Voluntary sector should continue to play integral role in health and social care services

Ireland benefits from having a voluntary sector, which should continue to play an integral role in the delivery of health and social care services, according to the report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services. Maureen Browne reports.

Maureen Browne
Maureen Browne

The Group also found a high level of mutual interdependence between the State and voluntary organisations, emphasised the complex, intertwined and evolving relationship that has existed between the State and the voluntary sector for many years and called for a renewal of this relationship based on trust and partnership.

the voluntary sector accounted for approximately one quarter of publicly funded acute hospital care, and provided around two thirds of disability services and 80% of residential services.

The Group, composed of Dr Catherine Day (Chair), Professor Jane Grimson and Professor Deirdre Madden, was established to provide a space for an inclusive and respectful process of consideration, and to inform the development of policy over the medium term.
The report found that there were over 2,000 voluntary organisations receiving funding from the HSE, the voluntary sector accounted for approximately one quarter of publicly funded acute hospital care, and provided around two thirds of disability services and 80% of residential services.

It said eight voluntary hospitals accounted for 28% of beds in publicly funded acute hospital care according to Hospital In-Patient Enquiry (HIPE) data. In 2017, voluntary hospitals accounted for 26% of in-patient discharges from publicly funded acute hospitals.

It said the State paid the voluntary sector approximately €3.3 billion for services delivered in 2017, representing just under a quarter of the HSE budget in that year.
For the purpose of this report the group did not include St. James’s Hospital or Beaumont Hospital, Dublin as voluntary hospitals – both are State-owned and their Board members are appointed by the Minister for Health, thus distinguishing them from voluntary acute hospitals.

The report made wide ranging recommendations covering areas such as the governance of voluntary organisations; dialogue, engagement and contractual processes between the State and the voluntary sector; ethos, asset ownership and public capital investment, and broader issues related to health system development.

Voluntary organisations should indicate publicly that, in the event of winding-up of the organisation, the proceeds of any asset sales would be re-invested in a charitable body with similar objectives in Ireland.

It recommended:
Voluntary organisations should indicate publicly that, in the event of winding-up of the organisation, the proceeds of any asset sales would be re-invested in a charitable body with similar objectives in Ireland.

To protect the State’s investment, the HSE should compile a database of all charges on capital assets owned by voluntary organisations and funded by the State. This should be updated and published at regular intervals. The HSE should also systematically verify whether there were any other charges on the same assets before granting funding.

Where the State decided to build any new hospital or facility, it should endeavour to ensure that it owned the land on which the hospital or facility is built.

Where the State was unable to secure the purchase of land on which it intended to develop a new facility, any capital investment by the State should only be provided subject to prior agreement on the services that would be delivered in this new facility and the governance arrangements that would apply.

Boards of voluntary organisations should be required to demonstrate compliance and alignment with modern corporate governance standards, specifically in relation to issues such as the appointment of Board members, Board size, competencies required, tenure and conflict of interest declarations.

Board members of voluntary organisations in receipt of state funding should undergo training in good corporate governance to enable them to undertake their responsibilities effectively. The State should co-fund
such training for smaller organisations.

In the case of voluntary organisations receiving over 50% of their funding from the State and where this exceeded €20 million annually, ways should be found to strengthen State representation at Board level, for example through the appointment of Ministerial nominees or Public Interest Directors.

All faith-based state-funded voluntary organisations should state clearly in their mission statements that their services were available to those of all faiths and none.

Voluntary organisations in receipt of state funding should be cognisant of the impact of décor on patients/service users and strive to ensure that their personal preferences in this regard were met to the greatest extent possible.

The State should provide full information about the availability of, and timely access to, all lawful services as close as possible to the location of the service user.

All organisations, including any that decided not to provide certain lawful services on grounds of ethos, should ensure that they provided service users with adequate information on the full range of services available in the State and how and where to access such services.

All organisations should make available all relevant patient records to ensure the safe and timely transfer of care.

