John Dolan (Independent) | Oireachtas source

I welcome the Minister, the Minister of State and the officials. I wish Mr. Paul Reid all the best in his new role. If I was to suggest to my daughter that I take a certain initiative, she might reply, "Best of luck with that". I wish Mr. Reid the best of luck way more empathetically. He has a difficult chalice in his hands.

I was struck by Mr. Woods' response on dieticians, occupational therapists and physiotherapists. Since the HSE was set up 15 years ago, we have been hearing about transformation and reform. We had beautiful documents depicting butterflies flying around. There were also enhanced transformation programmes. As we have had all these, I cannot figure out why we keep talking about this issue. I am not trying to blame anyone, but there is something really wrong if, 15 years on, we are only training 25 dieticians per year in one college, quite a number of whom enter private industry. That is just one example which I did not have in my head before Senator Colm Burke mentioned it. There are major issues and we keep talking about reform and change. The Minister has stated there is no place to hide for people who are not getting on the reform and change bus, but they have been somewhere for the past 15 years. Is there something with which we are not getting to grips in introducing some simple reforms?

I listened to the statements made by the Minister and the director general of the HSE, Mr. Reid, and was struck by what was absent in both.

They both went through the industrial relations processes, reforms, Sláintecare and so on but there was no mention of disability. It was almost 10 a.m. before disability was mentioned in this room and it was brought up by Ms Anne O'Connor. We have a cohort of people who are return users of services. They need clinical services for chronic conditions. Three chronic conditions were mentioned but there are more chronic conditions than I would name in a week. Some of them, thankfully, do not have many people suffering with them but an enormous amount of work is needed in this area.

A very important statement was released yesterday on behalf of the Rehab Group, which provided relief for more than 3,000 people. They have been given an assurance that the services they receive from Rehab will continue. It is interesting that there was no mention of that this morning. There was no mention of the work that has been going on with regard to the section 39 organisations. We ratified the UN Convention on the Rights of Persons with Disabilities in April 2018. We have been told repeatedly that almost €2 billion is going into the disability services programme every year and yet it does not merit a particular reference in all of the documentation before us.

It has been suggested that the word "crisis" is overused because there seems to be one all of the time. It is only when one puts the term "crisis" alongside going into the public space and protesting that something actually happens. Rehab has been talking about its funding shortfall for a long time and other disability organisations and community groups have been talking about underfunding and deficits but it was only when one group decided to go public that €2 million was somehow found. I am not making that point to have a go at anybody. I submitted two questions late last week and I am sure I will receive a response in due course. They related to the issue of the quantum of need and the amount of unmet or only partly met need in the context of disability services and connecting that up with very useful things that were mentioned by the Minister at the start of this meeting. He spoke about amelioration, prevention, population health and so forth. These are critical issues for people with disabilities and their families but we do not seem to be able to turn the corner. I go up and down the M7 regularly and have watched as the motorway is significantly upgraded while the road is still in use and the service is maintained but that seems to be impossible to do when it comes to health.

The letter that Mr. Reid sent us was written on his first day of service in the HSE which in itself, is a very significant event. I wish to speak about the mindset of a person with a disability reading that letter. The letter refers to living within budget, which is not a bad thing to do. Mr. Reid also refers to the need to ensure the quality and safety of the services being provided to people. Under the feudal system, one built a big stronghold which was the castle. If one was inside the gates, one had protection but if one did not get to the gates in time, one could be knocking on those gates for a long time. We do not have the honesty or the information to show how much unmet need exists or we are not making those data available.

The cynical view would be that Mr. Reid is the Department of Public Expenditure and Reform's man in health. We keep hearing from that Department and others that approximately one third of the public purse is spent on health. The implication of that statement is that there is plenty of money in health. I will make no judgment on that but if there is plenty of money, why are so many people not getting services? The Minister of State, Deputy Finian McGrath, and I, as well as others, were engaged just over a year ago on the issue of personal assistants. The departmental officials and the Minister accept that personal assistants support a person's independence. That requires more than half an hour in the morning to get a man to the toilet, shaved and so on and another half an hour at night to get him back into bed. A personal assistant can enable a person to get out of the house but the average service provision is less than two hours per day. Out of a total of around 2,500 people, only 65 get 40 hours per week. It is a lie to say that is a personal assistant service. It is a bum steer.

A range of organisations are now in very severe territory with regard to governance and funding. Rehab came out publicly about this. I ask Mr. Reid and the Minister to respond to the statement I am about to make. It is my view, based on what we know about unmet need in the sector, that we will not get to the end of this year without the system cracking open. What happened with Rehab has opened up that possibility. Other organisations will now be saying that they should have done the same thing because they have deficits and unmet need. They will be lining up, one after another, looking for a meeting. How will that be dealt with?

Some work is being done on the pressures in the section 38 organisations with regard to staff churn and so forth. We also have the very specific issue of the underfunding of the disability services programme to the tune of €16 million. That programme was based on what was delivered last year but there were some deficits in that. While I would love to be wrong, I cannot see how we can get to the end of this year without some very serious cracks appearing in the disability services programme.