Maurice Quinlivan (Limerick City, Sinn Fein)
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Apologies have been received from Deputy Micheál Carrigy. Today's meeting has been convened to consider the Revised Estimates for Vote 40, which relates to disability. I remind members that the remit of this select committee permits for a consideration of disability elements of the Revised Estimate only.

As always, before we begin, I will read a note on privilege and housekeeping matters. All witnesses are reminded of the long-standing parliamentary practice that they must not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statement is potentially defamatory in relation to the identifiable person or entity, they will be directed by me to discontinue their remarks. It is imperative they comply with any such direction I may make.

The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both statue and the Constitution by absolute privilege. I remind members of the constitutional requirement that, in order to participate in public meetings, members must be physically present within the confines of the Leinster House complex.

These Revised Estimates were referred to the committee for consideration on 17 December 2025. Under Standing Orders, the role of the committee is to consider the Estimate and then to report that the committee has done so by way of a message to the Dáil. I thank the Minister of State, Deputy Higgins, and her officials for attending and for assisting with our consideration of the Estimate. I propose that she make some brief opening remarks, after which I will invite members to contribute. Is that agreed? Agreed. A document has been circulated to the committee providing detail on the Revised Estimate for disability. The secretariat has prepared a briefing setting out details of the Revised Estimate for the Vote in tabular form. I remind members that, in accordance with Standing Orders, discussion should be confined to the items constituting the Revised Estimate, specifically those relating to disability. I now invite the Minister of State to begin.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Cathaoirleach for the invitation to be here today and I thank the committee for making time available for us to consider the Revised Estimates 2026 for the Department of Children, Disability and Equality this morning.

For 2026, the Department has an overall gross financial allocation of €6.9 billion for current expenditure and €138 million for capital expenditure. The 2026 allocation supports a range of key services relating to children and young people including: child protection and family support services provided by Tusla, the Child and Family Agency; early learning and care; and school-age childcare services. In addition, the 2026 allocation provides for the Government’s response to address the sad and difficult legacy of mother and baby institutions. It also sets aside funding for the areas of equality and inclusion, which extend to human rights, gender equality, LGBTQI+ issues, and Traveller and Roma inclusion.

Alongside this, the allocation also covers funding for disability policy and services, recognising that specialist community-based disability services account for 55% of the total departmental allocation. The Minister, Deputy Norma Foley, appeared before the Select Committee on Children and Equality on 12 February to discuss the elements of the Revised Estimate which relate to the wider departmental allocation. For this committee meeting, I will focus specifically on funding for disability equality and specialist disability services.

This leads me to a breakdown of the key funding components for those areas. A record budget of €3.9 billion has been allocated for HSE specialist disability services in budget 2026. This amounts to an increase of almost 20%, or €628 million, over 2025 and builds on significant year-on-year increases and an overall increase of €1.85 billion, or 91%, since 2020. Turning to the Department's broader five-year strategy to 2030, the national development plan provides for investment of €278 million across specialist disability services. The additional funding includes a significant increase of €478 million for existing levels of service provision and will help to address sectoral funding pressures such as the increased cost of service provision, pay cost pressures, capacity limitations and service provider sustainability.

In addition, €150 million is provided to fund service expansion in residential and respite services, day service provision, home support, personal assistance and children’s services. It will also support continued strong recruitment, with approximately 1,000 additional staff in line with the 2025 workforce levels. The capital allocation has also increased from €27 million to €43 million.

A key focus in 2026 will be on ensuring the budget reflects the real cost of delivering services and supporting long-term planning and capacity development. It is vital that we provide stability for a sector that has been operating under sustained cost pressures and increasing demand for services. We also need to make sure that this year’s significant budget allocation of nearly €4 billion is managed as effectively and efficiently as possible. For that reason, strengthened oversight and governance arrangements have been agreed with the HSE and they will be implemented this year.

In that context, I will outline some of the key areas of investment in more detail. With regard to residential services, there will be a focus on delivering more planned places this year and beyond to move away from a crisis-driven, unplanned response in residential services. The aim is to reach approximately 200 new residential places in the community, at a minimum. Budget 2026 also supports 45 transitions from nursing homes to community settings. Investment of €25 million in respite services will provide for an increase in the availability of centre-based respite services and alternative respite models.

In the areas of personal assistance and home support, funding is provided to further align the hourly rate with that in place for older persons’ services and to support approximately 150,000 additional hours for service users. In day services, funding is provided for the new intake of school leavers. This year, new funding has also been specifically provided for 50 new day service placements for older adults, who are non-school leavers.

Funding is provided for an additional 150 posts in children’s services. Reform of the assessment of need process, including amended legislation, will be advanced as a priority in 2026. I thank the committee in this regard. I know it has started pre-legislative scrutiny on this legislation. I look forward to engaging with the committee on it. The targeted wait list initiative will focus on delivering approximately 6,000 clinical assessments.

As well as expanding services, the Department will deliver a new vision and strategy for the progressive improvement of specialist disability services in Ireland, which will be fully aligned to the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, and the principles of long-term financial and operational sustainability. Throughout this year, the Department will also continue to work collaboratively across government to deliver on the commitments set out in the national human rights strategy for disabled people and advance our shared goal of supporting people to live the lives they choose.

I thank the committee for its time today. I echo the recommendation of the Minister, Deputy Foley, on the Revised Estimate for the Department of Children, Disability and Equality - Vote 40. I welcome any questions members may have.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State. I now invite members to contribute. When I call members to speak, they should adhere to the agenda and items scheduled for discussion today. Members have seven minutes each. There is a rota in place, as members will know. The first speaker is Deputy Quaide of the Social Democrats.

Liam Quaide (Cork East, Social Democrats)
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I thank the Minister of State and colleagues for being here today. A response I received to a parliamentary question in December informed me that, of the then €3.8 billion disability budget, €2.2 billon was targeted at residential services. The Department, however, could not say how much of that €2.2 billion was being spent on private, for-profit services. How can the Department spend vast amounts of public money on a service model that is so problematic? The services are often scattered in remote areas, many miles from residents’ communities of origin, and they are not necessarily joined up to community supports. They are not involved in meaningful collaboration or a shared strategic vision with section 38 and 39 providers. How can so much money be spent on these companies that, ultimately, do not have loyalty to us? They could be gone overnight if it suited them. Will the Minister of State explain how that was the case back in December?

