Tuesday, January 11, 2011

Direct payments to disabled people more efficient, cost-effective delivery of services, Irish report says

From The Irish Times:

Providing direct payments to people with disabilities for services could be more equitable and cost-effective than giving money to voluntary organisations, according to a report commissioned by the Government.

The report, expected to be published shortly, is based on a public consultation of about 200 voluntary groups, family members and service users regarding the efficiency and effectiveness of disability services.

The State pays about €1.5 billion for residential and day services in the disability sector each year. Much of this goes to voluntary service providers.

Providing direct payments, or individualised budgets, to people with disabilities emerged as the favoured alternative policy to improve disability services. The introduction of such a system would allow the person to have much greater control over their life and care, the report noted.

“People should be able to choose their services rather than ‘fit’ into what a provider offers,” said one unnamed voluntary service provider, quoted in the report. Another said: “[We need] a campaign to change the national culture from [being] charity-based to seeing people with disability as equal citizens.”

The report has been submitted to Minister of State with responsibility for disability John Moloney, who has spoken in favour of introducing a direct payments model. This consultation report forms part of a wider value-for-money review of the sector.

Most respondents – 60 per cent – reported being dissatisfied with the amount of choice people with disabilities have over the services they receive. Just one in five reported being satisfied.Similarly, a majority – 61 per cent – reported feeling dissatisfied with the independence they have in their lives.

The changes recommended by respondents include increasing personal assistant services for disabled people and increasing the availability of local authority housing.

Another key theme among people with disabilities was a strong desire to be listened to and consulted by staff and service providers. “Families and some staff should treat us like adults and listen to what we want for ourselves,” said one unnamed service user.

The provision of independent advocacy services was another suggestion, with many saying it would enhance their ability to make choices and provide them with greater levels of independence. “[We need more] out-of-hours support. Life goes on after nine-to-five and during weekends,” said one service provider.

There was also widespread dissatisfaction with the efficiency of disability services. When asked how the sector could be made more effective, many suggested more sharing of resources or partnerships between organisations.

A greater focus on frontline staff and less focus on administration was another theme in the report.

When asked what services were working particularly well in meeting people’s needs, just over one-third provided a response. The most common response (18 per cent) was that assessments of needs and person-centred planning were having a positive impact. Some, however, felt very few services were meeting the needs of disabled people.

“I don’t see one thing that is working . . . there is no respite – nothing, nothing, nothing works,” said one family member/carer.