11

Paper Submitted to the Joint Oireachtas Committee on Health and Children

July 1 2008, 09:02am

oireachtas

1st July 2008

Introduction

DFI welcomes the continued interest of this Committee in the development of necessary services for people with disabilities. This paper will focus on the quantum of funding and also on a few key related issues, namely, relationship/partnership between the voluntary disability sector and the HSE, and authority/governance issues between the HSE and the Oireachtas.

Health services, including personal social services, are at the core of successful outcomes from the National Disability Strategy (NDS). Our statutory health service is continuing to undergo massive structural changes. At the same time, it is under sustained and critical pressure to meet growing needs, and all of this within the context of a funding crisis and publicly expressed concerns around its ability to manage health service provision.

Under the National Development Plan (NDP), total current spending on disability services is set at over €2.5 billion for 2008. DFI is concerned, having been informed by the HSE, that they are seeking to achieve "efficiency savings" of 1% per annum from that allocation, amounting to €25 million, by diverting that money to areas of overspend within their budget. Furthermore this year's allocation of €50 million, as part of the multi annual funding package announced in 2004, has not been released. It is now our view that this €50m has been earmarked to go elsewhere. On that basis, €75 million of funding voted by the Oireachtas for disability services in this year will instead go to solve the HSE budget deficit. The intention to take back the €25 million of so called 'efficiency savings' in itself breaches the Government's agreed NDP.

Many voluntary disability organisations continue to fundraise to provide necessary health services, services that the HSE has a statutory remit to provide. While this continues, not alone have we the financial cut backs to contend with, but the HSE is simultaneously attempting to draw the sector into new contracting arrangements through which they state that they cannot respect the independence and autonomy of the sector. Yet the State is very clear about the independence and autonomy of the sector, and the value of working with it to ensure the provision of public services.

Noting all of these current issues, DFI presents its case with the expectation that people with disabilities and disabling conditions will have access to the comprehensive range of health and personal social services that they need. Given that expectation, we cannot be satisfied with year on year allocations which simply provide the same level of service or a small incremental increase. That expectation comes for two reasons. Firstly as human beings people have a right to their human dignity being vindicated through the provision of basic health and personal social services. Secondly, the commitment by Government and the Social Partners to the implementation of the NDS in Towards 2016 and more recently in the "Agreed Programme for Government", states that "This Government is determined to continue to prioritise the interests of people with disability over the next five years, through a series of significant measures."

We know of, and are deeply concerned about the serious downturn in the economy. Disability in itself is enough of a vulnerability for an individual and their family without adding the fear and burden of service cutbacks. Let us be clear. The State has just recently accepted that there is a huge backlog or gap in service provision for people with disabilities. It has provided under statute the Disability Act 2005 for the systematic undertaking of comprehensive and independent assessments of health needs for all people with disabilities. We are, as a State, at the start of that work, and the momentum needs to be kept up. As noted above, the provision of health and personal social services is key to the overall success or failure of the NDS. It will drive either the success or failure of the Strategy. Last December, the disability sector experienced its hard landing. Through Budget 2008, a deceleration from €95 million to €50 million (47%) in the rate of growth in funding for disability services since last year.

Before setting out our views on what needs to happen next, this paper will now further consider in more detail a number of areas critical to the understanding and ensuring the delivery of disability services:

  • The new environment and the role of voluntary disability organisations
  • The HSE and the voluntary disability sector partnership
  • Funding the NDS, and
  • Core funding of voluntary disability organisations

The New Environment and the role of voluntary disability organisations

The issue of disability is now placed strongly within the policy context in Irish society, as evidenced by the commitments contained in the National Disability Strategy, Towards 2016, the "Agreed Programme for Government"(1), and other policy papers. Towards 2016 identifies a vision for people with disabilities in Ireland, to be achieved through five long term goals (2). In agreeing that future policy in relation to people with disabilities will be progressed through the National Disability Strategy a number of priority actions are identified in Towards 2016 (3).

