Josepha Madigan (Dublin Rathdown, Fine Gael) | Oireachtas source

I thank the Acting Chair, and Senators O'Loughlin and Clifford-Lee for proposing and seconding this motion. I also thank Senators Boyhan, Seery Kearney, Warfield, Black, Currie, Sherlock and Pauline O'Reilly for their various contributions. As Senators know, I am not a Minister or a Minister of State in the Department of Health but I have taken a note.An official sitting behind me has taken note of all the Senators' contributions. If she needs to come back to the Senators about anything, I am sure that will happen.

I express my gratitude to the Irish Women's Parliamentary Caucus, which does incredible work on gender equality. One of the Senators mentioned that 77% of carers in Ireland are female. That statistic alone is enough for us to table a motion like this.

The Government is strongly committed to ensuring that the rights of everybody with care needs are upheld in accordance with their needs and preferences throughout their lives. Recognising the invaluable contribution that unpaid carers make to caring for the most vulnerable in our society, we are also committed to ensuring that carers are fully supported and empowered.

The UN Convention on the Rights of Persons with Disabilities, UNCRPD, has been mentioned a couple of times this afternoon. Since its ratification in Ireland in 2018, we have taken great strides in the development of services and supports for people with disabilities, their families and their carers to ensure that these are aligned with the principles set out in it. A critical milestone in this regard, also mentioned today, was the commencement of the Assisted Decision-Making (Capacity) Act of 2015 and the amending Act of 2022 on 26 April 2023. This brought wardship to an end in the State. This legislation also provided several key measures for further compliance with the convention previously set out in the Disability (Miscellaneous Provisions) Bill, which lapsed with the last Dáil.

In fulfilment of the programme for Government commitment to develop an implementation plan to co-ordinate the implementation of the UNCRPD, the development of a successor strategy to the national disability inclusion strategy is under way, with targeted stakeholder consultation focusing on disabled persons' organisations. Outlining an ambitious programme of work, the new strategy will support the co-ordination of the body of work already in train across the public service on advancing rights under the UNCRPD.

The disability action plan was approved by the Government in July 2023 and will support the implementation of the disability capacity review, in accordance with the programme for Government commitment. The action plan sets targets for addressing demographic pressures, making significant progress on unmet needs, working to replace remaining congregated and institutional residential care with community-based models, and indeed continuing the reform towards individualised, person-centred models of service while growing service capacity appropriately.

The HSE's progressing disability services, PDS, programme is enhancing the model of service delivery to ensure equitable access to standardised services across the country. The PDS roadmap for service improvement will be launched imminently, reaffirming our commitment to providing high-quality services for children with complex disabilities and their families.

Under the national service plan for 2023, the HSE will deliver an additional 70,370 personal assistant hours to expand and enhance the supports for people to live self-directed lives in the community. Approximately 3.12 million hours of home support services for people with disabilities are also expected to be provided in 2023. In addition, as at the end of July 2023, 8,330 residential places were provided for people with a disability and 84 emergency placements had also been provided.

The forthcoming disability action plan proposes the provision of 900 additional residential care places to tackle unmet needs and ensure supply keeps pace with demographic change.

In budget 2023, approximately €11 million was allocated to address waiting lists for clinical assessments for people with disabilities. A working group on workforce enhancement, focusing on disabilities, has been established to examine, identify and provide solutions to matters that are constraining the supply of health and social care professionals to provide disability services.

Increased investment has impacted positively on the provision of respite services for people with disabilities in successive years. HSE data indicate that, in the first half of this year, 76,994 overnight sessions and 21,947 day-only sessions were accessed by people with a disability. The forthcoming disability action plan commits to increasing this level of respite provision by around a third.

The Department of Children, Equality, Disability, Integration and Youth is supporting the HSE on an ongoing basis to improve the availability and quality of data on disability services. The HSE's disability support application management tool enables community healthcare organisation areas to manage requests for support and ensures that the application process is equitable and transparent. It provides a detailed profile of adults and children who require funded supports outside the current service quantum and supports the HSE in its decision-making processes around the prioritisation of services subject to budgetary constraints.

In addition, the development of an integrated community case management system, which will support the patient journey through disability services, is in train. The HSE is also rolling out a dedicated, single consolidated management information system that will collate and provide meaningful data on the provision of children's development network team services.

The Government is also firmly committed to helping older people to age in place in their communities. With its emphasis on reorientating the model of care towards primary and community care, the ongoing Sláintecare reform of our health and social care system, led by the Department of Health, aims to support people with care needs to live independently in their own homes and communities for as long as possible, which is what we all want.

