motion this evening, for the reasons I will outline in the course of my address.
The importance of the community and voluntary sector is recognised in Sustainable, Inclusive and Empowered Communities, the Government's five-year strategy for community and voluntary sector development in Ireland. I was asked about a strategy. The strategy covers the period 2019 to 2024. This strategy sets out a long-term vision for communities in Ireland and a general direction of travel for Government policy in regard to the community and voluntary sector for the coming years. It also copper-fastens the renewed relationship and partnership between the Government and the community and voluntary sector that has developed over time.
Ireland's health and social care system is characterised by a mix of public, voluntary and private providers that has evolved over many years and is reflective of historical and societal developments. More than 2,000 voluntary organisations receive funding from the HSE to provide health and social care services, including acute hospitals and disability, mental health, older persons and hospice services.
The House will recall that the Minister, Deputy Harris, announced the establishment of an independent review group to examine the role of voluntary organisations in publicly funded health and personal social services in July 2017. The report recognised the continuing important contribution of the voluntary sector and recommended placing the relationship between the State and the voluntary sector on a new footing.
In response to the independent review group's report, the Minister for Health recently established a new dialogue forum, with the aim of building a stronger working relationship between the State and the voluntary sector based on trust and partnership and to facilitate regular dialogue with the voluntary sector on future policy and strategic developments.
The forum is being chaired by an independent chairman, Mr. Peter Cassells. Forum membership includes the Department, HSE, HIQA, the Mental Health Commission and eight of the main representative bodies of voluntary providers of health and social care services.
At the first meeting of the dialogue forum on 2 December, it was agreed that change is needed on all sides to improve the relationship between voluntary organisations and the State. The establishment of the forum is an important foundational step in this regard. There is a deep commitment among voluntary sector representatives at the forum to build a strong, effective relationship with statutory partners so that we can collectively act in the best interest of service users.
As regards the suggestion that future Governments would give consideration to a junior ministerial portfolio for the community and voluntary sectors, it is worth noting that the Taoiseach has established a dedicated Department of Rural and Community Development, led by its Minister, Deputy Ring. The brief of its Minister of State, Deputy Canney, includes community affairs. In my case, as Minister of State responsible for disability issues, I also have a seat at the Cabinet table. This reflects the level of the commitment of this Government to the community and voluntary sector. I am keenly aware that the voluntary sector plays an integral role in the delivery of health and social care services and has made a valuable contribution to the development of services for people with disabilities in this country.
About one in seven people in Ireland, amounting to about 635,000, reported having a disability in the 2016 census. In line with the mainstream-first approach of the Disability Act 2005, more than 90% of those with a disability are supported through general community health and social services, with about 9%, or about 56,000, receiving specialist community-based disability services.
Health and personal social services are, by their nature, varied and complex. In some instances, the HSE delivers these services directly and in other circumstances it relies on funded providers to deliver these services on its behalf. Sections 38 and 39 of the Health Act 2004 legally underpin the provision of services by non-statutory providers on behalf of the HSE - section 38 - and the provision of services similar or ancillary to a service that the HSE may provide - section 39. Among section 39 voluntary organisations are hospices, mental health providers, nursing home and homecare providers, small community-based groups and social care services. The voluntary sector provides some two thirds of all disability services and 80% of residential services.
A small number of national-level service providers receive significant levels of funding, in excess of €30 million, but the majority receive much smaller amounts.
I would like to turn to the issue of pay restoration for section 39 workers, which has been the subject of earlier debate in this House. The people employed by these organisations are not public servants and are not subject to the terms of the public service stability agreements. Having said that, it is important to note that a pay restoration process, where it is warranted, is already under way. Some 43 organisations, totalling about 12,000 people, have been paid almost €7 million. This was part of the agreement reached in the Workplace Relations Commission, WRC, in October 2018 on pay restoration for staff in 50 pilot organisations.
The HSE conducted a data-gathering exercise regarding the 50 pilot organisations, which showed that in some places pay was cut, in others pay was not cut and, in a number of instances, pay had already been restored. That is the actual research. Following this significant and complex piece of work, pay restoration, where warranted, for these bodies commenced in April of this year, with further payments due in 2020 and 2021. It should be noted that the sole objective of the WRC agreement is to ensure that staff in the 50 pilot organisations who received direct pay reductions over the period 2010 to 2013 are restored back to the pay levels they were on before the reductions. I strongly support that. It is not intended to encompass any future pay progression for employees of these bodies or to fund any pension costs.
There are approximately 250 bodies that have not yet received pay restoration under this agreement. The parties have agreed, and I support this point, that there will be a phase 2 of pay restoration to look at these bodies. Management is willing to undertake the necessary preparatory work around this next group. A dedicated resource in the HSE will be assigned to commence this work in January 2020. The HSE will meet the unions to provide them with updates as this work progresses. I meet them regularly. In summary, the WRC agreement has resulted in significant progress and a continuing dialogue between all parties. I ask the House to be cognisant of this ongoing process and let the WRC, which is the appropriate mechanism, continue its important work.
Finally, I would like to emphasise that the State is committed to a whole-of-government approach to improving access to and quality of services for people with disabilities. In recognition of the cross-departmental nature of the supports required by people with disabilities, the Department of Justice and Equality published the National Disability Inclusion Strategy 2017-2021, which I chair. Furthermore, in 2018 Ireland ratified the UN Convention on the Rights of Persons with Disabilities, UNCRPD. In line with Time to Move on from Congregated Settings: A Strategy for Community Inclusion, 2011, almost two-thirds of the 8,300 people with disabilities who avail of residential care now live in ordinary houses or group homes in the community, rather than large-scale institutional settings. I accept that work has to be done and we are moving in that direction. This year we are spending more than €2 billion on disability in the HSE service plan for 2020. Even today, in the last couple of hours of the service plan, we managed to negotiate extra money for residential places and also new funding for personal assistance hours. There are, therefore, changes and reforms going on and we intend to ensure that everybody is treated fairly in Ireland.