Ms Sarah Molloy:

I thank the committee for its invitation to discuss the rights-based approach in day services. Ability West has been providing services and supports to children and adults with intellectual disabilities for over 60 years. Over 600 people avail of our services and supports in 13 geographic locations. We have 29 day service locations across Galway city and county. Ability West's guiding principles are: placing the fundamental rights of the people we support at the centre of everything we do empowering each person we support to live self-directed lives and to play a meaningful role in all aspects of community life; listening and developing a variety of options that can be used flexibly to meet their identified needs; developing the skills and dedication of our staff in a supportive and motivating environment; and working in active partnership with the people we support, families, staff, our voluntary supporters and the broader community.

The New Directions policy introduced by the HSE represents a significant shift towards a rights-based approach. This framework is designed to move away from traditional centre-based models to more individualised outcome-focused supports, promoting greater autonomy and community inclusion for individuals with disabilities. One of the key elements of New Directions is flexible and individualised service. This can be difficult to implement, as the current structuring and funding for services is only really from 9 a.m. to 5 p.m. The HSE has developed interim standards and an evaluation, action and service improvement, EASI, tool for us to use. This allows services to align their practices with the New Directions framework, which further allows for feedback from service users, staff and management. While New Directions is progressive, it also poses several challenges. All day service staff in Ability West need to be adequately trained and equipped to deliver a rights-based approach, overcome financial barriers and maintain consistent quality across diverse service locations. Overall, New Directions is a transformative initiative and needs to be funded accordingly.

I will now turn to developing rights-based funding conditions, SLAs and indicators to support the transition to a sustainable rights-based day service. The HSE is moving towards more individualised, locally based services. This allows for the decongregation of institutional settings under the New Directions initiative. Funding supports are required to allow this model for a rights-based approach. Ability West identifies with this model but there are extensive costs to resourcing more local individualised and smaller locations. Ability West currently struggles to adapt to meet the needs of the ageing population. Meeting the needs of ageing adults with intellectual disabilities and autism requires a new structured and funded model of support. Many older people came into our services decades ago, when congregated living and large group-based day services were the main funded models of service, based on block funding allocations. The funding model changed in 2015 for school leavers accessing day services, which was a very welcome development that enabled more individualised responsive supports to be provided. For many people who entered day services prior to 2015, however, the funding model has not changed, with nearly 35% of people attending day services in Ability West being over 55 years of age, and 8% of these people having a diagnosis of dementia. Greater overall investment in disability services is essential in order to meet the growing and diverse needs of the population. The process to secure additional funding for changing needs can be complex and slow. There is a need for a simpler process for funding.

On the issue of ensuring support for transitions to further education and employment in line with the UNCRPD, unfortunately, a key barrier to realising rights for people with disabilities is that they do not have equal access to fundamental supports in education, employment or transport. Ability West would welcome a robust and ambitious plan to address the high rate of unemployment among people with intellectual disabilities. Day services can play a vital role in addressing this inequality, but the reality is that with the shortfall of staff and resources in day services, staff often need to stay in day services for the day-to-day running of these services and do not always have the flexibility to be out in the community providing one-to-one support in an employment or educational setting. People using day services also face the barrier of accessing transport to get to their place of employment or education, especially in rural settings. Although the HSE provides one-off buses, it does not provide the recurring running costs associated with the bus. This needs to be reviewed.

Loss of services during Covid meant that some people with disabilities stopped coming to their day services, and some of them did not come back. The Covid-19 pandemic significantly disrupted disability services in Ability West. This disruption highlighted several critical issues and many lessons were learned. Those lessons include the need to focus on the importance of flexibility and adaptability for a rights-based approach in day services. While many people were delighted to return to day services, there were also those, including many over the age of 55, who expressed their will and preference to have their day service provided differently. Other lessons include the importance of strengthening remote and hybrid models and better individualised communication and support networks. Regarding policy and funding support, Government policies and funding need to prioritise the sustainability of disability services to ensure that they can weather crises without severely impacting on the individual.

There is a lot of good work being done in day services but there are still a number of barriers to fully effective services. These include the inflationary pressures of costs associated with day services, a recruitment and retention crisis, growing unmet need and a lack of funding for changing needs as people age. Service providers are experiencing a crisis in sustaining quality rights-based supports. Appropriate and sustainable resourcing is required across all aspects of service provisions. I thank the committee for listening. I hope we can focus our efforts going forward.