(1) The Programme for Government 2007 – 2012 states that "This Government is determined to continue to prioritise the interests of people with disabilities over the next five years, through a series of significant measures. We are committed to ensuring that the Strategy is driven and managed from a whole of Government perspective and it will be overseen and supported by the Department of An Taoiseach." (p.33)

(2) The Vision outlined in Towards 2016 is one 'of an Ireland where people with disabilities have, to the greatest extent possible, the opportunity to live a full life with their families and as part of their local community, free from discrimination.' A number of long-term goals are outlined in Towards 2016: access to sufficient income to sustain an acceptable standard of living; access to appropriate care, health, education, employment and training and social services; access to public spaces, buildings, transport, information, advocacy, and other public services and appropriate housing; support to enable, as far as possible, the leading of a full and independent life, to participate in work and in society and to maximise their potential; Carers would be acknowledged and supported in their caring role. Towards 2016, p. 66.

(3) The key issues through which the priority actions will be addressed are set out in Towards 2016 These include assessment for and access to a number of services, including mental health services, supports; the elaboration of a comprehensive employment strategy with measures to promote education, training and employment opportunities; the introduction of National Standards in respect of specialist health services; the enhancement and integration of supports in line with overall social welfare commitments and targets, including rationalisation of existing allowances in the context of mainstreaming, and issues in relation to cost of disability payment; improved standards and design in housing leading to general improvements in accessibility, the development of a National Housing Strategy for People with Disabilities as recommended in the NESC Housing in Ireland Report; the development of information and advocacy services, including the Personal Advocacy Service; the development of accessible transport services. (Towards 2017 pp.67, 68).

The National Disability Strategy contains commitments to working with the voluntary disability sector in the provision of services and supports. Voluntary disability organisations will also have new responsibilities. The introduction of Charities Legislation, new Financial Regulations and a Complaints Procedure are just a few examples of increasing and necessary demands on voluntary disability organisations.

Government has acknowledged the value of collaboration between statutory bodies and disability organisations. In Towards 2016 Government commits to ensuring

"a constructive relationship with stakeholders in relation to progress on the (National Disability) Strategy as a whole."(4)

(4) Towards 2016, p.69

This relationship has also been reviewed in the Report of the Comptroller and Auditor General (5). The 2006 National Economic and Social Council (NESC) Strategy, People, Productivity and Purpose, highlighted the need for "healthy community and voluntary organisations" as "an important requirement for overall economic and social development".(6) Now, more than ever before, voluntary disability organisations need to be supported so that they can respond to increasing responsibilities in terms of accountability and transparent delivery of services.

(5) Comptroller and Auditor General Report on Value for Money Examination: Provision of Disability Services by Nonprofit Organisations (December 2005)

(6) NESC Strategy 2006: People, Productivity and Purpose (2005).

The National Disability Strategy and its reflection in Towards 2016, is central to promoting the rights and participation of people with disabilities. Government has committed to full delivery of the National Disability Strategy, and to the vision and goals outlined in Towards 2016. To ensure that the National Disability Strategy is implemented as promised, Government must honour these commitments and support the voluntary disability sector as partners in the delivery.

Health Service Executive and Voluntary Sector Partnership

It is almost impossible to quantify the length and depth of the resources that voluntary disability organisations bring to Irish society. Apart from raising funds to provide services and supports to people with disabilities, the governance of these organisations is provided entirely by volunteers, as is a significant amount of service provision. In addition, many of these organisations carry with them capital stock in the form of buildings, the origins of which is often found in the religious orders who may have started the service in the first place. This is also of huge economic benefit to the State.