In emergency situations, the life and well-being of patients must always take precedence over the ethos of the organisation and therefore organisations must ensure that all legally permitted treatment was made available safely to the greatest extent possible within the capabilities available to the organisation.

A list of essential services to be funded by the State should be agreed in consultation with the voluntary sector.

The full cost prices for delivery of these services should be agreed centrally.

The list should be updated regularly, with provision for adjustment to meet local circumstances.

Appropriate national standards should be developed for services in the list of essential services, where these did not already exist. Organisations that provided these services should be robustly monitored by the appropriate agency to ensure their compliance

The Department of Health and the HSE should undertake a full mapping of all voluntary organisations providing personal social care services receiving public funding, and of their capacity to provide a range of essential services in the coming years. The results of this mapping should be updated and published at regular intervals.

A Charter should be drawn up to give official recognition to the legally separate status of the voluntary sector and to reflect its public service role in the provision of health and social care services. The Charter should be developed and agreed with the voluntary sector and adopted within a twelve-month period.

A Forum should be established to facilitate regular dialogue between the relevant State representatives and the voluntary sector to ensure their full involvement in future policy and strategic developments.

Working groups composed of representatives from the Department of Health, the HSE and voluntary organisations should be established, according to level of funding received, to review and simplify the Service Arrangements and Grant Aid Agreements with a view to introducing new arrangements by 2020. New arrangements should be applied on a trial basis and subject to an evaluation after the trial period.

To ensure that information requests were necessary and proportionate, the HSE should develop a set of principles and processes governing information requests to organisations, which adhered to data protection principles and the best standards of information governance.

Requests for information that had already been provided to another arm of the State should be avoided.

A Memorandum of Understanding (MoU) should be agreed between the main relevant bodies which would commit them to re-using data already provided to other State bodies.

The Departments of Health and Public Expenditure and Reform should undertake a review of the financial position of voluntary organisations that would include an analysis of surpluses/deficits over the last five years and the main drivers and put forward proposals for resolving any deficits identified. There should be a move to multi-annual budgets for 3-5 years in duration to facilitate strategic service planning and reform of services.

There should be open and transparent discussion on the financial capacity and fundraising plans of the voluntary sector as part of the Service Arrangement process.

An independent process should be put in place to resolve disputes (excluding the negotiation of budget allocations) between the HSE and voluntary organisations.

The Department of Health should play a stronger role, as the parent department of the HSE, and in the interface between the HSE and the voluntary sector.

Voluntary organisations should be consulted fully regarding any future health structures so that a solution was agreed to enable them to retain their separate legal identity and autonomy, while ensuring that the services they contracted to provide were part of an integrated concept for the whole region.

The roles of commissioner and provider of services should be separated.

An Innovation Fund should be created which would award grants (initially €20 million) on a competitive basis to innovative projects to be carried out in the voluntary and public sectors.

A publicly funded support function should be established to help smaller voluntary organisations. This could provide access to training (for staff and Boards) and shared legal, accounting and other services.

A Charter should be drawn up to give official recognition to the legally separate status of the voluntary sector and to reflect its public service role.

Welcoming the publication of the report, Minister Harris said “I fully agree with the Independent Review Group that we owe a debt of gratitude as a society to voluntary organisations. This report provides a timely reminder of the contribution that voluntary organisations continue to make in the delivery of health and social care services across the country. It also highlights that Ireland is not unusual in this regard, with the voluntary sector forming a core component of many European health systems. This is sometimes forgotten.”

“I am committed to further strengthening the relationship between the State and voluntary organisations so that both can work together in the best interests of patients and service users. The publication of this report provides us with an opportunity for starting a new chapter in this relationship. In response to the Group’s recommendations, I intend to establish a new dialogue process between the Department, relevant health agencies and representation from voluntary organisations in the health and social care sector to provide a forum for engaging with the sector, in particular on proposed Sláintecare reforms and other policy initiatives This must be a two-way process with recognition.