Áiseanna Tacaíochta
Realising Equality through Active
3rd December 2014
Supporting Innovation and Change through
the AT Model
Sheila Marshall
Area Operations Manager
HSE North Dublin
HSE North Dublin
HSE North Dublin - Profile
• Population: 244,324 (Census 2011)
• 10% population growth in North Dublin since 2006 over the
national average of 8.2%. North Dublin has the largest population
growth over DML (8.6%) HSE South (7.4%) and HSE West (7.7%)
• Covers a wide geographical area.
• GMS Patients – 33% of population (82,505)
• Further 2% eligible for GP Visit only cards (5187)
• Age profiles
under 4 years= 8.3%, under 19 years = 28%, over 65 = 10.9%
• Deprivation score: 42% of population classed in the high, medium
or low deprived category.
• Persons with disabilities: 7.4% of population.
HSE North Dublin
Disability Services
No of Home Care Packages: 292
No of private residential placements: 89
Budget: €50.2m
Policy Documentation
United Nations Convention on the Rights of
Persons with Disabilities – Article 19
Requires that people with disabilities can live
independently and be included in the community,
with choices equal to others.
Programme for Government (2011 – 2016)
Commits to the introduction of personalised budgets
for disability services.
The National Disability Strategy.
Time to Move On from Congregated Settings.
Policy Documentation
HSE’s New Directions Personal Support Services for
Adults with Disabilities Report.
Personal Support Services for Adults with Disabilities
underpinned by the Core Values of:
- Person Centredness
- Community Inclusion and Active Citzenship
- Quality
Policy Documentation
Promoting Inclusion and Participation - Strategic Plan 20132015 – National Disability Association.
Strategic Priority 1:
National Disability Strategy
Strategic Priority 2:
Living Independently in the community.
Strategic Priority 3:
Universal Design of the environment.
Strategic Priority 4:
Effective and efficient organisation.
Promoting Inclusion and Participation Strategic Plan 2013-2015 – National Disability
Strategic Priority 2:
The National Disability Authority’s policy advice,
based on research evidence, and on learning from
other jurisdictions, is that better outcomes for
people with disabilities can be achieved by
refocusing the current spending and orientation of
disability services away from block-funding of
providers and towards a more personalised
Policy Documentation
Value for Money (VFM) and Policy Review of
Disability Services in Ireland – approved by
Government Decision of 17th July 2012
• Steering Group Project Initiation Document –
September 2014.
VFM Working Groups
Established in 2014.
Working Group 1:
Person-Centred Model of Services and Supports –
Strategic Planning
Working Group 2:
Person-Centred Model of Services and Supports –
Implementation, Oversight and Support.
Working Group 3:
People with Disabilities and Community Involvement.
VFM Working Groups Cont.
Established in 2014.
Working Group 4:
Quality and Standards.
Working Group 5:
Management and Information Systems.
Working Group 6:
Governance and Service Arrangements.
VFM Working Group 1 – sub group 2
Evaluation Process: Service Delivery Models
and Demonstration Projects:
Terms of Reference:
• Develop the baseline data and comprehensive
evaluation process to evaluate existing services and
new demonstration projects, and assess suitability
for wider application.
• The Health Service will develop a mechanism to
enable this work to be carried out in an appropriate
VFM Working Group 1 – sub group 2 Cont.
• The work will seek to use research and analytical
capacity to support this work, rather than the Health
Service itself resourcing this input separately.
• The work will involve a statement of current projects
and the evaluation of these projects and their
subsequent learning will inform the development of
alternative service options.
• The output from this work will inform the decisions
on the Annual Service Plan and Operational Plan for
Social Care.
VFM Working Group 1 – sub group 2 Cont.
• Based on the output of the work outlined above and
input from the other working groups an
implementation plan will be developed, taking
account of any policy appraisal, the scale of
organisational change and associated capacity
Áiseanna Tacaíochta (ÁT)
Direct Payments Model
“Supports people with disability to move away
from dependency on service providers and to
gain control over their own budgets, their own
services and, ultimately, their own lives. By
self managing and taking new responsibilities,
our Leaders move from being passive users of
services to becoming active business people in
the community” – An Introduction to
Áiseanna Tacaíochta – 2014.
ÁT Direct Payments Pilot
• In October 2010 Genio provided funding to ÁT in the sum of
€60,000 to support five individuals to establish a system for
managing their own funding and directing their own supports.
• AT proceeded to establish a pilot system of Direct Payments with
4 Personal Assistant (PA) users. With ÁT as the proposed
intermediary who facilitates the financial transfer of funds from
the HSE to the individual Leaders by itself negotiating an
omnibus SLA with the HSE and a Grant Aid Agreement with each
• ÁT submitted a business plan to HSE North Dublin in March
2011.Successful discussions were held with the Regional
Specialist for Disabilities and the Disability Manager.
ÁT Direct Payments Pilot
• The first meeting of the ÁT Pilot Monitoring Group was held in November
2011. The membership comprised representatives from ÁT, the Irish
Wheelchair Association (IWA), HSE North Dublin and HSE Dublin North
• Project suspended for a period during 2012 to deal with a number of
issues including TUPE arrangements.
• Evaluation and risk assessment (Finance/HR/contingency arrangements
etc) was submitted to the HSE in February 2013 – describing ÁT’s
governance arrangements/operating procedures and its planning and
financial reporting.
• In March 2013, HSE North Dublin agreed to enter into a Service Level
Agreement with ÁT for the clients that were current to the service,
thereby bringing the pilot phase to a successful conclusion.
ÁT Direct Payments Model – post pilot phase
• Further funding was secured from Genio - €50,000, in
addition to financial support from the National Lottery
and funding from membership subscriptions.
• ÁT currently has 21 members with an additional 5 joining
in January 2015.
• Aim to have 50 members by 2016.
• Development of training programmes.
• Virtual Office and online hub for members.
• HSE North Dublin continues to support the model –
currently funding 18,972 hours per annum (€355,123)
Direct Payments - The Future
• Legislation
• VFM Governance document – HSE framework for
• Models of good practice
• Learning
• Sustainability for AT model – 50 participants
• Selective application – may not suit every person
using PAs.
• Legal capacity and contractual status.
• Continuing fiscal and economic challenges

Sheila Marshall - The AT Network