Dr. Joanne McCarthy:

I thank the committee for the opportunity to discuss neurorehabilitation services. I am familiar with many members so I will not go into too much detail on the Disability Federation of Ireland, DFI. We are an umbrella organisation that supports over 120 disability organisations and works with many others. We provide information, training, networking, advocacy and representation, research and policy development and organisational development.

I will start by asking if we know who we are talking about when we refer to the disabled. According to census 2016, 13.5% of the population, or 643,131 people, identify as having at least one disability. One in four of those acquire a disability at working age, meaning that most of them are likely to be already in work, married or living in their own homes in their communities. Once the onset of disability occurs, timely access to neurorehabilitation services will directly impact on a person's life and family so we fully endorse the NAI's call for greater investment in neurological and neurorehabilitation services. However, DFI can only do half the job alone because most people with disabilities will continue to live in their own homes and communities. They may have a short-term intervention in the form of acute services but they will return to their communities and, unless we invest in a solid community services programme that supports them and their families to live and navigate the world with their neurological condition, we will be putting money in false places.

We also need to ask what the disability spend is achieving. We currently spend €1.9 billion on disability, health and personal social services in Ireland. In 2019, 85% of the HSE disability budget supports over 8,500 people through a range of residential supports and for 27,000 people in day places. We are not questioning the need for these individuals to receive that support. However, a small cohort of the disability population is soaking up a large amount of the disability spend. These figures reinforce a report compiled as part of the value-for-money and policy review of disability services for the Department of Health. Less than 10% of funding is directed towards community services programmes such as personal assistants, respite, day services and other services, areas where the neurorehabilitation services are involved.

Community services and supports are mostly co-funded by a range of disability organisations. Ms Battles will give members a good sense of what that means. Many of these are condition-specific and help individuals and families to navigate the diagnosis and develop strategies for self-management and for access to a range of services such as acute and primary care services, housing services, social welfare services and local education and training services which they need to retrain or reskill to enable them to return to work. We fully support the call for acute neurorehabilitation services but we also call for a better understanding of, and investment in, a range of specific community services.

They include home supports, family supports and health and well-being services which Ms Battles will go through further.