What are Service Arrangements and Grant Aid Agreements?
The HSE provides funding to voluntary organisations under Sections 38 and 39 of the Health Act 2004.
For organisations that receive in excess of €250,000 the terms and conditions associated with the funding are set out in a Service Arrangement (SA). For organisations that receive less than €250,000 the terms and conditions are set out in a Grant Aid Agreement (GAA).
The Service Arrangement and Grant Aid Agreement are contracts and operate on the principles of contract law. There is a requirement that they are renewed each year to support the transfer of the very significant sums of public money involved. In 2023 the HSE provided over €6 billion to approximately 1,800 voluntary organisations.
Why do we have Service Arrangements and Grant Aid Agreements?
The HSE provides a wide range of health and social care services to those who need them each year. It delivers many of these services directly. However, it also relies on non-statutory or voluntary organisations to deliver services on its behalf.
Voluntary organisations play an essential role in the delivery of hospital and community-based services and are an essential component of Ireland’s public health and social care system. The HSE provides funding to voluntary organisations, through Service Arrangements and Grant Aid Agreements which set out the level of funding to be allocated and the services to be provided for that funding.
What is the Service Arrangement and Grant Aid Agreement review?
The Service Arrangement and Grant Aid Agreement review is a review of the contractual documentation and engagement process between the HSE and voluntary providers. The review is being carried out by representatives from the HSE, voluntary organisations and their representative bodies. The Service Arrangement and Grant Aid Agreement review formally commenced in July 2023.
Why are we carrying out this review?
The review aims to develop a more collaborative relationship between the HSE and the voluntary sector with a view to improving the services we offer to those who need them.
How is it different from other reviews?
Previous reviews have been carried out by the HSE and mainly focused on updating the documentation for new legislative and regulatory requirements. Typically the input into previous review from voluntary organisations or their representative bodies has been limited. This review is being progressed on a more collaborative basis in line with the ways of working outlined in the Partnership Principles. Voluntary sector representatives are working together with HSE colleagues to review both the documentation and the overall engagement process.
Who is carrying out the review?
The review is being carried out by a working group made up of HSE representatives at assistant national director and operational management level along with executive management representatives from a broad range of voluntary organisations.
The objectives of the working group are agreed by an oversight group. The oversight group is chaired by the Chief Financial Officer of the HSE and includes national director and executive management representatives from the HSE and chief executives of voluntary sector representative bodies.
Recommendations arising from the review are submitted to the HSE Executive Management Team for approval. The Dialogue Forum and Department of Health are kept informed by regular updates and engagement.
What are the objectives of the review?
The overall objective of the review is to revisit the Service Arrangement and Grant Aid Agreement documentation and engagement processes in the context of the Partnership Principles, specifically to:
- Review the content of the Service Arrangement (Part 1 and Part 2) and Grant Aid Agreement
- Review current engagement processes throughout the Service Arrangement (SA) and Grant Aid Agreement (GAA) lifecycle and suggest improvements
- Identify ways to support the timely signing of SA and GAA documentation by the HSE and voluntary organisations
- Explore options to help reduce duplication and administrative burden for all parties while meeting essential legal and operational requirements
- Identify potential IT solutions that will improve efficiency, accessibility and consistency within the SA and GAA process
- Identify ways to improve information-sharing processes between the HSE and voluntary organisations
- Contribute to the development of consultation and engagement structures and processes in the new Health Regions
- Ensure that any proposed changes to the SA and GAA are consistent with relevant regulation and contract law requirements
- Ensure that the SA and GAA review is conducted in a way that demonstrates the behaviours and ways of working set out in the Partnership Principles
What has the review achieved so far?
The review has delivered some significant changes and improvements to the documentation and processes to date, including:
- A comprehensive review of Part 1 of the Service Arrangement
- Development of a simplified Part 2 of the Service Arrangement
- Implementation of pilot projects designed to reduce administration
- Agreement of process to support the timely signing of SAs and GAAs
- Input to the design of consultative processes for the new Health Regions
In addition to the above, the review is looking at ways to streamline the financial allocation process, increase the use of technology within the SA and GAA process and improve information sharing between the HSE and voluntary organisations.
What are the plans for 2025?
The work programme for 2025 includes the following key areas:
- Implementing the revised Service Arrangements (Part I and Part 2) for 2025
- Applying learnings from the pilot projects to the documentation and process
- Continuing to identify ways to support the timely signing of the SA and GAA
- Supporting the implementation of revised documentation in the Health Regions
- Monitoring and evaluating the impact of changes introduced during the 2025 cycle
- Completing the review of the financial allocation process, the use of technology to support the SA and GAA process and information sharing between the HSE and voluntary organisations.
What are the challenges facing the review?
The review is taking place at a time where there is increasing pressure on the voluntary sector in terms of governance, regulation and service demands. It also coincides with a major re-organisation of the HSE into six autonomous Health Regions and the administrative challenges arising from that process.
How do I find out more about the review?
Information on the review is shared in a variety of ways including: Joint email updates from the Oversight Group, HSE all staff updates by email, regular updates in the HSE Partner Pack sent to voluntary organisations, information on hse.ie and a series of webinars supporting the pilot projects.
What is the Dialogue Forum?
The Dialogue Forum was established in 2019 following the publication of an Independent Review Group report which examined the role of voluntary organisations in the delivery of health and social care services. The aim of the Dialogue Forum is to build a stronger working relationship between the State and the voluntary sector for the benefit of patients and service users. It is chaired by an independent chair and includes representatives from the Department of Health, HSE, Voluntary Representative Bodies and HIQA. More information on the Dialogue Forum (Gov.ie)
What are the Partnership Principles?
The Dialogue Forum developed a set of Partnership Principles, which set out the basis for building a new, improved relationship between the State and the voluntary sector. The principles sought to build on the collaborative, integrated ways of working evident during the response to the Covid-19 pandemic. The Partnership Principles (Gov.ie, PDF) were launched by the Minister of Health in April 2023.
The Dialogue Forum also commissioned a series of Case Studies to help identify ways to put the partnership principles into practice. The findings highlighted the importance of the Service Arrangement and Grant Aid Agreement review which was designated an exemplar project. Case Study Process Final Report (Gov.ie, PDF)
