Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

There is no doubting that the headline figure for the winter plan, €600 million, is very substantial and dwarfs any amount set aside in previous winter plans. It requires and deserves further scrutiny, however. The small print indicates that only one-third of the amount is to be spent in the current year and potentially two-thirds - the funding has not been secured yet - will require agreement in the budgetary process. Theoretically, just one third of the amount is to be available for spending this year. A lot of digging down has to be done into the details of the figure. It includes expenditure on many services that have been put in place in recent months. Therefore, there will not be new services to the net value of €200 million this year.

On a very positive front, I very much welcome the considerable allocation made for home care. Many of us have been looking for that for years. It makes absolute sense. It should have happened long before now. The amount provided, as I understand it, will address the needs of the 6,000 people at home who have been approved for home care but who have been on a waiting list. Those people, in the main, are in very vulnerable circumstances. They may be on their own or infirm and they desperately need care. I hope all the waiting lists can be cleared with the allocation made. I hope it will ensure that, in so far as it is possible, they will not end up hospital or nursing homes. That is all the allocation will do, however. It will not cater for new people who require care. A very considerable number who are ready to be discharged home from hospital need to be catered for also. These are the two separate groups.

In the time remaining, I wish to concentrate on what I believe to be glaring omissions. Three points arise: the lack of any provision at all for mental health services, the lack of any provision for disability services, and the wholly inadequate position on ICU beds.

With regard to mental health services, many of us have been talking in recent months and years about the underlying underinvestment in mental health services. There are long waiting lists for children, in particular, and adults. I provided the figures here a couple of weeks ago. Thousands of children are on waiting lists for community services, whether child and adolescent mental health services, CAMHS, or community psychological services. That was the situation before Covid. We are aware that A Vision for Change was not funded adequately. There has been a shortfall of €50 million in funding in recent years for the implementation of A Vision for Change. Sharing the Vision has finally been published, and it has a price tag attached to it. It has not been provided for in the winter plan.

That was the pre-Covid position. With Covid, it is significantly worse. We heard the very good contribution of Deputy Lahart, who very eloquently described the circumstances in which people find themselves as a result of the major psychological impact of Covid. Isolation, depression, anxiety, grief and loss are all taking a very significant psychological toll. More than ever, we need to put in place significant funding to address the major mental health problem we are storing up, which is at the point of exploding. Most Members of this House have referred to it as a crisis coming down the tracks very quickly owing to inadequate services. It is just shocking that no provision was made for mental health services in the winter plan. I cannot understand it. I cannot understand what the Minister has been doing, nor can I understand what the Minister of State has been doing. It is deeply disappointing. I urge the Minister to make this a priority in the budget in a couple of weeks.

There is a major omission in respect of disability services. There is no mention of these in the winter plan. There was an announcement of €10 million last Sunday but the Minister knows that falls very far short of what is required.

We now have a situation where large numbers of family carers are looking after their loved ones at home because many services closed during Covid. At this point, some of them are opening, but only gradually and for approximately one day per week or, at most, two days per week. There is a huge level of need in this area. There are 1,250 primary carers over the age of 70 caring at home for somebody with an intellectual disability, 400 of whom are carers aged 80 or more. This is shocking and it has been going on now for over six months and is taking a huge toll on people. Many children with disabilities for whom timely services are essential in order to meet their milestones are being denied access to essential therapies that should be provided at community level, including speech and language therapy, physiotherapy and so on. Many respite services are closed or severely restricted. People with intellectual disabilities are experiencing severe mental health challenges as they struggle to cope in the current circumstances.

The Minister is aware of the cost of addressing the huge gaps in services. He is also aware of the cost of putting in place the additional services that are required as a result of Covid and meeting all of the requirements under public health advice. What he provided last Sunday was a small fraction of that cost. It is not good enough. These are the most vulnerable citizens and they must be catered for and looked after in the upcoming budget.

On intensive care beds, we knew pre-Covid that we were hugely underprovided in this area. We had less than half the recommended number according to European standards. There has been some small number of additional ICU beds provided. The fear last March was around the low level of ICU beds. We had so much catching up to do. What is provided for in this plan in terms of net additional beds is 17. Inclusive of all that is funded under the winter plan, we are still more than 200 beds short of the pre-Covid requirement. I put it to the Minister that this is hopeless.

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