Oireachtas Joint and Select Committees
Tuesday, 12 June 2018
Joint Oireachtas Committee on Social Protection
Joint Meeting of the Joint Committee on Employment Affairs and Social Protection, Joint Committee on Education and Skills and Joint Committee on Health
Supports for People with Disabilities: Discussion (Resumed)
12:00 pm
John Curran (Dublin Mid West, Fianna Fail)
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Deputy O'Loughlin, who chairs the Joint Committee on Education and Skills is en route. She is a little late but she will be here shortly. We have received apologies from Senator John Dolan, Deputy Margaret Murphy O'Mahony, Deputy Michael Harty, Deputy Hildegarde Naughton, Senator Paul Gavan and Senator Lynn Ruane.
The witnesses are all welcome to the meeting of the Joint Committee on Employment Affairs and Social Protection, the Joint Committee on Education and Skills and the Joint Committee on Health. This is the third meeting of this configuration of three committees. We are continuing our discussion on the necessity to improve the supports available for people with disabilities intending to transition from education or training into employment. The three joint committees first met the Disability Federation of Ireland and Inclusion Ireland on 3 May. We subsequently heard contributions from individuals of their lived experiences at our last meeting on 29 May. Today's meeting will focus on the input from departmental representations. I hope that our combined efforts and consideration will enable us to make some real proposals that will improve the outcomes for people with disabilities. The content of the previous meetings has been circulated to the Departments and, therefore, officials will know the issues we have examined.
I welcome the attendance of colleagues today. Specifically, I welcome Ms Simonetta Ryan and Mr. John Bohan from the Department of Employment Affairs and Social Protection, Mr. Jim Mulkerrins and Mr. Phil O’Flaherty from the Department of Education and Skills and Ms Patsy Carr and Mr. Dave O'Connor from the Department of Health. They are all welcome. I will ask them to make your opening statements presently and then committee members will have a number of questions.
I wish to draw the witnesses' attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. Witnesses are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable.
Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.
There is no particular order for the speakers. The first person I will ask to make an opening statement is Ms Ryan.
Ms Simonetta Ryan:
I am assistant secretary in the Department of Employment Affairs and Social Protection with responsibility for disability policy and the administration of the disability allowance scheme.
I am joined today by my colleagues, John Bohan and Danny Harty, also from the Department. I thank the committee for this invitation to discuss supports provided by the Department for people with disabilities, particularly in respect of employment.
I will focus on three key areas as follows: working with other Government agencies and services to ensure good cross-governmental functioning to secure better employment outcomes; providing a range of income and employment supports and services to address the needs of people with disabilities; and engaging with people with disabilities to advise them of these supports and to guide them where appropriate to employment or to other services.
Before I say something about each of these, I would like first to recall some of the main statistics of relevance to this area. According to Census 2016, there are almost 645,000 people living with a disability in Ireland. In April 2016, there were 130,000 people with a disability at work of which 122,000 were in the working age population range. People with disabilities, however, are still only half as likely to be in employment as others of working age. Census 2016 figures show that the employment rate for people with disabilities of working age is 37% compared with a rate of 73% for people of working age without a disability.
We know that many people with disabilities want to work. In our survey of 2015, 35% of people not then working said they wanted to work part time, while 8% said they wanted to work full time. Young people with disabilities are likely to start out with lower employment rates and the gap widens with age as people leave employment.
The data tell us that to improve employment rates we need a twofold approach: early engagement with young people with disabilities and a focus on retention of those already established in the workforce. For young people, the potential benefits are greatest in the crucial years following school to young adulthood when otherwise their disability threatens to keep them out of the workforce. For older people, the advantages of early engagement can also apply to those who acquire disabilities later in life and who may need retraining and other supports to stay in the workforce.
The comprehensive employment strategy was adopted by Government in October 2015 having been developed in consultation with Departments, State agencies, the National Disability Authority, NDA, and disability stakeholders. The ten-year strategy is a cross-governmental one co-ordinated by the Department of Justice and Equality and provides a roadmap to ensure that people with a disability who are able to and want to work are supported and enabled to do so. The Department of Employment Affairs and Social Protection is engaged in delivering 33 actions through the comprehensive employment strategy. Progress to date includes the publication in April 2017 of the Make Work Pay report. This was an interdepartmental report with independent external participation and chaired by Professor Frances Ruane. We have either implemented or made significant progress on some of the recommendations and I will return to some of these later.
The Department has worked jointly on the pilot project to integrate employment and mental health support which was developed with Genio and departmental funding and in partnership with the HSE mental health division, EmployAbility companies and Mental Health Reform. A central objective of this project was to improve integration between public mental health and supported employment services at national and local levels. There has been joint working, supported by the National Disability Authority, NDA, with the Department of Health and the Department of Education and Skills, on action 5.1 which focuses on transition points for people with disabilities. The group has produced a report agreed by Government, to be published shortly, outlining the policy approach and an implementation plan.
More generally, the Department participates in the comprehensive employment strategy implementation group chaired independently by Mr. Fergus Finlay who produces an annual report. We provide a range of income and employment supports. The primary income supports for people with disabilities are disability allowance, invalidity pension and partial capacity benefit. Disability allowance is a means-tested payment for people who are aged between 16 and 66. To qualify a person must be substantially restricted in undertaking suitable employment. Disability allowance is structured so that a person who wishes to do so may take up employment and still retain all, or a significant portion of, his or her payment, thereby ensuring that work is seen to pay. The first €120 of weekly earnings is disregarded in the means test for the payment while weekly earnings between €120 and €350 are assessed at 50%. A single person earning more than €420 a week can retain the minimum amount of disability allowance and continue to qualify for the free travel pass.
A number of contributors to the joint committees mentioned that uncertainty around the retention of benefits, including the medical card, represents a barrier to people with disabilities exploring their work options. The Make Work Pay report made a number of recommendations, including that the requirement that work be of a rehabilitative nature for the disability allowance earnings disregard should be dispensed with. This would mean that a report from a doctor would no longer be required before commencing work and that the focus is on capacity rather than incapacity. Legislation is required to give effect to this change and is included in the Social Welfare Bill 2017. Currently, 10% of disability allowance recipients - about 13,000 people - avail of the disability allowance earnings disregard.
Other recent changes to the income supports to make them easier to retain if employment is taken up include the extension of entitlement to a travel pass to five years after commencing full-time employment or exceeding the appropriate income threshold, which exceeds the three years recommended in the Make Work Pay report; a fast-track return to disability allowance if employment does not work out; a clear statement that disability allowance payments will not be stopped or reviewed on the basis of an enquiry about work at an Intreo centre; and the introduction of an online benefit of work estimator to assist people with disabilities in assessing the impact of taking up work on their disability payment. Since the launch of the Make Work Pay report, just over 800 disability allowance recipients have entered full-time employment and ceased claiming the allowance.
Invalidity pensionis an income support payment paid to people who are permanently incapable of work because of illness or disability. It is based on a claimant's social insurance contributions and is not means tested. While invalidity pension is generally paid to pension age, where a person with a disability wishes to return to work, he or she may apply for partial capacity benefit. Partial capacity benefit was introduced in February 2012 and is designed for people who are in receipt of long-term social insurance invalidity, illness or disability income support payments who have some capacity for work.
As well as providing these income supports, the Department also provides a range of supports specifically intended to improve employment outcomes for persons with a disability. The EmployAbility service, for example,is a nationwide employment service funded by the Department and dedicated to improving employment outcomes for jobseekers with a disability. There are 23 limited companies, each with a specific geographical remit. The Ability programmeis the new pre-activation programme for young people. The focus of the programme will be on projects aimed at young people who have disabilities and who are aged between 15 and 29 and it is designed to assist in their transition from school to further education and employment. This will be undertaken using person-centred, case management approaches that support participants to identify and follow progression pathways based on both their needs and their potential. We also provide a range of grants under the reasonable accommodation fund and the disability awareness training support scheme to assist employers in the private sector to take appropriate measures to enable a person with a disability or impairment to have access to employment.
The Department also funds two significant disability projects directed at participants in third level education. The Willing Able Mentoring programme, WAM, builds the experience and confidence of graduates with disabilities and employers through the method of a mentored work placement programme which is paid for by the employer programme. Get AHEAD is a training programme and forum for students and graduates with disabilities to discuss their experiences of education and employment.
