CIL Report on VFM

CIL Report on Value for Money and Policy Review of the Disability Services

Introduction

This report represents the future planning structure of the disability services in Ireland and presents the planning and policy processes that will undermine future service provision in Ireland. This report outlines the response and analysis of CIL CMH.

Underlying principles

This report is based within the medical model school of thought, and is not a rights based report. This report does not recognise the state and societies responsibility to remove barriers to social inclusion and participation. This report outlines that future the scope of future disability services will depend on the health of the economy, and sets parameters to its implementation. CIL CMH does not accept that investment in disability services should be affected by the economic climate and developing a rationale for budget cuts in this report is not acceptable in an era where disability rights and independent living has been on the agenda for over two decades.

The guiding principles of this report should be equality, inclusion and independence and not how far we can provide equality, inclusion and independence if the economic circumstances are not as expected. This raises huge concern, and the potential of any service to fulfil its mandate should be premised only on the standard of the service received.

Personal Assistance

CIL CMH was hoping that there would be a cast iron commitment to the extension of personal assistance services, and the mainstreaming of personal assistance services as method of service provision. There is a commitment to personal assistance services within the report, but we would have hoped to have this as a key element to the future provision of disability services. To date, 3% of the HSE disability budget is spent on personal assistance services and this represents a tiny section of the budget and we would have welcomed the opportunity for this to be expanded.

Direct Payments

CIL CMH was anticipating a commitment to direct payments in the recommendations of the report. The adoption of a direct payments model would be the next logical step in evolution of disability services. We are concerned that there is no movement on the mainstreaming of direct payments, and we would have expected that this would be the future direction of disability services.

Quality of Service Provision

We are also concerned about the lack of commitment to the quality of services provided by organisations. Recommendation 4.8: The HSE should begin the process of substituting non‐professionally qualified care staff for professionally qualified care staff to achieve pay savings in the statutory and voluntary sectors. This will be consistent with the new person‐centred model envisaged as the future direction of disability policy.  This is of concern, particularly when they outline quality as a core value. CIL CMH is responsible for ensuring that that highest standards of services are provided to our members, and we query whether or not we can allow standards in qualifications to be downgraded.

Also, there is no specific role assigned to HIQA within the document, it should be much stronger and there is no accountability given to them and their role. They have been perceived as being largely ineffective to date, and it should have been outlined how this could have been improved and/or expanded. If the body charged with enforcing standards is not effective, none of the aims outlined in this report will ever be achieved.

Use of Terms

The use of the term ‘person-centred’ throughout the report does not represent a commitment to the principles of independent living. The definition used by the HSE is particularly weak, and essentially acts to undermine the goals of this section. ‘‘services are planned and delivered with the active involvement of the individual and developed around his/her particular characteristics’ (HIQA, 2009). There is a need to further develop this definition as there is a huge difference between independent living and person centred services, and ideologically, they are not interchangeable. Person-centered approaches do not confer the same rights as independent living approaches, and we have to point out that they do non infer the rights of choice, autonomy or independence.

Attitudes

Overall there is a despondent attitude to independent living and they make reference to the nineties being the era of independent living. This implies that the movement has come and gone, however, we exist until the full and complete rights of people with disabilities has been recognised and adopted and do not depend on value for money. The rights of people with disabilities are not wholly quantifiable and this represents a major challenge to CIL CMH into the future.

Recommendation 3.8 - The role and funding of agencies that are wholly or substantially engaged in representation rather than direct service provision should be re‐appraised having regard to the recommendations in this Review on the person‐centred approach. Overall the report embraces the merits of a rights based approach, but they do not commit to it fully. As a result organisations that strategically represent people with disabilities should be supported and not placed in the firing line. They also allude to previous mergers internationally that remove representative organisations. This is damaging to the voice of people with disabilities and we question the motivation of the writers of the report.

 

Conclusions

Overall the approach of the document is rights based, but is consistently undermined by an over emphasis on reducing costs and attempts to reduce a sector that is largely ineffective in delivering strategic aims due to an over emphasis on the medical model and inefficiencies in the HSE. Whilst a cursory reading of the report presents rights based rhetoric, there is no concrete follow through in the recommendations that suggest to CIL CMH a full commitment to a rights based approach. At a minimum we would expect future disability services to recognise the role of personal assistance and direct payments as key to the development of disability rights.

 We conclude that perhaps that department responsible for the funding and management of the disability services should be examined, as the basis of any service to promote inclusion and participation should be based on rights and rights alone.