Dr. Joanne McCarthy:

With regard to the €1.9 billion, it is interesting that 90% of it is for core specialist disability services. That is what the Senator was talking about on the 19th. It is for the day services, 24-7 residential services and the respite care. There is 10% which relates to much of what we are discussing today. They are funded through disability services, but they equally could be funded through primary care. They are a significant resource to primary care because they provide a specialist network of resources that enable people to live with conditions. They do self-management courses, specialist yoga and so forth. They provide core primary care services that have a specialist interest.

That goes back, perhaps, to what Senator Dolan said. We are almost stuck to delivering disability services in an historical way when the reality of disability has changed over time. One in four people now acquires a disability at working age. That is all neurological. Many of them are, for example, people with acquired brain injury and people with MS. They are not planned for within disability services. That is the 1,400 people who acquired a disability at working age and are now living in nursing homes because they are not planned for and there is no service for them. We must think differently about what type of service we are willing to offer people with disabilities. That includes better demographic planning for the 30,000 people who are in core disability services but it equally means we must plan the value of community-based disability organisations into the delivery of generic primary care community-based services at local level. Where one will ring for the epilepsy, MS or motor neurone person, the HSE offices should know who the person in the region is and it plans in a coherent way the delivery of community services to people, whether it is through primary care or disability support services.

In that way one can see how critical it is for Sláintecare to fully understand what community disability services do when it is beginning to plan its services. The DFI had a seminar to which we invited Ms Magahy. She acknowledged that and she said she recognises how critical it is for Sláintecare to look at the recommendations from the Dr. Catherine Day report in this context. We know that. She also acknowledged that perhaps disability in its entirety had not been planned into Sláintecare in its current position but that she was open to it and, hopefully, following our seminar, will begin to do that. Undoubtedly, Sláintecare should offer a way to create threading between specialist and disability services in the mainstream and then specialist community services and core disability residential or wraparound services. It should allow us to thread those and see them as a tapestry of opportunity so people can come into and out of different types of services depending on what their need is.