The Independent Review Group Established to Examine the Role of Voluntary Organisations in Publicly Funded Health and Personal Social Services Contents

Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal social services Contents 1 Introductory remarks and mandate 5 1.1 Foreword 5 1.2 Terms of reference 7 2 Executive summary and recommendations 9 2.1 Executive summary 9 2.2 List of recommendations 13 3 History and context of voluntary organisations in health and social care services in Ireland up to the present day 19 3.1 A brief history 19 3.2 The situation today 20 3.3 The scale of the voluntary sector 21 3.4 Differences between Section 38 and Section 39 voluntary organisations 23 3.5 Reliance on public funding 25 3.6 The case of faith-based voluntary organisations 25 4 The situation in other countries 29 4.1 Role and scale of the voluntary sector in other countries 29 4.2 Funding frameworks in other countries 30 4.3 Conclusions 31 5 The added value of voluntary organisations 33 6 Ownership, control and governance of voluntary organisations 37 6.1 The legal structure of voluntary organisations 37 6.2 Regulation of voluntary organisations 38 6.3 Ownership of assets 38 6.4 Governance 43 2 7 Ethos 47 7.1 Faith-based voluntary organisations in receipt of state funding 47 7.2 Mission statements 48 7.3 Issues arising from the ethos of faith-based voluntary organisations 49 7.4 Funding and provision of services 52 8 The relationship between voluntary organisations and the State 57 8.1 How services are commissioned 57 8.2 Relations between the State and the voluntary sector 59 8.3 Contractual relations 63 8.4 Information requests 65 8.5 Funding 67 8.6 Need for an appeals process 68 8.7 Role of the Department of Health 69 9 Future opportunities 71 9.1 The place of the voluntary sector in the new architecture of Irish health and social care services 71 9.2 Fostering innovation 72 9.3 Joined up government 72 9.4 Consolidation 73 Appendix 1 – List of stakeholder meetings 75 Appendix 2 – Ownership of assets 76 Appendix 3 – Governance arrangements 84 Appendix 4 – List of abbreviations 96 Supporting documentation 97 List of Tables 97 3 InTrOductory rEmArks and mAndate 4 InTrOductory rEmArks and mAndate 1 Introductory remarks and mandate 1.1 Foreword The Minister for Health established an Independent Review Group (IRG) in August 2017 to examine the role of voluntary organisations in the provision of health and personal social services and to make recommendations on the future evolution of their role. Today’s system has developed over many years, often in response to changes on the ground and in society. The publication of the Sláintecare report1 in 2017 and of the Sláintecare Implementation Strategy2 in August 2018 mark a new stage in designing a national vision for our health and social care system and mean that further changes are to come. Our recommendations should therefore be seen as a contribution to a process of transition and evolution over the coming years. Ireland owes a debt of gratitude to all of those who work in the voluntary sector. Historically, it was the first to provide hospital and social care to the poor and most vulnerable in Irish society. Voluntary organisations, often originating in religious and charitable bodies, offered care at a time when the State did not. The sector has grown from that historical basis to provide approximately one quarter of acute hospital services3 and approximately two thirds of services to people with disabilities4. Thus, the delivery of many of our health and social care services today is dependent on voluntary organisations, which form an essential and integral part of the overall system. One of the key principles guiding our approach was to listen to all views and to build an evidence base for our findings and recommendations. In the course of this review, we met with many dedicated people from the voluntary sector who work and advocate on behalf of service users. We also met many highly committed staff who work in the public sector and who demonstrate similar dedication. We are grateful to all of them for sharing their expertise, their ideas and, sometimes, their frustrations with us. We were struck by their need to be listened to and by their willingness to find a new basis for co-operation. In addition to over 40 stakeholder meetings5 and the many written inputs we received, we conducted a public consultation process to seek views on the role of the voluntary sector. We received 102 responses to the consultation questionnaire, and a further 11 submissions6. Our thinking was also informed by research conducted by the Health Research Board (HRB) on the governance of voluntary health and social care providers in England and Ontario7, and by a meeting with experts from Portugal, France, Belgium and Germany facilitated by the European Observatory on Health Systems and Policies to discuss issues of relevance to our work. Our work over the past year has led us to conclude that Ireland benefits from a strong public service commitment in both the statutory and voluntary sectors. Our remit specifically asked us to examine the role of voluntary organisations. We identified the following areas in which the sector provides added value: • Leadership, innovation, flexibility, responsiveness and local community involvement in health and social care – a sector that affects all citizens at some time in their lives and, for some, for all of their lives; 1 Houses of the Oireachtas Committee on the Future of Healthcare, Sláintecare Report, May 2017. 