The latest scandals in the charity sector highlight several important questions, particularly about the voluntary health sector. What services should be farmed out to not-for-profit organisations? How can the HSE ensure funded charities operate to best-practice standards? Are charities delivering value for money? Who knows? These services are seldom evaluated. We do know how much money charities receive from the HSE every year.
According to the HSE Annual Report 2015, Putting people at the heart of everything we do, €3.7 billion was allocated to the so-called voluntary sector that year. There is nothing either charitable or free about the organisations listed in the report because they are largely funded by the State. Many also fundraise on a large scale. Charity is very big business.
Half of the €3.7 billion was allocated to voluntary hospitals, general practice services and hospices. The remaining €1.8 billion was given to an astonishing range of organisations – so many it took three hours to count and categorise them.
In 2015 nearly 500 different groups received grants of more than €100,000 from the HSE. Many organisations got several million euro. Parkrun Ireland, which organises free, timed runs, received €108,000. Community Games was allocated €200,000. Console got €622,000. Muscular Dystrophy Ireland received €1,277,000.
Hundreds of groups (number not specified in the report) received grants of less than €100,000 totalling €38,301,000. For example, Donegal Sexual Abuse and Rape Crisis Centre received a grant of €1,250 for "advertising and information materials".
Citizens catered for by the funded organisations include older people (124 organisations), people with disabilities (109), addicts (62), children/youth (38), homeless people (20) and minority ethnic groups (eight).
A further 70 different groups provide services for people with chronic health problems such as depression, anxiety, HIV/Aids, deafness, eating disorders, kidney/heart/lung problems, migraine, arthritis, haemophilia and diabetes.
Duplication
Twelve organisations provide services for survivors of child abuse, rape and domestic violence. A large number (53) of community groups operate from resource and family centres, and through partnerships and networks, funded by the HSE.
The huge range of organisations leads to duplication of, and gaps in, services. Several groups deal with almost identical mental health issues. Some parts of the country have many organisations operating in the same geographical area.
Charities are in competition with each other for funding and clients. There are governance problems, as shown by the latest scandals.
Why are some of the charities even receiving funding? Does the Edward Worth Library – a book collection housed at Dr Steevens' Hospital, Dublin and receiving an annual HSE grant of €125,000 per annum – benefit citizens? What outcomes do parkrun Ireland and the Community Games deliver for those least likely to engage in physical activity? They have a feel-good quality, but are they effective?
Mismanagement and corruption are problems in all sectors of society and the charity sector is no different. According to Transparency International’s Corruption Perceptions Index, 2015, “not one single country, anywhere in the world, is corruption-free”.
More than 80 per cent of the global population live in countries with major corruption problems. Ireland is no exception. The Index measures levels of corruption in 168 countries on a scale from 0 (highly corrupt) to 100 (very clean). Denmark is the least corrupt, scoring 91, and Ireland, in 18th place, is regarded as fairly clean, scoring 75.
Does the HSE check that the funding given to charitable organisations is spent on services and not on salary top-ups for senior executives?
Health outcomes
Since the latest scandals, commentators have been stressing the great work carried out by charitable groups. But how great is it? No one knows if they are delivering measurable health outcomes. The HSE is eager to farm out services to the not-for-profit sector many of which should be provided directly by the HSE. Older people should not have to rely on charity for home supports.
People in mental health distress should not have to rely on volunteer counsellors. It is hard to escape the conclusion that the funded organisations cater for people who mainstream services don’t want to bother about.
Irish people love volunteering. The latest figures from the Central Statistics Office show that more than one in four people over 15 years of age spend 232 million hours annually on voluntary work with 18,000 organisations. This is worth €2 billion to the economy and an immeasurable amount of social capital – the glue that binds society together.
Scandals in the charity sector are a huge breach of trust and may put people off volunteering. The HSE must put robust structures in place without delay to ensure that services provided by State-funded charities are delivering real health outcomes.
Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.
drjackyjones@gmail.com