Peter Fitzpatrick (Louth, Fine Gael)

The World Health Organization has an interesting and revealing definition of the term "disability". The word "disabilities" is an umbrella term covering impairments, activity limitations and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in life situations. Thus it is a complex phenomenon, reflecting an interaction between features of a person's body and the society in which he or she lives. When an organisation of the magnitude of the World Health Organization describes disability as a complex phenomenon, it is worth taking note, as such a complex phenomenon warrants due care and detailed consideration. As a result, it is a subject to which the Government gives special consideration. I will explore some of the major issues involved.

The Health Service Executive national service plan for 2012 was drawn up against the backdrop of significant funding challenges and has been designed to reflect the changed priorities of the new Government and the significant programme of reform to be undertaken. The allocation for disability services will reduce in 2012 by 3.7% as a consequence of the impact of efficiency, procurement and targeted pay reduction savings. However, the level of service reduction will be lower than the level of budget reduction as a result of the efficiencies achieved. All service providers will be expected to achieve some efficiency savings, but the level will vary depending on the profile of the service provider, efficiency savings achieved to date and the scope to make further savings. HSE managers will have scope, within the national figure of 3.7%, to vary the level of reduction applying to individual service providers. The aim of the HSE will be to tailor such reductions in a way which will minimise as much as possible the impact on service users and their families.

Provision has been made for the investment of €1 million in autism services. This is a particularly welcome development as I have witnessed at first hand some of the excellent results achieved. These funds will be used to address the issue of waiting times for specialist therapy services for children diagnosed with autism and for developing early intervention teams. A review of the HSE's national service plan for 2012 will be undertaken, once the full impact of the reduction in the numbers of staff leaving by the end of February is known.

A review of the efficiency and effectiveness of disability services is being undertaken as part of the Government's value for money reviews for 2009 to 2011. This in-depth review of disability services will assess how well services for people with disabilities meet their objectives and support the future planning and development of services. These terms of reference should ensure accurate findings. The scope of the review is to define and describe the objectives of disability services; consider the extent to which existing policies are consistent with the delivery of these objectives; assess whether current policies and investments arising from these policies are sustainable in the changing economic climate; and propose the policy changes, if any, needed to ensure overall objectives are achieved.

The review group is chaired by an independent chairperson, Mr. Laurence Crowley, and considering a draft of the final report. Amendments agreed to by the group will be incorporated in the report and the steering group will hold its final meeting in the near future to sign off on the report. On completion, it is the intention of the Minister of State to look at it in conjunction with the Minister for Health, Deputy Reilly, to ensure proposals on the future of disability services will be brought to the Government for its consideration and publication in due course.

Other aspects which warrant particular attention are the standards and inspections of residential services for people with disabilities. Unfortunately, this aspect was neglected by the previous incumbents of the House, leading to much negative press in recent times. Approximately 9,000 people with disabilities live in residential care settings provided by or on behalf of the State, the majority of whom have an intellectual disability. However, there is no independent inspection system in place for these residential services. The legislative framework for regulating the sector is provided by the Health Act 2007 which envisages a role for the Health Information and Quality Authority in this regard. However, the relevant sections of the Act that allow for mandatory registration and inspection of designated centres for people with disabilities have not been commenced to date.

In anticipation of the expansion of its role to include the regulation of this sector, HIQA has prepared and published standards which outline what is expected of a provider of services and what a person with a disability, his or her family, and the public can expect to receive from residential care services. The National Quality Standards: Residential Services for People with Disabilities clearly sets out what a quality, safe residential service for people with disabilities should be and supports the delivery of person-centred care in this sector. The current programme for Government includes a specific commitment to put those standards on a statutory footing and ensure the services are inspected by HIQA.

As announced by the Minister, Deputy Kathleen Lynch, on 16 June last, discussions began between the Department of Health and HIQA to progress the programme for Government commitment to regulate residential service provision for people with disabilities. Given the complex nature of service provision across this sector, careful consideration is being given to designing the most appropriate regulatory model. That work is ongoing.

A target date of January 2013 has been provisionally set for the commencement of the new mandatory scheme of registration and inspection of residential services for people with disabilities.

The lack of regulation of this sector is acknowledged as a matter of concern. Unlike previous Governments, this Government is committed to addressing that issue and ensuring that vulnerable people with disabilities in residential services are safeguarded and protected, and that their quality of life is enhanced.

Regarding congregated settings, the HSE published a report in June 2011 entitled Time to Move on from Congregated Settings - A Strategy for Community Inclusion. A total of 3,600 people currently reside in congregated settings which are defined as settings in which ten or more people with disabilities live. The report proposes a new model of support in the community for those in congregated settings.

In addition, the report proposes a seven year phased closure of congregated settings with individuals actively supported to live full, inclusive lives at the heart of the family, community and society. A national implementation group, chaired by the HSE, was set up in October 2011 to drive and implement the transitioning of this worthy programme.

It is worth noting that a disability may occur at any stage during a person's lifetime or may be present from birth. It is incumbent upon us to look after those in society who need support, and the measures I have outlined are a firm commitment by this Government to that end.

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