A review is under way into what the Health Service Executive has described as "the unacceptable use of client funds" at one of the country's largest organisations providing services for people with disabilities.
It is understood that management at Stewarts Care alerted the HSE to "legacy" practices in place in the past relating to how money it was essentially minding on behalf of people in its facilities was used.
External consultants, BDO, have been appointed by the HSE to look into the issue and whether it was in line with official patients' private property guidelines. It is unclear at this stage the sums that will be involved in the review. This process is expected to be completed in September.
It is understood that gardaí were also informed by Stewarts Care management but any investigation is not expected to take place until the consultancy report is finalised.
Stewarts Care provides residential care to more than 260 people overall, with about 150 at its campus in west Dublin with others based in a number of houses. It also provides daycare for about 500 people, respite for adults and children as well as support for families.
Some sources suggested that the issue surrounds whether money being held for those in residential care should be used for their individual benefit exclusively or whether it can also be used for purposes that would benefit others , such as on works in their accommodation.
Projected spending
Separately, it is understood that Stewarts Care, along with other disability service providers, have been told to scale back projected spending in the months ahead to offset financial deficits in the overall sector which had reached more than €20 million by the end of April.
Disability providers have expressed concern that new spending controls ordered by the HSE to live within budgets will leave them in conflict with obligations to the watchdog Health Information and Quality Authority (Hiqa) on level and standards of services to be provided.
Stewarts Care, which has a budget of more than €50 million and employs about 1,000 staff to care for about 1,000 patients, recorded a financial deficit of €6.2 million in 2018. It subsequently received about €5 million in HSE supplementary funding.
It is understood the HSE had anticipated that it would have an overrun of about €2.3 million this year. However in recent days Stewarts Care has told senior HSE management that its projected deficit could hit €5.2 million.
It is understood that Stewarts Care, on foot of instructions from the HSE to scale back spending in the months ahead, has now told trade unions that staffing levels will be restricted to providing “a safe level of service”.
Funding is unlikely to be available for additional “meaningful or quality of life” services such as to provide staff for outings or trips away from the campus. Funding for non-pay issues is also likely to be curtailed.
Stewarts Care has strongly argued that expenditure recorded over the last year or so, including on more than 80 additional staff, training and new structures, was critical to meet standards laid down by Hiqa to allow it to achieve official registration.
Regulatory/performance concerns
The HSE last year issued Stewarts Care with a “performance notice” or official warning in relation to the review of unacceptable use of client funds and financial governance and deficits.
The HSE said it was working closely with Stewarts Care on a number of identified governance and regulatory/performance concerns, which include an independent review which has not yet concluded.
“At this point in time, it would be prejudicial to comment further until the review process has been concluded, and due process has been afforded.”
Stewarts Care is what is known as a section 38 organisation and its staff are considered to be public servants.
Internal HSE reports maintain there is concern about "substantial deficit challenges" in both section 38 and section 39 organisations – non-State bodies which are grant-aided to provide services – in the disability sector. HSE documents say it has advised the Department of Health of "high-level risks" about both the finances of these organisations and in relation to the delivery of services.
The HSE said a joint group would be established with the Department of Health to examine financial overruns in disability services to date and identify measures to limit potential deficits in 2019 .
The Department of Health said: “Organisations which provide health and social care services for people with a disability under service arrangements with the Health Service Executive (HSE) are in continuous dialogue with the HSE, as their key funder, regarding their financial positions.”
