Jerry Buttimer (Cork South Central, Fine Gael)

This important debate is about the delivery of specialist disability services. Those services are provided by a diverse range of groups in a variety of community and residential settings. Disability services operate effectively because of the integration and co-operation of non-statutory, voluntary and community groups. I take this opportunity to pay tribute to groups such as the COPE Foundation in Cork which do Trojan work through the efforts not only of staff but of the family of friends of the people availing of their services.

The significance of these groups is clear when we consider that the Health Service Executive's service plan for 2012 includes 9,100 residential places and 18,600 day service places. That is a substantial provision no matter what way one looks at it. The Minister of State, Deputy Kathleen Lynch, indicated in her opening statement today that the Government's objective is an enhanced quality of life for people with disabilities. The national disability strategy must be focused on the people it will benefit by way of the services it provides to them and their families.

Deputies opposite will undoubtedly refer to the expenditure reductions introduced in the budget. That is to be expected, but what we must focus on is our objectives in all of this. There are two points to make in this regard. First, we must mitigate the impact of adjustments on individuals and families. Second, as Deputy Billy Kelleher will know from his time in government, many service providers have already begun achieving efficiency within their own organisations. I hope those organisations which have delivered savings while maintaining the highest standards of care will be duly recognised. I must declare an interest in this as a member of the COPE Foundation in Cork. On the other hand, organisations which have not achieved the same levels of savings and efficiency must do so now. They must work with the HSE to reform their management structures and implement the necessary changes. The HSE itself has a critical role to play in offering flexibility and co-operation in its dealings with these groups.

There is a huge variance in the disability services available across the State. Some have developed in an ad hoc way, being mainly provided by voluntary bodies. Traditionally, there has been no global overview and no uniform model of service provision. Instead, different health board regions and voluntary bodies developed services based on local need and demand. This has worked very well in many instances, offering local control and allowing families to feel personally involved in the service being provided. Moreover, it has minimised the need to deal with cumbersome State bureaucracy. However, the drawback is that models of best practice were not utilised across the country and not every organisation operates at the same level of efficiency.

If we are to reform the provision of disability support, we must ensure that we deliver high-quality, efficient services uniformly across the country. We must plan for the provision of disability services on a regional and national level. Whether in terms of resource allocation, service provision or the duplication of costs, we must strive to eliminate geographical or sectoral inequity. The Minister of State referred to the expert reference group on disability policy. Public consultation carried out by the group shows that people with disabilities and their families would like more choice in the services they receive and more control over how they access them. To facilitate these preferences, the group proposes moving towards individualised supports and individualised budgeting. This is, in effect, a model of direct payments or brokerage.

It is important to ensure that there is independent support and advocacy for individuals within such a system. It will fundamentally change the way in which services are delivered and the power relationship between people with disabilities and service providers. We must safeguard against the provision of services on the cheap and maintain professional standards and quality provision focused on best practice. There will be a need for significant training and investment in mainstream services. We must also be aware that individualised supports will be dependent on the voluntary and local community to sustain them. At present the capacity is simply not there.

Last June the HSE published a report, Time to Move on from Congregated Settings - A Strategy for Community Inclusion. Implementing the recommendations of that report will result in dramatic changes for people with disabilities, their families and service providers. The report proposed moving the 3,600 people currently living in congregated settings to dispersed forms of housing in ordinary communities, to be provided mainly by housing authorities. Congregated settings are defined in the report as "living arrangements where ten or more people share a single living unit or where the living arrangements are campus-based". A cluster of three or four houses, each with three or four residents, could come within this definition. The report proposes a move away from this model within seven years.

This is a cause of concern to parents whose children are living in clustered accommodation. The reality is that there is insufficient capacity in many areas of the country outside of these congregated settings. While proposing a seven-year programme of change, the report does not provide a plan for that transition. Nor does it provide estimates of the costs involved. We must consider whether it is appropriate to do away with all congregated settings. People have different levels of disability and different care needs, and we must ensure we cater for everyone. As people with disability age and become more dependent, the appropriate facilities must be available to cater for them. If we abandon all congregated settings, are we to expect nursing homes to cater for older people with disabilities? If so, there are significant implications for how nursing homes and community hospitals operate and for service provision within the community. Moving on from congregated settings is a complex transition. Should we choose this as our model of service provision, we must ensure all persons with disabilities, at all stages of life, are catered for.

I commend the Minister of State on her lifelong involvement with disability and her close working relationship with many organisations across the country long before her appointment. Several challenges lie ahead in regard to the delivery of adult disability services in the next ten to 15 years. Significant advances were made in recent years in the provision of childhood disability services. The next logical development is in respect of the transition from childhood to adulthood. As people leave the school system we must ensure there are sufficient services in place to cater for their needs, be it sheltered employment, housing and so on. We must replicate the current child services model to cater for adults. Ensuring that these provisions are in place will have cost implications for public finances and service providers.

My father used to say, when he worked in the COPE Foundation, that we have a responsibility to look after people from the cradle to the grave. That is what we should work from and toward. I compliment the Minister of State on her speech today. She did not shirk her responsibility and was clear in her objectives. I very much welcome the reference to a mental capacity Bill and to the UN Convention on the Rights of Persons with Disabilities. We have obligations we must meet. It is not all about pounds, shillings and pence. Rather, it is about looking after the needs of those who are, according to the old Irish saying, duine le Dia. During a recent visit to the COPE Foundation, I saw the joy and contentment of the individuals who are looked after there. It is a testament to the staff and the quality of care. I hope we never lose sight of the imperative to provide quality care as our main priority.

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