This ambition is being supported by the expansion of home support services, in which the Government has invested an additional €228 million since budget 2021. This year, the overall budget of €723 million for home support has enabled the delivery of 22 million home support hours – an increase of 4.1 million hours since 2019, during which 17.9 million home support hours were delivered. This increased investment has resulted in a reduction in the number of people waiting for home support from over 9,000 at the start of 2020 to 5,992 by the end of July 2023. Of this number, 3,151 new applicants were approved funding for supports, and 2,841 people were already receiving some level of support.

Expanding the provision of home support services necessitates addressing workforce challenges in the sector, particularly the shortage of care workers. To this end, the implementation of the recommendations in Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Healthcare Assistants, 2022, is being advanced as an immediate priority. As recommended by the advisory group, 1,000 employment permits for non-EU and non-EEA home support workers were authorised last year.

The development of a statutory home support scheme, to which the programme for Government commits, is well under way and is advancing at pace within the Department of Health. The preparation of primary legislation for the licensing of home support providers, regulations to underpin the new licensing regime, and national standards to support the ongoing quality enhancement of home support services are all in train. Importantly, the regulation of these services will help to safeguard everyone who uses the service and ensure that all service users receive a uniformly high standard of home support when they need it and wherever they may be.

As part of the development of the statutory scheme, a reformed model of service delivery for home support has been piloted across four sites, encompassing the assessment of the care needs of 592 service users with the interRAI single assessment tool. The Government is committed to the national roll-out of interRAI as the standard assessment tool for the care needs of older persons. In furtherance of this objective, the HSE has begun the recruitment of 128 interRAI care needs facilitators.

The Government has also significantly enhanced the benefits available for carers in recent years, with expenditure on income transfers to unpaid carers, who were mentioned this afternoon, having increased by over 50% since 2015.

The number of recipients of the carer's allowance has nearly doubled from 50,577 in 2010 to 94,310 in 2023, and in 2023 over 120,000 carers will receive regular income supports, to the value of about €1.6 billion.

As part of budget 2021, the carer's support grant was increased to its highest-ever rate, €1,850, and in budget 2022 significant improvements were made to supports for carers. The introduction of the long-term carers PRSI contribution provides for a State pension for those who have cared for incapacitated dependants for over 20 years, which is really important.

More broadly, the Government has delivered on the commitment in the programme for Government to introduce a carer's guarantee that will provide a core basket of services to carers across the country regardless of where they live.Since 2021, the Government has invested €2 million per annum in these services, with additional funding of €950,000 being provided for community supports, and €950,000 being provided for individual supports in 2022. At the same time, a pilot of an interRAI family carer needs assessment tool has been undertaken, funded through the Dormant Accounts Fund, with a view to establishing a standardised mechanism for assessing carers’ needs.

The Government recognises that respite care is a vital part of the toolkit to support carers, and this is reflected in our investment of approximately €62 million in respite beds per annum. In addition, in June 2021, the HSE, in partnership with Family Carers Ireland, launched the home support emergency respite scheme, with funding of €600,000, to provide a total of 27,000 hours of respite care to unpaid carers who require additional emergency respite. In 2023, €4.1 million has been invested in day care services, which are another important source of respite for carers. The Government also allocated €2.1 million in new funding to the Alzheimer Society of Ireland this year to support the resumption of dementia day care services at full capacity following the pandemic.

Recognising that responsibility for caring rests disproportionately with women - and I mentioned that I understand that the statistic is that 77% of carers are women - the Government has announced its intention to hold a referendum on gender equality as recommended by the citizens’ assembly and the Oireachtas Joint Committee on Gender Equality. An interdepartmental group is supporting the development of policy proposals for decision by Government and this work is well progressed. The ongoing enhancement of supports for unpaid carers and the expansion of care in the community under Sláintecare will help address the gender inequality that arises from the fact that the majority of unpaid carers are women.

While we have made tremendous progress in enhancing the provision of care in the community for our older citizens, we recognise that there remain significant challenges which both the Covid-19 pandemic and the scale of ambition of the Sláintecare reform agenda have set in relief. Accordingly, the Government is committed to the establishment of a commission to examine care and supports for older people, as envisaged in the programme for Government. While the scope of the commission has yet to be approved, it is envisaged that its purpose will include the examination of the health and social care services and supports provided to older persons across the continuum of care, and to make recommendations for their strategic development. The work of the commission will be cognisant of the need to ensure continuity of care for persons with disabilities when they turn 65 as well as, more broadly, the need to ensure that the care and support needs of older persons with disabilities are met in accordance with Ireland’s obligations under the UNCRPD. It is expected that the proposal for the commission will be considered by the Government in the coming weeks and that the commission will be formally established by January 2024. I want to again thank the Irish Women’s Parliamentary Caucus, particularly Senators O'Loughlin and Clifford-Lee, the proposers and seconders of this motion, and I thank everybody who contributed. I am grateful for the opportunity to discuss the progress that has been made on all fronts and to discuss the plans to fully deliver on the rights-based care economy, to which we are all committed.