Alan Kelly (Tipperary, Labour)
Link to this: Individually | In context | Oireachtas source

579. To ask the Minister for Health if he is satisfied with the Health Service Executive's ability to monitor section 38 agencies and organisations; if the system of oversight has been strengthened since 2014 when the executive indicated that the system of oversight for sections 38 and 39 organisations was lacking and that new procedures were needed; and if he will make a statement on the matter. [21151/16]

Alan Kelly (Tipperary, Labour)
Link to this: Individually | In context | Oireachtas source

583. To ask the Minister for Health the measures he is proposing to strengthen the 2013 governance arrangements the Health Service Executive introduced with the section 38 agencies in particular in terms of strengthening the direct relationship between the executive and the boards of each of these agencies; and if he will make a statement on the matter. [21155/16]

Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I propose to take Questions Nos. 579 and 583 together.

Section 38 and 39 Service Providers (Providers) in receipt of in excess of €250,000 annually are required to sign a standard Service Arrangement (SA). The SA comprises two Parts: Part 1 sets out the detailed terms and conditions which attach to the release of the funding to Providers and Part 2 (the Schedules) sets out inter alia the annual amount of funding to be released and the quantum of services to be provided for that funding. (In some instances, there may be a number of sets of Schedules per individual Provider). Part 1 generally covers a four-year period; however, the Schedules are renewed annually by local Service Managers with each Provider to reflect the funding for the year in question and the quantum of services to be provided for same.

Providers in receipt of less than €250,000 are required to sign a Grant Aid Agreement (GA) which also sets out the terms and conditions which attach to the release of the funding to these Providers. These GAs are entered into on an annual basis.

The following initiatives have been taken to strengthen the system of oversight for Section 38 and 39 Providers.

The HSE Compliance Unit was established in late 2014 to provide programmatic oversight of the arrangements in place with voluntary agencies funded by the HSE for the provision of health and personal social care services.

A key element of this oversight are the Service Arrangements Part 1 & Part 2, which underpin the HSE's relationship with the Service Providers and in this context, a comprehensive review of the SA documentation (Parts 1 and 2) was conducted in 2014/2015 to further strengthen the governance with Providers. This review involved input from all relevant internal stakeholders and also an extensive engagement took place with representative bodies from the voluntary sector.

As a result of this review, some key changes, as set out below; have been incorporated into the revised SAs (Part 1) to enhance the governance elements of these documents:

- Additional requirements in respect of Internal Audit, Finance, Governance Arrangements and information requirements;

- Requirement to submit an Annual Compliance Statement in respect of the Provider’s governance;(Currently applies to Section 38 Providers – see below)

- A clause which enables the HSE to appoint an individual to, in specific circumstances, assist and provide guidance to the Board of a Provider organisation;

- A detailed mechanism to deal with performance issues which includes the appointment of a manager by the HSE in exceptional circumstances to manage the services in a HSE-funded organisation;

- Requirement for a Provider to request the consent of the Executive where the Provider proposes to re-organise or restructure its organisation;

- Requirement that a Provider shall give 12 months notice where the Provider does not wish to provide services or receive funding;

- Option of mediation between the HSE and the Provider as part of the dispute resolution process.

These changes were occasioned by inter alia an Internal Audit report, Public Sector Pay Policy, various Circulars and other matters that have emerged with Providers in the intervening period since the last documentation review.

The Annual Compliance Statement (ACS) process referred to above is an important element of the oversight process and requires the Board Chairs of each Section 38 Service Provider to certify on an annual basis that they are compliant with the necessary governance requirements or in cases where they are not compliant, they are obliged to explain why that is the case. The ACS process currently applies to Section 38 agencies, however from November 2016, this will be rolled out to Section 39 agencies as well. In addition, as part of the ongoing development of the Compliance Process, and in order to provide external assurances to the HSE, it was decided that a review of governance at Board and Executive level in all Section 38 Providers, to be conducted by external consultants, would be undertaken. The purpose of these reviews is to establish the level/standard of governance in place in these organisations and to confirm independently that the governance practices and procedures accord with those set out in their respective ACSs. These reviews involve an examination of key governance processes and documents, including obtaining confirmation that there are internal financial controls and that formal written financial procedures are in place in these organisations. Six of these reviews are currently underway. The outcomes of the reviews will both inform the HSE's relationship with the agency concerned and any further enhancement of the HSE's overall governance framework.

The Compliance Unit also coordinates governance issues within the HSE regarding Service Providers, interfaces with the key stakeholders involved in the governance framework and provides support and advice to staff in the recently established Community Healthcare Organisations and Hospital Groups in relation to governance matters as they apply in the context of Section 38 and 39 Agencies.

The Compliance Unit also has responsibility for the Service Provider Governance (SPG) IT system which has been developed to monitor the completion rates of the Service Arrangements. The system provides regular reports to service managers throughout the HSE on a regular basis. This allows managers to monitor levels of completion of Service Arrangements and Grant Aid Agreements.

Finally, as part of the ongoing development of the governance process within the HSE, the Compliance Unit develops and introduces new measures to deal with matters that may arise in the context of the HSE's ongoing relationship with Section 38 and 39 agencies such as the issues that have arisen in the course of recent weeks.