On engaging with persons with disabilities through the public employment service, the Department of Employment Affairs and Social Protection, DEASP, network of 62 Intreo centres provides a gateway for people with disabilities who wish to explore their work options and they may voluntarily look for an appointment with a case officer to discuss their work ambitions and develop a personal plan to progress their goals. We recognise that our engagement with people with disabilities will require developing our employees' skills in engaging with them. In November 2016, a certificate in professional practice in employability services provided through the National College of Ireland was introduced for DEASP staff. There is good coverage of disability issues, including a guest lecturer who is a specialist in the area, and contributions from two staff development unit case officer trainers specialising in DEASP supports for people with disabilities.
As I mentioned earlier, the publication of the Make Work Pay report in April 2017 marked an important step in the identification of specific actions that are intended to secure better employment outcomes for people with disability. The report made many recommendations, including that disability allowance payments and other schemes should be reconfigured for new entrants aged 18 and over to ensure that their work ambitions could be explored systematically at an early age. This is referred to as the principle of early engagement.
Following the publication of the report and the recognition that some of the recommendations may be controversial, the then Minister indicated that the Government wanted to consult persons with disabilities and their families on some of the recommendations. We engaged an experienced facilitator to ensure the consultation process was as wide-ranging as possible and included representation from a wide range of stakeholders. The information documents were designed to allow people with disabilities and their families to provide an input to the process. We made considerable efforts to ensure that the materials were fully accessible. The documents were also produced in a range of accessible formats such as easy read, Braille, audio, video captioned and Irish Sign Language.
The Minister, Deputy Regina Doherty, and Minister of State, Deputy Finian McGrath, launched the consultation process in Richmond Barracks, Inchicore, Dublin 8, on 7 March 2018. Regional seminars were held in Cork, Dublin, Sligo and Limerick during March and April this year. The findings of the consultation process are being consolidated and a report will be prepared for the Minister and Minister of State on the outcome of the consultation process when it is finalised to inform the next steps in the implementation of the Make Work Pay report.
In conclusion, I hope this presentation demonstrates that while many supports and services are in place to assist people with a disability to fulfil their employment ambitions, the Department is very active in addressing the objectives of the comprehensive employment strategy in trying to improve the employment rates of people with a disability. The multifaceted nature of the barriers faced by persons with a disability calls for a similarly multifaceted approach and the Department is pursuing a range of actions across a number of areas to achieve this. The fall in unemployment and the transformation of the Intreo service provide an opportunity to make significant progress in this area.
Mr. Jim Mulkerrins:
I thank the Co-Chairman and members. I am principal officer in the special education section of the Department of Education and Skills. I am joined by Phil O'Flaherty, who is the principal officer for further education and training in the Department. I apologise for the late delivery of our remarks; I was out of the country late last week which contributed to the delay.
I thank the joint committees for the invitation to today's meeting. We are aware of the joint hearings of 3 and 29 May and will try to address the matters highlighted during those meetings. Our statement today will primarily address the provisions made for supporting children with special educational needs to support participation in further studies, training or employment, the supports available in the further education sector to facilitate access to further education and the transition from further education to employment and career guidance for those with a special educational need.
The Department recognises the importance of planning for transitions throughout a child's education and at present all schools are required to develop education plans for all children identified with special educational needs and additional care support needs. The Department's inspectorate's advice is that the majority of schools are now using some form of individual education planning for children with special educational needs, which is welcomed by the Department.
Educational plans should be differentiated in line with pupils' needs. A student's support plan should include clear, measurable learning targets and specify the resources and interventions that will be used to address student needs in line with the continuum of support process. Individualised support plans for students should be developed through a collaborative process involving relevant teachers, parents and guardians, the pupils themselves and outside professionals, as necessary. The individualised planning process should include regular reviews of learning targets as part of an ongoing cycle of assessment, target setting, intervention and review.
Members may know that the comprehensive review of the special needs assistant, SNA, scheme was published by the NCSE on 30 May. It has found that while the scheme is greatly valued by parents, students and schools and works well in meeting the care needs of younger students it is less effective for some older primary and post-primary students, as over-reliance on SNA support has been found to result in some of students experiencing alienation and stigma. It also found that there can be an overdependence on SNA support, leaving some young people inadequately prepared for life in post-school settings, and it is seen as a blunt instrument to deal with the wide range and variety of needs, ages, developmental stages and school settings. The Department is now developing proposals to implement the review's recommendations in consultation with other key Departments and agencies.
Turning to further education, a major focus of the further education and training strategy is to deliver skills for the economy and support active inclusion of all citizens. These twin goals are closely connected and both point to the importance of assisting people with disabilities to access employment.
Overall in 2017, more than 17,000 people with a disability were enrolled in a wide range of mainstream further education and training, FET, programmes. Details on all FET programmes are available on the FET courses website. Learners on FET programmes have access to appropriate guidance services. Some programmes also provide income support by enabling learners to retain their entitlements under schemes provided by the Department of Employment Affairs and Social Protection and have provision for meal and travel allowances. The Higher Education Authority fund for students with disabilities also funds services and support for students with a disability in post-leaving certificate colleges.
SOLAS and the Department meet regularly with the Department of Employment Affairs and Social Protection to discuss issues relating to the training and upskilling of unemployed people and those on other payments. Protocols are in place between Intreo offices and education and training boards, ETBs, to deal with issues relating to the planning of training and the management of referrals. This provides a good opportunity for the Department, SOLAS and the ETBs to assist the Department of Employment Affairs and Social Protection as it looks to extend the employment services and supports for people with disabilities.
SOLAS, through the education and training boards, also provides specific funding of almost €47 million per annum for dedicated education and training for people with disabilities through specialist training providers. More than 3,500 learners benefitted from this provision in 2017. Generally, this provision is accessed by people who need more intensive support. Features of the programme include longer duration, adapted equipment and transport arrangements.
SOLAS regularly commissions follow-up surveys to establish what happens to participants, primarily in terms of outcomes, after they leave the FET training delivered by ETBs. The most recent follow-up survey was conducted in 2017 and it surveyed those who exited ETB training in the period from January to March 2016. Within this survey, a customised survey to gain feedback from participants with a disability who participated in specialist training programmes, STPs, was conducted. The findings included outcomes indicating that 26% were in employment, 4% were on Government schemes and 15% were engaged in further study. There are plans to extend the approach to monitoring outcomes in order that we can also get a better picture of how people with disabilities on mainstream programmes do after completing their courses.
SOLAS engages with ETBs each year to discuss funding priorities, taking account of local need and labour market data. This year, SOLAS has required ETBs to set out how they are addressing barriers to accessing FET. This is done in the light of the 2017 SOLAS report on barriers for vulnerable groups accessing FET. A fuller picture of initiatives in place at ETB level will emerge from this process and provide a basis for determining future supports.
The Department recognises that there are still access difficulties in some FET settings. Until now, the scope available to address these difficulties has been limited as no specific capital budget was allocated for FET. Enhanced allocations of capital funds for the sector over the period of the national development plan will give greater capacity to address these issues.
Turning to apprenticeships, the Department noted that many contributors to the previous joint committee hearings spoke about the potential of apprenticeship to provide access for people with disabilities to the labour market. A total of 371 current apprentices, out of a total population of almost 13,500, report as having a disability.
As part of a review on "Pathways to Participation in Apprenticeship", which is due to be completed at the end of June 2018, research is being undertaken on barriers to participation by people from diverse groups, including those with a disability. Alongside this research, SOLAS is conducting café dialogue sessions to further inform recommendations for the review. Attendees at the sessions have included individuals from organisations representing people with disabilities. It is expected that the expansion of apprenticeship into new sectors, giving access to a much broader range of job opportunities and occupation types, will also assist in enabling people with disabilities access this valuable pathway to employment. As members know, the Disability Act 2005 places an obligation on public bodies, including our own Departments, to ensure that at least 3% of their workforces are people with disabilities.
I turn to career guidance for those with a special educational need. Guidance in schools refers to a range of learning experiences provided in a developmental sequence that assist students to develop self-management skills which will lead to effective choices and decisions about their lives. It encompasses the three separate but interlinked areas of personal and social development, educational guidance and career guidance. For all children in mainstream post-primary schools, including those with special educational needs in mainstream or special classes, the support of the guidance counsellor is available where it has been provided to the school. There is no other additional or separate guidance support for children with special educational needs and there is currently no policy to support an alternative or separate guidance provision for children with special educational needs in mainstream post-primary. That is in keeping, I suppose, with the policy of inclusion which the Department supports.