2 Sláintecare Implementation Strategy, Department of Health, August 2018. 3 Voluntary hospitals account for 28% of in-patient beds in publicly funded acute hospital care according to HSE Business Intelligence Unit data. According to HIPE data, in 2017 voluntary hospitals accounted for 26% of in-patient discharges from publicly funded acute hospitals. 4 As estimated by the National Disability Authority in its submission to the Independent Review Group. 5 See Appendix 1 for further details. 6 See report in 2018 Consultations, www.health.gov.ie/consultations. 7 Joan Quigley and Jean Long, Governance of voluntary health and social care providers – England and Canada, 5 Health Research Board, 2018. InTrOductory rEmArks and mAndate • Capacity to make decisions close to the service provided and benefitting from the personal involvement of volunteers who give their time and expertise freely for the well-being of their fellow citizens; • A long tradition of advocacy on behalf of service users and an important role in influencing public policy. There is also a growing realisation in recent years that health and social care funding needs to move away from a focus on providers towards a greater focus on the services needed by individuals and the overall population. We note that the Sláintecare Implementation Strategy puts great emphasis on delivering care in the community, close to where people live, and this in our view is one of the strengths of the voluntary sector. Indeed, this is a trend that can also be seen in other countries. For these reasons and in order to preserve the positive impacts of the voluntary sector into the future, it is important that the sector is included in future developments, including licensing and commissioning. Good policy development in health and social care relies on learning from the experience of those who work within it. If the voluntary sector is to be retained, as we believe it should, there is a need to give public recognition to its legally separate nature and at the same time enable it to work more closely and effectively with the statutory system. We concluded that this will require a re-setting of the relationship between the State and the voluntary sector. The challenge is to find an appropriate balance between the necessary control by the State over policy and funding, and the autonomy and independence of the voluntary sector. This would ensure that the voluntary sector can continue to deliver agreed services to nationally determined standards of care in ways that enable it to play to its strengths. The voluntary sector must also recognise that its dependence on the State for a large proportion of its annual funding means it cannot work in isolation but rather must co-operate fully in delivering national health and social care strategies and must demonstrate compliance with best practice in terms of governance, quality, safety and financial probity. As part of our mandate we analysed the involvement of faith-based organisations in the sector and examined whether their faith-based ethos affects the availability and delivery of publicly funded health and social care services. We also discussed the State’s obligation to organise its health and social care services to ensure access to lawful services by all its citizens, and the obligation on health and social care organisations to comply with Irish law irrespective of their religious affiliation. The work of our group was limited in time but we consider that we have been able to fulfil our mandate to provide information on the voluntary sector and to make recommendations that can support a new partnership between it and the public sector. We believe that many of our recommendations fit with the policy direction outlined in the Sláintecare Implementation Strategy and can help to deliver on its ambition. We would like to thank the secretariat in the Department of Health (Sarah Rose Flynn and Colm Solan) who supported our work tirelessly and very effectively. Catherine Day Jane Grimson Deirdre Madden (Chairperson) October 2018 6 InTrOductory rEmArks and mAndate 1.2 Terms of reference The Review Group shall examine and inquire into the current role and status of voluntary organisations in the operation of health and personal social services in Ireland, including religious and faith-based organisations, the strengths and weaknesses of this mode of service provision, the issues which arise in connection with the provision of services to the public through such organisations, and to make recommendations on how the relationship between the State and voluntary organisations in the arena of health and personal social services should evolve in the future.

Load more