Ms Yvonne O'Neill:

I am joined today by my colleague, Ms Olive Hanley, head of disability services in CHO area 9, that is Dublin north, Dublin north central and Dublin north west. Unfortunately, Mr.Bernard O’Regan, has had to send his apologies after becoming unwell this morning. Mr. O'Regan has appeared before the committee before and he regrets being unable to attend.

The HSE provides a range of assisted living services including personal assistant and home support services to support individuals to maximise their capacity to live full and independent lives.

Pioneered 30 years ago in Ireland, personal assistance is to support a person with a disability to maximise his or her independence, to live in communities and to access community facilities. The home support service separately provides domestic or personal care inputs or both at regular intervals. Temporary relief is offered to the carer by providing a trained, reliable care attendant to look after the needs of the person with the disability.

A vital element of PAS is the full involvement of the individual in planning and agreeing the type of, and the times when, support is provided to them. It aligns with the UNCRPD, which emphasises the right of disabled people to live where and with whom they wish in the community; to self-determination; to exert control over their life; to have opportunities to make decisions and take responsibility; and to pursue activities of their choosing, regardless of disability.

The HSE is progressing a new working group to address common definition and consistency in assessment of, and access to, PAS. Terms of reference and proposed membership are being finalised, with work commencing in April 2023 and the group will have its work completed by December 2023. Progress on these issues, which was planned in 2019 in line with Sláintecare and the UNCRPD, was unfortunately impacted by the onset of Covid. It is now further supported by specific findings in the Ombudsman's report, Wasted Lives, from 2021, which highlighted the lack of consistency in how people access PA services. The working group, which will include representatives of the primary stakeholders, including disabled people, will develop a model of service, scope and access criteria that will feed into the Department of Children, Equality, Disability, Integration and Youth's draft action plan for disability services from 2023 to 2026, and into the policy development in this area.

Currently, each CHO has a process to manage applications and referrals for PA services. People's needs are assessed against the criteria for prioritisation. Resource allocation is determined by the needs of the individual, prioritisation criteria and the level of resources available. The number of hours granted is determined by the available resources and other support services already provided to the person. An individual’s PA hours may be adjusted following service reviews where service demand can result in one individual’s service being reduced in order to address priority needs of other people with disabilities within that community. While there is no centrally maintained waiting list for PA services, the local HSE CHO areas are aware of the needs in their respective areas and work with the local service providers to respond within the resources available.

The national service plan, NSP, for 2023 provides for almost 2,700 people to be provided with almost 1.8 million PA hours, which in the main are being provided through a range of voluntary service providers. The current level of service, through welcome additional annual funding under the NSP, provided for a 15% increase in PA hours since 2020, totalling 270,000 additional hours, in line with NSP targets. In 2020, we had 40,000 additional hours, in 2021 another 40,000 additional hours, in 2022 120,000 additional hours and in 2023, we are funded for in excess of 70,000 additional hours. The level of service delivered is determined by the needs of the person and the available resources, resulting in a range of hours provided to individuals. Additionally, home support hours for people with a disability were increased by 30,000 additional hours in 2022, so that 3.3 million hours were provided to more than 7,000 people that year.

The HSE has contributed to the development by the Government of the 2020 capacity review of the disability sector and the draft disability action plan for 2023 to 2026. These set out the future service needs and how they might be addressed. They incorporate the dual development goals to increase the range of hours available to individuals already in receipt of PA support and increase the hours available to make the service available to more people . While many individuals are adequately provided for by their current level of support, it is acknowledged that many would benefit from more support hours, should additional resources be made available.

The HSE welcomes the ESRI research bulletin, Personal Assistance Services in Ireland: A Capability Approach to Understanding the Lived Experience of Disabled People. It adds to the understanding of how personal assistance is allocated and used across the services provided and funded by the HSE. It sets out the importance of this support to people with a disability living an independent life and in supporting them to participate in community life as an equal. The report also describes the inconsistencies experienced by disabled people in accessing personal assistance supports and the limitations in how those supports might be used.

The report will be used by the working group to improve this important service, as well as making a valuable contribution to the service planning process. It will also contribute to the consideration of appropriate regulation of providers of personal assistance by the Department of Health and the Department of Children, Equality, Disability, Integration and Youth, aligned with the ongoing work to develop a statutory home support scheme. Increased investment by Government in recent years is welcome. The HSE will lead the work to improve how the available resource is allocated and used to provide this essential support for people to live an independent life.