Dr. Joanne McCarthy:

I am always really conscious that in providing data one is splitting a sector into those who have and those who have not. That is not the intention.

I needed people to see the starkness of the inequity in accessing disability services in Ireland.

There was a question about whether we had the wrong models of support. Without a doubt, this would have been mentioned in our policy review in the context of value for money. Looking at what is expected of us under the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, of course, we have the wrong mix of services. People with disabilities and their families should be confident that they can receive services as close as possible to their local community. This resonates with what we are talking about with respect to neurorehabilitation services. The services should be as individual as possible. It is no surprise that there has been no real increase in personal assistant and respite care services; such services facilitate a person in living in the community.

There is also the issue arising from the lack of demographic evidence to support the case for transitioning to a new model of service. That is what is being attempted in decongregation and supporting new models of day services. The evidence is available and people know the data and what they are talking about. It can be planned. It is very hard to speak about a new model of service with community services infrastructure when there is no demographic evidence to show what the need will be time and again to support the planning process. That is required to give confidence to the planners and those who will deliver the service, as well as those who will depend on it.

The member is correct that we could rewrite a service model for people with disabilities as it is not fit for purpose. People need to live at home or independently, or at least as close to communities as possible. The process must be person-centred and there should be a mix or range of personally driven services such as personal assistants and home supports. We also spoke about episodic health interventions that were required. The process needs to move beyond health, as it is only the enabler. Health services should be available to enable people to access services provided by other Departments and agencies. Education services should be delivered through the education and training boards, for example, and there should be support to deliver them in a mainstream way as much as possible. Social welfare and housing services are all mainstream services, but we need a health service that has resources and provides supports such as personal assistant hours that are fit for purpose and which can support people in accessing mainstream services. We need to reinvent our understanding of the role of health bodies and look more at the personal social services side of health services in order to invest in them.