Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the joint committee for the invitation to attend to discuss disability issues. I appreciate its interest in this important matter. As the Vice Chairman indicated, I am joined by Ms Frances Spillane, Mr. Kieran Smyth and Ms Grainne Duffy from the Department of Health, with Mr. Pat Healy, national director of social care at the HSE.

The Government, statutory and non-statutory agencies which provide services for people with disabilities have been working towards the goal of enabling disabled citizens to live as independently as possible, with appropriate social, housing, employment and all other mainstream supports from the State. Our aim is to transform services to provide a model of personally chosen supports designed to enable the individual to live a normal life in society.

During 2015 funding of almost €1.5 billion is being provided for health and personal social services. It is important to illustrate the range and complexity of the services and supports this significant figure encompasses. Residential services are being provided for some 9,000 people with disabilities at more than 1,200 locations. These facilities range from large congregated settings to community group homes to supported independent living. Day services are being provided for approximately 22,000 people at 850 locations. Some 1,400 young people who left school and rehabilitative training programmes this year have received new services and supports. Respite residential support, amounting to 190,000 overnight stays, is being provided. The target for the provision of personal assistance or home supports in 2015 is 3.9 million hours. A variety of other services are also provided under the disability services programme, including non-centre-based respite care, early childhood and family support, community-based medical, nursing and therapy services, rehabilitative training, and aids and appliances.

I will outline briefly how disability services are supporting people with disabilities from childhood onwards and the major reforms taking place in children's disability services. Implementation of the HSE's national programme for progressing disability services for children and young people, covering birth to 18 years of age, involves a reorganisation of existing therapy services into geographically based, multidisciplinary, early intervention and school-aged teams. The key objective of the programme is to bring about equity of access to disability services and consistency in service delivery. There should be a clear pathway for children with disabilities and their families to services, regardless of where they live, what school they go to or the nature of the individual child's difficulties. Some €8 million in additional funding has been invested in 2014 and 2015 to fund 200 additional posts to support the implementation of the new model.

Improving access to children’s therapy services is a particular priority for the Government, not only in disability services but also in primary care. An additional €20 million was allocated in 2013 to strengthen primary care services and to support the recruitment of prioritised front-line posts, including more than 260 additional posts for primary care teams. Further funding is being provided in 2016 to expand the provision of speech and language therapy in primary care and to support the reorganisation and expansion of speech and language and other therapies under the progressing disability services programme. Full implementation of the progressing disability services programme is expected before the end of 2016.

This brings me to the matter of health-funded supports for young people after they leave school. Government policy is to enable young people with disabilities to develop the skills they will need to live independent lives to the greatest extent possible and to receive the supports they need in order to achieve this. Every year, young people finish their second level education and progress to the next stage in their lives. For most, the hope is that they will progress directly to further education, vocational training or employment. However, young people who have more complex support needs will initially rely on life-skills training or day supports provided by the HSE. Additional funding of €12 million was allocated by the HSE to meet the needs of around 1,400 young people who require continuing health-funded supports on leaving school or rehabilitative training this year. Some €6 million of this has been made available to provide services from September. The provision of services to these numbers of young people has, in recent years, posed a challenge to the HSE. When this year’s support requirements were identified, the cost of meeting those needs in full exceeded the amount available. I am pleased to say that an additional €1.5 million was added by the HSE to the overall allocation, making a total of €13.5 million full-year costs available to meet those needs. A further €1.5 million once-off capital funding was also allocated by the HSE for the provision of suitable buildings, premises and accommodation. There is an onus on us all to use the substantial resources committed to disability services throughout the public sector more effectively and efficiently and, most importantly, we must ensure that we are achieving real and significant improvements in the lives of people with disabilities.

Transforming Lives is the programme to implement the recommendations of the Value for Money and Policy Review of Disability Services in Ireland. This transformation of our disability services will mean that person-centred and individually chosen community-based supports will increasingly become the norm, which is a distinct move away from the group-based, often segregated approach of the past. People with disabilities will be supported to make the types of choices about their lives which are available to everyone else in society. This new approach will be underpinned by a more efficient method of assessing need, allocating resources and monitoring resource use.

