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.