John Dolan (Independent) | Oireachtas source

What are the actual and anticipated costs for this year and next year, respectively, for things that were not anticipated in the service plan, such as the wage agreements? I refer to things that increase the cost of delivering the service but do not shift or increase the amount of service being offered. It is important because when we look at what the service plan set out to achieve, it is not the same as the level of needs that exist for people. I will return to that in my next question.

I was happy to see page 4 of the Minister's submission which looks at the end of this year and into next year, that it refers to the service pressures being experienced. It references disability services particularly and notes that " ... the pressures in disability services largely arise as a result of regulatory compliance, emergency places and in non-achievement of targeted savings". That is fair enough at one level but I contend that there is significant unmet need which is not captured in that because it was not going to be addressed this year. That is important to say. We have 1,200 people misplaced in nursing homes. They are young people with disabilities, some of them are the Minister's own age and all of them within the age groups of the people sitting in this room. It is frightening. The average length of stay of someone in a nursing home is around two years, but it is not for these people. We have other pressures that others have spoken of such as home helps, personal assistants, therapies and aids and appliances. When we look to next year, we should remember there are many areas which are not captured that still have outstanding needs.

The Minister mentioned emergency places and expressed his concern and that of the Minister of State, Deputy Finian McGrath, on the matter. There are many more issues for young people in addition to emergency places. I mentioned personal assistants, aids and appliances, which are areas where need is growing. If we look at next year, what will be within the service plan and what will not be addressed in it in terms of outstanding needs?

The Minister reminded us of the statutory underpinning of the community services. There is no doubt in my mind - and I cannot see that anyone would credibly disagree with me - that the statutory underpinning of nursing homes on one hand, and the level of resources for community interventions on the other, is sucking people out of the community and into residential places unnecessarily and wrongly. I cannot see the statutory underpinning being done next week or the week after but something has to be done to correct that bias or tracking in the system. Something must be put in place, even if it is not ideal, to start to redress that. Ultimately, there must be more tools and more resources in the tool kit to make sure that people can stay where they ought to. It is ironic that we have a programme to get people who have lived in institutions all their lives out of them when every day there are people within the HSE - and I do not suggest they want to do this - actively suggesting to people that they go into a nursing home. In many cases, that is the only option they are given. That is a chronic issue.

I want to ask a hard question on scoliosis, and we could mention other issues. To what extent do issues such as scoliosis or Orkambi displace resources from other areas? If they are not, there must have been capacity in the system which was not used. It is a hard question because, no more than the Minister, I am not trying to suggest that these groups should not be provided with services but we need to be honest. Are we at a point where we are robbing Peter to pay Paul? It is important that we be honest about that. When one sees there are so many quantified and known unmet needs, it is hard not to come to that conclusion.

During the year, this committee invited before it some of the main umbrella and representative groups across the disability and mental health sectors. One of the themes to come out of that was that there are many things that should be happening outside the health system that have an impact. If people get a decent education, public transport, housing - they can be rhymed off - and these things work well for people with disabilities, it will take pressure off the Department of Health in time. It will not do so in time for its Estimates next year, that is clear. I am not convinced that enough space is being given within health planning to start serious conversations with other Departments. They are all enjoined in the UN Convention, the disability strategy and so on. When things are not being done elsewhere, the consequences finish in health, and worse still, people with disabilities finish up where they do not belong.