Dr. Joanne McCarthy:

I have dealt with that issue. Sláintecare is very silent on disability services. It speaks to the new neurorehabilitation strategy, but otherwise it is very silent on disability services, although there may be one or two references to them. We are looking for an interface. People with disabilities are heavy users of the health system. They are the people who are presenting with neurological issues and availing of acute services. They are people with acquired brain injury and in relapse. They are heavy users of core health systems. They are also using neurorehabilitation services through primary care services and accessing personal assistants and home supports. They draw across the health system, but they are dealt with individually through each siloed part of the HSE. Sláintecare looks for joined-up services and we want to have them "disability-proofed". How can we enable these models of service? Ms Battles could probably give a better example, but the majority of services could be delivered within a much softer community-based infrastructure such as the resources and supports for self-management provided at community level. There are times, with a peak in the condition, when access to primary care services is required, but there are also times, especially at the time of diagnosis, when more acute services have a role to play in intervention. Equally, it is critical to have fluidity in step-down services. Sometimes there is silence in Sláintecare in understanding the population and how it uses the health service. That is something on which we probably need to work.