4,228 entries for Historical Context
BackThe report recommended an early meeting with the Conference of Major Religious Superiors to acquaint them with their thinking and how best to resolve the pay issues in relation to residential care. The report also noted that ‘in this connection, it is significant to note that the members of the hierarchy who met the Tanaiste on 4th March emphasised that increased controls on the homes would be acceptable to the Hierarchy’.
In a memorandum to Government from the Department of Health, dated 18th April 1977, it was noted that the CMRS was seeking a substantial increase in the capitation rate and ‘in the absence of a favourable response, eight homes will be closed and further seventeen will refuse new admissions’. It noted that the Inter Departmental Group found that a capitation rate of between £28 and £30 per week was necessary and sought agreement to negotiate an increased capitation rate of not more than £30 per week. The Minister for Finance in his comments on the memorandum noted that State support for the homes increased from £0.8m in 1972-73 to an estimated £1.6m in 1977 and that he considered: that £30 per child per week should be the absolute limit of the Government grant in the current circumstances and that the Conference of Major Religious Superiors should be firmly informed accordingly. In his view the Government should not in any circumstances concede to unreasonable demands from any quarter whether it be the Conference of Major Religious Superiors or a more humbly titled organisation. It should be quite feasible to place most, if not all, of the children concerned in good homes within the community, to the advantage of the children, if an allowance of a lesser amount that £30 was payable to each child. In this connection it is relevant to point out that the highest weekly allowance currently payable to foster parents by Health Boards is understood to be of the order of £10 per child.
The Minister for Health in response to the comments made by the Department of Finance noted that ‘it would always be necessary to have some children in residential care and that this form of care will be relatively expensive’.
On 20th April and 11th May 1977 a series of meetings took place between the relevant Departments and the CMRS on the issue of financing the home and on 18th May 1977, a meeting took place between the CMRS and the Local Government and Public Services Union with representatives of the Departments of Health and Education in attendance. Following these meetings it was agreed that the capitation rate would be increased to £30 per child per week and that scales of pay and other conditions for child care staff would be recommended by the Union to their members. The Department of Health noted: Notwithstanding the recommendation for a budget system, the Department of Education (which has administrative responsibility for the majority of the residential homes) still strongly favours the straight capitation system on the grounds that it gives the homes greater freedom to manage their own affairs and to decide their own priorities. They accept, however, the necessity to have the capitation rate adjusted regularly to allow for the effects of inflation and to provide reasonable remuneration for the staff, having regard to the nature of their work.
In September 1979, a further review of the financing of residential homes was undertaken, with terms of reference to: carry out a study of the organisation, staffing and financing of homes providing residential care for children under the Ministers for Education and Health to establish: the existing financial position in each home, including the extent of the deficit, and to make recommendations on the appropriate arrangements to be made in event of a decision to finance the homes on a budget basis, including the appropriate level of staffing and other costs involved, procedures for the agreement of an annual budget through Health Boards and the phasing in of a budget system; and a realistic interim capitation made for 1980.
To aid their deliberations, the committee undertook a survey of the financing, staffing and organisation of the homes and replies were received from 38 homes catering for approximately 1,200 children. The committee found that the average cost of maintaining a child in residential care averaged £51.13 per child per week, albeit that wide variation was evident. The report also found that the estimated cumulative deficit in the homes was expected to be in the region of £1.5m. The committee agreed in principle that the financing of homes would transfer to a budget system when the resources permitted. To deal with the deficits, a system of capitation (deficiency payments) was established, totalling payments to the homes of £54,000 in 1980, £402,300 in 1981 and £777,700 in 1982. The cumbersome nature of payment was also highlighted. Three Ministers are involved in the making of the necessary regulations. Adjustments in the level of payment are justified on historic costs e.g. increases in the cost of living index in the previous year and pay awards under National wage Agreements. Given the high level of inflation, this means that the homes are continuously in debt, and a number have considerable overdrafts. In addition, the present system where the home may receive payment from four different sources – the Departments of Education and Justice, local authorities and the health boards also lead to delay.
The Final Report of the Task Force on Child Care Services also contributed to the discussion stating: The present capitation system of contributing to the financing of residential centres has been found unsatisfactory, particularly in the case of centres having relatively few children. We understand that consideration is already being given to the making of arrangements to have residential homes placed on a budget basis and we recommend that this system be extended to all centres as soon as possible.343
The Task Force concluded, in relation to the homes, that because responsibility rested with two Government Departments, while almost all the facilities are provided by voluntary bodies supported by State grants, no coherent systematic planning procedures existed for children in residential care. Accordingly they recommended that responsibility for all children’s Residential Homes should be vested in the Minister for Health. The Task Force also recommended that, as far as possible, residential facilities should be situated near the homes of children who will require such care. They considered that different kinds of residential facilities were required to meet the differing needs of children and recommended that: [each] area of the country, roughly coinciding with existing community care areas of the health boards, should have access to one identified residential centre located in or adjacent to the area. These centres, should be multi-purpose in nature in the sense that they should cater for the ordinary needs of the area through the provision of short-tem or medium-care for children of all ages from the area.344
In addition the Task Force recommended that ‘small community centres for about 4 or 6 children would be required’ to cater for children with delinquent tendencies and for other children with serious personal problems who require intensive, personalised care. This was accepted by the Department of Health who stated they were: examining, in consultation with the health boards, the feasibility of existing residential facilities adapting their structures and revising roles and objectives to facilitate development along these lines. The Minister’s aim is to have under his aegis a comprehensive and inter-locking locally based child care system serving the needs of identified communities. Residential homes would be only one of the elements within this system with a very specifically defined, though complementary, role to play. Homes will fall into one of the categories..., each category being given clear objectives for the service they are providing. Homes will, it appears, tend to be small units, providing a defined service for a clearly identified client group. Indeed, the process of changing to the smaller family style residential unit is now well advanced although there remains a small number of homes still operating along old institutional lines. Plans are almost complete to replace three of these institutions with purpose built group homes in the immediate future.