Emer Higgins (Dublin Mid West, Fine Gael)
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At present, about 1,400 residential placements are being provided by private service providers. They constitute in the region of 15% of total residential places. It represents a slight increase over a two-year period. It is an increase of 3%.

Liam Quaide (Cork East, Social Democrats)
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There has been a doubling of the proportion since 2021. How much money does that add up to? I know the proportion. How much are we spending?

Emer Higgins (Dublin Mid West, Fine Gael)
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We can get that figure for the Deputy. To give him the caveat or context, the cost of every placement varies significantly based on the needs of the individual.

Liam Quaide (Cork East, Social Democrats)
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I understand that. That also applies to the services of the HSE and section 38 and 39 providers. I totally appreciate that. It is worrying that the Minister of State does not know the overall spend. Mr. Michael Hegarty, CEO of St. Joseph’s Foundation, which is a section 39 service in north Cork, was before the committee a few weeks ago. He said that residential placements with private companies were “costing twice and sometimes three times the price compared with placements in the voluntary, not-for-profit organisations.”. The previous week, witnesses from the Muiríosa Foundation, which is a section 38 service across a wide geographical area, told us that it is relying on the private rental market for 46 out of its 142 residential properties. They explained that it could invest €50,000 or €60,000 in a property to get it up to HIQA standards, only for the landlord to decide to sell and then all that investment is lost. Meanwhile, the private companies are building up property portfolios with the large sums of money they are receiving from the Department. All of that is difficult to get our heads around, both the human cost to residents and families but also how grossly uneconomical it is.

Emer Higgins (Dublin Mid West, Fine Gael)
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I hear the Deputy’s concerns in that regard. That is why, as a policy and vision for residential services, we want to be able to move away from private providers and into the space of HSE-run services, as well as HSE-funded services in the form of the section 38 and 39 organisations. That is part of the vision but the reality is that, a lot of the time, we are dealing with crisis places. We, therefore, need emergency responses to be provided and we find that the private sector is able to stand up those emergency places quicker and, perhaps, in a more agile way. We want to better fund the sector so that it can be able to future plan and expand its footprint. I wish to recognise-----

Liam Quaide (Cork East, Social Democrats)
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I am very limited with time.

Emer Higgins (Dublin Mid West, Fine Gael)
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-----that is what the 20% increase in budget is for.

Liam Quaide (Cork East, Social Democrats)
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I appreciate what the Minister of State is saying. A number of section 38 and 39 providers were before the committee, and I have also engaged with them privately. There are many such organisations but all of them are telling us that they need multi-annual funding because they cannot get out of reactive, crisis-driven mode without it. Some organisations told me that they are down to the wire every year. They are not sure whether they will be able to pay staff wages and they almost have to turn to the HSE for a bailout. Why will the Department not provide multi-annual funding so that these services can properly plan for the future need instead of reacting all the time in the here and now to a crisis?

What the Minister of State said is legitimate. The private companies are able to come in and offer a placement very quickly. While that relieves the pressure from the HSE, the residents of those services are often getting stranded there. They might be 100 km from home. This might happen in the context of a parent dying where there is traumatic upheaval on top of traumatic grief. While there is a need for an immediate crisis placement, where is the plan for multi-annual funding?

Emer Higgins (Dublin Mid West, Fine Gael)
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We are aware that people would prefer to be in their locality. For that reason, we continually assess people in residential care to see whether there are better options they may wish to transfer to. In recognition of the impact that distance can have on people and their loved ones, HSE south west has recently been engaged to purchase a house in Cork which will enable people to move closer to their home county if they so wish, in addition to creating capacity within the system. HSE mid west has confirmed it is also endeavouring to offer individuals the option of living in residential services closer to their communities through capacity building.

Liam Quaide (Cork East, Social Democrats)
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That comes back to the issue of multi-annual funding. Every section 38 and 39 service is telling us that multi-annual funding is pivotal to their viability and capacity to plan rather than simply react to a crisis. It would allow them to develop services as well as retain what they have and keep the lights on.

Emer Higgins (Dublin Mid West, Fine Gael)
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We have now moved to a multi-annual budget perspective in the Department of housing. The Department of Health is currently under review when it comes to multi-annual funding. If that happens, it will absolutely inform the possibility for disability services to move to that area. That is an ongoing budgetary discussion. It is not something that is provided in this year’s budget. What is provided in this year’s budget is the 20% increase in funding for disability services to do exactly that – to invest.

Liam Quaide (Cork East, Social Democrats)
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We do not know how much of that is going into private, for-profit companies. We know the percentage.

Emer Higgins (Dublin Mid West, Fine Gael)
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I can give the Deputy euro figures based on a sample we did in 2024 where the average costs were derived, as I said, from a sample of placements. They were reflective of very specific requirements of people supported in that particular timeframe in the assessments of needs.

Liam Quaide (Cork East, Social Democrats)
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We need to know what the overall budget spend was.

Emer Higgins (Dublin Mid West, Fine Gael)
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It was €420,000 for in-profit providers, €260,000 for section 39 organisations, €415,000 for section 38 organisations and €620,000 within the HSE.

Liam Quaide (Cork East, Social Democrats)
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That is the cost of an average placement, is it?

Emer Higgins (Dublin Mid West, Fine Gael)
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Yes, based on the sample we conducted in 2024.

Liam Quaide (Cork East, Social Democrats)
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There are very different needs within all of that.

Emer Higgins (Dublin Mid West, Fine Gael)
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Well, that is the point I made.

Liam Quaide (Cork East, Social Democrats)
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What Michael Hegarty of St Joseph's Foundation stated here was very stark. It is very worrying that the Department does not have the figures on how much it is spending on those companies, while at the same time, multi-annual funding is not being provided to section 38 and section 39 services.

Emer Higgins (Dublin Mid West, Fine Gael)
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Just to be quite clear, we are spending 15% of the total residential budget on residential places provided by those companies.