In Towards 2016 Government commits to strengthening the relationship between the State and the community and voluntary sector through

"…maximising the contribution of the community and voluntary sector by deepening the partnership between statutory bodies and voluntary and community organisations." (7)

(7) Towards 2016, p.70

Through this commitment Government recognises that community and voluntary activity forms the very core of a vibrant and inclusive society, adding that

"the great strength of voluntary activity is that it emerges organically from communities." (8)

(8) Towards 2016, p.70

Government has acknowledged the valuable role played by the sector, and has stated that the relationship between the voluntary disability sector and the State should be one of partnership in the provision of public services and the general advancement of public policy. However, The Draft Service Level Agreement concerning Section 38 of the Health Act 2004, and Grant Aid Agreement in relation to Section 39 of the Health Act 2004, recently published by the HSE, have given rise to a number of fundamental concerns for the voluntary disability sector. These contracts need to be redesigned and rewritten from the perspective that both parties are partners in the challenge to provide health services and where both parties respect each others roles.

While the sector strongly supports the need for, and value of, agreed and written terms and conditions in relation to funding, these must be drafted in the context of a partnership relationship. However, DFI considers that these current draft agreements are based on an approach to the disability sector that does not acknowledge a partnership relationship. The draft agreements are built strongly around a control / dependency relationship, rather than on a relationship of trust and joint problem solving, where both parties are understood to have the same interest and intent, that of achieving positive outcomes for people with disabilities. This latter relationship would be one of partnership between the statutory and voluntary sectors, as committed to by Government, and in line with the recommendations of the Report of the Comptroller and Auditor General.

Furthermore, the introduction of Charities Legislation, new Financial Regulations and a Complaints Procedure are just a few examples of increasing and necessary demands on voluntary disability organisations. The White Paper, Supporting Voluntary Activity, notes that

"Community and voluntary organisations need to undertake staff training, management training and development, service evaluation and organisational reviews. These require resources." (9)

(9) Supporting Voluntary Activity: A White Paper on a Framework for Supporting Voluntary Activity and for Developing the Relationship between the State and the Community and Voluntary Sector. (2001)

Voluntary disability organisations themselves recognise the need for regulation and for training. However additional investment in resourcing the sector is required to enhance capacity building and governance processes. This is supported by the Comptroller and Auditor General in his Report, which notes that

'the continuance of a relationship with non-profit service providers as partners in service development and delivery……would involve the State in actively working with organisations to strengthen their organisational capacity'.(10)

(10) Comptroller and Auditor General Report, 2005 (p.40)

DFI urges Government to implement its commitment in Towards 2016 to

"resourcing the sector into the future as part of this agreement." (11)

(11) Towards 2016, p.71

Now, more than ever before, voluntary disability organisations need to be supported to ensure that their governance structures can rise to the challenges of these times of change, where we need to enhance service delivery and respond to increasing responsibilities in terms of accountability and the transparent delivery of services. However, many voluntary disability groups find themselves in a difficult situation when it comes to supporting the development of their organisations. This is the area of their activities that will first suffer with the 1% cuts now being imposed. Our organisations would welcome regular and ongoing engagement with the HSE, on an organisation to organisation basis, around achieving greater efficiencies, so that the level of services to people with disabilities can be further enhanced.

The ongoing reform programme within the HSE continues to hinder the forming of positive partnership relationships with our sector. DFI has been trying to engage, at every level, with an organisation that seems to be consumed with its own evolving or revolving structures, where the impact of these internal efforts to reform would seem to distract from sufficiently and consistently focusing on people with disabilities and their organisations.

Funding the National Disability Strategy

The investment in new and enhanced services grew year on year during 2005, 2006 and 2007, but came to a grinding halt with Budget 2008. Unfortunately it did not just stop, it receded from a high point of €95 million in 2007 to €50 million in the current year. This represents a deceleration in the rate of growth of 47% over the previous year.

Government committed to investing €50 million annually to high priority disability services between 2006 and 2009 through the multi-annual funding programme(12). To date the 2008 allocation has not been released. Furthermore the multi-annual funding has not kept pace with the rate of inflation, further undermining the value of funding directed to disability. For example, €50 million in 2006 is worth just €46 million in 2008.