We can see this person-centred approach being progressed by the HSE in the provision of day services, as outlined in the New Directions report on HSE-funded adult day services. Service providers are actively engaging in delivering services which have a person-centred focus, with person-centred planning now widely implemented, along with an increase in the delivery of community-based day services. Service providers are taking practical steps to support and actively engage with people with disabilities in community settings and are exploring new and innovative ways of doing this, including through a range of demonstration projects. An example of this is the Next Steps Project, a network of shared learning and support, set up by the National Federation of Voluntary Bodies, involving people with disabilities, their families and their key workers. A measure of its success is the fact that the project received an International Zero Project Innovative Practices award earlier this year at the United Nations headquarters in Vienna.

Person-centred planning also underpins the movement of people with disabilities from congregated settings into the community. In July 2012, the national implementation framework was launched to support the Government’s National Housing Strategy for People with a Disability 2011–2016. This continues the successful collaborative approach between the Department of Health and the Department of the Environment, Community and Local Government. The implementation framework reflects the recommendations of the mental health policy, A Vision for Change, and in respect of disability, Time to Move on from Congregated Settings - A Strategy for Community Inclusion.

The congregated settings report identified that in 2008, around 4,000 people with disabilities were living in congregated settings, which the report defined as residential settings where ten or more people with disabilities live together. I am aware that implementation of the report will introduce a huge change for people, including people with disabilities, their families, service providers, the HSE, various Departments, statutory bodies and representative organisations. To ensure that the needs of people transitioning from congregated settings are fully taken into account during the process, the model of care will be based on a person-centred plan.

The HSE has established a working group under the Transforming Lives steering group, which is developing an implementation plan for the process which will be rolled out at regional and local levels, in full consultation with the stakeholders. At the end of August 2015, there were around 2,800 people with a disability living in congregated settings. In 2015, the HSE prioritised the transition of people from congregated settings under its social care operational plan and the target was for 150 people to move. So far this year, 84 people have moved and the HSE will accelerate implementation of this policy next year.

The Government is very committed to the protection and safety of our most vulnerable citizens. We placed regulation and inspection of residential and respite care disability centres on a statutory footing in November 2013. The purpose of the regulations is to safeguard and support the delivery of person-centred care to vulnerable people of any age who are receiving residential care services and to ensure that their health, well-being and quality of life is promoted and protected.

Compliance with national standards for disability residential centres is now a requirement under the service level arrangements between the HSE and voluntary service providers. More than 1,000 inspections have taken place to date and the lessons learned from those inspections are continuing to improve the quality of services. People with disabilities and their families can be assured that this regulatory regime is being rolled out across all residential facilities.

I am aware that while the Health Information Quality Authority, HIQA, has reported evidence of good practice in the delivery of many residential services, where the support and care needs of residents have been prioritised, it is also sadly true that some of HIQA’s findings can make for difficult reading. However, those findings serve as evidence that the regulatory process works effectively and in the interests of protecting vulnerable people in the care of the State. They serve to increase our determination to ensure that the regulatory regime is used to shine a light on poor, out of date practice and make real and tangible changes in people’s lives.

The HSE is implementing a comprehensive change programme of measures to improve the quality of residential services for people with disabilities. The HSE has also appointed an independent person as a confidential recipient. This role supports the implementation of the policy launched in December 2014, Safeguarding Vulnerable Persons at Risk of Abuse.

I asked the National Disability Authority, NDA, to undertake an independent review of the impact of one year’s implementation of the registration and inspection system, focusing on the actual experience of those who have been involved in the inspection process. This has included service users and their families, the HSE, HIQA, service providers and organisations representing people with a disability. The NDA’s report is being finalised at present. It will be supported by an advice paper which will guide us in determining next steps in implementing the learning from their analysis.

Plans for 2016 will be set out in detail in the HSE’s service and operational plans. While we intend to move on implementation of our policy objectives, 2016 will involve consolidation of the existing significant resources invested in disability services. The actions for next year will include a major focus on ensuring we are getting the best value for that investment. This will include use of a service reform fund, recently established by way of agreement between Atlantic Philanthropies, the Department of Health, the HSE and the Genio Trust.

I welcome this opportunity to discuss the Government’s position on services for people with disabilities. Central to that position is the recognition that people with disabilities have the same goals, aspirations and abilities as every other citizen and the same right to participate in society and to make a contribution.

While we are making good progress in achieving a fully inclusive and equal society with appropriate services and supports for people with disabilities, we still have work to do. I assure the committee that I am firmly committed to that task.