Vested interests profit from disability as cuts bite

OPINION:A review of services exposes a reluctance to reform while highlighting issues of excess waste and accountability, writes DEIRDRE CARROLL

The Value for Money and Policy Review of Disability Services was published by the Department of Health last July to little discussion in the media or debate in the Dáil.

The disability services examined were those for which the Health Service Executive is responsible, and comprise day, residential and respite services.

This long-awaited review is not an easy read. However, for those willing to persevere there are many illuminating nuggets. The review puts to bed the myth that services for people with an intellectual disability are provided by poorly paid voluntary service providers, struggling valiantly with insufficient Government resources.

This myth was first debunked in 2005 when the report of the Comptroller and Auditor General (CAG) into the not-for-profit disability sector highlighted the scandalous lack of transparency and accountability in how these organisations are funded.

Large sums of money were allocated by the HSE without any audit of funds spent or services provided, and no tendering or measurement of outcomes was achieved. A system of block funding existed where financial support was based on what was given the previous year, with a bit more added.

Despite the evidence of the CAG report, money continued to flow.

Gross expenditure on disability services increased 34 per cent from €1.34 billion in 2005 to €1.789 billion in 2009. Expenditure for 2011 is estimated at €1.708 billion. Pay costs accounted for up to 85 per cent of spending.

While in the last two years there have been pay reductions and a moratorium on recruitment, the extent of these reductions (approximately 5 per cent) is significantly less than the 34 per cent increase in funding over the preceding period.

Some changes were introduced, notably the establishment of service level agreements, under which for an agreed annual sum from the HSE a specified amount of service, in an area such as respite care, is delivered.

However, the value-for-money review found that the information from these agreements is not collated at a national level and does not contribute to any monitoring of performance.

The imperative to reform was not there as long as money was flowing freely.

It is now clear that little of the extra cash was being allocated on the basis of rigorous analysis or consideration of value for money. Much of the spending was targeted at pleasing vested interests or buying them off.

The vested interests, being large religious and not-for-profit providers, trade unions, professional groups and quangos, all have done well out of disability (and continue to do so under the Croke Park agreement).

The failure of the Department of Health and HSE to monitor this use of taxpayers’ cash can only be called gross negligence.