Thursday, 31 March 2022
Ceisteanna Eile (Atógáil) - Other Questions (Resumed).
Will the Minister inform the House of the status of discussions about multi-annual funding for section 38 and section 39 organisations? This has been a critical issue for many community and voluntary organisations throughout the State. They have been calling for multi-annual funding for years. Proper financial support is essential for project management. Staff retention is difficult and most staff are on year-to-year contracts with no pension entitlements or job security.
I considered the Deputy's question at length and I was trying to understand exactly what he was asking. If I do not cover the specifics he wishes me to cover, I will happily revert to him with a note or talk to him about the issue separately.
Section 38 and section 39 organisations have service provision arrangements with the HSE across a range of services, including healthcare, social care, mental health and disability services. The arrangements cross over voluntary acute hospitals, under section 38 funding; disabilities, where a significant proportion of the funding goes to both section 38 and section 39 organisations; and some other section 39 organisations which provide services for older persons, mental health, palliative care and so forth.
With regard to the disabilities sector, the disability capacity review to 2032 has identified the importance of multi-annual funding, to the Deputy's point, to support forward planning of the services, which can be difficult and frustrating for many of these organisations. The review has drawn on the best available evidence and information to estimate the scale of the current outstanding need for HSE-funded disability services and how we can shape this and invest in it over the next ten years.
Work is under way to prepare an action plan for disability services for 2022 to 2025, in line with the commitment in the programme for Government to work towards implementing the disability capacity review and building out all of those services. In practice, however, the full roll-out of multi-annual budgeting across Government is constrained. That is not only the case for section 38 and section 39 agencies because funding is constrained for hospitals and waiting lists. We launched the waiting list action plan for this year. I would have loved to have been able to launch a multi-annual plan but there are legal constraints around multi-annual funding. It is something we are looking at for current expenditure. We can provide multi-annual funding for capital expenditure. To the Deputy's point, section 38 and section 39 organisations would be in a much better place if we were able to make the kind of multi-year commitments we would like to be able to make.
I appreciate the Minister's response. Multi-annual funding is a cornerstone for most community and voluntary groups to be able to put themselves on a firmer footing, as the Minister has explained. I will give him a good example of how important it is. I am aware of a particular addiction service that was down a member of staff for a period of six months during the pandemic and, for specific reasons, it could not recruit to find a replacement. This led to an underspend of €23,000 on the project. The HSE has insisted that money is paid back, despite the fact the same project has requested funding for the past five years to run programmes for people who are suffering from long-term mental health issues which have now been exacerbated by the ongoing pandemic.
Multi-annual funding would allow for timely, well-thought out and strategic planning based on communities, agencies and stakeholders. It would allow for realistic key performance indicators to address ever-changing trends in drug use. Multi-annual funding would allow for services to respond with measures that are tried and tested. If there were multi-annual funding, the HSE could not come to the organisation I spoke about and request the return of the underspend. That organisation could use the money to address emerging needs, which is the essence of community development.
I thank the Deputy. He has covered several of the challenges we have. One of those is around multi-annual funding. To some extent there is multi-annual funding, in that when we put money in the health budget base, it is understood that money will stay there going forward. If we have invested in disability services, drug services, which are led by the Minister of State, Deputy Feighan, mental health services, acute services or whatever else, those are seen within the budget base as permanent expansions. That is very useful. However, the voluntary organisations, as the Deputy said, do not have the same level of guarantee to allow them to offer permanent contracts in some cases.
The Deputy raised another important point which I might address in my final response. When there is an underspend, we have a slightly perverse incentive to just get the money out and spent so that it does not get taken back.
That is absolutely the case. That is key. I have seen it many times, as I am sure the Minister and every other Deputy has. Anybody who has worked in the community or voluntary sector will know about it. If an organisation that has a service level agreement is very good at managing its finances, it is penalised at the end of the year because that money is taken back. There is a concern that when the following year comes around, the HSE decides that organisation is very good because it did not need the level of funding allocated. The HSE will then consider chopping off a bit of the budget for use somewhere else. That is where multi-annual funding is critically important. It gives people an opportunity to know the level of funding available to them for the next three to five years, or whatever length of time it may be. It gives people certainty and the opportunity to manage that money. It is the same in every business, as the Minister knows. Some years you spend more and some years you spend less.
However, over a period of time it is possible to plan and strategise. If there is a special project, it could be decided to use that underspend on that the following year. That would be critical.
I agree. The way healthcare in this country is funded generally needs a radical overhaul. For example, most of our hospital and community services are funded through a block grant. We give hospital managers a certain amount of money for the year regardless of what happens in their hospital, how many patients they treat or how much innovation they do. Instead, we should be saying to the HSE, or the section 38 and section 39 organisations, that we are paying for services. We should be commissioning services and paying per patient, or for each person supported in addiction services, for example. If at the end of the year they are a few people short and there is extra money, we would not simply pay them less next year because we would be funding this amount of service. The Deputy's points are very well made, not just with regard to addiction and community services but services right across the healthcare system.