Secret Cabinet memo reveals Ministers cautious at voluntary sector plan

The review group on the future relationship between the State and voluntary healthcare sector has recommended widespread reforms, including a radical new funding arrangement.

Sources suggest its proposals have not been greeted with wild enthusiasm in the Department of Health and there will be no mad rush in Government to implement them.

In a confidential memo to the Cabinet last Tuesday, Minister for Health Simon Harris accepted the report's call for dialogue between the department, health agencies and voluntary organisations as well as for a need to improve corporate governance.

However, he signalled that many of the group’s key proposals would effectively be kicked to touch.

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"Other recommendations in the report will require further consideration and engagement with other Government departments and State agencies including the HSE, " the memo says. "Many of these recommendations relate to broader health service reform objectives and will be considered further as part of the Sláintecare implementation programme."

Voluntary organisations

Highly-placed sources maintained that a number of Ministers believe the findings were very close to the arguments put forward by voluntary organisations.

It is understood that a proposal for the Government to review the financial position of voluntary organisations and table proposals for resolving any deficits did not go down well in the Department of Public Expenditure.

The Department of Finance told the Cabinet this "unspecified proposal...while subject to a further Government decision, would most likely give rise to a general Government expenditure" and could also have implications under EU State aid rules.

Harris said he would consider a process to examine issues raised in the report by a group chaired by former European Commission official Catherine Day, including the main drivers of deficits and financial management in the sector.

Much attention has focused on the recommendation that voluntary organisations in receipt of State funding should be cognisant of the impact of religious décor on patients/service users.

However, the group’s main proposal was for a major change to existing funding arrangements. It suggested that rather than providing block grants to voluntary hospitals and other organisations, the State should compile a list of essential services it wants provided for the public.

Public system

It said the State could commission these either from voluntary or private providers or else deliver them directly through the public system.

Harris was very cautious about this idea in his memo. He said the commissioning model “would require much further consideration”.

“Internationally, there is mixed evidence in relation to the effectiveness of commissioning and in many cases it can be very costly to implement.”

Harris also said that while he accepted that voluntary organisations were “clearly frustrated” by some of their engagements with the HSE, he also “recognised the importance of maintaining robust oversight and reporting given the levels of public funding involved”.