Value for Money & Policy Review of Disability Services

Background Information: The National Federation of Voluntary Bodies Providing Services to People with Intellectual Disability is a national umbrella organisation for voluntary/non-statutory agencies who provide direct services to people with intellectual disability in Ireland 61 Member Organisations who account for in excess of 85% of this country’s direct service provision to people with an intellectual disability Section 38 & Section 39 Organisations 2000 – Largest investment ever in services development 2004 – Health Act – Service Level Agreements (SLAs) 2005 – Report of Comptroller & Auditor General 2009 – Value for Money Report

Value for Money & Policy Review of Disability Services Evaluation of the efficiency and effectiveness of disability services in Ireland. The review was overseen by a Steering Group, chaired by Mr. Lawrence Crowley. Its primary purpose was to: a) assess how well current services for people with disabilities meet their objectives and support the future planning and development of services; and b) to make recommendations that will ensure that the very substantial funding provided to the sector is used to maximum benefit for persons with disability, having regard to overall resource constraints.

Value for Money & Policy Review of Disability Services  Expert Reference Group on Disability Policy was established to look specifically at:  existing disability policy; and  assess whether it needs to be changed to better meet the expectations and objectives of people with disabilities.  Oversaw a public consultation process:  more choice;  more control.

Value for Money & Policy Review of Disability Services  The over-riding focus of the recommendations is on:  a programme of Governance;  delivery-model change; and  a detailed upgrading of information in respect of precision, scope and format.

Value for Money & Policy Review of Disability Services 1. Administration & Governance: The national disability function within the HSE must be strengthened and given a central directional role in funding, shaping and driving the Disabilities Service Programme. 2. Person Centred Services & Supports: HSE should drive migration towards a person-centred model of services and supports through the Service Level Agreement process. Note work already being done in this regard: Genio Projects; Next Steps Project. 3.Commissioning & Procurement: Re-shaping of certain services and models.

Value for Money & Policy Review of Disability Services 4. Resource Allocation: A national resource allocation model should be developed  Supports Intensity Scale (SIS);  In-Control;  InterRAI. 5.Information Infrastructure: Strategic information requirements should be established.  National Disability Databases;  Service Level Agreements.

Value for Money & Policy Review of Disability Services IMMEDIATE ACTIONS: 1. The Service Level Agreement process  Improvements to information gathering; and  performance monitoring. 2.Standardise Financial Reporting – Development of a common coding system to enable expenditure to be tracked, analysed, and compared at national, regional and local levels. 3.A unique identifier should be put in place to facilitate: a) Individual Needs Assessment; b) Person-Centred Planning; c) Individualised Budgeting.

Value for Money & Policy Review of Disability Services IMMEDIATE ACTIONS (continued): 4. Examination of Value for Money Findings i. Audit of Rosters: Rationalise staff deployment across service units in accordance with client need and cost effectiveness. ii. Skill Mix: National guidelines should be developed to advise on the appropriate mix of professional and non-professional staff. iii. Unit Cost: HSE should work jointly with service provider to critically examine existing cost bases in the light of the findings and recommendations contained in Chapter 5 of the Value for Money Review. iv. Average Costs: Pending the development of a resource allocation model, the Service Level Agreement process should be used to reduce current direct pay costs.

Value for Money & Policy Review of Disability Services IMMEDIATE ACTIONS (continued): 5. Policy Appraisal 6.Implementation Plan A robust Implementation Framework should be developed which takes account of the policy appraisal.

Value for Money & Policy Review of Disability Services IMPLEMENTATION PLAN: a) Disability Programme Objective  more choice;  More control. b)Economy & Efficiency  a Framework to assess need, identify outputs and outcomes and plan and monitor resource usage. c)Effectiveness  Develop national indicators to objectively measure the effectiveness of the Disability Services Programme. d)Governance & Accountability  Role of the National Disability Unit of the HSE;  SLAs agreed with Regional Director of Operations and Integrated Service Area Managers.

Value for Money & Policy Review of Disability Services IMPLEMENTATION PLAN (continued): e)Information Framework f)Funding Framework  Block Grant Funding no longer sufficient to address degree of accountability and transparency required. g)Future Policy Direction g) Current objectives are still valid, but the policy approach used to deliver these objectives has not been effective.  Continued sustainability of the current policy approach is questioned.

Value for Money & Policy Review of Disability Services  Existing services should be re-configured;  New resource allocation models developed;  Transition from traditional programme type to more individual costing approaches can take place;  All future developments will be delivered in line with the new vision.