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Building a New Relationship Between Voluntary Organisations and the State in the Health and Social Care Sectors

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Building a New Relationship Between Voluntary Organisations and the State in the Health and Social Care Sectors Building a New Relationship between Voluntary Organisations and the State in the Health and Social Care Sectors Paper from the Dialogue Forum with Voluntary Organisations June 2021 1 Table of Contents Chapter 1 . Introduction ................................................................................................................4 Chapter 2 : Ireland’s Health and Personal Social Service Sector .......................................................6 2.1 A Hybrid System ...................................................................................................................... 6 2.2 The Voluntary Sector .............................................................................................................. 7 2.3 The Role and Value of the Voluntary Sector ........................................................................... 8 2.4 A Problematic Relationship ..................................................................................................... 9 2.5 Building More Productive and Collaborative Relationships ................................................. 11 Chapter 3 . Covid 19––A National Heath Emergency: .................................................................... 13 3.1 Introduction .......................................................................................................................... 13 3.2 Responding to Covid-19: A National Collaborative Effort..................................................... 13 3.3 The Suspension and Restriction of In-person Services ......................................................... 17 3.4 A Growing Funding Crisis for the Voluntary Sector .............................................................. 18 3.5 A Growing Demand for Services ........................................................................................... 20 3.6 Staffing Issues ....................................................................................................................... 21 3.7 Continuity and Contingency Planning ................................................................................... 21 3.8 The Key Outcomes ................................................................................................................ 23 Chapter 4 : An innovative, flexible and collaborative response: Cross Cutting Themes ....................... 31 4.1 Introduction .......................................................................................................................... 31 4.2 A Unity of Purpose ................................................................................................................ 31 4.3 Intensive Engagement, Information Exchange and Collective Problem Solving .................. 32 4.4 Regional and Local Level Co-operation ................................................................................. 36 4.5 Tight and Loose: Towards Accountable Autonomy .............................................................. 37 4.6 Interdependency and Mutual Respect ................................................................................. 39 4.7 A More Balanced ‘Performance’ Dialogue ............................................................................ 40 4.8 Remote Working and Service Provision––Towards a More Digital Future........................... 41 4.9 (Re) Connecting with Communities ...................................................................................... 45 4.10 Addressing the Funding Crisis ............................................................................................... 47 4.11 Protecting the Most Vulnerable............................................................................................ 49 4.12 The Quality of Staff: Committed, Flexible and Engaged ....................................................... 52 4.13 Strong Collaborative and Engaged Leadership ..................................................................... 53 4.14 Core Values and Strengths .................................................................................................... 54 2 4.15 Resilient and Robust Organisations ...................................................................................... 56 4.16 Adopting Public Health Advice and Guidance ...................................................................... 58 4.17 Supporting the National Public Health Response ................................................................. 59 4.18 Trade Unions: Supporting Flexibility and Change ................................................................. 60 Chapter 5 . Building a New Relationship and Delivering Better Outcomes ..................................... 62 5.1 Introduction .......................................................................................................................... 62 5.2 From Problematic To Partnership-Style Relationships ........................................................ 62 5.3 Accountable Autonomy ........................................................................................................ 65 5.4 A New Approach to Funding? ............................................................................................... 66 5.5 Improving Access to Quality Integrated Service Provision ................................................... 68 5.6 Maintaining the Momentum for Reform and Innovation..................................................... 69 5.7 A National Conversation about Health and Social Needs ..................................................... 73 Appendix A: A. Interaction, Information Exchange and Collective Problem-Solving .................................... 75 B. Transitioning to Remote Service Provision ........................................................................... 80 C. Connecting with their Communities ................................................................................. 88 D: A National Response to the Public Health Crisis .................................................................. 91 E: Business Continuity Planning ................................................................................................ 95 Appendix B: Dialogue Forum with Voluntary Organisations: Members Appendix C: Research Methodology 3 Chapter 1. Introduction The Dialogue Forum with Voluntary Organisations was established by the Minister for Health to provide a platform for regular and structured dialogue between the State and voluntary providers of health and social care services.1 The impetus for this initiative was the Independent Review Group’s contention, as outlined in their final report, that substantially improving the quality of the relationship between the State and voluntary organisations was critically important to improving the quality of service delivery, and to delivering better outcomes for service users.2 The overarching mandate of the Forum is to build a new and more collaborative relationship between these actors. This will be key to delivering the transformative reform envisaged by Sláintecare, and achieving better quality people-centred health and personal social services. Despite the prevailing problematic relationship, initial work for the Forum, undertaken by the NESC secretariat, concluded that a combination of factors—including a joint recognition of the need to change and a strong commitment to making the Forum work—suggested that there was fertile ground for cultivating a new paradigm of collaborative and productive engagement. This work also proposed a dynamic and iterative conceptual framework for fostering a new relationship, based on a commitment to intensive engagement, information-sharing, mutual trust and problem-solving deliberation. The outbreak of the Covid-19 pandemic in early 2020 has had a dramatic impact, not only on the healthcare sector but on the wider economy and society. Significantly, the manner in which the national healthcare system has responded to this unprecedented public health crisis is an example of the aforementioned dynamic and collaborative framework in action, in real time. The crisis has transformed the environment in which the state and voluntary actors operate. It has also supported the transition to a new and more productive relationship, underpinned by a commitment to collective problem-solving, innovation and practical action. Equally, it has reaffirmed that mutual interdependence is a defining characteristic of Ireland’s hybrid healthcare system This paper draws on a series of qualitative interviews with senior decision-makers from public and voluntary organisations, which were carried out over the period June to September 2020. The paper seeks to document and analyse the health system’s response to Covid-19 with the aim of: 1 In the remainder of the report the term Dialogue Forum is used. 2 Independent Review Group (2019). Report of the Independent Review Group, established to examine the role of voluntary organisations in publicly-funded health and personal social services, available at https://www.gov.ie/en/publication/9b5f87-independent-review-group-examining-role-of-voluntary- organisations/ 4 highlighting the capacity of the health care system to respond to challenges in a flexible, innovative and dynamic manner; exploring the factors which underpinned the emergence of more collaborative and productive relationships between the voluntary sector, HSE, and other public actors during this period; and identifying lessons that can help foster a new relationship, with the capacity to drive
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