(12) 'High Priority Disability Services' focused particularly on the provision of extra residential, respite and day places, extra home support and personal assistance, and extra places in community based mental health facilities.

While multi-annual funding is very welcome, it represents just a fraction of what is needed to undo decades of under-funding and to respond to the need for new services.

In 2004, the Minister for Finance made it clear that, in addition to multi-annual funding, other disability services would continue to be dealt with as a normal part of the annual estimates process. Despite these assurances no funding was allocated to develop new and enhanced disability services in 2008, as shown in Figure 1.

D
Funding for Health Services for PwD 2005-2008

  • 2005 - 70 million (Development Money)
  • 2006 - 50 million (MAF), 40 million (Development Money)
  • 2007 - 50 million (MAF), 45 million (Development Money)
  • 2008 - 50 million (MAF)

The lack of investment in Budget 2008 was met with great disappointment by disability groups, particularly in the context of the pressing need for new services. At the same time, DFI recognises the commitment to allocate €50 million as part of the Multi-Annual Funding (MAF) programme targeted at high priority health services for people with disabilities, as identified in 2004. We have no confidence that this money will be made available for disability services this year.

We are now into July 2008, €45 million down on last years allocation, with no sign of the €50m multi annual funding. On top of all that, the HSE has informed DFI that it is seeking to take back 1% (€25 million per annum), termed by the HSE as "efficiency savings", from the current disability services budget, for the purpose of diverting the money to other areas of HSE budget over-runs. Over the remainder of the National Development Plan that represents €150 million. How is it that an executive agency under the aegis of one government department, the Department of Health and Children, can unilaterally overturn not only the funding allocation remit of the Oireachtas, but also of the NDP? These may be called "efficiency savings", but let us be clear that what is going on is the conscious and systematic removal of funding, voted by the Oireachtas for disability services, to other areas of the HSE.

DFI has informed the HSE that it will not be taking up the HSE invitation to nominate areas of DFI's budget where it, DFI, considers that savings can be made. DFI has made this decision on the basis of the express intent of the HSE to remove the money from the area to which it was allocated, namely, disability. Having regard to the fact that DFI has worked hard to get increased allocations for disability, DFI and its member organisations will not be complicit in the permanent removal of that money to other areas. DFI confirmed that it would welcome the engagement of the HSE, on an organisation by organisation basis, around achieving greater efficiencies, so that the level of services to people with disabilities can be further enhanced. Furthermore we have similarly advised our member organisations of this.

Turning to the NDP, Fig. 1 above shows clearly that Budget 2008 marked a major recession in disability funding compared with the previous three years by allocating only the 2004 commitment to €50 million per annum for certain high priority services.

DFI is deeply concerned at the lack of any funding for additional and enhanced services in Budget 2008. In addition to multi-annual funding directed at priority services, ongoing investment is needed to deliver new services arising from the implementation of the Independent Assessment of Need (IAN) in particular. This was acknowledged by the Minister for Finance in 2004 when he made clear that other disability services would continue to be dealt with as a normal part of the annual estimates process and would receive extra funding into the future.(13)

(13)'However, I want to make it clear that other disability services will also continue to be dealt with as a normal part of the annual estimates process and will receive extra funding going forward as overall budgetary circumstances permit.' Statement by Minister for Finance, Brian Cowen, December 2004,

The National Development Plan allocation for disability services takes in all the funds being spent in this area. The €18.8 billion, allocated over seven years to 2013, represents much more modest real increases in spending once the Multi-Annual Funding is completed by the end of 2009, with percentage annual changes reducing from 6.57% in 2008 to 2% each year from 2010 to 2013 – see Table below.

