Dáil debates
Thursday, 11 May 2017
Topical Issue Debate
HSE Funding
4:15 pm
Tommy Broughan (Dublin Bay North, Independent)
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In 1960, a small group of wheelchair users came together to form the Irish Wheelchair Association, IWA, with the aim of trying to improve the lives of people with physical disabilities in Ireland. The Irish Wheelchair Association has now grown to a network of 20,000 members with 2,300 staff and many more volunteers. Resource and outreach services are provided to over 2,000 people in 57 locations. Some 1.17 million hours of assisted caring services are provided to 1,863 people per annum. As their website states, all IWA staff, including the CEO and senior management, are paid in compliance with Department of Health, public service and HSE guidelines in relation to salary scales and rates of pay. No additional payments are made to any member of staff.
Last Friday, I met the IWA's CEO, Ms Rosemary Keogh, and the advocacy officer, Ms Joan Carthy. In that briefing I was told that in recent weeks the HSE advised that 20% of the IWA's funding will be withheld until it signs a service level agreement. Some 20% of the funding has now been withheld for the March payments. This is significant as the CEO says that no service could sustain such a cut without an impact on services. Ultimately, it is the people with disabilities and their families who will suffer.
The Irish Wheelchair Association along with Rehab, Enable Ireland and many smaller bodies are so-called section 39 organisations. This means that under section 39 of the Health Act 2004 these voluntary providers signed up to service level agreements and receive funding to provide certain services. Those agencies, of which in 2014 there were more than 1,800, are part-funded under section 39 of the Health Act. Under section 38, the HSE may enter into an arrangement with a service provider on its behalf. Under section 39 the HSE may give assistance to a person or body to provide a service that is similar or ancillary to a service that the executive may provide.
On 3 May, in reply to a parliamentary question, the Minister for Health, Deputy Harris, said that any individuals employed by these section 39 organisations are not HSE employees and, therefore, the HSE has no role in determining the salaries or other terms and conditions applying to these staff.
The Minister went on to say that section 39 staff are not subject to the provisions of public service agreements or the FEMPI legislation. It is regrettable that the Minister for Health is not here this evening, but I appreciate that the Minister of State, Deputy Catherine Byrne, is present. In his reply, the Minister for Health was clearly ignoring the earlier decisions of the HSE and his own predecessors, as the HSE imposed pay cuts on section 39 staff in 2009. The pay scales had been linked for many years. It seems the Minister wants to have one rule when cuts must be imposed and another rule when restoration is due.
Irish Wheelchair Association salaries are clearly linked to HSE pay scales and section 39 staff were, in fact, treated like public servants. It is also clear that section 39 organisations' pay scales have been linked to HSE section 38 pay scales for over 15 years. The Irish Wheelchair Association informs me that the HSE cut funding to section 39 organisations in 2009 and instructed them to impose pay cuts in order to guarantee sustainable services.
Under the Lansdowne Road agreement, however, public sector pay is finally beginning to be restored and yet the HSE has confirmed that no funding is available to section 39 organisations to meet the cost of the pay restoration measures required.
The HSE's decision creates an intolerable situation for the Irish Wheelchair Association, Rehab, Enable Ireland and the other bodies concerned. The result is that home support workers and others in the large section 39 organisations are doing exactly the same work but receive different levels of pay depending on whether they are employed by a section 38 or 39 organisation.
Equally urgent is the fact that the IWA has been unable to meet the cost of the €1.34 million needed for pay restoration under the Lansdowne Road agreement this year, nor was it able to meet the €290,000 increase last year. As such, it has said that this "impacts seriously and immediately on our ability to fulfil our responsibility under the service arrangements, as well as the standards required by statutory agencies such as HIQA". The IWA was unable to sign the service arrangement by the end of February.
The Minister, Deputy Harris, who unfortunately is not with us, told the IWA in February that he wanted a quiet and quick resolution of this matter, which is putting IWA, Rehab and Enable Ireland staff under intolerable pressure. I urge the Minister of State to ensure that the Minister gets a settlement very quickly.
Catherine Byrne (Dublin South Central, Fine Gael)
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I wish to apologise for the fact the Minister of State, Deputy Finian McGrath, cannot be here. I thank Deputy Broughan for raising this important issue and will outline the current position on the situation.
The Irish Wheelchair Association is funded under section 39 of the Health Act 2004. The HSE has in place service level agreements with providers funded under section 39 of the Health Act 2004 that set out the level of service to be provided for the grant to the individual organisation and requirements in relation to standards of care.
The HSE has established a governance framework to cover funding relationships with all non-statutory agencies. It is the policy of the HSE that all funding arrangements with section 39 agencies are formalised by complying with this governance framework which has two different components.