In mainstream post-primary schools, it is common practice for the school guidance counsellor and the special educational needs, SEN, co-ordinator to work very closely in liaising with parents and the feeder primary schools, analysing psychometric assessments, identifying and supporting the needs of students with special educational needs, advising students and their parents on the most suitable subject choices and programme options, and facilitating students to secure appropriate work experience as part of the transition year, leaving certificate applied and leaving certificate vocational programmes. The SEN and guidance teams collaborate in facilitating students to apply for supports such as the reasonable accommodation for certificate examinations, RACE, scheme, the disability access route to education, DARE, scheme and other access routes into further and higher education and employment.
A key role of the guidance counsellor is to develop close links with employers, access officers in colleges, SOLAS training and apprenticeship schemes and other organisations, such as the National Learning Network, with a view to maximising the opportunities for students with special educational needs and other disabilities to access further education, training and jobs. The National Learning Network offers 70 different training programmes, including vocational and rehabilitative courses, to up to 5,000 students annually, many of whom have a disability and wish to up-skill, gain employment and live more independent lives. The programmes are funded through the Education and Training Boards and the Health Service Executive. The courses are free and individualised and offer a variety of awards including QQI levels 1 to 6, ECDL and City and Guilds. Of those students who completed a training programme last year, 90% went on to further education and training.
For students in special schools, the position is somewhat different. Special schools are substantially different from mainstream schools and these students typically have very different needs.
In all cases, the classroom teacher and other school staff are more intimately aware of the abilities and strengths of all students than would be the case in mainstream schools. That is partly because of the average pupil-teacher ratio of less than 5:1 and the special needs assistant ratio of 3:1 in the majority of special schools. Special school staff typically have extensive engagement with parents, HSE multi-disciplinary teams and the National Council for Special Education, NCSE, which involves planning for the child's future, including options for further education, training, employment or other placement options subject to the child's abilities, including the young person's transition to adult services when the child reaches the age of 18 years. Students who transfer to adult service settings can continue to participate in educational programmes through further adult educational programmes or in adult settings which are allocated resources towards educational provision.
The National Skills Strategy 2025 and the Action Plan for Education 2016-2019 provide for a career guidance review that will include recommendations on changes to improve the existing career guidance tools and career information for post-primary, further education, higher education students and adults currently in place across the education and training system in Ireland. The purpose of the review is to ensure that we are providing high quality, relevant career guidance information to students from post–primary level up to further and higher education. The review will look at the quality of information available to students and adults in relation to career guidance, the sources of this information and how the system is organised to support students and adults in this area.
The review will look at the quality of information available to students and adults on career guidance, the sources of this information and how the system is organised to support students and adults in this area. Opportunities have been provided for all relevant stakeholders to contribute to the review. More than 100 written submissions have been received, including a significant number of submissions from special schools. Drawing on the results of the consultation process and further consideration by the steering group, the specific role and objectives of career guidance in supporting students in special schools will be assessed further.
Related to the area of career guidance, some stakeholders have spoken about work experience. The Action Plan for Education 2018 includes an action to commence a review of work experience at post-primary level with a view to increasing access to, and the quality of, work experience for students. This review is at the early planning stages with a steering group to be established which will then define terms of reference and a project plan for the review.
While noting the broadly complimentary remarks made in a previous hearing concerning access to higher education for persons with disabilities, it may be helpful to provide some information on the higher education sector. Student support services in higher education institutions usually include an equity of access office, dedicated disability services and a career guidance support service. The central role of disability officers is to provide supports and services to students with disabilities to assist them in accessing higher education and successfully completing, as well as to ensure compliance with the legal requirement to provide reasonable accommodations as appropriate. A key ambition of the National Access Plan for Equity of Access to Higher Education 2015-2019 is to achieve the implementation of more inclusive practices and integrated approaches which contribute to the realisation of a student body which reflects the diversity and social mix of the population.
Perhaps the most important measure of how well access to higher education is facilitated is to note that the proportion of higher education entrants indicating they have a disability has increased from 6% in 2012 to 10.3% in 2016. The challenge, of course, is to maintain and build on these numbers.
The Department is represented on the working group of the comprehensive employment strategy for people with disabilities strategic priority action 5.1, which is led by the National Disability Authority. It focusses on transition points for people with disabilities. The group has produced a report agreed by the Government, to be published shortly, outlining the policy approach and an implementation plan.
Significant progress has been made in supporting learners with disabilities across the range of school levels and into further and higher education. The comprehensive employment strategy framework will also help us advance the cross-departmental co-operation which may be necessary in some areas. It gives us visibility and access to colleagues in other Departments. I thank the committee for the invitation today to present to it.
John Curran (Dublin Mid West, Fianna Fail)
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I thank Mr. Jim Mulkerrins for his presentation. I invite Ms Patsy Carr to make her opening statement.
Ms Patsy Carr:
I thank the committee for the opportunity to outline the policy context in which the Department of Health, through the HSE, provides services for people with disabilities, including employment supports.
Disability services are provided to enable each individual with a disability to achieve his or her full potential and live as independently as possible. Services are provided in a variety of community and residential settings in partnership with service users, their families and carers, along with a range of statutory, non-statutory, voluntary and community groups. Services, in the main, are provided either directly by the HSE or through a range of voluntary service providers. Voluntary agencies provide the majority of services in partnership with and on behalf of the HSE. The range of specialist disability services provided to people with disabilities includes residential; respite; day services and rehabilitative training; assisted living services, namely home support and personal assistant services; early intervention and school-aged services through progressing disability services for children and young people 0-18 years; multidisciplinary supports; aids and appliances; neuro-rehabilitation services; financial allowances; and miscellaneous support services.
Disability services were allocated €1.78 billion in 2018. This funding is providing specialist disability services to 36,000 persons across all nine CHO, community healthcare organisation, areas, ensuring that services are delivered in line with nationally agreed policy for persons with a disability, while, at the same time, endeavouring to maximise value. A wide range of disability services is provided to those with physical, sensory, intellectual disability and/or autism.
Over 60% of the resources available are allocated to provide a range of residential services to approximately 8,400 people with a disability. A further 20% is targeted at the provision of more than18,000 day places and supports to nearly 25,000 people. The remaining 20% provides respite care services to just over 5,700 people, over 4 million personal assistant and home support hours for 2,500 people, as well as multi-disciplinary teams and other community services and supports to children.
Last month, I met the Joint Committee on Public Petitions on the HSE-funded personal assistant service. I am also aware that personal assistants, PAs, have been discussed in this forum. The term "personal assistance user" refers to a person with a disability choosing a personal assistant of his or her choice to aid him or her in everyday tasks. The 2004 Health Act does not mandate the HSE to provide PA services. It is, rather, an ancillary service. However, the Department of Health and the HSE are committed to protecting the level of personal assistant services available to persons with disabilities. From 2013, the HSE has consistently, year on year, increased the number of hours of PA service delivered to persons with a disability. Last year, 1.5 million hours were provide to approximately 2,500 people at a cost of €42 million.
Day services are a key component of support services that enable service users to live within the community. Currently, day services are transitioning to a new approach outlined in the policy, New Directions. This policy is underpinned by the values of person centredness, community inclusion, active citizenship and quality. There are approximately 25,000 people availing of day services and there is an annual intake of approximately 1,000 additional young people who require such a service on leaving school.
Within the New Directions service approach, people in receipt of a HSE-funded day service are offered a choice of 12 supports. These include support for making choices and plans; support for inclusion in one's local community; support for accessing education and formal learning; support for maximising independence; and, support for accessing vocational training and work opportunities.
The first support referred to is support for making choices and plans. This sets the foundation for each individual's service. A person-centred plan is formulated for each individual and within that context, if a person has ambition to progress to employment, a plan is developed to support the person to achieve this target. The plan may incorporate a range of all of the 12 supports.
The range of supports and the timeframe involved in supporting a person to achieve his or her goal will depend on the needs and abilities of each individual. One of the key supports for people who express a wish to progress to employment is support for accessing vocational training and work opportunities. Within this support, depending on a person's social and work-related skills, preparation for the world of work commences. This support will include work experience placements which can act as a transition for people into employment.
The rehabilitative training programme, which is also provided within the framework of New Directions, acts as a foundation programme for people with disabilities. Work-related social skills are also a key focus of this programme together with work experience placements and trialling of vocational training programmes. There are rehabilitative training programme places available throughout the country. Rehabilitative training places are managed at CHO level and are often reallocated or moved within the CHO area to meet demand. They include all ages and disabilities, including mental health.
Since 2016, all HSE CHOs are allocated the funding required to meet the needs of all school leavers in their area. All school leavers in 2017 received the quantum of day service requested and a similar outcome is envisaged for this year's school leavers.
