Value for Money and Policy
Review of Disability Services
in Ireland
Presentation to the Irish Association
of Supported Employment.
14th November 2012
Colm Desmond, PO
Disability Services Unit, Department of Health
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Background


Review commenced in July 2009
Scope of the review:
Define and describe the objectives of the disability
services;
 Consider the extent to which existing policies are
consistent with delivery of those objectives;
 Assess whether current policies and investments
arising from those policies are sustainable in the
context of the changing economic climate; and
 Propose the policy changes, if any, needed to ensure
that overall objectives are delivered.

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Background (Cont’d)

The review comprised two strands:
 A examination of the effectiveness and
efficiency of the current disability services
programme; and
 A review of current policy in relation to
disability services funded from Health Vote
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Limitations

A number of factors limited the ability of the
project team to look at the sector in totality:
The size & diversity of the sector & time factor;
 Lack of agreed units of outputs for some services;
 Lack of outcome measurement / reporting;
 Lack of comparable financial data, collected in a
consistent manner;
 Capacity of some agencies to engage with the review
notwithstanding their willingness to do so.

Current Position



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Final report signed off by VFM Steering Group
on 5th June 2012
Review approved by Government and published
in July 2012
Agencies requested to examine
recommendations & draw up a plan of action
Implementation planning has commenced in
DoH and HSE
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Key Message

The Review proposes a fundamental change in
approach to the governance, funding and focus
of the Disability Services Programme, with the
migration from an approach that is
predominantly centred on group-based service
delivery towards a model of person-centred and
individually chosen supports
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Key Findings


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85% of expenditure is on pay, 15% on non-pay
45% of direct pay is on residential services, 19%
on day services, 11% on multi disciplinary
services, 9% management & admin, 4% respite,
12% other services
No national guidelines on rostering practices,
skill mix or staff/client ratios, although these are
essential components of the cost of providing
services.
Services are heavily
professionalised
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Key Findings (Cont’d)

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Past: focus on inputs, outputs and global costs.
Future: focus on outcomes and unit costs, but:
 no common definition of outcomes, and no
national measurement or monitoring;
 Insufficient information to determine unit
costs at individual service user level,
consequently no analysis or monitoring.
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Employment - Key Findings

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The provision of Health supports plays a vital
part in enabling a person with disabilities to
access education and employment.
Most people accessing specialist disability
services are not in employment in the open
labour market. (Expert Reference Group
reported that 2,389 of 25,302 people using day
services could be considered to be in the
workplace (9%) )
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Employment – Recommendations 1


Indicators should be developed to measure the
effectiveness of the disability services in promoting
personal progress through access to day services and
supports.
The health sector should continue to be responsible for
providing health-related supports to facilitate access to
mainstream services in the following areas: education,
employment, housing, transport, healthcare and
community inclusion e.g. personal assistance supports
for adults who live in the community or therapy
supports for children attending schools etc.
Disability Services Value for
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Employment – Recommendations 2

In the absence of day service standards being set
and monitored by HIQA, the HSE should
establish a framework whereby they can satisfy
themselves, within the context of the SLA
process, of the outcomes and quality of day
services through dissemination of quality
assurance guidelines, self-evaluation and
continuous quality improvement protocols.
Challenges

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Capacity of the system to implement the
recommendations
Need to increase efficiency of current system pending
migration to new model and achievement of target cost
per place
Implementation of standardised assessment method for
services and needs
Change-over to provision of services based on identified
need and personal choice
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Opportunities

Current financial climate will provide an impetus for innovative
solutions

Opportune time to make changes to staff mix and embedded
rostering practices

Desire amongst many service users and their families for greater
choice, control, independence and social inclusion

Realisation by service providers that the landscape has changed
and they must change with it

Innovative practices already evident on the ground
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Implementation

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Framework for implementation will depend
heavily on new structure of Health Service
Options are currently being considered for a
national implementation plan for VFM
Would welcome feedback and input from sector
to the report and to implementation
Implementation Priorities

Strengthen national disability function

Initiate demonstration projects to drive migration
towards person-centred model

Put in place commissioning and procurement
framework

Develop national resource allocation model which will
provide a framework for individualised budgeting &
‘money follows the patient’

Establish strategic information requirements
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Immediate Actions
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Streamline SLA process
Standardise financial reporting
Each agency to examine VFM findings and draw up
plans for: audit of rosters, review of skill mix, critical
examination of cost base, reduction in average cost per
place (for a range of service types and support needs)
Introduce unique identifier to support a move to
individualised resource allocation and service provision
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Conclusion
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Report sets out a clear direction for the development of
disability services
Policy direction is in line with the findings of various
public consultations and recent HSE reports (Adult
Day Services, Congregated Settings)
Broad welcome for the policy expected from people
with disabilities and families, and disability agencies, but
concerns about continuity of service pending migration
to new model, and also the effects of the country’s
current financial difficulties.
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Value for money & policy review of disability services in Ireland