Paul Connaughton (Galway East, Fine Gael)
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I thank the Minister of State for being here to take this debate today. We could not take it last Thursday. The funding provided to the Brothers of Charity and to Ability West in County Galway has been cut. I understand they received notification of this cut in October, even though it had been set out months previously. It seems that the cut stems from the Haddington Road agreement, under which savings were to be made, and from a value for money report that was carried out within these services. I would like to concentrate on the value for money report. The Minister of State might be able to give me some clarity on it. I understand that the details of this cut were set out to all the individual agencies involved a number of months previously. There seems to be some concern about the value for money report. The Minister of State might be able to let me know who carried it out. What were the terms and guidelines around that report? How is the cut of €5 million to be broken down between each of the individual agencies? It seems that €156,000 will come out of the budget of Ability West before the end of the year. How was it set out that Ability West would take such a cut? I think the cut being imposed on the Brothers of Charity is almost double that. How was the figure for that cut arrived at? There is some concern about how these cuts were arrived at and how they will be rolled out. I have been told that the HSE may have informed these agencies that the €5 million I have mentioned might be taken out of central Exchequer funding and would not be passed on down to the agencies at this stage. I know that half of the cut will come out before the end of this year and the full cut will come out in 2015. The Minister of State might be able to give me some clarity in that regard as well.

Since the decision to impose this cut was arrived at and the agencies were informed of it, I have been contacted by a number of families and parents who are concerned about the effect it might have on them. I know the HSE said on 2 October that the agencies should achieve these funding cuts without affecting front-line services. Is the Minister of State convinced that it is possible for these savings to be made without affecting front-line services? If it is proven that this cannot be done, will it be possible to reverse the cut? Is there any way to make sure these agencies are well funded? Much of the concern that is being expressed to me relates to respite care. Many families desperately need the respite care service to continue. They are concerned that if this cut goes ahead, they and their loved ones will not have an opportunity to get a break of a week or two weeks. Many people have contacted me today to express concern about reports that there has been an 11% increase in middle management in the HSE. This has led to some frustration because it has happened at a time when a cut to front-line services seems to be coming down the line. I ask the Minister of State to clarify the issues I have raised with regard to the value for money report and its impact on these agencies.

Kathleen Lynch (Cork North Central, Labour)
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I seem to be going slightly over time on these matters. I genuinely do not mean to do so. I know we are stuck for time. The value for money report, which was carried out by the Department of Health, took approximately two years. It was very difficult to get the type of information that was necessary on the services that are being delivered and the cost per unit of those services. We needed to be very sensitive because one does not want to categorise people as "unit costs". Nevertheless, when an audit of this scale is being undertaken - we are talking about €1.4 billion here - there is a clear need for it to be broken down in such a way. The value for money implementation group is really getting under the bonnet in terms of the money that is spent and how it is delivered. It is also involved in the personalised planning that will have to accompany the capacity legislation. Such planning will deal with how to disentangle the people's preferred choices in terms of service, for example. I have never denied that various agencies and groups of people have delivered services that the State did not deliver. They are delivering those services on behalf of the people of Ireland. In the main, they are doing an extraordinarily good job. I include the two agencies mentioned by Deputy Connaughton in that.

I will read out the prepared answer. If the Deputy wants to have a wider discussion at a later stage, I will not have a problem with that. I thank the Deputy for raising this matter. I am pleased to take this opportunity to outline the current position regarding the funding provided by the Government for disability services this year. The vision for the HSE disability services programme is to contribute to the realisation of a society where people with disabilities are supported, as far as possible, to participate to their full potential in economic and social life and have access to a range of quality personal social supports and services to enhance their quality of life. The HSE national service plan for 2014 and the accompanying operational plan for the social care division outline the quantum of specialist disability services, the key reform initiatives and the additional investment in 2014. The HSE has assured us that these plans will give effect to this vision in 2015.

The HSE will spend €1.4 billion and employ approximately 15,000 whole-time equivalents to provide specified service levels in 2014. An additional investment of €14 million in 2014 has been made to address deficits in disability services, to deal with a reform programme that will transform services to a community-based model of person-centred supports and to focus on the implementation of the HIQA standards for residential services for people with disabilities. Value for money efficiency targets of €5 million were identified this year in the national service plan. In order to arrive at a fair and equitable allocation of these efficiency targets, the social care division of the HSE has been assessing the capability of the voluntary disability providers to implement the necessary measures. In recognition of the amount of time that is required to complete this work, I understand that just 50% of the 2014 requirement, or €2.5 million, is being assigned to agencies this year. We are doing that because we understand there will be difficulties in the transformation we need.

The matter raised by the Deputy - the provision of funding to Ability West and the Brothers of Charity services in Galway - is relevant to this overall efficiency target. Ability West is funded by the HSE under section 39 of the Health Act 2004 through a service arrangement. The 2014 budget allocated by the HSE amounted to €21.7 million. This year, Ability West will have its budget reduced by €156,600, partly in line with efficiency targets under value for money but also through savings achieved by implementation of the Haddington Road agreement, by which we must all abide. The Brothers of Charity services in Galway are funded by the HSE under section 38 of the Health Act 2004. Services are provided through a service arrangement which is signed on an annual basis and reviewed continually.

6 o’clock

The agency was allocated funding of more than €44 million in 2014. This year, Brothers of Charity Galway will have its budget reduced by €88,000 - not double Ability West's, but just over half - in line with efficiency targets set out under the VFM report. I have been assured that the HSE will continue to work with both disability agencies to ensure that efficiencies are achieved without impacting on service provision.

Paul Connaughton (Galway East, Fine Gael)
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I thank the Minister of State for her reply. I will ask two questions. If the HSE cannot work with the agencies to make savings without hitting front-line services, what will be the next step in the process? Is there any possibility of a change in Ability West's €156,000 reduction? How will it be rolled out? People are concerned about the effects on front-line services. What effect has the €5 million reduction that was announced several months ago had on other agencies? I am sure the story is the same the length and breadth of the country. Have those agencies been in touch regarding that cut?

Kathleen Lynch (Cork North Central, Labour)
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Up until last year, every year that I was in this job - it was not a long time - I was told that applying a 2% cut to every agency was deeply and grossly unfair, as it did not take account of agencies that were doing things differently or progressing our aims for disability services, for example, centralised and personalised planning. We have since adopted an agency-by-agency approach. It is a mammoth task, but we are getting under the bonnet and taking a serious look at the situation.

The agencies to which the Deputy referred were told well in advance what would be the reduction in their budgets. There was, and still is, an interaction over service improvements, which is a new theme in the HSE and social care. We speak with the agencies about how we want everything to work. It is a question of operating differently. I am not saying that what was done previously was wrong - obviously, it was not. However, there are different ways of doing things. This is what we want and what we constantly hear. According to the groups representing the agencies, it was unfair to have an across-the-board cut and that we needed to cut based on what each agency could do. That is what we are doing now.

I happen to know Ability West. It does an extraordinary job in a different way. Unfortunately, there is no turning back. If, as we have done, we discover that some agencies find it difficult to continue providing the service in its totality, one must re-engage and take a serious look at how best to continue providing that service.