Liam Quaide (Cork East, Social Democrats)
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No, 15% of the overall proportion of placements is provided by those companies. We do not know how much money has been spent.

Emer Higgins (Dublin Mid West, Fine Gael)
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Apologies, yes. Does the Deputy want a percentage or a euro figure?

Liam Quaide (Cork East, Social Democrats)
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Just a euro figure. I have sought this through parliamentary questions and I sought it from the Minister, Deputy Foley, at the previous budget Estimates meeting.

Emer Higgins (Dublin Mid West, Fine Gael)
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We will take that away and see if we can come back to the Deputy with a euro figure for it.

Keira Keogh (Mayo, Fine Gael)
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I thank the Minister of State and her officials for their attendance. It is great to acknowledge that there has been a significant uplift in the budget for specialist community-based disabilities, as 20% is a big increase. We want to see now what that will deliver. We look at other figures like a €25 million increase in respite with a staff increase of 1,000 in 2025. Looking at that, in our offices we are not seeing that trickle down yet. How quickly do we think the uplift of the budget will start making a difference on the ground or is the uplift of the budget stopping leaks and keeping doors open? To focus on respite, I have made four or five referrals in the last six to eight weeks and there is no change from before Christmas or before the budget. I am still being told there is absolutely no respite available for these children and they are not at that critical level. One of those particular children is self-injurious and has significant challenges and is very difficult for the parents. I am thinking if she is not a case for emergency respite, I do not know who is. I want to get the Minister of State's feelings on that. How quickly are we going to see a difference on the ground or is this still an emergency increase in the budget?

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Deputy. She is right; we now have €3.9 billion allocated for HSE disability services in this year's budget and that represents a 20% increase, which is, as she said, a €628 million increase in funding on last year. It is our job to make sure that this funding translates into improved outcomes for exactly the type of people she mentioned and that is what we are working hard to do. I will break it down into two lots. The first lot is €478 million to address sectoral funding pressures. That was the first point the Deputy made in terms of investing in our services to make sure they have whatever their requirements may be. That is things like pay cost pressures, capacity limitations, service provision in terms of the increased cost, and service provider sustainability. Ultimately, we need all these organisations to be able to survive and thrive and to be able to continue to deliver really important and valuable services to people with disabilities and their families.

An extra €150 million has been provided to fund service expansion in residential, respite, day service, home support and personal assistants. Some of that will be additional headcount and some will be additional places. From a headcount perspective, we will have 1,000 additional people working in our disability services within the year. Included in that we will have 150 people working within our CDNT teams. These are new posts that we will be shortly going out to recruit for. These new posts will create and bolster regional and national capacity across our CDNT teams. They will be able to deliver the assessments of needs. We are standing up 11 in-reach teams to support the new autism assessment and protocol. We have residential review teams, which will make sure, as Deputy Quaide alluded to earlier, that people are in the right residential place. If a new place becomes available closer to them, they will engage with them to see does that suit them better. There is also work on respite and personalised budgets, home support and then obviously workforce pipeline development as well.

In relation to respite, which the Deputy referenced, there will be an extra €25 million this year. This will deliver 10,000 additional overnight respite sessions and 25,000 additional day-only respite sessions. The case the Deputy referenced sounds like an emergency case so I hope the family will benefit from that.

Keira Keogh (Mayo, Fine Gael)
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I suppose that is just one case and we know there are long waiting lists. To see this filter down and get the recruitment is the most important thing. We had a witness here a couple of weeks ago who put a figure on the cost for a residential place of €900,000 a year. I suppose it is more expensive to be looking after somebody on a full-time basis. Do we have future plans in relation to this if it costs €900,000? Keeping people in prisons costs a crazy amount of money and keeping people in full-time hospital care also costs a crazy amount of money. If someone is being looked after full time, that is what it costs. If we could take €900,000 and put it into one child for early intervention and they were to get 900 hours across three years, we would potentially be avoiding full-time residential care for many people. Are there those kinds of long-term discussions? At the moment we are providing residential places on an emergency basis. We want to get to the point where we are able to provide residential places on a more planned basis but really, we have to get to a point where we are actually investing more into early intervention. If we could say to a parent that they would get 900 hours across three years and they could use them for speech and language therapy, occupational therapy, behaviour support or personal assistance hours, that would be absolutely life changing. Yet, we are using that in one year to keep somebody in residential care, which is what we need to do at the moment.

Emer Higgins (Dublin Mid West, Fine Gael)
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Yes, absolutely. The model we want to move to is where we have better options for planned and unplanned residential. This year, we will be investing an additional €65 million into residential. We will be providing 199 new residential placements, with 72 of those planned priority 1 and 80 for unplanned urgent priority 1 new residential placements. There is a mix of us being able to put aside funding to deliver those emergency crisis placements and also then for us, for the first time in a very long time, to be able to deliver on a planned basis. It is a small number, given how many people are awaiting residential placements but it is a start this year and is something we want to build on next year. We want to continue to grow. Come July, we will have a new procurement framework that we will be using for any private providers when acquiring capacity through them.

Gillian Toole (Meath East, Independent)
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I thank the Minister of State and her team for being here today. I have a few specific questions related to the documents that were provided. The first is under the banner of governance data and transparency. Is there an indicative timeline for the enhanced oversight and planning? There is also a reference to strengthened oversight and governance and another reference to limited availability of service level financial data. Drilling into that, what does all of that mean? The budget that has been allocated is absolutely fantastic, most welcome and highly necessary. To get the best value for service users will depend on managing data and making sure that needs are met based on evidence.

Will the Minister of State flesh out the oversight, governance and planning, which is hopefully heading towards multi-annual funding? I read from it that the longer term planning and capacity building is heading towards multi-annual funding.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Deputy. My team and I are committed to delivering enhanced governance and oversight for a number of reasons. First is value for money for the taxpayer. It is also because this year at budget negotiations we succeeded in getting the most substantial increase in funding across government. We received a 20% uplift in funding. We do not want that to be the end of the increase in funding. We put in enhanced governance and oversight and new reporting structures with the HSE because we feel we need to very clearly demonstrate where the extra funding is going, how it is building capacity in our disability services and how it is delivering improved outcomes for people on the ground. That will be key to making sure the money is appropriately spent and it will put us on a better negotiating standpoint ahead of next year's budget. We hope to achieve an increase in budget next year as well because we will continue to fight and advocate for additional funding in this area.

