Dáil debates

Wednesday, 15 May 2019

Ceisteanna - Questions - Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Disability Support Services Funding

10:40 am

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
Link to this: Individually | In context

3. To ask the Minister for Health the action he will take to address issues in the voluntary and non-profit sector which have been brought into focus by the difficulties currently being experienced by the Rehab Group; and if he will make a statement on the matter. [21142/19]

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

5. To ask the Minister for Health the amount of the deficit in funding for section 38 and 39 disability organisations; if an organisation (details supplied) is the only organisation that has informed him of difficulties in funding and service provision; and if he will make a statement on the matter. [21004/19]

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
Link to this: Individually | In context

Deputy McLoughlin looked well on this side of the House. If he is watching in his office, he is welcome here at any stage if he manages to see the light.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

The clock is ticking.

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
Link to this: Individually | In context

How does the Minister of State intend to address the issues in the voluntary and non-profit sector that have been brought to light recently by the difficulties being experienced by the Rehab Group, and will he make a statement on the matter?

10:50 am

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

A Leas-Cheann Comhairle-----

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

No, Deputy. One Member poses the question and the Minister replies. I will give the Deputy an opportunity to come in. That is custom and practice.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context

Is the Deputy happy about that?

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

He is not but-----

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context

I was also expecting him to come in at this point.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

I am not going to set a precedent now.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

How can the Chair improve priority questions?

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

It is possible to do it. This is not the first time.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

I have never seen this happen before in all my years in this House.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

The Deputy will get his full time allocation.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

I will get to speak later but I have already lost 30 seconds.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context

I will give the Deputy extra time.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

Thanks.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context

I propose to take Questions Nos. 3 and 5 together. The Government’s priority is the safeguarding of vulnerable people in the care of our health service. We are committed to providing services and supports for all people with disabilities which will empower them to live independent lives.

Significant resources have been invested by the health sector in disability services during the past number of years. Since our Government took office, the budget for disability services has been increased by €346 million. This year alone, the Health Service Executive has allocated €1.9 billion to its disability services programme, which represents an increase of 7.5%. The voluntary sector provides up to 75% of disability services on behalf of the HSE, through sections 38 and 39 service level agreements.

A number of service providers, including the body referred to by the Deputies, Rehab, have written to the Department of Health highlighting their individual challenges, which include deficits accrued over many years. My Department and the HSE continue to put significant effort and resources into assisting the disability sector to manage priority needs within the funding available.

As the Minister of State with responsibility for disabilities, my primary concern is to ensure the continuity of appropriate person-centred disability services is maintained and delivered in an equitable manner consistent with the care and support needs of individuals.

Arising from the 2019 report of the independent review group established to examine the role of voluntary organisations in publicly funded health and personal services, I intend to establish a new dialogue forum between the Department, relevant health agencies and representation from voluntary organisations in the health and social care sector to provide a mechanism for engaging with the sector on the proposed Sláintecare reforms and other policy initiatives and to consider the group's recommendations on governance.

More broadly, I am continuing my examination of the recommendations of the report in the context of strengthening the relationship between the State and the voluntary organisations in the best interests of the service users. My focus will always be on the service users, the persons with disabilities and their families.

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
Link to this: Individually | In context

I raised this issue as a Topical Issue matter last night and put one question to the Minister of State which he failed to answer. Therefore, I will put it to him again now. Does he believe the HSE could provide the services that RehabCare provides and is he prepared to state that the HSE would provide a better service? Even if Rehab provided a year's notice in terms of service delivery that it would be obliged to provide if it were to terminate its service provision, it seems unlikely the HSE could step in and provide the services in a timely manner. Does the Minister of State believe the HSE could provide the services in a more cost-effective manner than Rehab? Does he expect there will be a resolution from the meeting he and the Minister, Deputy Harris, will attend today? I sincerely hope this is not a box ticking exercise and that everybody comes out of that meeting with a resolution that is good for service users of Rehab.

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

This is the next big crisis in the health service. It has been brewing for a number of years. We know the Minister of State is due to meet the representatives of Rehab today. I presume the Government will find the €2 million required; if not, it will have a serious problem. Three thousand people are affected, 222 of whom are in my county, which is the largest number in any county in Ireland.

There is a bigger issue behind the disability sector and section 39 funding. Funding alone is simply not enough. I want to state publicly in the Dáil that I believe there is a deficit across section 39 organisations which are dealing with the disability sector. Collectively, they are operating with a deficit of approximately €30 million. That raises a range of issues. Some of these organisations have got advanced loans from the HSE. That shows the scale of the issue involved. There are also questions related to operations and company law and how the HSE is working with them on this. These are serious issues. This is about to explode.

