Ms Louise Loughlin:

To go back to the question on local government and, in particular, whether local authority staff are equipped, trained and supported to provide the requisite services to people with disabilities, I cannot really answer that. They would really need to be asked. We would know of pockets of good practice but our experience would be that it depends on individuals. That is something that local authorities themselves would need to answer. They are under so much pressure in terms of the demand for housing at the moment and our experience would be that the issues around the accessibility of housing that is appropriate for people with disabilities is really problematic. That is an issue of supply. Obviously, I know the whole policy around housing is to increase supply both in the private sector and in the public and social housing sector. I know the Minister has made a number of commitments around universal design of new homes. This is really fantastic and should have been done a long time ago. However, that is going to take time to come on stream. It is this coming on stream of the housing which is the major issue. It is exacerbated if you are living in housing where you cannot get upstairs to your bathroom. The conditions some people are living in are absolutely appalling. That can lead to spirals of further decline in terms of your disability and your mental health.

I cannot answer the question about whether those staff are equipped. More could be done but I would say they are probably under huge pressure with regard to that.

On the separation between the HSE and local authorities, I know from my experience in Scotland that they have moved over to social care partnerships, between health and social care partnerships, and there is a history there of combining those services. If you live in a local authority area, your occupational therapy and speech and language services are all delivered through the local authority. There is probably a question mark over how successful that is in terms of stitching that in with an overall package. It is a relatively new in that they have stitched it all together. I am speaking from my own experience here. There are models there that could be considered. There are definitely issues with the complete separation of health from housing. If you are not living in good quality accommodation, your health is going to suffer, whatever your personal circumstances are. There is definitely something to be done there.

On that overall piece about stitching it together, there is a national housing strategy there and it includes an increased role for tenancy sustainment officers. I am not sure about the implementation of that. Again, that would be something that would be really welcome. If there was a link between a tenancy sustainment officer and what was going on with someone's healthcare package or their disability support package in a proper multidisciplinary manner, which included the person at the centre of that and directing it, we probably would get a lot further, more quickly. Sometimes these things sound a bit highfalutin or things we will never be able to do but we must remember those types of services are actually a lot cheaper to deliver than it is to have people living in campus-style or congregated settings or stuck in an acute hospital or an acute mental health facility. Someone who is having an acute mental health crisis might really need access to that facility.

Someone may be well enough to go home but cannot do so because there is nothing there for them. We have to step back and look at it more coherently and structure it in a better way. There is a lot of good stuff there. The policies are there. In Ireland, it is always the implementation.