Charity's decision to cut grants just didn't add up
Published 16/01/2016 | 02:30
There is nothing like a mugging on live radio and the white heat of public anger to produce a spectacular U-turn. Sometimes the grievance aired is justified - and this week, although the target was a charity and not the Government for a change, the outrage was no less vocal. It was a public relations crisis for a well-regarded charity.
The recession has had a bruising effect on all charities, requiring severe cutbacks. High-profile disclosures relating to Rehab unfairly cast a pall over the whole sector, leading to reduced donations and enhanced public scepticism about financial probity and governance.
But even set against that context, the Irish Cancer Society's decision to cut hardship grants to cancer sufferers and their families seemed a cut too far - one which could not be explained away by lack of funds.
Any fair analysis of the income and expenditure of the charity made it difficult to justify targeting this particular fund, which amounted to just €1.5m per annum, particularly when compared to annual staff salaries (€7.4 million, excluding the night nurse service), €3m on research and a remarkable spend on fundraising (€3.9m).
After 24 hours of defending the indefensible, the charity announced a partial reversal of the decision and an apology. Bizarrely, it restored the fund in respect of the support of child cancer patients - but not of adults, who constitute the vast majority of the claimants. This reversal was disingenuous.
What distinction can logically be made between families caring for children suffering with cancer and an adult facing similar financial hardship? This scheme was means-tested, discretionary and based on individual need. There was a formal application process administered by medical social workers in hospitals on behalf of the Irish Cancer Society. It was by no means a gravy train - average grants were about €1,000 per family, capped.
This debacle is an example of the dilemmas facing charities in making cuts to public services. Spokespersons pleaded that the scheme had become unaffordable, but this excuse failed to convince.
To be fair to the Irish Cancer Society, charities have to live within their means, avoid deficits and maintain healthy reserves. In addition, directors of charities have fiduciary and legal obligations to ensure the organisation is solvent and in good financial order, just like trading companies. Indeed, the duties of directors of charities are every bit as onerous as those attached to company directors. These days, following the financial and banking crash and with a greater focus on corporate governance, charities as well as companies are feeling the weight of additional vigilance and oversight.
Charities have also entered a new era of regulation and increased accountability. For years, charity legislation was long-fingered. The complex legislation was eventually enacted in 2009. Its purpose is to regulate a large sector which, for too long, was dangerously opaque and unaccountable. The Charities Act aims to maintain public trust and confidence in charities with detailed provisions - including a Register of Charities, a Regulatory Authority and clarifying the duties attached to directors and trustees of charities.
The community and voluntary sector is huge in Ireland, collectively making up for gaps and deficiencies in public services, particularly in the health sector. Volunteers make up most of the workforce in this sector but inevitably, as charities professionalise, staff salaries increase in line with standards and competition in the corporate world.
As with most charities, the Irish Cancer Society relies almost wholly on public donations, bequests and fundraising events. Despite no security of funding, they fund a range of services ranging from night nurses, counselling, advice, education, and volunteer drivers who ferry patients to and from chemotherapy - and is the major funder of cancer research here.
The financial hardship fund, which has been in existence since 1998, was increasingly in demand over recent years. Some 2,714 people - mostly adults - availed of the scheme last year, so it is a special support for a finite cohort of patients who really need it. Over 30,000 people are diagnosed with cancer each year. The rationale for the cut, according to the charity, was that the demand was "too big to manage" and was putting "free services at risk". But it didn't wash with the public and may have damaged the charity's credibility.
The good news is that there has been a measurable improvement in cancer care and outcomes in Ireland in the last decade. Most people who live through a cancer diagnosis and treatment these days report a comprehensive, compassionate and professional service from start to finish. The combined efforts of the State and charities such as the Irish Cancer Society have made the trauma of a cancer diagnosis more bearable, and with better survival rates, too.
There are now eight specialist centres of excellence providing state-of-the-art cancer care by multidisciplinary teams in the public health service. Previously, there were 31 different hospitals providing cancer services of variable quality. Who can forget the furore when the then government rationalised cancer services and introduced centres of excellence? Local politicians were irate, despite all the evidence that centres of excellence, because of the volumes of cases, produced better results.
At that time it was acknowledged that people who previously attended local hospitals would have the added expense of travelling to regional centres, and those costs would need funding. To meet this need, the National Cancer Control Programme began to fund 'Travel to Care', to be administered by the Irish Cancer Society. Last year, this funding amounted to €300,000 from the HSE.
But the hardship fund, now mostly discontinued, was for additional costs such as petrol, heating, childcare costs, parking and out-of-pocket expenses for overnight accommodation. And these costs are real. According to the Irish Cancer Society's report 'The Real Cost of Cancer', the average additional cost related to a cancer diagnosis is €862 per month - rising to €l,400 when a job loss occurs, regardless of having a medical card or private insurance. For self-employed people, the financial cost is even worse.
Clearly, this is a genuine, unmet need for cancer patients, regardless of age, and requires a budget from the State. If it is true that the charity cannot fund the scheme, and some will question the high salary costs, the supplementary welfare budget would appear to be an ideal place to make up the difference. It was surprising that the Tánaiste did not intervene immediately to ensure that cancer patients can easily access this modest support through that vote in her department. Now that would be the right thing to do - rather than engaging in auction politics with an eye on the election.