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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  (

)        or        through        the       following       link:

ENDS

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 (

).

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 (

).

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:

   Value for Money Report recommendations:

   Value for Money Report findings: