The future of vital and often life-changing care services for 3,000 vulnerable people with disabilities, including almost 200 children, this week hang in the balance.
Besieged by chronic underfunding, Rehab Group, the largest provider of care services for people with disabilities in Ireland, was forced to tell its funder, the HSE, that unless it receives an urgent injection of cash it has no choice but to cease providing all care within 12 months.
It is an unprecedented decision in the history of the relationship between voluntary service providers and their funders in Ireland.
It is one which was weighed down with the knowledge of the upset and anxiety the news will bring to the people in our services, their often hard-pressed families and our 1,500 staff, who almost universally provide their labour at below the going rate as successive governments fail to recognise their value or role.
The Rehabilitation Institute first opened its doors in 1949 to support people recovering from TB to rebuild their lives, to regain their independence and to re-enter the workforce following their illness.
We are now staring down the barrel of closing those doors more than seven decades later.
This was a deeply difficult and wounding decision for our organisation.
Having continued to try to meet the burgeoning need in the community in the form of respite, day services, resource and supported accommodation services to adults and children during a recessionary hit country beset by crippling cuts it is no surprise we have ended up with such a hole in our finances.
In recent years, necessary regulation has been introduced, but with it came a serious imbalance of heavily staffed regulatory bodies not being matched by the requisite supports to assist hugely under-resourced charities.
Chronic underfunding of the many organisations providing vital services to disabled citizens has created a situation now where many services are now operating on financial life-support.
Anecdotally, we understand that the combined deficit among Section 39 disability providers stands at €30m, while a number of organisations are existing on loans from the funder.
We are aware that the HSE itself could run the services we currently operate, or they could be put out to tender for other providers or for the private sector to run them.
But we believe that this is not necessary, and would not represent good value for money. Being a voluntary not-for-profit, we are not in the business of making profits.
In 2012, as the downturn in the economy bit, we lost valuable sources of independent income that we had been able to draw upon to enhance the quality of the services we provide for the HSE.
These included income from the Charitable Lotteries Fund, and later from a service we ran in Saudi Arabia as well as from other fundraising, which together at their height brought in millions of euro.
These meant we could carry the underfunding of RehabCare, but not anymore, as this income has dried up.
This was preceded by the HSE’s decision in 2010, to stop paying annual increments to take account of inflation.
This impacted at a rate of 2.5% every year and we picked up that cost.
Our sector has always been committed to providing high-quality services.
We bring this commitment, and our core values, to work every day.
We believe we are best placed to provide these services, but we must be properly funded to do so to the best possible standard, a standard set by the State’s own agencies.
Indeed, a recent benchmarking exercise conducted by Mazar’s to evaluate Rehab Group’s position relative to all similar organisations in Ireland revealed that Rehab demonstrated good value for money.
Without the services that RehabCare provides, people with disabilities would lose contact with their communities and become isolated; families would get no respite from the grind of providing round-the-clock care for children or family members with often very high support needs; people would continue to languish in wholly unsuitable and often inhumane institutional settings.
The crisis in our sector will not come as news to the HSE nor to the health minister.
We have been engaging with the HSE for years and have alerted them that underfunding has forced us to use our reserves to fill the gap.
The health minister was informed last July that if sufficient funding is not provided to RehabCare in 2019, the Board will be left with no choice but to terminate contracts as continuing to operate, while knowing that we are running out of cash, is contrary to the strict rules of company law which bind our board.
By issuing this notice, and going public with it, the Rehab Group is drawing attention to a growing crisis in the independent not-for-profit sector, on which the State relies to provide disability services; a crisis which has brought many organisations to the brink of financial sustainability, a crisis which must be addressed urgently.
The report of the independent review group on the relationship between the voluntary sector and the State, chaired by Catherine Day and published in January of this year, recommended a new funding approach be adopted by the State for the provision of social care services.
We welcome this, as well as the recommendation for multi-annual funding, rather than the year in-year out battle to secure sufficient funds to simply survive.
We are not walking away from our commitment to 3,000 people, their families or our staff.
We want to continue to provide quality day, person-centred services to people with disabilities all over Ireland.
Our staff are hugely committed and our Hiqa record is very good.
But we cannot do so unless there is a recognition, at a political level, that the whole disability sector needs an urgent injection of funding, and needs it now.
How the Government responds to the issue of the underfunding of the disability sector will be a vivid illustration of whether the recent ratification of the United Nations Convention on the Rights of Persons with Disabilities was sincere, or just optics.
‘Hugh has developed into a confident and independent man’
I would like to take the opportunity to express my heartfelt thanks to RehabCare for all that they have done for my family and tell you just how much it has meant to us.
I am the father of three great sons, the youngest being Hugh who has grown from child to man in the care of Bray RehabCare centre.
Hugh has developed into a confident and independent man with great social skills.
He has received great love and companionship and life-long friendship from his RehabCare family.
Hugh has also got competence in many skills including art and technology and even met his life partner. His work has pride of place on display in our home.
Hugh was identified with autism as a young child and while he received great early developmental support through his mother’s dedication, this was lost to him due to her untimely death in 2000 leaving the three boys, then teenagers, in my care.
From that day and because of RehabCare’s dedication I have managed to take care of my family in a happy and stress-free home.
I look at my sons with a huge sense of pride and to RehabCare in appreciation of all that you have done for us.
My two other sons have now their own homes and lovely partners and have found great success and happiness in their chosen careers.
I hope that the powers that be not alone provide you (RehabCare) with the resources you need to continue but show the wisdom to help you grow the organisation and help many others like Hugh.