THE taxpayer writes a €1.5bn cheque for disability care services each year, but the voluntary bodies that get most of this funding still have a huge level of independence about how they run their affairs.
The Health Service Executive (HSE) outsources most of the care in the disability area to these not-for-profit organisations rather than providing the service directly itself.
It involves residential care, day care, training and workshops for people with physical or intellectual disabilities.
There are around 100 organisations providing services and around a quarter of these are getting most of the funding. Small grants are also given to other carer groups.
In recent years, all these organisations have signed what are known as service-level agreements with the HSE, which aim to match the level of care they provide to the funding they receive.
However, this is only a relatively recent development and the Office of the Comptroller and Auditor General reported that many of the organisations were given funding with no service-level agreement in place.
And there is still no validated information on unit costs, for instance, to see if they are run efficiently.
It found the HSE does not have any legislative power to enter non-profit organisations to check delivery, either in terms of quantity or quality.
A government-commissioned value-for-money review, chaired by a former governor of the Bank of Ireland, Laurence Crowley, has been delving into the running of these organisations for well over two years and a report is due in the coming months.
But it may not give the full picture. This is because the terms of reference largely confine it to accountability for health service funding.
The organisations also get funding from fundraising, philanthropic donations, income from charges to residents and income from goods produced in workshops.
So if a chief executive's salary is topped up from sources other than state funding, the organisations are not obliged to divulge any information.
The HSE is cutting budgets again this year.