The HSE is allocating €12.5 million in 2018, that is, €25 million in a full year, to provide appropriate services and supports to young people with disabilities and autism who will require continuing health-funded supports on leaving school or rehabilitative - life skills - training this year. As part of the annual school leaver day service process, each service user seeking a day service is individually profiled to ensure that he or she receives the level of support required.
The Department and the HSE works closely with the National Disability Authority and are grateful for its support in ensuring that the right supports are provided at the right time to support each school leaver to maximise his or her potential.
Earlier, I spoke about day services and employment supports. The range of supports offered can include work experience, therapeutic work following a clinical recommendation, employment in the open labour market and supported employment. Supported employment can include the national employability programme, which my colleague, Ms Simonetta Ryan, from the Department of Employment Affairs and Social Protection, spoke about, or service provider supported employment initiatives.
In the absence of appropriate supported employment programmes being available to people with disabilities in recent years the HSE has funded some providers to provide this element of employment. This support will continue for those who are availing of it while a more responsive arrangement is developed as part of the comprehensive employment strategy.
The Department of Health and the HSE are collaborating with the Department of Employment Affairs and Social Protection and the Department of Education and Skills as part of the comprehensive employment strategy 2015-2024. This initiative is led and co-ordinated by the Department of Justice and Equality, which has a co-ordinating role for disability matters. With the assistance of the National Disability Authority, the Departments are exploring the development of a pilot project to test the policy approach for a comprehensive supported employment programme. Such a programme could be implemented over 2018 to 2020 and focus on a specific target group. This will provide learning for any future scaling of such an approach.
The 2017 report of the Make Work Pay group made two principal recommendations regarding medical cards to address a barrier to employment for people with disabilities. The Minister for Health, Deputy Harris, has committed to deliver on the recommendation to raise the medical card earnings disregard from its current level of €120 per week for people on disability allowance or on partial capacity benefit associated with invalidity pension. The Department has collaborated with colleagues in the Department of Employment Affairs and Social Protection and is working with the HSE on the operational aspects to enable implementation of this recommendation as quickly as possible.
A second recommendation made by the group sought to amend the medical card guidelines requiring that employment must be of a rehabilitative nature for the associated income to be disregarded when being assessed for a medical card. I am pleased to say that the guidelines were amended and the disregard has applied since April 2017.
Disability is not a health issue or an education issue or an employment issue. It is, however, an equality issue and Government has had a whole-of-government approach to disability for a number of years. The Minister of State, Deputy Finian McGrath, has responsibility for disability issues in the Department of Justice and Equality, the Department of Employment Affairs and Social Protection, and the Department of Health. The Department of Justice and Equality is the lead Department for policy co-ordination for all disability and equality issues. The Department of Health works on a cross-sectoral collaborative basis with colleagues in Departments on national policies for adults and children with a disability. For instance, an interdepartmental cross-sectoral group at assistant secretary level meets regularly to ensure a co-ordinated approach to policy development across the Departments of Health, Education and Skills, Children and Youth Affairs, and Employment Affairs and Social Protection. We know that more people with a disability have more complex needs. Government is responding by providing the supports that people with disabilities need to live the full and independent lives that we all take for granted.
I thank the committee for inviting me here today. I am glad to have the opportunity to meet in such a collaborative forum and I am happy to take any health related questions.
John Curran (Dublin Mid West, Fianna Fail)
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The first comment I wish to make relates to the three presentations. I thank the witnesses for the time they have taken. They obviously listened to the issues raised at the previous meetings and have tried to address them. That was the purpose of the exercise rather than having a general discussion. I thank the witnesses sincerely for taking the time to address those issues.
I was taken by the fact that a great deal is happening. If we read all the material submitted, we could sit here and say that we are doing a great job. All that has to be balanced, however, by the lived experiences of the people who attended the committee some weeks ago. I am not suggesting the services are not in place but the challenges those people have found along the way need to be considered. That was one of the reasons for the exercise rather than simply talking to advocates. The idea was to include the individuals themselves. I thank the witnesses sincerely for the presentations and for the way they went about addressing the questions.
The next session will allow colleagues to ask questions. I propose to allow each member up to ten minutes to direct questions because three different Departments are represented at the meeting. I will start with Deputy Brady. He has ten minutes initially. He can stop and start but I ask him, please, to be specific in who he addresses his questions to because I am conscious that we have representatives from three different Departments.
John Brady (Wicklow, Sinn Fein)
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I want to make a general comment and pick up on a particular paragraph in the presentation given by Ms Carr because it cuts to the chase and to why we are here. Ms Carr said that disability is not a health issue or an education issue or an employment issue but an equality issue. She said Government has taken a whole-of-government approach to disability for a number of years.
At our two previous sessions, the Disability Federation of Ireland, DFI, indicated that the current activation measures are not impacting on the employment rates of people with disabilities in post-recession Ireland. That view is echoed by numerous other organisations that deal specifically with people with disabilities. There are serious question marks over how successfully the measures are impacting on the ground.
To home in on one area, much has been said about the comprehensive employment strategy which has been in place for two years. The strategy has not had any impact on the employment levels of people with disabilities. That view is borne out by statistics that are available for everybody to see and have been referred to in a couple of presentations. It has also been echoed by the DFI and other organisations. The Department of Employment Affairs and Social Protection has responsibility for 33 actions in the comprehensive employment strategy, most of which were to be delivered in 2016. How many of those specific actions have been implemented? I can state categorically that few of them have been implemented, even though the target date for implementation was 2016. Will Ms Ryan indicate how many of the 33 actions in the strategy have been implemented by the Department?
Ms Simonetta Ryan:
We have done a considerable amount of work to advance the 33 actions. I understand, as I have read the previous presentations to the committee, that people are frustrated because they do not see enough action on the ground. What I tried to show in my presentation was that there is a great deal being done but this is a complex area and it is difficult to show where things are happening immediately or quickly. The most obvious action to point out is the large amount of work done on the Make Work Pay report, consulting people with a disability to try to come up with the best way to take matters forward. In terms of some of the other steps we have taken, I will ask one of my colleagues to contribute.
Mr. John Bohan:
I am in charge of the disability policy unit. I will revert to the Deputy with more details on the individual actions. There are 22 actions specific to the Department and those on which we have made good progress are those relating to the previous disability activation project, DACT, programme, co-funded by the European Union. In the past month or so, we have built on DACT by introducing a mainstream programme known as the Ability programme which implemented the findings of the review of the DACT programme. The review included a number of recommendations, including several on systematic engagement with people with disabilities. That recommendation also featured in the Making Work Pay report. For the past year, my colleagues and I have been engaging with disability groups, parents and stakeholders on how this recommendation could be implemented in practice, particularly how the principle of early engagement with young people might be systematised in Intreo services. We have made some progress on that.
The report also recommended the introduction of a ready reckoner, a benefits of work estimator. The Department implemented this recommendation in the past month. We have made good progress on some of the actions.
John Brady (Wicklow, Sinn Fein)
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I am sorry to cut across Mr. Bohan but I am conscious that my time is limited. Given that there were 33 recommendations, I do not expect the witnesses to rattle them all off. I ask them to furnish the joint committees with a progress report on all of them because there is legitimate concern that they have not been implemented, despite the report setting a timeframe for doing so of 2016.
Mr. John Bohan:
We can send two documents. We can send a note that goes through the actions that specifically related to the Department and also send a copy of the annual report by the chair of the implementation group, Mr. Fergus Finlay, who does an annual review of progress in implementing the strategy.
That might give the Deputy a good sense of the situation.
John Brady (Wicklow, Sinn Fein)
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I have another specific question. Some employment projects are doing fantastic work. WALK is one such programme. Year after year, it lobbies committees to try to get funding to ensure it can continue, which is ludicrous. It provides tangible benefits for people with disabilities. If we are serious about putting in place measures which work and benefit those with disabilities why is that the case? Projects such as WALK should be rolled out across the State. Maybe I could get a specific answer to that.
John Brady (Wicklow, Sinn Fein)
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That has to be welcomed. I was not aware of that. It is long overdue. WALK has done Trojan work over many years.
I am seriously concerned about social enterprises which do fantastic work. A number are closing and there seems to be confusion about who has responsibility for them. The HSE is not funding staff to support projects. Who has responsibility for social enterprises operating across the State? The buck seems to be passed between different Departments and ultimately the HSE is not providing funding. It is a general question which covers a couple of different Departments. I ask Ms Carr to address the role of the HSE.
