Dr. Kathleen MacLellan:

I thank the Chair and committee members for the invitation to attend today. I am accompanied by Ms Susan Scally, principal officer, Department of Health and Mr. Bernard O'Regan, HSE assistant national director for disabilities. The Department of Health welcomes this opportunity to come before the Oireachtas Joint Committee on Disability Matters to discuss the findings of the Ombudsman's report arising from his investigation into the placement of people under 65 in nursing homes.

The publication of the report is very timely given work under way to implement the programme for Government commitment to reduce and to provide a pathway to eliminate the practice of accommodating young people with serious disabilities in nursing homes. The Sláintecare vision and commitment to achieving equal access to services and enhanced community care is fundamental to building health and social care services that meet people's identified care needs at community level.

The Department of Health is committed to progressive realisation of the rights set out in the UN Convention on the Rights of Persons with Disabilities, in particular those set out in Article 19 on living in the community. We are committed to supporting all people with a disability to enable them to reach their full potential in all aspects of their lives in line with the Transforming Lives programme. The HSE National Service Plan 2021 provides more than €2.2 billion which will enable the delivery of services and supports this year to about 56,000 people in Ireland who require specialist disability services. This represents a 7.5% increase on the 2020 disability budget and reflects the strength of the Government's commitment to improve the quality of life of people with a disability. More than 60% of this budget is expended on the provision of residential support services, where 1,359 designated or HIQA-registered services across the State are providing over 8,000 disability residential places.

Approximately 1,300 people under 65 are living in nursing homes, based on nursing home support scheme data. It is important to acknowledge that nursing homes form part of the continuum of care, providing supports and care for clinically assessed complex medical and social care requirements which cannot be supported in the person's home. However, the Department of Health and the HSE fully recognise that within this cohort are persons under 65 years of age in respect of whom a nursing home is not the option that best matches their care and support needs. The HSE is, therefore, fully committed to identifying alternative solutions to support those who wish to move out of nursing homes and back to the homes of their choice. This is in keeping with the Transforming Lives programme, which highlights the need of people with a disability and their families to have a say and to access the supports they need to live fully included lives as valued members of the community so they can enjoy greater independence and choice in their daily lives.

Progressive realisation, in line with Article 4.2 of the UN Convention on the Rights of Persons with Disabilities, UNCRPD, requires a planned, systematic approach to tackling gaps in service provision. The Department, working in partnership with the HSE, is putting in place a step-by-step approach to address the findings of the Ombudsman's report. The HSE is establishing a steering committee to develop an action plan to progress implementation of the recommendations of the report. In the meantime, work is advancing on a pilot project to provide accelerated and focused support for the transition of 18 people under 65 years of age from nursing homes to homes within the community this year; a mapping and consultation exercise to identify the number of people with disabilities living in nursing homes who wish to access an alternative support service in the community, with a project lead currently being recruited by the HSE; and the progression of a review of existing case management capacity with a view to its further development. The pilot project has been allocated €3 million in 2021 as part of a new €100 million funding package for disability measures this year. These measures provide for more than 100 more community-based residential places, the decongregation of a further 144 people to homes in the community and the provision of additional home support hours, intensive home support packages and personal assistance to enable those who live in home environments to do so more independently. The pilot project and the mapping exercise will provide a better insight into the will and preference of those under 65 years of age living in nursing homes and how their support and care needs can be met. This is in keeping with a population needs assessment approach based on population profiling and segmentation as committed to by Sláintecare, which allows for the development of planned new services designed around the needs of each specific population, ultimately leading to provision of the best care as close as possible to people's homes. In addition, the disability capacity report is finalised and will, through demographic and disability projections, provide robust data for planning for health and social care disability services for a ten-year period up to 2032.

The progress of the statutory home support scheme is a key enabler to providing more alternatives to nursing home care and wider opportunities for people to live fuller, more independent lives. The scheme will provide for the financing and regulation of home support services in order to provide equitable access to high-quality services based on a person's assessed care needs. Developmental funding of €150 million is being provided for home support services in 2021. Some €140 million of this investment is to deliver 5 million additional hours of home support over and above the National Service Plan 2020 target, bringing the total number of home support hours to be delivered in 2021 to more than 24 million. This includes €10 million to roll out the interRAI standard assessment tool and the establishment of a national home support office. In April 2021 the Government gave approval to the Minister for Health to draft a general scheme and heads of a Bill to establish a licensing framework for home support providers. The system of regulation will ensure public confidence in the services provided as well as safeguarding service users.

The Ombudsman highlights challenges accessing primary care services such as physiotherapy, occupational therapy and speech and language therapy. While individuals living in nursing homes, irrespective of age, have the same level of access to primary care services as individuals living in the wider community, the Department acknowledges the need to reduce waiting times and improve access to services for those individuals who have care and support needs, whether they live in the wider community or long-term residential care. The Sláintecare reform process commits to develop a plan to reduce waiting lists, which, along with focused efforts to enhance care in the community, is key to achieving this objective. In 2021, €150 million of new development funding has been invested in an enhanced community care programme which, among other things, will see community health networks established across the country, with about 2,000 new front-line nursing and therapy staff to be recruited. In addition, Sláintecare care redesign funding of €2.29 million for 2021 is supporting the introduction of a managed clinical rehabilitation network demonstrator project involving the development of community neuro-rehabilitation teams. The lessons from this demonstrator project will inform implementation of the neuro-rehabilitation strategy across each community healthcare organisation, CHO.

The Department, taking account of the nursing homes expert panel recommendations and HIQA's report on the need for regulatory reform, is in agreement with the Ombudsman's considerations on regulatory reform for nursing homes. The Minister for Health has determined a phased approach to examining our legislation with a view to proposing enhancements to the primary and secondary legislation governing nursing homes. The general approach will be a move to a "services licensing system" of regulation.

I wish to take this opportunity to thank the Ombudsman and his team for conducting this report. The Department and the HSE are committed to the implementation of the findings of the report, which highlight the need for a priority focus on actions to improve the quality of life of young people with disabilities and to give them the opportunity to live "ordinary lives in ordinary places" in line with the vision of the Transforming Lives programme.