OURS is the first generation in the history of the State where the provision of social services is mainly non-denominationalal.
The State has taken up some of the slack and nearly all of the bill. Fine Gael’s Senator Colm Burke ascertained the bill amounted to €3.27 billion to 2,680 organisations from the HSE alone in 2012. Just 48 of those organisations accounted for 86% of that money. Officials from their ultimate paymaster, the Department of Health, will appear before the Public Accounts Committee on Dec 19.
Much of the organisational control, once almost exclusively denominational, is now secularised.
Take away the religious statues and it is clear we have not any greater accountability. The real religion is always control. As God, the doer of good works, shuffles from semi-retirement to redundancy, powerful people with a god-complex go on.
Compared to budgets counted in the billions, the money involved in top-ups to senior staff is peanuts. The problem is that we have been treated like monkeys.
Differing but not necessarily contradictory accounts from one serving and another former Central Remedial Clinic (CRC) board member provide an instructive but far from comprehensive insight.
Former Government Chief Whip Vincent Brady, serving currently, says the board never sanctioned any top-up. Des Peelo, a former board member of 24 years standing and a former chairman, says that key people in the HSE knew about the payments in 2009. Speaking to Seán O’Rouke on RTÉ radio Peelo made the point that senior employees had employment contracts. The CRC had legal obligations. Phasing them out through retirements was the best that could be done and this is what is happening. The net point of apparent difference between his and Brady’s account revolves around how, when and if this information was shared with the full board of the CRC.
It would be a storm in a tea cup, except nearly all of it is beside the point. The point is bigger, it’s cultural and it involves far greater amounts of money. It also involves far higher stakes.
In fact your life, and certainly your quality of life when you are most vulnerable may depend on it. What is at the core of the issue is not money, it is power, vast power across the improvised social infrastructure of our state.
There was apparently a legal argument for topping up some salaries in the CRC. There may be elsewhere too. Based on the figures published, there must be a question mark over whether a suitably qualified person could be found to do some the jobs for the officially going rate. The board of Crumlin Children’s Hospital has put its hands up and said that €110,000 is not an appropriate recompense for the responsibility of its chief executive. The pity is we were not told that a long time ago. In the meantime the profits from the tuck shop or other “commercial activity” at the hospital have been used to provide a top-up of €30,000 per annum. We were not told that either.
What is killing the voluntary and charity sector reputationally is less the fact of the payments, it is their non-disclosure. And this is all about power, not service of any kind. It is about how power is understood and how it is used. Bodies with the words charity or voluntary on their name plate enjoy an almost pervasive presumption of goodness. Very many do a lot of good. But many are also large businesses and powerful entities.
Few businesses and no minister could hope to enjoy the sort of soft soaping in the media that the representatives of powerful multi-million euro enterprises regularly bask in. Their contentions about resources or the lack of them are habitually swallowed hole. What has been almost entirely absent from public debate to date is a holding to account of the value for money and the standard of services being provided in the charity and voluntary sectors. A notable exception is religious run institutions in the past.
To even raise hard questions is to be accused in some quarters of feeding hemlock to children, the disabled and the dying. One good I hope for out of this hullabaloo is a much harder look at how vast amounts of public money are spent, and where exactly they are going.
The health budget is the second largest in the State after social protection. The HSE is the largest and by far the most complex organisation in the country. Fully 70 % of its budget goes on pay and pensions.
Writing now I try but fail to recall any credible narrative from an overwhelmingly publicly funded voluntary and charity sector ascribing its lack of resources even in part to the fact that we paid over the odds for years for the services of health professionals and certainly more than we can afford. Hand in glove with those health professionals, who always had first place at the HSE trough, it is hardly surprising that at least some voluntary and charity bodies themselves embraced the same culture of entitlement they historically worked so closely with.
I SUSPECT that the amount of illegality underlying this commotion is negligible. I know that the ethos of entitlement, the entitlement to decide who knows what, is much more pervasive. Two pillars of this state are resolutely strong and powerful. One is the judiciary and another is the executive. In contrast our parliament and social infrastructure are chronically weak.
Social policy was from the outset outsourced to religious denominations. The religious if remaining on the boards of voluntary hospitals and schools are otherwise largely absent. More recently a modern voluntary and charity sector grew up alongside the religious run institutions. Founded to meet often shocking social need, they grew to mimic and master opaque patterns of governance and in places the same sense of entitlement. Personnel and ethos changed but old patterns of power reemerged and were renewed.
Now facing a life expectancy of over eighty, and smaller families to support more aging people, it is unlikely many of us will escape the need for a service provider in the voluntary and charity sector.
We have a very personal reason for ensuring their governance is transparent and the standard of their services are the highest. Many are. Some clearly are not.
But this recent fuss is not about a new issue. The report of the Health Information and Quality Authority (HIQA) reporting on the governance debacle at Tallaght hospital had this to say about health and social care service providers in receipt of State funds, “They should be compliant with all directives from the Departments of Finance and Public Expenditure and Reform (particularly in relation to finance, procurement and staffing)”. Indeed.
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