Fergus O'Dowd (Louth, Fine Gael) | Oireachtas source

I take Senator Colm Burke for raising this important matter. There is a long history of non-statutory service providers providing health and personal social services in Ireland. While many of these organisations have access to financial resources through fund-raising, they rely substantially on the HSE to fund the services the provide. The HSE funds a range of service providers under either section 38 or section 39 of the Health Act 2004. Section 38 arrangements involve the funding of organisations to provide services on behalf of the HSE, while under section 39 the executive grant-aids a wide range of organisations to a greater or lesser extent. As the Senator pointed out, some of the section 39 providers receive very substantial amounts from public funds. Staff of bodies funded under section 38 are classified as public servants and are subject to the standard salary scales for the health sector, as well as having public service pension schemes and being counted in public service employment numbers. Employees of agencies that receive grants from the HSE under section 39 are not public servants and are not specifically subject to the pay scales approved for public servants. I acknowledge the contribution of such service providers to the development of health and personal social services.

The HSE is committed to the development of effective working relationships in line with the provisions of the Health Act 2004, which provides that the executive may, subject to resources and on such terms and conditions as it considers appropriate, fund services provided by non-statutory providers. Significant progress has been made in improving the governance and management framework between the HSE and voluntary service providers. In line with the Comptroller and Auditor General's 2005 report on value for money in the disability sector, a register of non-statutory agencies' service arrangements and grant aid agreements is in operation. This provides local, regional and national management information on more than 2,600 separate agencies which operate more than 4,300 discrete funding arrangements to a value of approximately €3.3 billion. This register is managed by the HSE business support unit and has created a unique identifier for each agency. It allows for the maintenance of key information on each separate funding arrangement, including current and historic funding, compliance with national standards, governance documentation and key contact details.

To ensure that the HSE and the non-statutory sector meet their obligations, the executive has developed a formalised national governance framework with national standard governance documentation to manage the funding. This governance documentation was developed in 2009 with the agreement of all major service providers and came into operation in 2010. Governance documents ensure a national standard consistent application of good governance and eliminate the need for individual contracts to be created each time the HSE funds an agency. This process represents value for money, in that there is a ready-made contract for all funding arrangements, and provides governance that is robust and effective, ensuring that the HSE and the agencies meet their respective obligations. The national suite of documentation is applied according to the nature and scale of the funding and services involved and contains the appropriate corporate, clinical and financial governance requirements. This documentation is the subject of regular review. In 2011 significant changes were introduced, including an extension of the section 38 clause to ensure that only salaries within public sector norms would apply to all funded agencies. In 2013 an additional information return was added to all section 38 and section 39 arrangements. This requires agencies to report separately on all individual staff paid at grade 8 level equivalent or above and provide details on their salaries, including those relating to allowances and any other benefits.

The HSE ensures a continuous focus on compliance with the governance framework and has included this as a key performance indicator for both corporate and regional reporting. At the end of 2012, almost 98% of funding was covered by the governance document.

Given the significance of the sector, all senior management in the Health Service Executive have key responsibilities within the governance framework. A national support structure is in place which includes local and regional heads and a national governance group forum supported by the national business support unit. Various guides and process control forms are maintained alongside a comprehensive operational manual which is in the approval process and awaiting formal adoption.

Since the introduction of the governance framework in 2009, a number of projects have been undertaken to examine the management structures to ensure they are effective. The key recommendations from these projects relate to the need for the HSE to build on the management processes which the national standard governance documentation and operational procedures have established.