Ms Kathleen Lynch T.D., Minister for Disability, Equality, Mental Health &
Older People today (20 July 2012) published the Report of the Value for
Money and Policy Review of the Disability Services Programme.
The Review recommends a significant restructuring of the Disability
Services Programme through:
- migration from an approach which is predominantly organised around group-based service delivery towards a model of person-centred, individually chosen, supports; and
- implementation of a more effective method of assessing need, allocating resources and monitoring resource use.
Through this restructuring, the Review points the way towards the
achievement of optimal effectiveness and efficiency within the existing
substantial resources expended on health and personal services for people
with a disability. The Minister has welcomed the recommendations in the
Review as providing framework for the development of effective and
accountable services and expressed her unequivocal commitment to the model
of person-centred supports recommended in the Review.
In the context of delivering a more person-centred service, and in line
with commitments in the Programme for Government, the Minister intends that
the actions recommended in the Review will lay the groundwork for a system
of individualised budgeting, once sufficient analysis of the benefits is
carried out in the Irish context and adequate financial management,
resource allocation and governance structures are in place to ensure its
long-term viability. Individualised budgeting, the Minister explained, is
an approach whereby a monetary value is placed on the supports required by
the individual to live a fully included life in the community. It may be
implemented in many ways, but the essence of individualised budgeting is
that the individual is given more choice and control over how the money
allocated to meet their needs is utilised. This approach must be
underpinned by a standardised needs assessment to ensure fairness and
transparency in the way in which funding is allocated.
The Minister commended the Chairman, Mr Laurence Crowley, and the members
of the Steering Group, the Project Team and the Policy Expert Reference
Group for their sterling efforts in delivering this important report. The
Minister also had a special word of thanks for the many service providers,
both in the HSE and the voluntary agencies, who co-operated with, and
provided assistance to, the Review. The Minister said “Although the Review
points to a new way of delivering services we must never forget the debt we
owe as a society to the dedication and commitment of voluntary agencies the
length and breadth of the country that have provided services for people
with disabilities for almost a century. I know that they will now
demonstrate the same dedication and commitment in re-shaping our disability
services to meet the challenge of providing a more person-centred and
outcome-orientated service” said the Minister. She continued “I believe
that the statutory authorities, working in partnership with service users,
their families and the non-statutory service providers, will prove equal to
the challenge. I am confident that by working together we will realise the
vision of a more inclusive society for people with disabilities, where
services and supports will be tailored to meet the needs of the individual
citizen, and not the other way round”.
The Minister went on to say “I fully endorse the re-articulated vision and
goals proposed in the Review, as an expression of a revitalised and
re-orientated Disability Services Programme.” “I have asked the HSE to
liaise with service providers immediately to commence the process of
implementing the recommendations in the Review, in conjunction with my
Department.” she added.
The full Report is now available on the Department of Health’s website (
www.doh.ie) or through the following link:
http://www.dohc.ie/publications/VFM_Disability_Services_Programme_2012.htmlENDS
Notes for Editors
Background
The VFM and Policy Review of the Disability Services was initiated by the
Department of Health in June 2009 and was conducted under the auspices of
the Government’s Value for Money & Policy Review Initiative 2009-2011.
The purpose of the Review was to assess how well current services for
people with disabilities met their objectives and support the future
planning and development of services.
Steering Group
The Review was overseen by an independent chair, Mr Laurence Crowley, FCA,
CBE, LLD. Mr Crowley is a Director of Bord Gais Eireann, Aer Lingus Group
PLC, and a number of private companies. He is also Chairman of Midletown
Centre for Autism and Executive Chairman UCD, Michael Smurfit School of
Business. He was previously Governor of the Bank of Ireland.
The Steering Group had two other independent members, Mr James O’Dwyer, f
ormer Chairman of Arthur Cox, the Dublin based law firm and a member of the
Advisory Board of the UCD Michael Smurfit Graduate School of Business and
Mr Gerard Flood who is a Director of a number of private companies and was
formally a Partner in KPMG with responsibility for its Corporate Finance
service delivery as well as members drawn from the Disability Sector,
Department of Health, the Department of Public Expenditure and Reform, and
the HSE. The Membership of the Steering Group is set out in Appendix 1 of
the Review.
Scale of the Disability Services Programme
During the period under review, expenditure on disability services
increased from €1.3 billion net in 2005 to €1.7 billion net in 2009.
