The current model for the provision of services to people with disabilities is not sustainable, an internal report by senior health service management for the board of the HSE has warned.
In the majority of cases disability services, such as residential and respite care and home support, are not provided by the HSE directly but rather by voluntary organisations which receive funding from the government.
The report says that many of these voluntary organisations, which are known technically as Section 38 and Section 39 bodies, are facing financial difficulties, and are trying to deliver services while meeting intensive regulatory requirements. It suggests they may not be in a position to keep going in the future.
“The degree to which these significant stakeholders can maintain their position should be of particular concern to the State in terms of resilience and capacity to continue indefinitely to maintain organisational service delivery.”
The HSE report says that many disability organisations are “struggling in terms of financial sustainability”.
It said a review of 29 of the Section 38 and Section 39 organisations undertaken by the HSE showed total financial deficits of about €30 million.
The report says the majority of services for people with disabilities are not provided directly by the HSE, but rather by voluntary organisations which receive money from the State.
Own boards
Section 38 organisations receive direct funding for their services from the State, and their employees are considered to be public service personnel. Section 39 bodies are grant-aided by the HSE. Their staff are not deemed to be public servants. All of the voluntary Section 38/39 organisations have their own boards.
The HSE report says the financial difficulties being experienced by disability organisations are mainly due to trying to meet and maintain compliance with standards set down by the health service watchdog Hiqa.
The problems are also as a result of their weakened financial resilience due to cuts in State funding over the austerity years.
“In this context, and given the range of other statutory regulatory compliance requirements (including charity, company law and housing regulations), it is critically important to note the vulnerable position of Section 38 and Section 39 company directors,” it says.
It notes all of the directors are volunteers “that are faced with intensive demands to deliver services whilst meeting extremely intensive regulatory/compliance standards which, whilst understandable in terms of achieving public confidence, has nevertheless created a significant burden in both reputational and professional terms for those concerned”.
The report says the single most significant driver of costs in the disability sector has been the regulation of residential and respite centres. It says between 2016 and 2018 the HSE spent about € 82 million on “Hiqa-related additional essential expenditure”.
Capital outlay
It says the cost of meeting regulatory requirements has led to significant increases in non-pay and capital outlay which has had a devastating impact on the accumulated financial reserves of some providers.
The report says the HSE has a budget of about €2 billion for disability services. However, “evidently the supply of services is not meeting demand”.
The report suggests € 82 million in additional funding will be needed annually to 2025 to meet identified needs in different areas such as multidisciplinary care, respite, home support and the provision of personal assistants. Several hundred million in additional capital funding may also be needed.