Following the aforementioned Government decision of 13th August 1982, an inter-departmental committee comprising officials of the Department of Education, Finance, Health and Justice was established to review the operation and financing of the homes. The inaugural meeting of the Committee took place in the Department of Health on 17th December 1982 and subsequently met on 12 occasions. Following a detailed discussion at the inaugural meeting, the Committee adopted the following terms of reference: (1)to determine the financial system most appropriate to children’s Residential Homes, based on an examination of their financial records and their perspective financial position; (2)to recommend appropriate transitional financial arrangements on transfer of responsibility for the 24 Residential Homes (former Industrial Schools) from the Minister for Education to the Department of Health; (3)to identify acceptable cost and other guidelines appropriate to monitoring and financing children’s residential homes in the future. 345
The final report of the Committee was completed in September 1983. It explored in detail the emergence of the capitation system of fund and the pros and cons of that system of funding. The increase in the capitation fee from the early 1970s is shown in Table 1.
| Central authority | Local authority | Total | |
|---|---|---|---|
| 01/07/1972 | |||
| 01/04/1973 | £5.70 | £5.30 | £11.00 |
| 01/04/1974 | £6.50 | £6.00 | £12.50 |
| 01/01/1975 | £7.80 | £7.20 | £15.00 |
| 01/01/1976 | £9.00 | £9.00 | £18.00 |
| 01/01/1977 | £11.00 | £5.70 | £16.70 |
| 01/02/1977 | £15.00 | £15.00 | £30.00 |
| 01/02/1978 | £16.25 | £16.25 | £32.50 |
| 01/03/1978 | £17.00 | £17.00 | £34.00 |
| 01/03/1979 | £19.25 | £19.25 | £38.50 |
| 01/06/1979 | £20.50 | £20.50 | £41.00 |
| 01/03/1980 | £23.25 | £23.25 | £46.50 |
| 01/01/1981 | £27.00 | £27.00 | £54.00 |
| 01/01/1982 | £34.00 | £34.00 | £68.00 |
The report also commented that: The homes’ current financial position under capitation is also a consequence of the manner in which the service is organised. Each home is independent and privately run and could have children maintained in it by any one of the eight health boards, or the local authorities and the Department of Education. The former industrial schools constitute the major element of residential capacity and statutory overall responsibility for their operations at present rests with the Minister for Education. However some 70 percent of children in them have been placed by the health boards. This has inevitably created a grey area as to which authority controls budgets, ultimately decides care standards and determines the client group to be served by the homes. It would appear that this, coupled with the development of the capitation deficiency payments system has given individual homes freedom to design their own care programmes without regard to any concept of overall care policy, standards or clear definition of the type of child to be served.
Ultimately, the Committee rejected the capitation method of financing Residential Homes and recommended ‘the funding of residential homes by way of annual allocation, based on budgets agreed with the local health board for projected expenditure, and paid monthly in advance’. The Committee also noted that while the proposed transfer of responsibility for the homes from the Department of Education to the Department of Health was a welcome step in clarifying responsibility, this by itself would not be sufficient. It argued that: It must be coupled with a clear statement of overall policy in elation to residential care services setting out the rationale for care of each client group intended to be served by the homes, standards of care to be provided, both in relation to accommodation and maintenance, and to the quality of the care input from staff. We have found no evidence of the existence of such a statement without which in our opinion the monitoring process cannot function.
On 25th October 1984, the Department of Finance wrote to the Department of Health agreeing with recommendations of the Committee.
A key recommendation of the Committee was that the Department of Health, ‘as a matter of urgency formulate and promulgate service objectives in relation to the care of children to guide health board policy’. In late 1984, the Department of Health produced a detailed memo on the operation of residential care in Ireland as well as outlining a philosophy for the future operation of residential care in Ireland.346 In relation to the operationalisation of the recently agreed budget system of funding, the memo reported that: Responsibility for financial control of individual homes rests with an officer designated by the local health board’s Finance Officer. They have reported coming up against a number of problems in implementing the budget system one being with homes’ accountants and auditors. In the case of some homes Officers had serious doubts abut their objectivity and hence the impartiality of the accounts submitted. Also, officers found that the homes’ accountants were over-estimating pay and non-pay expenditure for ‘bargaining’ purposes. Discrepancies also appeared in the number of staff actually employed in the homes as against alleged complements returned at various stages to the Department. All this resulted in long delays before homes could be told of their budgets for 1984. Hopefully, most of this can be put down to teething problems and the mutual understanding arising out of this year’s exercise should facilitate speedy agreement to budgets next year.347