Dr. Joanne McCarthy:

The Deputy's questions have spanned all of our organisation. We will have to go back to our colleague on the education question. We could talk about it but I do not feel we would give the right answers. We will come back to the Deputy with a written response on that.

We were before the health committee on the personal assistance, PA, service issue only last year. It has formed a core part of the DFI's work. I do not know if the committee has been following who we are but we are branded on community supports and infrastructures to enable people to live with dignity in their own homes and communities. This is possibly the most important service to enable people to live, and continue to live, at home. In saying that, only 0.3% of people with disabilities are in receipt of a PA service. There is a significant lack of investment in that service model.

We do not have good data because the reporting conflates PA and home supports. One cannot disaggregate the data but we suspect that any increase in those figures is reflective of an increase in home supports rather than PA.

We know from 2017 data we have managed to disaggregate somewhat that there is probably a little over 1,000 people in receipt of PA hours, 900-odd of whom receive less than five hours a week, which is tiny. We will send on the figures to the committee and make sure they are right because I am working from memory.

PA hours are a problem for people with disabilities. Most people with disabilities acquire their disability at working age. One in four people will acquire a disability at working age. Most people are not born with their disability. These people are probably married with their own homes and jobs. In many cases, the disabilities are neurological and progressive in nature and, therefore, their need for services such as PA home supports is critical to enable them to continue to live in their own home, sustain family ties and a job, even if it is on a part-time basis.

We cannot urge the committee enough, with its budgetary hat on, to find a way to understand the need and put a budget to it. It is very difficult because the HSE does not keep waiting lists on PA. It stopped doing that a number of years ago so we do not know the scale of the need for people in the community seeking PA services.

People often lose their PA hours if they have a relapse and end up in hospital. They often cannot sustain tenancies they may have and those are the people who end up in nursing homes. The newspapers reported last week about a man in his 30s who went into a hospital because there was a progressive onset of his condition. He lost his PA hours when he came out and ended up in a nursing home.

DFI is doing significant research, examining the 1,400 people under the age of 65 who have been inappropriately placed in nursing homes. PA is one of the critical elements in stopping them coming back out and living in the community.

If the committee puts it budget hat on, it will be important to begin to explore how best to put sustained investment into a service that people with disabilities value highly and are dependent on to be able to participate in, and sustain, independent living. Most of these people will only have a small draw on the expensive and heavy disability services programme that gets €1.9 million. That is important to highlight and I am glad the Deputy brought it up. I would be happy to come back and talk to him about it if he wishes.