Mr. Greg Dempsey:

I had covered the accessibility question. I will make one other point on the briefing I got. The HSE has pointed out that since August 2021, it has been audited on an annual basis by the NDA and it expects that monitoring and audit to continue indefinitely.

The next question Deputy Tully had was on screening. The national screening service has published a comprehensive report called Breaking Down Barriers, which outlines the finding of a study to access the needs of disabled people using Ireland's screening programme. The report gives people's perceptions and experiences and makes a number of recommendations. Those recommendations are now being implemented by the national screening services and being overseen by the HSE's equity oversight committee. To give a flavour of the recommendations, disability awareness training for all NSS staff and then tailored training for NSS access officers is recommended. These are the people who liaise with disabled people, the carers and family members, to facilitate accommodations to appointments, longer appointments, wheelchair access and so forth.

They have also created resources for all four programmes in accessible formats, such as easy-read leaflets. That is around developing an awareness among potential users of the benefits of screening and so forth. Finally, they are involving disabled people in the design of national spatial strategy, NSS, services. That was a key recommendation, so they are making good on that.

Reference was made to the lack - for want of a better word - of therapists and the impact this is having on primary care waiting lists. We are doing a few things in this regard. We are adopting a programmatic approach to waiting lists to try to reduce them. We are doing workforce planning generally, but specifically around matching population growth and translating that into health needs and then identifying the gaps where we will need particular skill sets in the future. In response to that, we consider where they might come from. An obvious place is increasing training and education places. We are working with the Department of Further and Higher Education, Research, Innovation and Science on this and we have increased the number of therapist places this year.

We are also working with the Department of Children, Equality, Disability, Integration and Youth because to some extent, a number of services are competing for the same skill set, so we are working to make sure, as much as possible, that we are not competing against each other and that we are making best use of the limited resources at our disposal. I can provide more detail, if necessary, on the waiting lists but I will keep going and I can come back to it.

Homecare supports are delivered by the Department of Children, Equality, Disability, Integration and Youth but I do not want to be saying that too much so I have a brief from the Department which I will quote from, but bear in mind that these are the Department's figures. It has an action plan for disability services from 2024 to 2026 which contains targets for additional personal assistant and home support hours. For the first two quarters of this year, the Department indicates that the number of personal assistant, PA, hours was up by 8.2% compared to the same period last year. That reflects additional PA hours supporting people in their own communities. A total of 2,865 people are in receipt of PA services, which is 4.6% ahead of the national service plan, NSP, target. Home support hours delivered, to the end of Q 2, are 8.2% ahead of the NSP target and significantly ahead of the same period last year. The Department has indicated that some of this is due to intensive support packages.

On the medical card thresholds, the HSE is providing access to medical cards in line with the qualifying financial threshold. However, every effort is made to support applicants who apply for a medical card to take account of any difficult circumstances. For example, discretionary medical cards can be issued to people with significant medical expenses or emergency medical cards can be issued. As the members are probably aware, medical cards can also be issued to patients who are terminally ill.

Progressing disability services comes under the remit of the Department of Department of Children, Equality, Disability, Integration and Youth, so I am reluctant to comment on it. Dr. Gowran has indicated that she would like to come in on that.