Alice-Mary Higgins (Independent)
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The Deputy might be referring to the schemes Ms Carr mentioned that the HSE had funded in the absence of other schemes.
John Brady (Wicklow, Sinn Fein)
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I have two other specific questions covering two different areas. A lot of evidence has been given about the barriers which have been put in place for people with disabilities in terms of entering or re-entering the workforce. One has been touched on. There has been some welcome progress in terms of people being able to keep the free travel pass for five years. I do not think the scheme goes far enough, even though I acknowledge it exceeds the recommendation of three years.
Another issue is medical cards. I note the response that the Minister is working on the issue and the Department of Employment Affairs and Social Protection is currently working with the HSE on the operational aspects to enable implementation of the recommendation. What is the current status of the project? This has been going on for quite a while. It was suggested at a previous committee meeting that specific legislation is required to allow changes to be made.
Ms Patsy Carr:
In respect of one aspect of the Deputy's question, as I said the rehabilitative training scheme has been in place since 2017. The income disregard piece has almost been finalised.
Discussions are ongoing with the HSE on finalising it, but the Department also wants to be consistent with what is done in the Department of Employment Affairs and Social Protection. I think that is what requires legislation.
John Curran (Dublin Mid West, Fianna Fail)
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We may come back to the Deputy in a moment.
John Brady (Wicklow, Sinn Fein)
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To clarify, is specific legislation required?
John Brady (Wicklow, Sinn Fein)
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In relation to the income disregard.
John Brady (Wicklow, Sinn Fein)
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Is work ongoing on the legislation required or what stage is it at?
Mr. John Bohan:
I am not sure if that is the case. I think the income disregard in the area of social protection works in a different way. It starts at €120 but extends over a range to €350. The medical card scheme cannot operate in the same way because one cannot taper the withdrawal of a medical card. The Department of Health has been considering various options. It would like to align the income disregard in some way with that in the Department of Employment Affairs and Social Protection, but it cannot mirror it. Therefore, it is looking at options in order to be able to do so. We have been engaged in discussions with the primary care reimbursement service, PCRS, of the Department of Health, the section that manages the issue. We have given it information on the number of people in receipt of disability allowance to allow it to do so. I am not fully sure whether there is a need for the Department of Health to change the legislation, but I do not think we need to change ours to allow it.
Ms Patsy Carr:
I am sorry if I misinterpreted the question, but I do not think we need to change our legislation. We have to develop a policy, but the Minister wants it to be consistent with what applies in the area of social protection. As Mr. Bohan pointed out, the Department of Health has more flexibility. As far as I am aware, it has more to do with a medical card for a family. For an individual, there is one arrangement. If the medical card is for a family, the arrangement is different. The Department is in the process of agreeing to it and working it out with the HSE, but as far as I know, it is expected that it will be sorted out in a matter of months.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank all of the delegates for their work and statements. I count 22 pages of statements. Clearly, there is a lot of activity, but I could not find a single sentence identifying existing problems. It is unbalanced. I appreciate that this is a political arena and that it is not really up to civil servants to come and hang out to dry the Government of the day on what is not working, but the report is not balanced. It talks about a lot of activity, but there is no critical analysis of what is working, or rather what is not working, where additional resources are required, where enabling legislation is required or anything else. That is very disappointing because there is very little we can do with the information supplied. The statements outline where we are at, but they do not really tell the Oireachtas what the Departments need and how we, as legislators, could help, particularly in the run-up to the next budget when there may be a little money to spend. I am disappointed with the information supplied from that perspective, but that is not to take from what is, undoubtedly, a lot of work that is ongoing across the Departments.
What strikes me about the three presentations - the Chairman also alluded to it - is the disconnect between all of this activity and what is actually happening on the ground for people with a disability. I will direct my first question at the HSE.
I spent about half of Friday in the National Rehabilitation Hospital trying to help a young man to get out of it. He was injured a year and a half ago and is paraplegic as a result of the injury. He was discharged from the hospital last September. I engaged with the HSE. The family also engaged with it. The young man in question was told that he would have to move back to Sligo to the intensive care unit to live out his days, which obviously is completely ridiculous. He was told this because people were screaming at the National Rehabilitation Hospital for the bed he had. He wants to lead his life and go back to work, but it took me and his family having his case highlighted on "Prime Time" and me raising it in the Dáil to even get a response from the HSE.
I wrote multiple emails. I, as a Member of Parliament and as Fianna Fáil's health spokesperson, could not even get a response to my emails. That is the reality. The reality is that it is now June. He was discharged last September but he is still there. To be fair, at the table last Friday were people from stepdown facilities, senior clinicians and people from the HSE who have been trying very hard. The reality is that he was discharged almost a year ago. He is in the wrong setting and his bed is needed by about 50 other people. That is the reality.
Can I ask the HSE how it can possibly be, with all this activity going on and all this emphasis on and work and money aimed at helping people with disability lead as full a life as they can, that someone can be discharged from the National Rehabilitation Hospital, NRH, last September and still be meeting me, his clinicians and members of the HSE last Friday? How is that still a reality today?
Stephen Donnelly (Wicklow, Fianna Fail)
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The Department of Health. I beg your pardon.
Ms Patsy Carr:
I am not familiar with the case the Deputy is talking about. We are all aware that there are 110 beds in the National Rehabilitation Hospital and obviously that is not enough for the needs around the country. As the Deputy rightly pointed out, there are a lot of people in beds there who could have their care provided, and would prefer to have their care provided, in their own community. There are an awful lot of people in acute hospital beds all around the country waiting for those specific beds.
There is a new rehabilitation strategy and the desire is to move some of the services to the community but we do not have the staff. The programme is expensive and we do not have an allocation for it. Every year the HSE makes a case to the Department for funding and we negotiate with the Department of Public Expenditure and Reform, but no matter how much money we get for the disability services, we have had years of no funding. Quite frankly, since the economic downturn, there has not been investment in disability services, and not just in neuro-rehab. We have huge waiting lists for residential care and respite care and, unfortunately, it is a case of loaves and fishes.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank Ms Carr. Her answer is that there is not enough money. In this case, moving this gentleman into a stepdown facility out of the NRH, which is obviously a high skill and expensive place for someone to be, would be cheaper. Given any envelope of money, why is it that we are keeping people unnecessarily in a high-cost, high-care environment, and not changing the mix of the money we have to put people in a clinically more suitable situation and provide a cheaper solution? Why is that not happening?
Ms Patsy Carr:
Without getting into the specifics of it, the bed he is occupying in the NRH is already funded. It costs extra money to provide the funding for him to go into the community. It is not always cheaper. I do not know the level of that man's needs but he could require 24 hour care at home. This is not cheap but would give him the quality of life that he requires and deserves. It is about having additional funding but it is also about having the additional teams to work on the ground in the various settings around the country. That all takes planning and funding.
Stephen Donnelly (Wicklow, Fianna Fail)
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I thank Ms Carr. I wanted to raise this again because that is the reality. We can have all the plans, the work and the decent gestures we want, but if the reality is that we have a quadriplegic man, fully capable of going back to work and fully capable of leading quite an independent life with the right supports, who was discharged almost a year ago from the NRH, then something is badly broken in terms our spectrum of care for people with disabilities.
I have a similar question for the Department of Education and Skills on assessment. There has been a lot of talk about the need for assessment and the need for transition. Certainly in Wicklow, and I imagine in most if not in every other constituency, one of the most frustrating conversations one has as a Deputy when canvassing is to meet the parents of children with disabilities who are waiting for years for assessment.
I am not even talking about getting the supports; I mean for assessment. I met a mother whose daughter has serious spinal issues who has been waiting a year for an assessment for a wheelchair because the curvature of the wheelchair that she has is wrong. She is in pain and cannot use the wheelchair. She sits on the ground for most of the time. She is not waiting a year for a wheelchair; she is waiting a year for someone to assess the wheelchair requirement. In the meantime the HSE will not fix wheelchairs and throws them into a big skip.
I talk to parents who are waiting literally years for speech and language assessment for their children. We all know that early assessment is incredibly invaluable. How is that happening? Is anything being done to get the assessments and the supports in place for young children with various disabilities, be they physical, learning or intellectual disability. It seems that things are moving in the wrong direction and that this is a profoundly stupid, dangerous, damaging and unnecessary thing for us a State to be doing.
