AS YOU READ these words, tens of thousands of vulnerable children and adults across Ireland are without access to vital services, appropriate care, and disability support. Our community health and social services are at a moment of true structural crisis. This crisis is a direct result of a widening pay gap faced by state-funded organisations, which has today resulted in catastrophic recruitment and retention challenges and understaffed services.
Examples of this crisis abound. As reported recently in The Journal, the recently published Nowhere to Turn report from the Ombudsman for Children’s Office (OCO) has found that “The failure of the HSE to implement key systemic recommendations as summarised below is having a detrimental effect on children and families.” The report details cases of children with severe intellectual disabilities, complex behavioural needs, autism and ADHD stranded in hospitals and respite centres, and of families left with no home support services, for months at a time.
Likewise, one of the major addiction services in this country is now unable to accept as many clients as they would have previously. Having lost 40-50% of its staff in the last year alone, they are struggling to find experienced people to replace those who moved on. Less-experienced staff cannot reasonably handle as much work as experienced employees, nor provide care to the same high standard, so the service is forced to reduce the number of individuals it can provide care for or risk a serious falloff in the quality of that care.
In Ireland, our “hybrid model” of providing public services—where the State funds charities to offer certain essential services and supports—is, like those it is supposed to provide for, suffering from a chronic lack of care. An Independent Review Group, appointed by the Government to examine the role of voluntary organisations in publicly funded health and personal social services, found that these organisations deliver approximately one-quarter of publicly funded acute hospital care and around two-thirds of disability services. In fact, these organisations collectively account for more than a quarter of the total health budget each year.
Despite their indispensable role, however, community and voluntary service providers are grappling with a pay and staffing crisis that is blocking access to and affecting the quality of vital services. This crisis stems from the stark pay gap between staff working in these organisations and those in the civil service who perform similar, often identical, roles. Current funding levels provide for salaries that will be, on average, 12% lower than civil-service salaries by October of this year.
The consequences of this crisis extend far beyond the organisations themselves; they jeopardise the delivery of essential services that countless individuals and families rely on. A report published by The Wheel and TASC in June 2023 highlights the dire consequences of pay inequity: “Turnover and vacancies are increasingly forcing organisations to reduce hours and cancel services because they lack the staff to deliver them.” The vulnerability of service users and the risk of burnout among existing staff make this a matter of utmost concern.
Over time, the relationship between the State and the community and voluntary sectors has become increasingly interdependent. The scope and scale of organisations funded to deliver essential services have expanded significantly. The looming collapse of those services has transformed this issue from a pressing internal concern for charities into a full-blown public crisis. Addressing the pay deficit is one of the most serious issues facing our health service today, yet it is rarely if ever, mentioned.
It is clear that these organisations provide services on behalf of the State which are essential to the health and wellbeing of our entire population. As such, they require levels of funding that truly reflect the magnitude of their many contributions. The Government must act now to address the existing pay deficit, which traces its roots back to funding cuts imposed in 2008.
Bringing pay levels in line with public-service agreements is not just a matter of fairness; it’s a matter of maintaining the integrity of our healthcare system.
To effectively address this crisis, we urgently need comprehensive data from the HSE, Tusla, and the Department of Housing, Local Government and Heritage which will enable us to quantify the full extent of the crisis and identify the precise amount needed to bridge these gaps. In the process of resolving this issue, we must also recognise the unique position of sector representatives as employers. While their organisations are contracted to deliver services by the state under specific funding arrangements, they have limited control over salary levels and employment benefits. Simultaneously, they are subject to industrial action from a union perspective. Engagement with relevant bodies must consider this complex interplay of factors.
The growing crisis in health and social care services has the potential to affect us all, from current and future service users to dedicated, hardworking, and underpaid staff members. It is all but a certainty that, at some stage in our lives, we, or one of our loved ones, will need to rely on the support provided by our voluntary health and social care services; unless we address this crisis, we risk the very existence of these vital providers of public wellbeing.
The organisations that provide these essential services deserve our full support, and that includes fair compensation for their employees. The time to act is now. Let’s ensure that these organisations can continue their vital work and that no one in Ireland is left without the care and support they need.
Ivan Cooper is CEO of The Wheel, the National Association of Charities.
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