During recent debates over the new religiously run National Maternity Hospital (NMH), it has become clear that Irish citizens have no idea how their public services are provided. In Ireland we have a model called ‘welfare partnership’ which means that the government funds the third sector (charities, foundations, social co-operatives, non-profit organizations, trusts, associations and other forms of organization) to provide public services. It is a common model, also used in Germany, Belgium and elsewhere. The reason we have this model in Ireland, as others have already pointed out, is historic.

Protests against the new NMH owned by St Vincent’s Holdings CLG, associated with a Catholic religious order, reflect the open wound that years of abuse have left. This is proof that we have not fully taken into account the suffering and abuse of the past. It is important to separate the two issues – the role of religion in public services versus the autonomous governance of civil society.

Ireland has a large, active and dynamic third sector which offers an impressive range of services. Benefits is the publicly accessible and searchable database that lists all civil society organizations in Ireland – all 34,331 of them. This is a relatively large number for our population, but many of them are very small unincorporated associations with no staff.

A total of 10,225 organizations are incorporated as formal companies and therefore governed by company law. Some 11,341 are registered charities (which include both incorporated companies and informal associations) and are also governed by the Charities Act. There are 1,130 non-profit organizations providing health services in Ireland, and 636 of these are registered charities. Some 3,965 non-profit organizations are schools. As you can see, this is how we deliver public services, including health and education.

It is understandable that the Irish public does not realize that their public services are provided through charities. If you search for hospitals in Ireland on the Health Service Executive website, independent nonprofits such as Coombe and NMH on Holles Street are listed as public hospitals. They are referred to as “public” which means that they are available for free, as opposed to private services, which are chargeable. However, they are not public, but private entities: non-profit organizations with charitable status.

Choice

The advantages of the social partnership model are that we have a diverse range and choice in our public services. You can choose from different primary schools, many different sports clubs, different types of hospitals. We have a lot of choices. The downside is that the quality of services can vary widely across the country, and you may find yourself in a school or hospital with an ethic that conflicts with your own. Arguably, when it comes to public services, high, consistent and accessible standards of care are more important than the choice of ethics.

Another characteristic of social partnership is responsiveness to the needs of the public. The public sector is generally good at providing the services most people need, but often poor at providing services that only a very small percentage of the population will need. For example, Debra Ireland was established in 1988 by families affected by genetic, painful skin epidermolysis bullosa (EB) who had no support or public services available to them. Because they are ruled by those affected by EB, Debra has provided much needed services highly tailored to the needs of families in ways the public sector could not. They are now funded by the HSE, but only provide less than 5% of Debra’s income in 2020.

The downside of leaving minority public services to civil society is that it takes the energy and resources of citizens who are already paying their taxes and who face a special need to have to come together to provide their own public services. , often with a small fee. budget and usually at a time when they are already facing a health or other problem. In a way, this is an approach to utilities that stems from neglect.

A big drawback of the social partnership model is that nonprofit organizations that provide public services can be shaped by ideologies that are inconsistent with public civic values. While Catholic schools and hospitals have provided excellent and comprehensive services over the years, they have also been responsible for human rights violations and abuses that have not been fully recognized or explained.

Referendum

It is now the case that the ideology of the church no longer aligns with that of the public, as evidenced by the referendums on marriage equality and the repeal of the Eighth Amendment. It would make perfect sense to hold a referendum to finally decide whether religious organizations should provide public services. It would be possible to reconstitute these non-profit organizations as civic and non-religious entities.

However, it would be a massive reorganization of Irish society for the public sector to take over the governance of all public services provided by civil society organizations. And likely to end in disaster.

A final important point about social partnership models is that they are not tied to the amount of public spending. Research that compares third sectors in different countries shows that the extent to which public services are provided by the third sector does not correlate with the size of the welfare state. In other words, you can have extended public services provided directly by the state, or through the third sector; and, also, you can find examples of minimum public spending on social protection that is provided either directly or through non-profit organizations.