Part 1 is a service level arrangement that is signed every three years by both parties and sets out the legal requirements that the agency must comply with to receive funding for the provision of services. Part 2 is a set of schedules which must be completed and signed by the agency and the HSE, which sets out the detail of the service and the exact funding that the HSE is providing for the delivery of this service. This set of schedules also identifies the quality standards and best practice guidelines to be adhered to in the provision of all services, along with the process for managing complaints in relation to service provision.
The HSE has implemented a measure whereby for agencies who have not completed the necessary governance arrangement process within the required timeframe of 1 March 2017, a 20% withholding of funding is applied. Every effort was made by the HSE to encourage agencies to complete this process within the timeframe, including extending the timeframe to 1 April for some agencies.
With regard to the Irish Wheelchair Association specifically, this organisation was unable to complete these governance arrangements as outlined above. Consequently, 20% of its funding under its SLA has been withheld. To be clear, this is not a funding cut or a fine. The full funding will be returned to the agency on completion of the governance arrangement process. The HSE has advised that a refusal to complete its governance arrangements due to pay restoration issues is not acceptable to the executive.
With regard to matters relating to pay of staff in the IWA, it should be noted that the individuals employed by section 39 organisations are not HSE employees. As such, the HSE has no role in determining the salaries or other terms and conditions applying to these staff. The staff concerned are not subject to the control of the Department of Health and they are not classified as public servants.
Staff in section 39 agencies were not subject to the provisions of public service agreements or the FEMPI legislation which imposed the associated pay reductions. Accordingly, any arrangements offered by each service provider in regard to its employees' terms and conditions, including rates of pay, may vary.
The HSE acknowledges the significant savings in efficiencies service providers have made since 2008. The health service, as a whole, must operate within the parameters of funding available to it. Given the current economic environment this is a challenge for all stakeholders, including the HSE, voluntary service providers like the Irish Wheelchair Association, service users and their families.
Tommy Broughan (Dublin Bay North, Independent)
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I thank the Minister of State for the Minister, Deputy Harris's reply, but it is totally disingenuous. It does not reflect how grossly unfair the situation is to the Irish Wheelchair Association, Rehab, Enable Ireland and the other bodies.
I note that the IWA has entered a dispute resolution process with the HSE. The SIPTU trade union has rightly referred the matter to the Workplace Relations Commission. I understand that the chief executive of the IWA, Ms Rosemary Keogh, had her first meeting with the HSE today following a letter she sent to them on 4 May. That letter indicated that as per clause 33 of the service arrangement 2015-2018, the IWA was beginning the dispute resolution process.
The IWA is a member of the Not-for-Profit Association, NFPA, which has been attempting to find a resolution to this problem since last September. On 29 March, representatives of the NFPA met with representatives of the HSE, including Mr. Pat Healy, Mr. Cathal Morgan and Ms Marion Meaney.
Clearly, over many years the HSE did instruct section 39 organisations to come in line with HSE pay scales.
They did that, as per instruction. During the crash, the Irish Wheelchair Association and other bodies were told to make the FEMPI reductions, which they did. Now the staff of section 39 organisations have been excluded, most unfairly, from the Haddington Road and Landsdowne Road national pay agreements. The SIPTU trade union has rightly sought the restoration of pay scales for these staff and to have the matter referred to the Workplace Relations Commission.
The Minister of State mentioned a three-year service agreement which the Irish Wheelchair Association has not felt able to sign. It feels that way because it simply does not have the funding, as it has to meet the additional salary costs. Approximately €5 million per annum over the duration of this service level agreement would settle and resolve this situation for the hard-working and valiant staff of the Irish Wheelchair Association, the Rehab Group and Enable Ireland. It is a small sum of money. The Minister should resolve this as soon as possible.
4:25 pm
Catherine Byrne (Dublin South Central, Fine Gael)
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I understand Deputy Broughan's frustration. I am very familiar with the work of the Irish Wheelchair Association. All organisations, no matter what Department they deal with, are governed by certain arrangements. If there has been a problem with the governance arrangements of the Irish Wheelchair Association, it has been said in the reply that the HSE is willing to talk to it and to try to resolve the matter as quickly as possible. There are rules and regulations however. When people were not adhering to certain governance measures in the past there were problems in services right across the board. It is important that any agency providing a service should meet the governance standards.
Tommy Broughan (Dublin Bay North, Independent)
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On a point of information, there is no governance issue here. The issue is the governance of the Department of Health, the HSE and the Department of Public Expenditure and Reform.
Catherine Byrne (Dublin South Central, Fine Gael)
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The Deputy raised a number of issues of which I have taken note. I will bring them back to Minister, but the reply clearly outlines that the HSE has no control over salaries within section 39 organisations. I will relay to the Minister the fact that SIPTU has taken up this issue as well. I will relay all the comments back to the Minister and I will ask him to communicate with the Deputy.