Fig. 2 NDP 2007 – 2013 - Current spending on disability services (14)
 2007200820092010201120122013
 €m€m€m€m€m€m€m
Current Spending2,389.1332,546.1632,669.1922,722.5752,777.0272,832.5672,889.157
Annual Change €m 157.03123.0953.38354.45255.5456.59
% Annual Change 6.574.832.002.002.002.00

(14) Source: Department of Finance

DFI appreciates the progress that has been made to date, and acknowledges the immense scale of the project that is the National Disability Strategy. Leaving aside DFI's contention that the NDS requires much more resourcing, what must be stopped immediatedly is the leakage of disability services funding to other areas.

What we do know in this regard is:

  • Firstly, the HSE has admitted that funding has been diverted to other services, and has stated that "decisions to reallocate funding were made by the 'senior management team', at national level".(15)
  • Secondly, the HSE Chief Executive, Professor Brendan Drumm has also acknowledged that money earmarked for palliative care services has been spent elsewhere. Professor Drumm stated that a judgement call had to be made when money was required to cover the cost of increased attendances at hospitals for example.
  • Thirdly, in December 2007 the Minister for Health and Children wrote to the Chairman of the HSE, Liam Downey (16), with the instruction that development funds designated for specific projects in the health service were not to be used to address the financial deficits incurred by the HSE in other areas. The letter highlighted the growing concern at Departmental and Ministerial levels that the HSE was ignoring planned developments and national agreements as it struggled with its own huge deficits. This situation has continued, and is at odds with the role of the Oireachtas in relation to the voting of resources to the HSE.
  • Fourthly, A Vision for Change is explicit that, at a minimum, an additional €25 million is required annually for a six-year period to allow for its implementation. The Government allocation of this €25 million in 2006 and 2007 was welcome. However, a Freedom of Information request made by the Mental Health Coalition reveals that only 57% (€17m) of the 2006 funding allocation has been spent, and only 40% (€10m) of the 2007 funding.

(15) Statement by Hugh Kane, Assistant National Director, HSE, to the Oireachtas Joint Committee on Health and Children, 13th May, 2008.

(16) Source: The Sunday Business Post – Article by Aileen O'Meara, 'Health Services Suffer as Cash is Diverted; 18th May, 2008

It is increasingly evident that additional shortfalls in funding will adversely impact on disability services as a result of the diversion of funds by the HSE to meet cost over-runs in demand led drug schemes, acute hospital services, and the general medical card scheme.

The current Multi Annual Funding Programme included, amongst other service developments, 200 new residential places, more than 450 day places, new respite places and the appointment of 140 multi-disciplinary posts for children with disabilities. There are many people with physical and neurological conditions, conditions which by their nature are often progressive. These people badly need this funding to be in place. The provision of personal assistance is another critical area to be supported through this funding package. The HSE recently stated that it is still in discussions with the Department of Health and Children and that it has held off spending the money pending a review of its financial situation.(17) How can it be that, half way through the year, voted and specifically dedicated funding has not been made available?

(17) Ireland.com, 27th May 2008; '€200m for health services left unspent HSE says expenditure deferred pending review'

It is unacceptable that resources allocated to disability should be diverted to other areas within the health services where there are shortfalls. The net result of actions such as these now being carried out by the HSE is that disability organisations are, in effect, fundraising by default for the HSE through their successful efforts over the years to encourage Government to increase funding for disability only to find that the HSE has spirited it away.

Furthermore, many voluntary disability organisations must not only continue to fundraise to offset existing core deficits, incurred through funding services that have not been funded by the HSE, but they are also under pressure to develop additional fundraising activities because allocated funding has been diverted to other areas of the HSE.

The commitments of Government contained in the National Disability Strategy, must not be sidetracked or overturned by internal HSE decisions to divert funds already allocated to disability services. Government commitments need to be fully honoured. This committee has an important role to play in that regard.