In terms of specifics, the strengthened governance and oversight priorities are reflected in my Department's letter of determination and the HSE's national service plan for 2026. That was approved in December by the Ministers, Deputies Foley and Carroll MacNeill. Areas of focus for enhanced governance and oversight include finance, workforce, service delivery and performance oversight. Under the Sláintecare health regions reform programme, these new structures will provide increased disability leadership, capability and governance oversight and will realise a more sustainable and effective service delivery.

Reforms under way include budget control and oversight arrangements. Those are being put in place with the HSE and their strong focus is on the national service plan. They will facilitate performance evaluation on a regional and programmatic basis, for example. When I say "programmatic", I mean theme-specific, so residential, day services, respite, personal assistance, home support and children's services. This year we also are shifting to a more proactive approach to controlling budget management and ensuring a stable base on which to expand services. Engagement with the HSE is improving. Escalation and reporting are improving as well. We have introduced trilateral meetings between the Department of public expenditure and reform, the HSE and ourselves. That allows for the escalation of any challenges where necessary, so they can be ironed out at that table.

The Deputy asked about data enhancement. I firmly believe that is an enabler of policy and service reform. A good body of work is happening in that space. Our action plan for disability places data quality, integration and strategic use of data at the centre of ensuring person-centred outcomes and focused reforms. A new national implementation and monitoring committee is being established to provide enhanced political oversight. That relates to national human rights for disability. We are improving data-driven decision-making at the core of Government policy. This is being achieved through the establishment of the new disability unit in the Department of Taoiseach. The Taoiseach is now chairing the disability Cabinet committee, which meets regularly. We hear the data aspect coming from that disability unit and that frames the discussion we have at the Cabinet committee.

Gillian Toole (Meath East, Independent)
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I thank the Minister of State. Her detailed reply leads me to my next question. I may be confused on this, so pardon me if I am. We have a unit in the Taoiseach's Department. We have a dedicated committee. On page 11 of the briefing document, I see reference to a disability vision and strategy unit having been established. We also have the National Disability Authority. Its remit is independent, evidently. Is there a likelihood of duplication of process and, therefore, a possible diminution of fiscal resources? What will be the differentials between the different bodies?

Emer Higgins (Dublin Mid West, Fine Gael)
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There is no possibility of that and we have been very clear on that. I will outline what each of them is for. The National Disability Authority is an independent agency that advises the Department on disability policy. It engages directly with DPOs and the lived experience of people and representative organisations across the country. We also have a disability unit that sits in the heart of government, in the Department of the Taoiseach. Previous Governments have had specific units. The idea behind that is there is somebody in the Department of the Taoiseach who can co-ordinate a whole-of-government approach. That is key.

My ambition is for disability to be not just a key priority of our Department - which it absolutely is - but a key priority of Government. That means disability policy being weaved through every Department and being seen as a priority in every Department. That is why we now have a Cabinet committee on disability, chaired by the Taoiseach. We just met on Monday. On the committee are relevant Ministers and Secretaries General in different Departments. We come together to give updates on what is progressing in our Departments, where we need support, where the challenges are and how we can work together to achieve all the goals outlined in the national human rights strategy on disability. That strategy was co-designed with disabled people and their families to ensure they have a voice.

We have also set up an implementation and monitoring group which disabled persons and disabled persons organisations sit on to hold the Government to account. Many of the Ministers who are at the Cabinet committee are at that implementation and monitoring committee. It meets twice a year and the idea behind it is to ensure we are being held to account against that plan by the people this matters most to. The work happens on an ongoing basis and is reported on directly to the Taoiseach at the Cabinet committee. The implementation and monitoring group is where we report further out and where we get other people's advice and opinions and use them to shape our plans.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Cuirim fáilte roimh an Aire Stáit. The Minister of State went through a couple of figures on residential care places. We all heard in here from Muiríosa and Horizons. We have all had meetings with the likes of Cheshire, who have said the problem has been the lack of multi-annual funding. There has been a huge amount of reactive care. The Minister of State said there is planning this year for around 199 places. They spoke about anything between 91 and 200 places that needed to be allowed for. Should that 199 places deal with, in general, the amount of reactive care issues we have?

Emer Higgins (Dublin Mid West, Fine Gael)
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It is a good question. I am not confident saying yes to that, and that is because emergencies arise.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I get that emergencies arise but there is an average over a year. Is it around 200?

Emer Higgins (Dublin Mid West, Fine Gael)
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It is 199 new residential places.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I get that but do we have the average number of those sorts of cases?

Emer Higgins (Dublin Mid West, Fine Gael)
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The Deputy is right. It might even be slightly higher than that.

Ruairí Ó Murchú (Louth, Sinn Fein)
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So around 250 is the number-----

Emer Higgins (Dublin Mid West, Fine Gael)
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No, it is about 220 on average.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Okay, 199 is obviously better than the allowance for last year. What was that?

Emer Higgins (Dublin Mid West, Fine Gael)
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Last year, the original allowance was 70 places.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That obviously was not going to cut the mustard. The 199 is broken into a number of figures I did not get completely. Will the Minister of State give me those?

Emer Higgins (Dublin Mid West, Fine Gael)
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There are 72 planned priority 1-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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What is a "planned priority 1"?

Emer Higgins (Dublin Mid West, Fine Gael)
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We categorise people who have applied for residential services as priorities. Priority category 1 is our most urgent category.

Ruairí Ó Murchú (Louth, Sinn Fein)
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We are talking about older parents or changed circumstances when a house physically-----

Emer Higgins (Dublin Mid West, Fine Gael)
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It may well be included in that - absolutely - but it is wider than that. There are 80 planned, urgent priority 1-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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Is that the emergency department?