Mr. Jim Mulkerrins:
There are three separate questions there and I will have to bounce some of this back to Ms Carr because the main provider of assessments is the HSE. However, we have a National Educational Psychological Service. Its function is not to provide assessments but to upskill and support schools and to ensure that they are supporting children within the schools as well as they possibly can. We are conscious of the long delays that have been there for assessments historically and we have been engaging with our colleagues in the Department of Health, the HSE and the National Council for Special Education, NCSE, in a cross-sectoral format on a very regular basis about this. Back as far as 2012, we engaged with the National Disability Authority, NDA, and it was telling us at the time that assessments just for educational supports were costing the equivalent of in excess of 75 whole-time equivalent psychologists across the State. We took the view that that was wasteful because it is better that our therapists and practitioners are providing services rather than assessing for services. We were proactive about this and the committee will be aware that we introduced a new resource teacher allocation model in September 2017, which removed the need for an assessment in order that resources would be provided. In the past, a child had to have an assessed disability before additional teaching hours were provided but that is no longer the case.
The special needs assistant, SNA, review I mentioned in my presentation contains similar recommendations. Hopefully, if these recommendations are accepted and implemented by Government in the future, it will no longer be necessary for children to have an assessment of need before they can access SNA-type support. I am conscious that that review also had a number of other recommendations which primarily all blend together to ensure that in future children will get the right support from the right person and at the right time. In order that that would happen the over-reliance of the assessment of need process will be discontinued or rolled down. We know, of course, that children will continue to need assessment for clinical reasons and perhaps to guide the professionals and practitioners in understanding the levels of support and the types of needs that children have.
On speech and language therapy, we are very conscious, that while the Department of Education and Skills is not currently the provider of speech and language therapy services, there is a commitment in A Programme for a Partnership Government to develop an in-school approach and language support service to ensure that children can get access when and as they need support. To that end, from this September, in collaboration with our colleagues in the Department of Health and the Department of Children and Youth Affairs, we will roll out a pilot project across CHO 7, involving 76 schools, including a number of special schools, and 76 preschools, where therapy services will be delivered in school in line with the continuum of support service - a high level of support for the higher level of need; a middle level of support for the middle level of need and a whole school approach to children to try to identify and deal with needs as they first arise in order to try to prevent them from getting worse, so to speak.
That pilot is being rolled out in on a collaborative basis. We work on a very regular basis with our colleagues in the Department of Health to ensure that the need for clinical governance and clinical support for therapists currently being recruited for this particular pilot will be available. The HSE will do the recruitment process for us and the NCSE will manage the programme for us. This heralds a new era of enhanced co-operation and collaboration between our Departments to ensure that children get access to supports without having to wait years for assessments.
The National Council for Special Education, NCSE, will manage the programme. This heralds a new era of enhanced co-operation and collaboration between our Departments to ensure children get access to supports without having to wait for years for assessments. I accept this will take some time. The pilot will run from September to the end of the school year and then we will work towards delivering a nationwide project, assuming that the evaluation of the pilot tells us it is positive.
Ms Patsy Carr:
Deputy Donnelly mentioned an assessment for a wheelchair. I understand that is done in the primary care setting in the HSE. While a quantum of service is funded, it is only a quantum and I do not know what the situation is in the case the Deputy has raised. I know that primary care does the assessments and, based on funding available, provides the wheelchairs to individuals on a priority basis.
Stephen Donnelly (Wicklow, Fianna Fail)
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It struck me as extraordinary, when I spoke to this mother, that she was waiting for over a year for an assessment. Is the Department aware that we have young girls with curved spines who are no longer able to sit in their own wheelchairs, sitting on the floor, waiting for a year for an assessment for a new wheelchair? Is the Department aware that is the level of the crisis?
Ms Patsy Carr:
Not to pass the buck, but I work on the disability side, which is primary care, as I said. If the Deputy wants to give us the details, I can have it looked into.
Alice-Mary Higgins (Independent)
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I am following up on some of the issues which have been highlighted already, including the huge level of unpaid administrative work. It came across very strongly in the testimonies of the many individuals who have navigated the system. A huge level of unpaid administrative work is undertaken by individuals to access not just equality but their rights and entitlements and to navigate the system. Something that came across very strongly was that the huge level of administrative and bureaucratic work that individuals have to undertake - sometimes in a supported capacity, since they may be lucky enough to have strong advocates, or they may not - seems to begin again at each new chapter in their lives. There is a question of transition points. A key reason we have all these Departments in together is those problems of transition points. I will not ask for all of the points in the comprehensive employment strategy to be discussed. I am sure we are due to receive a report on that. It would have been wonderful if one that was mentioned was ready in time for these hearings since it relates strongly to them. It is priority action 5.1, which focuses on transition points for persons with a disability. While I am a little concerned that the other Departments did not mention it, it is mentioned in the statement from the Department of Education and Skills that it will be published shortly. It will be relevant for us to know when that report on transition points will be coming through. It is key. I expected that it would be the focus of a lot-----
John Curran (Dublin Mid West, Fianna Fail)
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Will we see if there is an answer to that?
Alice-Mary Higgins (Independent)
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I will make a couple of points and then there can be general answers. Maybe the witnesses can give that date. Is there a date?
Alice-Mary Higgins (Independent)
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Is it expected before the summer recess or do we not know?
John Curran (Dublin Mid West, Fianna Fail)
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For clarity, the report is complete and with the Minister.
Alice-Mary Higgins (Independent)
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Perfect. That was a key question. I will give input regarding a couple of points that really struck me on that issue of transition points from the testimony of others. Special needs assistants were mentioned. People may have had special needs assistance in our higher education institutions or post-primary institutions and then find themselves wishing to transition into employment but the educational supports that they had were tied to their educational chapter. There are people who may have managed to navigate and, for example, receive a degree but in that period immediately afterwards, when it is so important for translating into employment, they are almost entering a brand new system cold, starting the negotiations again and trying to get support again, rather than having a period of overlap which allows them to transition into employment. That was one example. Those transitions are a key concern. I welcome that there is a fast-track for those who may seek to leave disability allowance and return to it. It is positive that that may happen a number of times.
I have a couple of concerns on the social protection system. One is the fact that people can become invisible in terms of their disability at a number of points. For example, if somebody transitions into full-time employment the fact he or she is a person with disability can become invisible. We have talked about the level of income disregard on medical cards. There are many situations when we talk about making work pay and the cost of disability where people may well need quite extensive medical supports over the course of a lifetime that are not going to go away and are not going to be fundable. We heard from people who felt they had to go back on disability allowance because of that cost and the fear they would lose their entitlement to the medical card and who would have preferred not to be getting disability allowance and the medical card but simply getting the medical card. However, they had to transition back to get both again.
The other concern I have is where people get to pension age and they disappear as somebody with a disability in terms of the visibility of that issue. There were a lot of concerns on the question of the invalidity pension. The transition to partial capacity benefit was mentioned. Partial capacity benefit is an interesting one because the recognition of partial capacity is not as well recognised for those on a disability allowance, although they have the disregard. Given that we know some people are working, using the income disregard while on disability allowance, and others are seeking to work, and perhaps Ms Ryan might answer this question, are there quality part-time educational and employment options that recognise that people may be available and seeking work on a part-time basis?
John Curran (Dublin Mid West, Fianna Fail)
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Would the Senator like answers to some of those-----
Alice-Mary Higgins (Independent)
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Yes. I have one last set of questions which I will come to.
John Curran (Dublin Mid West, Fianna Fail)
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I call Ms Ryan.
Ms Simonetta Ryan:
There are a lot of different things going on there. We have the two different schemes - invalidity pension and disability allowance. They are different schemes and have different conditionality. One is based on contributions and the other is means-tested and the payment rates are slightly different. It always becomes complicated if one tries to merge two schemes because it does not lend itself to it. We are doing a lot on the ground with people and are developing our services to engage with people. If the committee would like it, we can talk a little about what we are doing. We recognise also that we have a lot more to do and that is what hopefully will come from the work we have done on the Make Work Pay and the article 5.1 group. Part of that is to look at how one helps people who need more supports and what are the options as one goes forward. All these things, to some extent, have to be iterative, because one has to try different ways of working to see what is going to work.
The Senator talked about the full-time or part-time option. As regards part-time, we have the part-time capacity benefit for people on illness pension. That is a good scheme. Given that disability allowance, DA, is different, the way it is dealt with in DA is through the disregards. There is an option for people on DA to work and to still retain quite a lot of benefits for quite a long time.
Alice-Mary Higgins (Independent)
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I am talking education and part-time options and not simply the entitlement to same. I refer to things like quality part-time educational options. For example, the CE scheme is one of the few schemes that is part-time. Perhaps this is too micro in detail but that is not available to people on certain schemes. The question is about quality part-time options.
