The Recession, predicted for the past few years, has now arrived with the impact of a force-10 hurricane. There are many different views and opinions as to what caused the recession in Ireland, but whether it was caused by local factors within our control or global factors outside our control, it will inevitably affect each and every citizen in Ireland. How we cope with and respond to this recession will have a profound impact on our living standards in years to come.
We have all become accustomed to affluence and very high standards of living during the ‘Celtic Tiger’ years. We will want to keep these high standards come what may during the recession. We all know that funding and resources for services for people with an intellectual disability have been significantly reduced over the past few years as the Health Services Executive has sought to get better value for money through ‘efficiency cuts’ and other funding cutbacks. And that was during the ‘Celtic Tiger’ years!
People with an intellectual disability and their families are no doubt wondering how their standard of living and the services they access will be affected by the recession. Will the next few years bring the harshest cuts in funding for our people with disabilities ever witnessed? Will we receive regular respite which is so badly needed in order to keep our son, daughter, brother or sister living at home? Will there be day services in 2009 and subsequent years for those leaving school? Will there be a service for my child when I am ‘gone’? Many families will be seriously stressed by these concerns.
Service providers and staff are also very concerned about the impact of the recession on their capacity to maintain and develop services over the next few years. ‘Voluntary’ service providers have always endeavoured to respond to service needs as and when they arose. However, for many service providers the capacity to do so has been sucked out over the past few years through ‘efficiency’ cuts, ‘employment ceilings’ and other resource cuts. Many service providers already give more than 100% return to the HSE through fundraising, housing, etc.—but despite this fact ‘efficiency’ cuts were still imposed. Fundraising income will no doubt be affected by the recession also with inevitable consequences for services already dependent on such income for survival.
Most service providers are adopting ‘person centeredness’ as the core value underpinning their service models. There is a big shift from ‘caring for,’ to ‘supporting’ those who use services. This has inevitably resulted in many challenges for service users, families, staff and service providers.
In Budget 2009 the government announced that it was undertaking a review of ‘voluntary’ services for and of people with a disability. The review will be completed by June 2009. Services for and of people with a disability will be rationalised following the review. Does rationalisation mean that smaller organisations will be taken over by larger organisations or merged into large organisations? Will each existing organisation be assessed on its merits? What standards will organisations be benchmarked against? Will there only be large organisations? These are very fundamental questions that must be asked and discussed before any decisions are made to ‘rationalise’ existing organisations. Will the local and personalised services offered by so many smaller organisations be lost? Will it be necessary for parent and friend groups to establish new local services again as happened in the 1960s and 1970s?
Procurement of services
The HSE has stated that many new services for people with a disability will be subject to a procurement process in future. This, they claim, is necessary to comply with European Union legislation and to get the best value for public monies invested in disability
services. We can also anticipate that more people with a disability will elect to receive personal funding with which to purchase services of choice from service providers of choice. Such changes from traditional ways in which services were funded and delivered will no doubt cause concern to people with a disability, their families, staff and service providers.
A time of opportunity and vision
Cuts in funding, rationalisation, person-centred services, procurement and personalised funding are all challenges that must be faced. However, they also present opportunities to be grasped. We can either lambaste the government and the minister for challenging us with less funding and new ways of delivering services to people with a disability—or we can seize the opportunity that those new challenges present. Remember the voluntary sector was set up in lean times and has survived both lean times and times of plenty. We can, and must, survive this recession also.
Service providers should look critically and objectively at the service models on offer and the structures in place to support these models. Are current structures and support services cost effective? Have they evolved over the years or have they been developed in response to best practice, efficiency and need? Could support services be shared or outsourced more cost effectively?
These are very difficult questions for many organisations. Historically voluntary service providers were set up to respond to specific needs and developed as self-sufficient entities with a ‘parochial’ mentality. The ‘parochial’ model has no future in the HSE’s Strategic Plan for service delivery. Service providers need to critically review existing structures and support resources and to take whatever actions are required to make them more cost efficient and relevant to the changing needs of those who use disability services today.
The embracing of person-centred services and personal outcomes offers an opportunity for service providers to review their deployment of staff and other resources. Traditionally the ‘care’ model was used by those providing services ‘for’ people with an intellectual disability. This is no longer acceptable to people with a disability, their families, staff or service providers. Change was inevitable and it is happening. The shift from care to support has brought both challenges and opportunities for all concerned, with many asking ‘can we deliver person centred services without additional resources? Many personal outcomes for those who use our services can be delivered without additional resources.
Person-centred services and personal outcomes are very much about changing attitudes and adapting the way we have traditionally done things. The challenge that changing attitudes poses for everyone concerned should not be underestimated. However, changing attitudes does not require additional funding. And such changes are essential for those who use services.
The need to change attitudes is not confined to staff or service providers only. Parents, siblings and public officials must also embrace change. The person, not their disability, must be centre stage. We must think empowering and support rather than care. Many people have been given employment opportunities which have provided them with the respect and dignity they deserve as equal human beings and equals. With these guiding principles, changing our attitudes and perspectives from care to support should not be too difficult. What may be more difficult is dealing with the different and often challenging demands that such support requires.
Many organisations were set up to meet an identified need and gaps that existed in service provision for people with a disability. The services range from full residential and day services, to support and advocacy groups. It would be unacceptable if, in the interest of saving money, many of these services were either discontinued or subsumed into larger organisations. Larger is not necessarily better. For a cautionary lesson, need we look any further than the amalgamation of the health boards into the Health Services Executive?
Any rationalisation must be based on an in-depth review of all existing organisations and an analysis of how best they can be configured to meet the needs of those they serve. Shared services (i.e payroll, human resources, training and specialisation across regions) and a closer working relationship with statutory services—rather than the traditional ‘parochial’ model of total self-sufficiency—offer opportunities to maximise service delivery in the most focused and cost-effective way.
Volunteers were once the backbone of many services. The ‘professionalisation’ of services has resulted is a sharp decline in the number of volunteers currently involved in service delivery. Volunteers are now mainly confined to membership of Boards of Directors and to fundraising. The current recession and the move to person-centred services and personal outcomes offer a great opportunity to invest some time and resources in re-introducing volunteers into service delivery.
The value of volunteers has been recognised in many studies and reports over the past yen years. The most recent report Volunteering in intellectual disability services in Ireland’ (recently completed by the National Federation of Voluntary Bodies) offers many valuable insights. The Special Olympics movement has proved beyond any doubt the value of volunteers working with and supporting people with an intellectual disability. Now is an opportune time to invest some time and resources in re-introducing volunteers into service delivery.
An old cliché comes to mind: ‘When the going gets tough, the tough get going’. This cliché can be adapted to the challenges now faced by all stakeholders in the disability world. Advocacy groups such as Inclusion Ireland and the Parents & Siblings Alliance, and service provider umbrella organisations like the National Federation of Voluntary Bodies and the Disability Federation of Ireland must work together to ensure that the current challenges have the least possible negative impact on the those we serve—people with an Intellectual Disability and their families. That is the challenge facing us. Time will tell how we respond and whether we are tough enough for the tough times ahead.