Emer Higgins (Dublin Mid West, Fine Gael)
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No, by and large, traditionally that would be cases the Deputy references in terms of people who have left in very urgent situations.

Ruairí Ó Murchú (Louth, Sinn Fein)
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No, I get that; for example, where a family falls apart and leaves somebody in an emergency room. I assume those circumstances are few and far between, but they do happen. What is the other number made up of?

Emer Higgins (Dublin Mid West, Fine Gael)
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There are 35 fair deal top-ups for new residential placements in nursing homes, where disabled people may opt to go into nursing homes or where we may have people who move in there.

Ruairí Ó Murchú (Louth, Sinn Fein)
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So we could still be dealing with a cohort of people who are in a nursing home, for whom we should have an alternative but we do not.

Emer Higgins (Dublin Mid West, Fine Gael)
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I will get back to the figures, but just in relation to that point, we have €10 million in this year's budget that has been provided for under-65s – the cohort the Deputy referenced – in nursing homes. Some €8 million of that will be used to enable 45 people who are inappropriately placed in a nursing home to transition to a more appropriate living arrangement.

Ruairí Ó Murchú (Louth, Sinn Fein)
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What number do we believe are inappropriately in nursing homes?

Emer Higgins (Dublin Mid West, Fine Gael)
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Is the Deputy referring to those who are under 65?

Ruairí Ó Murchú (Louth, Sinn Fein)
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Yes. The Minister of State can come back to me.

Emer Higgins (Dublin Mid West, Fine Gael)
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The other part of that fund, €2 million, is to provide enhanced quality-of-life supports to those who remain in nursing homes. They may benefit, for example, from day sessions and anything like that that they wish to be able to utilise for enhanced quality of life.

To go back to the Deputy's previous question on the breakdown of the 199 residential places, 12 are enhancements for new residents entering an existing placement. They would be new residents going into residential care that already exists where, for example, they might need a different support structure, a different support plan, extra staff or changes and adaptations made to a room or an ensuite.

I can give the Deputy an answer to the other question. It is 656 individuals who are being reviewed and assessed for transition from nursing homes.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That is a frightening figure. We welcome the fact that it is being addressed, that we will have a figure and the Minister of State will come back to us in relation to that. We need to ensure that we-----

Emer Higgins (Dublin Mid West, Fine Gael)
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The figure is 656.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I appreciate that. We had Gerry Tully in who said the HSE was making attempts to ensure that we are dealing with the voluntary sector rather than the for-profit sector while 15% is being dealt with. Of those 200, how many would fall into the for-profit category?

Emer Higgins (Dublin Mid West, Fine Gael)
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It depends, because these are done on a needs basis. It may be more likely that the urgent, unplanned ones use private care. From July, we will have a new public procurement framework that we will then be using going forward for engagement with the private sector.

Ruairí Ó Murchú (Louth, Sinn Fein)
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No, I get that. We hear that there is a specific project in place from the point of view of moving towards the voluntary sector as opposed to the for-profit sector. Again, I get that there is a dispute in relation to how much more it costs with the for-profit sector, but we can accept the fact that if it is for profit, that would mean it is going to cost more. How do we get to that place? I asked Bernard Gloster and he said the preference is that the State would provide and then we would look at the voluntary sector from the point of view of supplying this service in State-owned premises, which would obviously be a lot better. The question is where we are.

Emer Higgins (Dublin Mid West, Fine Gael)
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Yes, that is absolutely where we want to get to. The vast majority of our 72 planned priority 1 new residential places are being catered for in section 38 and 39 organisations and the voluntary sector, which shows that we are building capacity and utilising the fantastic services of those organisations in a better way. This week, we published the new capital plan, which also provides funding for the delivery of new residential placements. I will also reference the Department of Housing, Local Government and Heritage, which is responsible for physically providing buildings as well. We are now engaging more directly with it.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That is necessary.

Emer Higgins (Dublin Mid West, Fine Gael)
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Yes, it is.

Ruairí Ó Murchú (Louth, Sinn Fein)
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There is obviously a housing crisis but there is a very particular issue in relation to housing for people with disabilities.

Emer Higgins (Dublin Mid West, Fine Gael)
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Yes. The Department of housing and the Minister for housing are involved in the cross-governmental work that happens in this space. We have now recruited four HSE officials and we are currently recruiting an additional two, who will specifically be tasked with delivery of residential capacity. They will work with the Department of housing and with local authorities to identify new capacity that could come on stream. We will work to ensure that it transitions because ultimately what we want to do is utilise capacity that exists in the market to support section 38s and 39s and the HSE to provide residential services in new properties as well.

Ruairí Ó Murchú (Louth, Sinn Fein)
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That is okay. Could the Minister of State come back at some point in writing with the breakdown of costs, in particular on what Deputy Quaide has spoken about in relation to the for-profit versus the voluntary sector, so we can have a notion of how much more expensive it is as well because that is crucial?

Emer Higgins (Dublin Mid West, Fine Gael)
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Yes, it is important. I am happy to reiterate the results of the sample that we have. I can give the Deputy those figures again.

Mr. Colm Ó Conaill:

We have more detail on more recent years. We do not have all the detail going back a while because of the limits of the financial management system. We can give the Deputy the detail we have.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I appreciate that.

Maurice Quinlivan (Limerick City, Sinn Fein)
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That concludes round 1. If people want to come back in again, they should just indicate. Does Deputy Keogh want to come back in again? She is first. She has five minutes.

Keira Keogh (Mayo, Fine Gael)
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I thought the Chair was going to take some questions himself. I will jump straight in. In terms of the one-door policy or whatever we want to call it - no wrong door or just shared care, is there a specific budget to support that or what is the framework around it? I have outlined to the Minister of State outside the committee a number of cases that fall between the cracks of the HSE disability service, CAMHS and even NEPS. Aside from that, when we look at the planned movement of people out of nursing homes into residential places, we see the other side of it too where there is often a breakdown between local authorities and section 38 and 39 organisations. We had great examples here a couple of weeks ago where Limerick does this really well, and then we had another example where one local authority had only earmarked one unit for a disabled person. They are two questions, but they are the same. We need shared care within resources and within Departments but we also need it between local authorities and those providing care. What are the specifics of the budget or the frameworks? How is it happening?