Another key issue that relates to this is the concern around the invisible, that is, those who have a disability but because disability allowance is means-tested may not be on disability allowance and, moving away from the payments, their access to the educational, the training and the employment supports. That is what I was talking about in terms of there being suitable good quality options. Are they available to people, regardless what payment scheme they are on, and to those who may not be on a payment scheme but who may have a disability?
The other witnesses might answer my question on what we heard about the iterative process because there is a real concern here. Disability is one of the issues that has not landed suddenly; it is one of the most known issues. We know it is a long-term fact of society and yet it seems there is a huge reliance on pilot schemes.
JobPath, for example, scaled up very quickly and yet we have had a litany of excellent practice schemes which seem to have come and gone. WALK PEER was mentioned as was the three-year funding. Is it national? Is it available everywhere? There is the Care project and the Inclusive Learning Project at Maynooth University, about which we heard great things but then the funding stopped. There is also the Career Pathways, a transition to employment scheme in Trinity College. There is a litany of excellent good-practice schemes. However, what seems to happen is that the pilots are put in place but then the scale-up does not happen. I am very concerned about a new project, namely, the pilot project testing the policy approach for a comprehensive supported employment programme. This is just another example, which will be a pilot from 2018 to 2020, and will provide learning for any future scaling of such an approach. How do the Departments plan to move from pilots to national implementation?
John Curran (Dublin Mid West, Fianna Fail)
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I thank the Senator. Who would like to answer?
Alice-Mary Higgins (Independent)
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I have one tiny final point.
John Curran (Dublin Mid West, Fianna Fail)
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We will come back to the Senator if we have the time. I call Ms Ryan.
Ms Simonetta Ryan:
I will try to answer some of those points. On the question of the part-time education options, to be honest I do not have specific answers on that, but we are developing the capacity of our case officers to work with people with a disability. People can come talk in to us about activation and engage with us, whether they are on a scheme or whether they are these invisible people. Part of that may be about awareness and people realising that is something they can do. We have put a lot of work into our case officers. I always accept that we have more to do because this is a complex client group; it is not homogenous. We accept that.
Side by side with that we have pilots. There is one running in the midlands at the moment. It is not that we are just doing pilots. We use the 62 Intreo services around the country to provide access for people. However, we have to look at how can we do it better and how we can target particular situations and circumstances, working with our colleagues, whether in health, education or elsewhere. That is where the pilots can help us. They help also people with disabilities and their families to input into what is working and what is not. It is slow and I accept that.
Alice-Mary Higgins (Independent)
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What might be-----
John Curran (Dublin Mid West, Fianna Fail)
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Senator, please. There is quite a bit to do yet. I want to hear the comments from the other witnesses. I will come back to the Senator if I have an opportunity. I call Ms Carr.
Ms Patsy Carr:
We work regularly on working groups with our colleagues in a number of Departments on the Make Work Pay and on the comprehensive employment strategy because from the specialist disability service side, we are working with people from a particular cohort. We want to get them into a day services that meet their needs and that are changing and evolving with their needs. Now we have people with disabilities living longer. I appreciate what the Senator said about pilots and that they should not end but sometimes what is required changes. We work collectively on that and the Department of Education and Skills would be involved as well in ensuring that people are trained to meet their needs.
John Curran (Dublin Mid West, Fianna Fail)
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Does Mr. Mulkerrins wish to come in here?
Mr. Phil O'Flaherty:
There are a probably a couple of points to be made. Ms Ryan raised the issue of the role of the Intreo offices. As members are probably aware, there was some major reconfiguration of further education and training and the employment service whereby training, delivered by FÁS in the past, moved to newly-created education and training boards, the former vocational education committees, that also delivered vocational education.
There are protocols in place locally with all the Intreo offices and the education and training boards. That is giving Intreo offices a much greater visibility as to the full range of education and training offerings that are out there where previously most of the referrals would have been to the training side because the employment and training side were together in FÁS at one point. That includes quite a lot of part-time provision - for example, the back to education initiative and a range of programmes at various levels, including in areas like literacy, numeracy, digital skills and basic skills.
More broadly, in further education, training and, indeed, higher education, there is a major push to increase the range of flexible options available. Members will be aware of the Springboard programme, for example. Springboard was previously heavily pushed towards people who were unemployed, were on jobseeker's assistance or benefit but now it has been opened up much more broadly and provides good options, including for people in employment, which may include people with disability. There has been a considerable push and some funding through the higher education funding mechanisms, through the Higher Education Authority, and also in further education, through SOLAS, on technology-enhanced learning, with blended approaches. That is through both the use of technology in classrooms, which is something that can be very important to people with disabilities, and also online, with blended approaches which deliver greater flexibility. It is reasonable to say that those protocols have been in place for two years for Intreo offices and ourselves.
Our Department, SOLAS and the Department of Employment Affairs and Social Protection regularly meet on a tripartite basis to review how that is working locally. As the Department of Employment Affairs and Social Protection broadens its focus more clearly beyond people who are unemployed - and some capacity maybe has freed up in Intreo services - our Department also needs to look at how we can support the broader range of clients that are likely to come our way. That is a focus of our discussions too.
Bernard Durkan (Kildare North, Fine Gael)
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My apologies for being absent for quite a long time. I had to attend another meeting. It is very difficult when two meetings are being held at the same time.
. I welcome our guests. I have a couple of quick comments. Something that has become obvious to me and, I am sure, everybody in public life is that families that are affected by disability spend much of the time waiting for something to happen, waiting for services to kick in or waiting for attention. It has become a burden to them with the anxiety that is attached. Can the Departments do anything to try to eliminate that? For example, why should children with special needs of an acute nature have to wait indefinitely for urgent surgical procedures? These families have to wait a long time and they do not know when an outcome will be forthcoming
The burden on families has to be experienced by means having close contact with the families. These people will readily relate the facts. The mother of a teenager who has a serious disability recently informed me that she has been at it for 20 years, day and night and on call all the time. She said that some things are well done and some are not; that sometimes provision was made and sometimes it was not. Certain families have more than one member with a disability and that increases the burden. I would like the service providers to bear that in mind when they refer to waiting.
In the context of the disability allowance versus the invalidity pension, the former is insurance-based but there was a tradition whereby a person, a year from coming off a disability allowance, particularly when coming off a domiciliary care allowance, automatically qualified for an invalidity pension. This does not happen any more. That is a huge disadvantage to people who may have a limited income and who may find themselves in a difficult position. Any extra money is a huge advantage to them.
That needs to be looked at again.
This is important and I do not want an answer to it. It is a comment. Some people can overcome disability to a huge extent, whether a physical disability or a sensory disability. Others cannot. Others may find the disability so overpowering, whether inherited or a disability following an accident, that they find themselves at a huge physical and psychological disadvantage and feel unable to cope, and feel very pressurised, as I saw at a recent case where it was suggested that an amputee should seek employment. It was an appalling decision. I cannot understand how an official or anybody could stand over a decision like that. The simple reason was the unfortunate person was at a very severe physical disadvantage to start with and, to overcome that physical disability mentally, in itself, was a huge issue for him. To suggest to the person concerned that he should be looking for a job and there was no reason he should not get a job is crazy.
The Intreo people have been referred to. The jury is still out on that for me. They have done some interesting and useful work but they have also gone off on a tangent on some occasions where a little more thought could have gone into what eventually became a decision and a burden on the people affected by that decision. I am not asking for answers. I am making a comment. I have serious concerns about the things I have mentioned because I have daily contact with people who are affected in that way.
John Curran (Dublin Mid West, Fianna Fail)
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I will come back to the Deputy in a moment. I want to be fair to the witnesses we had here a couple of weeks ago. I will make a couple of comments and they can be referred to specifically. I reflected on it before I came in. Something the witnesses all said collectively was that they felt lucky about where they have got to. Despite all the programmes and policies we have in place, they all felt lucky to have worked through the system and for their entitlements. They all came by different pathways but there was an element of luck. That was the way they felt about it and, in that way, there is something wrong with the system in that there are not clearer, more identifiable pathways onto which those people or their advocates can see them. They all referred to it as luck. I was very taken with it. The witnesses have quite rightly explained a significant range of programmes that are available but the people who are to avail of them do not see it as easily as that. Information and education are issues.
I will address a couple of specifics that the individuals referred to, in no particular order. One lady spoke about what she was able to do because she had a personal assistant. She was a little bit older and had the personal assistant for some time, but she made the point that if she was a younger person, she would not have access in the same way that she does. She recognised the old system versus the new system and was quite specific in it. We had one person who spoke about special needs assistants and their support in primary, secondary and third level. There was no continuity of support. There was a significant drop-off in second level and they were quite impressed with the level of support they got in third level.
