Why are so many of our health services provided by charities?
Basic services are the State’s responsibility, yet it pays others €3.7bn to deliver them
Surely if civil society organisations worked together, and with statutory agencies, more would be achieved.
The Director of the Dublin Region Homeless Executive, Eileen Gleeson, recently criticised “unauthorised” voluntary groups for not working with “official” homeless agencies.
Her remarks caused offence and controversy, but were correct. Civil society organisations seldom work in partnership with each other or with statutory agencies. They are more likely to be in competition, than to be working together, which creates duplication and gaps in service delivery. Successful outcomes are harder to achieve.
This is a growing problem because, more and more, charities are now providing essential services. For ideological and historical reasons, statutory agencies favour an arms-length funding model instead of delivering services directly. The 2016 Benefacts Annual Report notes that “Ireland is uniquely dependent on non-profit organisations for the delivery of many public services, especially in health and social care, in education, in culture, sport and recreation”.
According to Irish law, charitable purposes include, among other things, the prevention or relief of poverty, the advancement of education or religion, and the promotion of civic responsibility. The number of charities and not-for-profit organisations operating in Ireland and funded by taxpayers, either by donations or statutory agencies, is astonishing.
The Charities Regulator, established to maintain a public register of charitable organisations and ensure their compliance with the Charities Acts, lists 8,849 charities on its website. Benefacts, established to make the work of civil society organisations in Ireland more transparent and more accessible, now has almost 20,000 civil society organisations listed on its database, including 2,567 delivering health and social care services.
The Health Service Executive (HSE) Annual Report 2016 shows that grants to “outside agencies” last year amounted to a massive €3.7 billion, the same as the budget allocated to Primary Care. Recipients included the Irish Wheelchair Association (€37 million), the Irish Travellers Movement (€5.9 million)*, and Mental Health Ireland (€1.9 million). Several so-called “voluntary” hospitals and disability services are funded almost entirely by the taxpayer, via the HSE.
In 2016, the Child and Family Agency gave nearly €144 million to 986 different organisations to deliver child welfare services, school completion programmes, women’s refuges and family support services.
The National Office for Suicide Prevention (NOSP) funded 30 organisations to deliver mental health services and projects. This year the Irish Human Rights and Equality Commission (IHREC) funded 32 organisations to deliver projects on understanding diversity and eliminating discrimination.
Should essential services be delivered by civil society organisations?
Is it just cheaper?
The present funding model seems to be that civil society organisations will provide health and social care services to disadvantaged and vulnerable people – about 20 per cent of the population – and the statutory sector will provide services needed by everyone else, including higher socio-economic groups. For example, cardiac care and cancer treatments are almost exclusively delivered by the HSE and private hospitals.
Are the outcomes of services delivered by the civil society sector as good as those delivered directly by the State?
Despite all the charitable work, life is not getting any better for the most disadvantaged and vulnerable people.
No one knows. Outcomes are seldom measured by either the public or voluntary sector. Travellers’ lives have not improved, despite the millions of euros spent on services every year. Recent surveys show they are still 22 times more likely to experience discrimination when accessing private sector services – such as in shops or restaurants – than any other population group in Ireland. Domestic violence rates are the same as ever, if not worse. Poverty rates have increased. Despite all the charitable work, life is not getting any better for the most disadvantaged and vulnerable people.
It is not enough for the statutory sector to hand over billions of euros to civil society groups and expect them to solve the problems created by an unequal society.
As was pointed out by Eileen Gleeson, all services, projects and programmes delivered by voluntary and not-for-profit groups must be fully integrated into those delivered by statutory organisations.
This is beginning to happen. For example, NOSP has aligned the work of its 30 funded partners with the goals of Connecting for Life: Ireland’s National Strategy to Reduce Suicide. Suicide rates are now coming down. The IHREC has aligned the funded projects with its strategic focus.
When it comes to vulnerable and disadvantaged groups, the statutory sector must take the lead role, not an arms-length approach.
It is the State’s responsibility to ensure the health and social care needs of those who cannot meet their own needs are met by statutory services and not by charities.
Sadly, this does not happen.
Societal problems such as poverty and homelessness will never be solved until vulnerable, disadvantaged people are valued the same as everyone else.
* The HSE has since clarified that, while their 2016 report says the Irish Travellers Movement received €5.99 million, the ITM did not receive any funding directly from the HSE. The money was paid to 33 Traveller organisations around the country.