Emer Higgins (Dublin Mid West, Fine Gael)
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I will speak to the frameworks. The point the Deputy made is really important because ultimately what she is talking about is silos. People do not live in silos; they live in communities. They do not live in services provided by the HSE, the Department of Health, the Department with responsibility for disability or the Department with responsibility for local authorities; they live in communities. No matter what their situation, we need a cross-government approach to be able to support them better. That is the rationale behind why we have the Cabinet committee on disability and the national disabled persons strategy and the national human rights strategy, and why, most importantly, we have an action plan deriving from that which puts different Departments in the driving seat to ensure this is not just a priority for our Department but is also a priority right across government.

The single point of access - the no wrong door or one-door policy - is something that the HSE is operating on a phased basis since about August of last year. The main funding for that is coming from the Department of Health. One point to mention is a new addition to that, which we hope will be up and running very shortly - the new autism assessment and protocol. We are actually getting a briefing on it this week. Once we have that briefing from the HSE, we hope to be in a better position to give more information as to when and how people will access that. That is a really good example of where we need the Department of Health, the HSE and my own Department to be able to provide a multitude of options for people because this boils down to making sure that no matter what people's needs are, they will be met.

Keira Keogh (Mayo, Fine Gael)
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It is great to hear that the Department of Health is doing that on a phased basis, but if the Departments of children, education and housing do not have similar protocols, and the people who are responsible for those protocols are not liaising together, we are still not going to have shared care.

Emer Higgins (Dublin Mid West, Fine Gael)
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Absolutely. I suppose that is why, for example, some practical things are happening. We have got a lot of funding going into a new ICT development for a new system that the HSE will be able to use, and that our own Department and the Department of Health will also be able to be feed into.

That is important because the data needs to be, where relevant, accessible to different Departments.

The Deputy is right that does not make sense if other Departments are not co-ordinating in the same way. That is what the Cabinet committee is all about; it is about putting structure, guardrails and accountability around that. That is why the Taoiseach chairs that meeting, to ensure there is full authority and backing behind that strategy, which is very much breaking down silos.

Keira Keogh (Mayo, Fine Gael)
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It was positive that when Department of Health officials were here, they felt that within six months if people were coming for an assessment, they were going to have that one-door response.

I do not see that in any way being six months, ten months or 12 months where someone is going to be eligible for a social house and will have synced up personal hours. I do not see somebody who wants to go to a disability day service and gets moved back to mental health changing in the next 10 months.

Can the Minister of State uplift that at all?

Emer Higgins (Dublin Mid West, Fine Gael)
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It is hard to comment on another Department and another agency's plans-----

Keira Keogh (Mayo, Fine Gael)
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Sections 38 and 39 organisations are also under the Minister of State's Department, so it is her Department as well.

Emer Higgins (Dublin Mid West, Fine Gael)
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Sections 38 and 39 organisations absolutely are, as are the CDNTs. The Department of housing, CAMHS and some of the other primary care services the Deputy spoke about are not necessarily. However, to be clear, the HSE is telling us it is implementing a new strategy that means there will be no wrong door. When people are in a queue for primary care or CDNT or CAMHS, they are not going to reach the top of that queue and be told that they are in the wrong queue. They are going to be supported and given a pathway through the entire process.

Keira Keogh (Mayo, Fine Gael)
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My time is up. Essentially, if someone goes to the HSE, there will be no wrong door in the HSE, but there will still be a wrong door because there is not the same policy across children and housing. It is not co-ordinated yet.

Emer Higgins (Dublin Mid West, Fine Gael)
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From the HSE's perspective, the vast majority of funding from my Department is channelled through the HSE for the provision of services. Specifically, when I am talking about my Department, that funding is coming under that HSE no wrong door vision. It is very important that this happens. I see it in our CDNTs and the collaborations they have with the likes of primary care.

Many primary care centres are being built throughout the country and we will see that collaboration happen in real time in our primary care centres, where our CDNTs are also.

Gillian Toole (Meath East, Independent)
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Referring to table 1, subhead D14, the total amount is €8 million. There is a figure of €500,000 for the administration of the seven-year trial or pilot of personalised budgets.

Is there any estimate of what a personalised budget figure might be, or is that pending the outcome of the NDA, review of personalised budgets?

Maurice Quinlivan (Limerick City, Sinn Fein)
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Does the Deputy mean an individual person and what it would cost, or does she mean an average?

Gillian Toole (Meath East, Independent)
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A total figure if the scheme were to become mainstream rather than continuing as a pilot.

Emer Higgins (Dublin Mid West, Fine Gael)
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There is not one yet, and that is because we are still assessing the pilot. We have 302 individuals engaged with the pilot at various stages. To be clear, that includes individuals who withdrew or who had insufficient funding for what they required. By the final stage of the pilot, we had 50 individuals. The pilot was entitled the "Living Life Phase", and those 50 individuals were allocated a personalised budget. The HSE continues to support those persons in utilising their personalised budget. That would be some of the budgetary figures the Deputy spoke about in that budget line and we are continuing to ensure support for the personalised budget is provided to them.

The pilot was operated with no additional expenditure as regards the actual personalised budget but, as the Deputy pointed out, an administrative and staffing cost was associated with that. Between 2020 and 2025, that staffing and admin cost was €981,322.

Gillian Toole (Meath East, Independent)
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Subhead D12 is an allocation for specialist community-based disability services Covid-19? What are those? Correct me if I am wrong, but it is a figure of €18 million.

Emer Higgins (Dublin Mid West, Fine Gael)
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At the time, that was introduced as a Covid-19 measure. It was contingency funding, but when we are given funding, we like to keep it. We are now repurposing that to support our residential services and the delivery of AONs.

Gillian Toole (Meath East, Independent)
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Is there a figure for alternative respite care? Has a decision been arrived at as to how alternative respite might be defined?

I have mentioned possible alternative options and I am just wondering if there is a timeline for same.