Expenditure in the current year will be approximately €1.5 billion.
Residential services are provided to around 8,500 people by almost 60
agencies at over 1,200 locations, ranging from large congregated settings,
to community group homes, and supported independent living. Day services
are provided to around 18,500 service users with intellectual, physical or
sensory disabilities and autism at 850 different locations by 80
organisations. A variety of other services are also provided under the
Disability Services Programme, including respite, home support, personal
assistance and assisted living, early childhood/family support, community
based medical, nursing and therapy services, rehabilitative training, aids
and appliances.
Objectives of the Review
The objectives of the review were to:
· Examine disability services in Ireland funded by the Health Service
Executive, including the statutory and non-statutory sectors;
· Deliver a comprehensive analysis of data in relation the services and
service providers; and
· Review current policy objectives and provide policy objectives for
further service provision.
The full Terms of Reference of the Review are given in Chapter 1 of the
Report.
Public Consultation
As part of the VFM Review, a public consultation process was undertaken on
existing disability services which confirmed that people with disabilities
and their families, more than anything else, are looking for more choice in
the services they receive and more control over how they access them. It
clearly underlined the necessity of reform in how disability services are
funded and organised.
Some of the main findings of the consultation include:
· Almost three quarters (73%) of people consulted felt that the best
option for meeting the needs of people with disabilities would be for
them to have a choice to get different elements of service from
different providers.
· Exactly half of respondents said that people with disabilities should
get to choose and manage their own services
· 96% of respondents agreed that the current objectives of the
Disability Services are relevant.
· Many felt that access to services and information about services was
not adequate and that there are inequities in how resources are
distributed within the system.
A report on the findings of the public consultation are available on the
Department of Health website (
www.doh.ie).
Policy Review
As part of the overall VFM review, an Expert Reference Group on Disability
Policy was established to look specifically at existing disability policy
and whether it needed to be changed to better meet the expectations and
objectives of people with disabilities and to advise the Steering Group
accordingly. The Expert Reference Group report proposed a reframing of
disability services towards a model of individualised supports, underpinned
by mainstreaming of all public services. The Group’s final report was the
subject
of internal consultation within the Department of Health and with
other Government Departments and was also released for public consultation.
In drafting its final report the Steering Group took into consideration the
recommendations made by the Policy Review Group and the results of the
public consultation on the Policy Group’s report. The Report is available
on the Department of Health website (
www.doh.ie).
Vision and Goals for the Disability Services Programme
The vision proposed by the Review and recommended by the Minister is:
To contribute to the realisation of a society where people with
disabilities are supported, as far as possible, to participate to
their full potential in economic and social life and have access
to a range of quality personal social supports and services to
enhance their quality of life and well-being.
This vision will be underpinned by the following goals:
1. Full inclusion and self-determination through access to the
individualised personal social supports and services needed to
live a fully included life in the community.
2. The creation of a cost-effective, responsive and accountable
system which will support the full inclusion and
self-determination of people with disabilities.
Implementation Priorities
The Review outlines a set of implementation priorities. Some actions are
prioritised because they provide the necessary infrastructure to support
other key recommendations, others because they have the potential to result
in immediate efficiency savings. The priorities are to:
× strengthen the national disability function;
× initiate demonstration projects to drive migration towards a
person-centred model;
× put in place a commissioning and procurement framework;
× develop a national resource allocation model, which will ensure best
use of existing resources and provide the groundwork for
individualised budgeting;
× establish strategic information requirements.
Immediate Actions
In order to make progress on the implementation priorities, a number of
immediate actions have been identified as essential to the process of
reforming the Disability Services Programme:
× streamline the Service Level Arrangement process;
× standardise financial reporting;
× each service provider to examine VFM findings and draw up plans for
an audit of rosters, review of skill mix, a critical examination of
the cost base and a reduction in the average cost per place.
× introduce a unique identifier as part of the groundwork for
person-centred resource allocation and service delivery;
× develop a national implementation plan, informed by appropriate
policy appraisal.
Further information on the report is available on the website of the Department of Health or can be accessed through the following links:
Q& A document:
http://www.dohc.ie/publications/pdf/VFM_Review_QandA.pdf Value for Money Report recommendations:
http://www.dohc.ie/publications/pdf/VFM_Review_Recommendations_MasterList.pdf Value for Money Report findings:
http://www.dohc.ie/publications/pdf/VFM_Review_Findings_MasterList.pdf