The Government's commitment to mainstreaming services for people with disabilities represents one of the largest challenges to be undertaken by the State. However, if health issues are not addressed, the policy of mainstreaming will fail. Full delivery of the National Disability Strategy is central to promoting the rights of people with disabilities as equal citizens of Ireland. The "Agreed Programme for Government" states that "This Government is determined to continue to prioritise the interests of people with disabilities over the next five years through a series of significant measures". This commitment must be honoured if another commitment, namely the implementation of half of the Strategy by 2010, is to be honoured.

Core Deficit Funding

Even if the full amount of funding allocated had actually been used for the purposes for which it was intended, there would, however, still be a shortfall in terms of implementing the commitments in the NDS and Towards 2016. To add to the problems noted above, voluntary disability organisations face ongoing core deficits incurred as a result of providing services that were not funded by the HSE.

Traditionally, funding, or more often the lack of it, has been at the centre of the voluntary disability sector's relationship with the statutory sector. This has been concentrated around resourcing for necessary service delivery. In many instances the level of such funding does not fully meet the costs associated with the services being provided, resulting in a core deficit issue for organisations. These organisations must, therefore, of necessity rely on fundraising to address this shortfall.

There has been little done to progress the persistent problem of core funding deficits for services provided to disabled people. Voluntary organisations are fundraising to provide services that the HSE has a statutory remit to provide. While this is bad enough, these groups are now having 1% taken from their HSE funding allocation. Many disability organisations (See Table below) continue to raise 50% of their income themselves. This is despite Government commitments in Towards 2016 to ensure that the sector is adequately resourced 'where delivering services on behalf of the State'.(18)

(18) Towards 2016: p.71

Fig 3. Annual Income & Fundraised Income 2006 for Eleven DFI Member Organisations
OrganisationAnnual
Income
Fundraised
Income
Fundraised
Income
%
Alzheimers Soceity of Ireland13,657,3683,806,33128
Arthritis Ireland919,851603,00066
AWARE1,649,0281,042,12663
Cystic Fibrosis Association1,650,7501,502,87391
Down Syndrome Ireland1,976,6541,905,86696
Heart Children Ireland192,181192,181100
Irish Deaf Society503,922397,10679
Irish Motor Neuron Disease Association1,311,0001,010,00077
Multiple Sclerosis Society of Ireland7,600,0004,400,00058
Muscular Dystrophy Ireland1,600,000250,00016
Jack and Jill Foundation1,900,0001,400,00074
Total 32,960,75416,509,48350

There has been a continued decline in the amount of funding to address core deficits in voluntary disability organisations. From €15 million in 2005, to €10 million in 2006, no funding has been allocated for this purpose in 2008. Furthermore, while €5 million was directed to address core deficits in Budget 2007, this was subsequently diverted to address the HSE's own funding shortfalls in other areas of the health services. Organisations are greatly disappointed that, in delivering these services, they continue to struggle to maintain current levels of service provision. Many disability organisations continue to raise significant amounts for their health related services. Voluntary fundraising is not a sustainable way of providing basic services.

Significant under-resourcing continues for services which voluntary disability organisations are expected to deliver on the ground. Organisations simply cannot be expected to maintain even the current level of services, never mind develop new services to deliver on the new strategies. DFI emphasises that to develop new services without addressing the issues arising from core deficits can only have one outcome – the development of new services on an unsustainable basis.

The Harmon Process(19), started some years ago, provided only a temporary solution to the problem. A new validation process now being developed by the HSE does not appear to be sufficient to resolve the issues.

(19) Initiated in 1999, the role of the Harmon Review was to examine 'core services' of selected voluntary disability organisations under the headings of 'Historical Underfunding', 'Core Underfunding', 'Revenue Developments' and 'Capital Requirements'. The emphasis of the Review was on the provision of health and related services.

Successful implementation of the National Disability Strategy will require that core deficit funding issues are addressed and that the sector has the capacity to develop efficient and responsive services to people with disabilities. If the historical under-funding of the voluntary disability sector is not resolved immediately it will be impossible to develop robust and sustainable services which are responsive to the needs of people with disabilities.