Emer Higgins (Dublin Mid West, Fine Gael)
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In respect of the type of respite, we have recently conducted an audit of respite services with the HSE. The HSE has completed it and it is now being considered by my Department. That audit was undertaken to get a comprehensive picture of current service provision nationally, and to provide insights into a range of areas, including unmet need, occupancy levels, data collection and, as the Deputy has said, the types of respite and alternative respite being offered in different areas. The audit is the first step in a wide-ranging programme of improvements we intend to deliver in the area of respite. The HSE is moving from quarterly to monthly reporting for respite and has implemented a new tracker specific to respite.

As regards new development in 2026, the HSE aims to expand capacity, where respite services are in existence through the development of capacity across three enhanced alternative respite models and 13 traditional centre-based services. This year, the bid includes a proposal to develop seven new alternative respite models. That includes after-school, summer camp, weekend services and the development of two new day centre respite services. It also includes a proposal to deliver 20 new traditional centre-based respite services, and they will be based in a combination of sections 38 and 39 private providers.

Gillian Toole (Meath East, Independent)
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Fantastic work is being done and a huge amount of information is being gathered. There has also been a massive 90% increase since 2020 in provision.

I know the Minister of State is new in post, but why was that not happening previously? We have the NAS figure, HSE data and census data. We also have public nurses, developmental check reports, etc.; we have all of that. We know from the time of birth and the first developmental checks that there is a continuum. Why was there a gap in planning? I appreciate the Minister of State is new and massive work has been done in a short time, but historically, why did this not happen?

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Deputy for acknowledging the efforts of the team. This is a relatively new Department. As she will be aware, it was only established several years ago and it was established to give focus to disability and to give it the authority to be able to negotiate its own budget. Ultimately, that is a key factor.

This year, we have increased our budget for disability services by 20%. That allows the team the committee sees here with me today, and the teams who work with them, to invest in this sector and in residential, respite and day services. It also enables investment in important data projects, to ensure we are making data-driven decisions and putting that finance into services that will deliver improved outcomes for people

Ruairí Ó Murchú (Louth, Sinn Fein)
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This is not the first time we have dealt with reform of the assessment of need process, including amending legislation. The Minister of State said that the targeted wait-list initiative would focus on delivering approximately 6,000 clinical assessments.

What is the AON waiting list at the minute? It was 18,000 or 19,000 at the end of 2025. At one stage, we were talking about heading for 25,000 but I think it had reduced down to 22,000.

Emer Higgins (Dublin Mid West, Fine Gael)
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It is 22,200.

Ruairí Ó Murchú (Louth, Sinn Fein)
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It is still nowhere near where we want it to be. I accept the arguments relating to something needing to happen. I welcome the Minister of State talking about the disability unit and the fact everything from now on is going to be factored through an evidence-based case.

That probably did not initially happen with AON, CDNT and the whole set-up, but we are where we are.

I turn to the proposals put forward and the discussion we had previously. What consideration is being made about who makes the assessment with regard to allowing someone to take a different pathway? That is on the basis that 39% had an assessment of autism and 29% were found to have no disability. From a technical point of view, I presume they may still have needed some element of SLT or OT and so on. I understand the number jumped even last year for those who had an assessment of autism.

Emer Higgins (Dublin Mid West, Fine Gael)
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We are reforming the system for many of the reasons outlined by the Deputy. It is important to remember that at the heart of this are children with disabilities who need access to therapies. Right now, children across Ireland are waiting too long. That is wrong and needs to change.

Ruairí Ó Murchú (Louth, Sinn Fein)
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We need assessments and therapies in whatever is the best format for them.

Emer Higgins (Dublin Mid West, Fine Gael)
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Absolutely. That is why we are investing in our CDNT teams that provide therapies. It is why we are rolling out in-school therapies to be provided in our special schools, and that is why we are reforming the assessment of need and legislation. To be clear, this will not affect anybody's statutory right. It will affect the timelines.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I get that the right has remained and people have advocated for that. That is welcome. However, it is the idea that people may want or need, and it may be easier to provide them with another means of getting an autism assessment and a service. Who will make that determination? There is some consternation at the idea of an assessment officer who may not necessarily have the clinical background, if that is the right term.

Emer Higgins (Dublin Mid West, Fine Gael)
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I will give the overall picture of reform and then deal with those two specific questions. One thing we are doing is producing statutory guidelines, which will streamline and standardise the AON process. That should be good news in terms of every child around the country getting the same approach. Decisions about whether a child has been identified as having a disability will also be communicated to parents earlier. New pathways are being developed. The Deputy referred to the huge increase in children being diagnosed as autistic. In response to that, the HSE is setting up a new autism assessment and protocol pathway. That will be supported by the development of 20 in-reach teams. Eleven of those will be recruited for this year, and nine of them will be recruited for next year. We are also hiring more people into our CDNT teams. They are the people who deliver therapies and services. Some teams are also delivering assessments of need. To supplement them and our workforce, and in recognition of the fact that we have had huge demand in applications for assessments, we are supplementing our workforce by outsourcing the delivery of 6,000 assessments of need this year through a targeted wait-list initiative.

As Deputy Keogh referred to, we are also working with the HSE on that single point of access to ensure there is no wrong door for a child or parent. The first draft of the Bill is published. It will shortly be before this committee for pre-legislative scrutiny. The main thing is that on top of these reforms we are also increasing our workforce and launching that new IT system, which we hope will increase operational efficiencies. There is more money going into this and more therapists being hired. There are also more AONs to be delivered. The ultimate aim is to have children waiting less time.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I get that, and we all need that communication to be improved. However, I am still asking who will make the identification.

Emer Higgins (Dublin Mid West, Fine Gael)
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The assessment officer will. The assessment officer is also the person who outsources assessments of need because they still need to sign off on any reports that come in from private providers. That is part of our standardised approach. We have requested the HSE look at the assessment officer post requirements with regard to skills, knowledge and all the rest to ensure we have the right people in the right roles-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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Or if there is a need for a clinical background or whatever.

Emer Higgins (Dublin Mid West, Fine Gael)
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Or to ensure that they are clinically supported if not.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Does the Deputy want to ask another one very briefly?

