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New Relationships Driving Innovation and Reform in Health and Social Care

The Covid-19 crisis profoundly challenged our health and social care sector. Staff, management and unions, responded to that challenge with vigour, energy and dedication.  A new NESC Secretariat paper, Building a New Relationship between Voluntary Organisations and the State in the Health and Social Care Sectors, looks in detail at the organisational changes and innovation that have taken place.

Ireland has a hybrid health care system as services are provided by voluntary bodies, the State and private sector organisations.  The paper shows that at a time of enormous national need new relationships and ways of working were forged.  These have driven innovation in the way services are delivered.  The paper outlines many examples and argues that they represent an unprecedented level of collaboration and cooperation between the state and voluntary organisations.   It finds that a unity of purpose is evident.

This is a remarkable transition.   In 2019, the report of the Independent Review Group (IRG or “Day”) characterised the relationship between voluntary bodies and the HSE and D/Health as problematic.  In response Minister Simon Harris T.D., established the Dialogue Forum with Voluntary Organisations in 2019.  Its objective was to provide a platform for regular and structured dialogue and to develop a more productive and collaborative relationship between state and voluntary actors.   In June 2020, the Dialogue Forum commissioned the NESC Secretariat to explore the healthcare system’s response to Covid-19 crisis.

Drawing on a series of qualitative interviews with senior policy makers and practitioners this study highlights how the healthcare system responded to the challenge of protecting citizens, in particular the most vulnerable, in a flexible, innovative and collaborative manner. Dr.  Damian Thomas, author of the study, argues that the core finding is that the public and voluntary organisations have forged an experimental and dynamic partnership.  He suggests that the partnership is based on intensive engagement, open information exchange, and collective problem solving and deliberation linked to tangible action.

The study illustrates the capacity of the sector to work with more autonomy and to be accountable for that autonomy.  It highlights the commitment of staff; the core values and strengths of healthcare organisations; the willingness to embrace digital services; and strong and engaged leadership.  The paper also describes a more balanced performance dialogue and the proactive support of public sector trade unions.

Responding to this publication the Dialogue Forum have indicated that there is now a real opportunity to build on this strong foundation by designing a new relationship, with the capacity to drive transformative reform, deliver quality integrated services, and improve outcomes for service users and their families.

Welcoming the report, the Director of NESC Dr. Larry O’Connell, noted that it was discussed by the NESC Council in June, because the report contains important lessons for reform and service improvements in other areas of the public sector.  In particular, the Council discussed how allowing, what the report refers to as accountable autonomy, could drive higher levels of organisational innovation, policy reform and service improvement at the local level across the public and voluntary sectors.

View the report.


Note to Editors

For further information please contact Damian Thomas,; or m: 0864678915

About the Dialogue Forum with Voluntary Organisations.

The Report of the Independent Review Group (IRG) to examine the role of voluntary organisations in publicly funded health and personal social services was published in February 2019. A key finding in the Report was the need to improve the relationship between voluntary organisations and the State.  In response to this publication, the Minister of Health established a new Dialogue Forum the first meeting of which took place on 2 December 2019.  The aim of this Forum is to build a stronger working relationship between the State and the voluntary healthcare sector for the benefit of patients and service users and to facilitate regular dialogue with the voluntary sector on future policy and strategic developments.

The Forum is chaired by independent Chair Peter Cassells and the following organisations are represented on it;

  • Department of Health
  • HSE
  • HIQA
  • Mental Health Commission
  • The Wheel
  • Mental Health Reform
  • Disability Federation of Ireland
  • National Federation of Voluntary Service Providers
  • Not for Profit Association
  • Voluntary Healthcare Forum
  • Voluntary Hospices Group
  • National Community Care Network

 About the National Economic and Social Council (NESC)

The National Economic & Social Council (NESC) was established in 1973.  NESC is an expert advisory and consultative body, focusing on strategic economic, social and environmental policies.  It analyses and reports to the Taoiseach on challenging policy issues and addresses the public system and the institutional challenges related to implementation, monitoring and learning.  It is chaired by the Secretary General of the Department of the Taoiseach.  The members of the Council are appointed by the Taoiseach, for a three year term.  They are representatives of business and employers’ organisations, trade unions, agricultural and farming organisations, community and voluntary organisations, and environmental organisations; as well as heads of Government departments and independent experts.  The Council has published 154 agreed reports on a wide range of policy issues, as well as research papers by its professional Secretariat and other experts.