Conclusion

To sumarise let me reiterate DFI's main concerns and issues

  • Getting the health and personal social services right is a prerequisite for the successful implementation of the NDS
  • Disability services funding needs to have its own budget sub head, or some other mechanism to protect the voted money. Otherwise any new funding coming in becomes an easy target for redirection to be used to solve budget pressures in the HSE
  • The funding set out in the NDP, although modest in terms of the needs challenge, must at a minimum be protected during these financially tight times

With respect to health funding:

  • Budget 2008 represents a deceleration of 47% in the rate of growth over the previous year
  • It is critical that the HSE deliver the €50 million MAF allocation identified in Budget 2008 in full
  • The 1% "efficiency savings" cuts being imposed on voluntary disability organisations must be stopped immediately
  • The HSE's view that it has an overriding statutory obligation to balance its books on a yearly basis is at odds with statutory decisions, such as the Finance Acts, which make funding available for specific purposes, and this also includes the commitments contained in the NDP
  • Unilateral action being undertaken by the HSE is undermining commitments that Government has made in its NDS

With respect to the relationship between the HSE and Voluntary Disability Organisations

  • The HSE must acknowledge, through their engagement with the sector, that voluntary disability organisations bring a lot to the table in terms of expertise, a long track record of working with people with disabilities, often the first responders, development of innovative services, maximising the involvement of people with disabilities and their families, promoting community wide understanding and engagement, a stock of capital and other resources, increasing knowledge and learning and interaction across social and public services to ensure that people get the services that they need
  • The HSE needs to start working with the voluntary disability sector on the basis that the sector is a partner with them, not a sub contractor, working in a joint approach to fulfilling the commitment that this State has recently made to people with disabilities
  • The HSE draft service contracts need to be rewritten from the perspective that both parties are partners in the challenge to provide optimum health services and where both respect each others roles
  • The voluntary disability sector has to consistently strive to improve its standards and attend to its overall effectiveness with particular regard to working in partnership and collaboration with voluntary and State organisations
  • DFI would welcome the HSE working with voluntary disability organisations on a one-to-one basis towards achieving greater efficiencies so that the level of services to people with disabilities can be further enhanced
  • It must be acknowledged that the ongoing reform programme within the HSE, when viewed against the significant extra demands that the Disability Strategy alone is putting on it, is having a detrimental impact on the implementation of the Strategy

It is reasonable to take the view that this presentation is deeply critical of the HSE in relation to how it deals with disability. However the HSE is not the beginning and end of the matter. The HSE is without doubt in the front line. People see and experience their performance and there is no shortage of media interest. People don't easily or readily see, however, the connections and relationships between the HSE and a range of key actors, Department of Health and Children, Department of Finance and the Oireachtas. Being critical of the HSE is now popular to the point of almost being the new national blood sport, and we should usefully resist adding to that discourse. It might then be useful for this committee to further analyse and reflect on matters that relate to the Oireachtas/HSE relationship having regard to disability funding. This committee must find a way to prevent the HSE from effectively subverting the decisions of the Oireachtas in relation to voted funding for the National Disability Strategy. Of course we are saying that not enough funding is going into disability to meet the commitments in the NDS, but right now we need to get delivery of what has been allocated to disabled people in this year's budget, along with the immediate withdrawal of the 1% cuts to the already existing funding.

Disability Federation of Ireland

The Disability Federation of Ireland is a national support and representation mechanism for voluntary disability sector organisations, covering all areas of disability and disabling conditions. There are currently over 100 voluntary disability organisations in the DFI Membership.

DFI provides:

  • Information
  • Training and Advice
  • Organisation and Management Development
  • Research and Policy
  • Advocacy and Representation

Disability Federation of Ireland, Fumbally Court, Fumbally Lane, Dublin 8
Phone: 353-1- 454 7978 Fax: 353-1- 454 7981
Email: info@disability-federation.ie
Web: www.disability-federation.ie