The Minister of State is reacting today rather than having dealt with the issue during the past number of years. The Health Information and Quality Authority, HIQA, which all these organisations came under in 2016, and we all know the issues related insurance costs, has escalated the expense and cost involved for all these organisations. We all know these organisations effectively are doing what the State should be doing but they are not being provided with enough funding. This is a crisis that is about to explode. The Minister of State need not tell me that he was not told about it. I can guarantee him that this is about to happen in the coming months.

Photo of Pat GallagherPat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context

The Deputy will have another opportunity to speak, and he was not deprived of those 30 seconds.

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context

I wish to advise Deputy Kelly that I do not react. I am well aware of the situation and I am not seeking to score points. I am trying to find solutions. I have been dealing with this issue over the past 12 months. I have had the representatives of the service providers come to my office. I am well aware, as will many of the Deputies in this House will be, of the current financial difficulties they have.

Regarding Deputy Murphy O'Mahony's questions, I have a strong belief in the voluntary sector providing the services funded by the State. That is my personal position. The voluntary sector provides up to 75% of disability services on behalf of the HSE. It should be noted, and this is where some of the problems come into play, that the disability service providers are operating in a heightened regulatory environment while at the same time charged with demonstrating efficiencies and cost-effectiveness in terms of the outcomes for the service users.

On the deficit issue, we accept the reality of that and are trying to find solutions. We are working with the HSE, the Department and the voluntary organisations. We are well aware of the impact of achieving and maintaining HIQA regulatory compliance, the decreased financial resilience owing to the issue of reductions in State funding, and the changing needs of service users.

On the issue of Rehab, the Minister, Deputy Harris, and myself met the representatives of Rehab last week. We will meet them again at 5 p.m. today with a view to making substantive progress on the understanding by the HSE of Rehab's financial position and cost base. That is the position in terms of where we are at.

Photo of Margaret Murphy O'MahonyMargaret Murphy O'Mahony (Cork South West, Fianna Fail)
Link to this: Individually | In context

In going public on its funding difficulties, the Rehab Group is highlighting a developing crisis in the independent, not-for-profit sector, on which the health service is so reliant for disability services. This crisis has brought many organisations to the edge of financial sustainability and it is one which must be addressed directly and that needs to happen now.

The report of the independent review group on the relationship between the voluntary sector and the State, which was published in February, endorsed a new funding approach be adopted by the State for the provision of social care services. Included in it were recommendations for multi-annual funding rather than the year in, year out battle to secure sufficient funds to simply survive.

On the publication of that report, the Minister, Deputy Harris, said he intended to establish a new dialogue process between the Department, relevant health agencies and the representation from voluntary organisations in the health and social care sector to provide a forum for engaging with the sector, in particular, on the proposed Sláintecare reforms and other policy initiatives. Can the Minister of State update me on that? How many formal meetings have taken place with the sector during the past three months? Will the recommendations on multi-annual funding be taken on board and does the Minister intend that this process will start with the next budget?

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
Link to this: Individually | In context

Approximately a year ago I raised the issue of a young man in Waterford who needs full-time residential care. His family cannot manage him any more. I am ashamed I cannot do more for that family, and I know there are many other such cases. It has become a crisis in this State as to how we treat these people. I state on the record that this is something that will come knocking very seriously on the Minister of State's door at a level he has never seen before soon. I want him to answer the following questions. What is the operating deficit of all section 39 disability organisations?

11 o’clock

Why does the HSE insist on these organisations signing contracts which show they are breaking even? If they do not sign the contracts, and we all know they are signing contracts while they have deficits, a 20% cut is automatically imposed upon them. Will the Minister of State stop that practice? Will he acknowledge they are signing contracts while operating in a deficit? Are some of these organisations signing contracts with the HSE where there are issues in regard to operations and company law? Will the Minister of State immediately bring forward a plan to deal with the deficit, which I have outlined in the House and on which I want the Minister of State to give us a figure? We can then look together at implementing the recommendations Dr. Catherine Day has put forward.

We need a plan for this year. This is about to explode. There are families who cannot survive and cannot deal with their loved ones any more. It is a very emotional situation.

11:00 am

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context

I am very concerned about the main part of my job, which is looking after families and people with disabilities who are worrying about this debate. I emphasise that I am very concerned about that.

On the particular issues, as I said, the Minister and I met Rehab last week and another meeting has been convened for today. The understanding with regard to Rehab's financial position and cost base is that it has agreed not to issue any notice of termination of service provision, so let us get that dealt with. Second, I am well aware of the issues raised by Deputy Kelly. Individual organisations and the HSE have commissioned consultants' reports and we know about the issue of deficits. We are sitting down and talking to them on a regular basis and this is something we understand and accept. We accept the deficits are caused by improving standards. I regularly meet service providers which are spending extra money to improve facilities because of requests by HIQA. We understand those issues. We are trying to put together a package to resolve that particular issue and I am confident we can do so.