We heard about the special schools and the fact that, in many of them, there is no pathway either to do the leaving certificate or applied leaving certificate, and what that means for those people in the future. Mr. Mulkerrins alluded to the fact that careers guidance in those special schools is not done in the normal way, as it would be done in a regular school. These were highlighted. Everyone expressed concern about the loss of the medical card or the travel pass. They all said to us in different ways that, while they might have a job, they still have their disability and the associated costs that go with it.
While they might have a job, the people concerned still have disabilities and face associated costs. We need to look at more than just means testing. One of the delegates is visually impaired. Some of the equipment covered by the medical card scheme is relatively expensive and she faced a huge personal burden. When the transition is considered in the round, people with disabilities face additional costs in getting to work. There is a feeling of nervousness and vulnerability in losing the medical card and free travel.
There was much talk about the disability allowance and illness benefit. I understand there are approximately 2,500 in receipt of partial capacity benefit. It was rightly set out that the person was assessed. My experience of partial capacity benefit is that many persons who are availing of it and have re-entered the workforce do not have a regular weekly salary because many do not work full time. The partial capacity benefit does not recognise whether a person has worked in a given week. Such persons are on a reduced payment, in comparison to the previous benefit of which they availed. We should look at the benefit specifically for those who are beginning to go back to work where the nature of the work is part time or casual or for a few hours a week. That is the stepping stone for them, but partial capacity benefit is only for a set amount, irrespective of what a person earns in a given week. I suggest a system be put in place to provides the full benefit if a person has not worked in a given week for a specified period of time. For many, it is a transition.
My colleagues will speak briefly about this issue, but they are the main points. I am taken by the reports and the actions proposed for the future, but I emphasise that the delegates who were here a couple of weeks ago all said they were lucky. They had all transitioned and were making progress in their lives. However, there was a feeling there was no clear stepping stone or that another person could follow exactly what they had done. There was a feeling those who had transitioned had met the right person at the right time or had been on the right programme at the right time. I was taken when I heard the delegates say that they had got lucky.
Alice-Mary Higgins (Independent)
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I was struck by what was said about technology in assisted learning. Perhaps the delegates might tell us more about the reasonable accommodation aspect that was mentioned, either now or in writing later. There were some strong recommendations for an overhaul in that area, particularly in the use of technology and in terms of how important it is. This applies not only to the provision of reasonable accommodation for those in work but also to the provision of reasonable accommodation in applying for work. One of the people who spoke mentioned the obstacles faced in merely applying for work. The update on that aspect was important.
In terms of SNAs and personal assistants, the question of autonomy and choice arose, as well as questions about the hours and quality of support available. Personalised budgets were discussed, as was the idea of providing a role for the individual in question in choosing the person who would be his or her personal assistant.
Fiona O'Loughlin (Kildare South, Fianna Fail)
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I sincerely apologise for not being here earlier. I will look back at the contributions made. I have had the opportunity to read the reports. What I have read is very informative, but the lived experience of the people who have appeared in front of the committee is key. There are programmes, but access and information are the big problems. I mentioned during the last session that we needed representatives of possible and potential employers at a meeting such as this because I believe we need to work with prospective employers on perceived barriers.
John Curran (Dublin Mid West, Fianna Fail)
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I will afford the delegates an opportunity to make some concluding remarks.
Ms Simonetta Ryan:
I note from the comments of the Chair that people feel lucky. It has been very helpful for us to read the testimonies of the people who have appeared before the committee. The feeling is that there should be access and information for those people now and in the future so that they are not relying on luck. That is the direction in which we are going. I do not believe we can answer Senator Higgins today on her point about employment and the reviews of reasonable accommodation, so we will revert to her in writing.
John Curran (Dublin Mid West, Fianna Fail)
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Will the witness discuss the partial capacity benefit question?
Ms Patsy Carr:
On the medical card issue that was raised, I am confident that it will be sorted out in the next couple of months and that the HSE and the Department will come to an agreement on what the disregard will be raised to.
John Curran (Dublin Mid West, Fianna Fail)
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To clarify, the issue in terms of the disregard is that there was a range for the other payments. I believe the problem is in trying to work out the level of disregard. Is that the technical issue that is holding it up?
John Curran (Dublin Mid West, Fianna Fail)
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That is the case in the Department of Employment Affairs and Social Protection, but it can vary between €120 and €350.
Ms Patsy Carr:
That is the problem that arises where a medical card is given out for a family. The level of the disregard can have knock-on consequences for a family. We do not want anyone to lose out as a result of something that is intended to improve matters for someone else. This matter needs to be investigated further, but I am confident that it is going to happen in the next couple of months.
We all agree with Deputy Durkan on his point about families waiting for services and assessments for whom this is particularly traumatic, especially those with children with special needs who are then going for acute services. I was only made aware recently that there are disability liaison nurses in the major acute hospitals, so those processes for a child with a disability requiring acute services can be streamlined. That is a positive.
No one disputes the huge burden families face. This year, as part of the Estimates for 2018, the Government allowed an extra €10 million to provide extra respite services. It is a drop in the ocean, but it helps provide an extra respite house in each community healthcare organisation, CHO, area. This is having a positive impact throughout the country, and we would hope to build on that next year.
Mr. Jim Mulkerrins:
I will make three points, if I may. The first is a general point that I imagine reflects all of our views. The Department of Education and Skills accepts that while it has provision and policies for support in place, individual experiences may not necessarily reflect that. We are aware that individual experiences are less than satisfactory, and it makes it all the more important that we have opportunities to come to committees to hear about individual experiences. We also hear about such experiences through parliamentary questions and representations as well. We are very conscious of it, and it affords us an opportunity to try to modify our arrangements to make the individual experiences better.
On the second point, I read some of the presentations that were made at earlier meetings about special needs assistants, SNAs, the experiences of one particular person at primary, secondary and third level, and the drop-off in the service that person experienced at second level. I was somewhat surprised by that individual example, because if I recall the case correctly the drop-off occurred during leaving certificate year. I was surprised to hear that because we operate a policy, between ourselves and the National Council for Special Education, NCSE, that when an SNA allocation is reviewed, unless there was absolute clarity that the individual need had diminished substantially, there would be no removal of that level of support in the final year. I suspect that was an individual example of something falling through the gaps.
I am not sure when this happened, but I would make the point that between 2001 and 2010, the number of SNAs in the system grew by approximately 1,000 every year. There was a period of cooling off between 2010 and 2013, largely because of the economic downturn, I suspect. However, we continued to make additional provision. By the end of this year there will be 15,000 SNAs in the system. A person attending school ten years ago may not have had the same level of access to SNA support as one would get now. We recognise that the levels of need have not changed greatly in the intervening years. The levels of assessed understanding of what those needs are has changed very substantially.
All of those needs existed in pupil populations ten, 20 and 30 years ago. We just were not supporting them the way we should have done, or in the way we now understand we needed to do.
Two points were raised about special schools, the first was about pathways to leaving certificate and applied leaving certificate. The committee knows that we have introduced levels 1 and 2 and there have been significant improvements in terms of accreditation for pupils. It is important that students' performance and abilities are recognised. In respect of the leaving certificate and applied leaving certificate there is a discussion between us and the National Council for Special Education which takes the lead in providing us with policy advice, having conducted research and consultation in the sector, about how we need to consider provision for special schools in the future. There is a discussion about getting the balance right. We recognise that there will always be children who will require the supports of special schools but who will have the capacity to go on and do leaving cert and applied leaving cert. That, unfortunately, is not the case for the majority. The issue is what the appropriate provision would be for pupils who are attending special schools but have aspirations to go on and do leaving cert applied and the ordinary leaving cert. It is a matter of getting the balance between where provision should be made, whether children should be provided with greater levels of access, even part-time, perhaps in the mainstream or access to a special class with transition to mainstream for appropriate subjects and whether the needs are such that they require special schools. That is a challenge we face and we hope to be able to improve our consideration of that over the coming year.
John Curran (Dublin Mid West, Fianna Fail)
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That concludes today's meeting. On behalf of the committee I thank Mr. Harty, Ms Ryan, Mr. Bohan, Ms Carr, Mr. O'Connor, Mr. Mulkerrins and Mr. O'Flaherty for their attendance today, their presentations, opening statements and responses to the questions asked. One or two pieces of correspondence will flow from today's meeting and we look forward to receiving those.