HSE Budget Cuts —their impact on services for people with disabilities

Deirdre Carroll, Inclusion Ireland


Parents of people with disabilities and service providers were greatly relieved by the statement issued on the 1st of July by the new Minister for State with responsibility for Disability and Mental Health services, Mr. John Moloney, TD., that the promised €50m to fund new developments will go ahead as planned in 2008. This money will fund much needed new residential, day and respite services and additional therapy supports for pre-school children and children with autism and is provided under the three year multi annual investment programme for disability 2007–2009 which forms part of the Government’s Disability Strategy. The Strategy was launched to much public fanfare in 2005 by the then Taoiseach, Bertie Aherne.

The stark decline in the economy and the ever increasing costs of hospital care and of demand led schemes such as medical cards, Domiciliary Care Alowance, has put extreme pressure on the HSE Budget. The HSE is obligated under the Health Act 2004 to remain within its Budget and strong warnings have gone out this year from the Minister of Health and Children, Mary Harney and the Department of Finance that no overruns will be tolerated. Unfortunately, Disability Services come under the HSE and at the beginning of this year alarm bells were ringing within the HSE. One way of saving money was to delay the allocation of the €50m for new disability services until the last possible minute keeping the unspent money to offset the inevitable overruns of the budget at the end of the year. It made no difference that the money was earmarked for disability services because within the HSE there is no distinction between acute hospital services and community care and ‘Peter can be robbed to pay Paul’. In 2007 the €25m earmarked to mental health services remained unspent much to the chagrin of those campaigning for change in these services and despite the Government’s commitment to introducing the recommendations outlined in the report of the expert group on mental health policy “A Vision for Change”.

Once it became clear that the promised investment in disability services in 2008 was not about to happen families and service providers became alarmed. A number of parents contacted Inclusion Ireland for help. Parents of school leavers were told that there would be no place for their child leaving school in September. Parents who had young people finishing three year rehabilitative training programmes were told that there was no money for them to access a long term day service place. Twenty one parents facing this bleak outlook were signatories to a letter to Inclusion Ireland
“what is to happen to our sons and daughters as they are unable to lead independent lives? Are they to be sent home and forgotten about? If this is allowed to happen they will not only suffer the trauma of being excluded from the work of support they have known for three years, they will also lose contact with their friends. They will be isolated. As parents we are also traumatised because this is a prospect too awful to consider.”

A great deal of pressure was brought to bear on public representatives and the impact of the funding shortfalls to public attention on RTE’s Morning Ireland programme by the CEO of St Michael’s House, Paul Ledwidge. As a result of this concerted pressure and insistence by Minister Moloney and the Department of Health that the money be spent for the purposes it was designed for, a reprieve was granted. Though the HSE has still managed to save €17m of the promised €50m this year because the start date for many new services has now been delayed .

This type of carry on and uncertainty naturally leads families of people with disabilities to question what will happen next year? Will parents again be faced with the same anxiety-provoking prevarications by that agency of government, the HSE? Will service providers be left in situations where they are unable to plan for future needs as they were over ten years ago? The Minister for Health has stated that cuts to the value of €144m are being sought from the HSE this year despite the fact that the HSE is running nearly €300m over budget. A welcome reprieve has been won in relation to promised new money but will this gain be clawed back through some other method?

The HSE says that the final tranche of the multi-annual investment programme will be secured for 2009 and that all new developments for 2008 will be delivered. This is indeed good news but there are growing concerns about the lack of an arrangement or plan to fund any new developments after 2009 when the multi annual investment programme is seen to be completed. It is hard to see in these more challenging economic times anything replacing this investment programme. Indeed, it will be difficult to continue to provide the same level of current services with rising inflation and all other costs increasing.

The picture painted is gloomy but perhaps there is an upside to these more straightened economic times. Services will have to look deep into their organisation and examine their current spending and seek ways to become not only more efficient but also more effective in terms of giving extra value to their service users. Greater financial transparency will follow which will be welcomed by all. Unions will have to be negotiated with to improve work practises that are no longer relevant to community based services. New ways of funding services such as individualised payments must be embraced. (While this is not the panacea to all funding woes it can be used effectively for a percentage of people.) Innovative and flexible services moving away from the traditional ways of doing things will be encouraged. Complacency and doing things ‘the way we always did them’ will be no longer good enough.

A great deal of investment has gone into disability services in the last five years and with the Government’s Disability Strategy the issues have been placed firmly on the political agenda. The new Taoiseach, Brian Cowen played an important role both as Minister of Health and Finance in drawing up this agenda it must not be allowed to fail.