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.
Sadly, this is not surprising in a country where the political system, as described by Stephen Collins (Irish Times, October 13th), has the propensity “to be captured by narrow interests rather than act for the common good”.
It is unlikely that issues of excess, waste or accountability would have raised their heads if the Government had not run out of money.
The value-for-money review team had huge difficulty in obtaining information. Consequently, two of the review’s key priorities call urgently for better data collection in the following areas:
Inthe financial reporting system, where allocations and expenditure should be tracked and compared at national level, regional and local level;
In the service agreements, which should be streamlined to allow for immediate improvements to information gathering and performance monitoring.
The absence of such basic financial reporting for a billion euro industry is an indictment of successive ministers for health and their senior officials.
Much is made in the review about the need to move to a new system of supporting people with disabilities to live in their own communities with control over their funding – a system that operates in the United Kingdom for 30 per cent of people with disabilities.
Disappointingly, the review affords little advice on how this can be achieved, apart from stating that it should be driven through the service-level agreements and recommends further research and pilot projects.
The country is awash with such projects, the end results of which will benefit a few. But they will have little impact on the 4,000 children and adults with disabilities living in unregulated and uninspected institutions.
People with disabilities know what they need and spending scarce resources testing different “innovative models of support” or funding research of limited value carried out by the National Disability Authority is not on their agenda when personal assistants and respite services are being cut daily.
To change policy requires action by the Government at a national level. This needs strong leadership from a minister for disability with the full backing of the Government to stand up to the vested interests.
A good start would be for the same Government to cut its own and highly-paid officials’ inflated allowances and pensions, rather than simply talk about protecting the vulnerable.
Unless people with disabilities mobilise as they did last summer outside Government Buildings, this review, worthy as it is, will end up on the shelf along with all the other worthy reports of the past 20 years.
Deirdre Carroll was chief executive of Inclusion Ireland – National Association for People with Intellectual Disability from May 2001 to May 2012