Ruairí Ó Murchú (Louth, Sinn Fein)
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Yes, I am very good at being very brief. I stated before that I have a worry. I welcome and we all support the idea of in-school therapies. My fear with in-school therapies is that it will take too long before they are in mainstream. That would take away a lot of the need that falls on the CDNT at the moment. The problem is the HSE is recruiting therapy or in-reach teams, AONs, in-school therapies and primary care, and doing this all at once. I am a big believer in using assistive technology and all that, but it creates a real difficulty. The Minister of State is talking about the CDNT gap. I assume there are still 400-plus positions not filled. If all of those positions were filled, the CDNT would still not be fit to what it is meant to do.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank our CDNT workers across the country.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Yes, I am not taking away from the huge work people do. It needs to be said.

Emer Higgins (Dublin Mid West, Fine Gael)
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Absolutely, and I appreciate that many of them work in teams that are understaffed and may have a high number of vacancies. That is why as we recruit 150 people for our CDNT teams, we will prioritise placements of people in teams with the highest vacancy rates. That is to support our children on waiting lists, but it is also to support the staff who are there and who do incredible work. We need to make sure we are doing our best to retain our staff. We also need to make sure we are recruiting more staff, as the Deputy said. The disability workforce is growing year on year. Last year alone-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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Is the Minister of State not worried about recruiting to all of these at the one time?

Emer Higgins (Dublin Mid West, Fine Gael)
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I absolutely am. That is why it is great to see the Minister for further and higher education announcing additional placements, clinical, medical and social work places coming on stream through our colleges. Our graduates are a strong pipeline for us. We work collaboratively with many colleges. We have student bursaries and placements, and we do our best to ensure we have roles on offer to people who graduate from these therapies. We also recruit from abroad. There is the work permit for specific therapeutic areas. We really want to make sure we are bolstering our workforce and part of that is making sure that happens at college level, and that places are available. I encourage anyone who might be listening in, who might think of a new career, to think of working in our fantastic CDNT-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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As would I-----

Maurice Quinlivan (Limerick City, Sinn Fein)
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Deputy, do not even try, if you are thinking-----

Ruairí Ó Murchú (Louth, Sinn Fein)
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I was going to say, at a later stage clarity might still be needed from the Department of education about the appropriate places. Can I also get the number of the missing positions unfilled in the CDNT? They should feel free to do it if the Chair asks a question.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I would like clarification on assessment of need. The Minister of State can correct me if I am wrong or putting words in her mouth. She told Deputy Ó Murchú that the HSE is doing a review at the moment on what the assessment officer will look like.

Emer Higgins (Dublin Mid West, Fine Gael)
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It is "Yes" and "No". We have assessment of officers in place.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I apologise. I mean the new ones.

Emer Higgins (Dublin Mid West, Fine Gael)
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We are working with the HSE to ensure we have the right skills mix and knowledge, and to ensure that any assessment officer who needs clinical support is receiving it.

Maurice Quinlivan (Limerick City, Sinn Fein)
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When will we see that review?

Emer Higgins (Dublin Mid West, Fine Gael)
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We have asked them to look at it. We are still waiting for that from the HSE.

Maurice Quinlivan (Limerick City, Sinn Fein)
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We will be looking at the Bill in committee in the next couple of weeks.

Emer Higgins (Dublin Mid West, Fine Gael)
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That is a fair point. We are going to have it for then.

Gillian Toole (Meath East, Independent)
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I have a key suggestion under subhead D12, the contingency fund. The Minister of State referenced that it may be reserved for residential or respite. There is a substantial amount in the increased budget for respite. The concern for parents with the waiting times while recruitment is ongoing for CDNT and primary care is that there may be the availability of evidenced-based in-school mainstream provision of services with even a small portion of that money on a pilot basis. I am happy to provide information for possible options. Mainstream is really where the panic and the need are. Fantastic work is being done by SNAs, SETs and after-school clubs, etc.

I do not even expect an answer now. I am flagging it as something that could be considered with a target for mainstream.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank the Deputy. It is important that we deliver therapies to children in schools. That is why the Government piloted in-school therapies and is now rolling them out. It is prioritising provision of special schools first and has said that it is its intention to roll it out beyond that. Ultimately, that is funded by the Department of education and I am keen to ensure that every penny that is allocated to disability services is spent within the disability services budget.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I am following up on the number of unfilled positions in CDNTs and the engagement with the Department. I get that it is the Department's work with regard to a child with disabilities having an appropriate place, be that in a special class or mainstream.

Emer Higgins (Dublin Mid West, Fine Gael)
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To be absolutely clear, special education comes under the remit of the Department of education.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I understand that.

Emer Higgins (Dublin Mid West, Fine Gael)
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I compliment the Minister and Minister of State at the Department of education for the roll-out of the in-school therapies, which will work really well. It will definitely be of benefit to those children who will receive that therapy. That does not preclude anybody from accessing therapies through our CDNTs. We are conscious that our CDNTs might still be required to supplement therapies that are happening in school or, for example, for a sign-off on particular application forms or anything to do with the household. We do not have the CDNT figures with us; I apologise. We can follow up afterwards.

Ruairí Ó Murchú (Louth, Sinn Fein)
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I think it is the high 400s. If we can get that number, that is fine. I agree with the Minister of State about in-school therapies. If we had in-school therapies, we would probably need a slimmed-down CDNT in real terms. It is a long time before we get there.

Emer Higgins (Dublin Mid West, Fine Gael)
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I thank Deputies for all the questions and the detail with which they go through these Revised Estimates. It is a really important part of democracy and accountability. I hope they will see that the Minister, Deputy Foley, and I and our Department are committed to ensuring that the significant uplift in funding that we got this year translates into improved services for people with disabilities and their families, and, most importantly, into improved outcomes. I look forward to engaging with the committee on the assessment of need pre-legislative scrutiny.

Ruairí Ó Murchú (Louth, Sinn Fein)
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The Chair, Deputy Toole and I are supreme democrats.

Maurice Quinlivan (Limerick City, Sinn Fein)
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I thank the Minister of State, Deputy Higgins, and her officials for attending.