Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“acknowledges that: — the Covid-19 pandemic has had significant impact on the delivery of all health funded services, and services for people with disabilities have been particularly affected;

— since the onset of Covid-19 the focus of service providers has been to mitigate its immediate impact on the disability community and the World Health Organization (WHO) anticipates that Covid-19 will be with us for a further 12-18 months;

— the implementation of Covid-19 restrictions has led to the reduction and suspension of services for both children and adults across disability services and while these restrictions have been introduced as protective measures, they have resulted in significant stress for individuals with disabilities and their families;

— the reintroduction of services is now underway, as detailed in the Health Service Executive’s (HSE) roadmap to reopening services, in line with public health guidance;

— since the outset, the HSE Community Healthcare Organisations (CHO) and disability service providers worked collaboratively with families using creative and innovative models of care to support service users where the need was greatest;

— the Government is very aware of the impact of the pandemic on people with disabilities, their families and their carers;

— children’s services, respite services and adult day services are all resuming, having been reimagined and redesigned to be delivered in line with new guidance published by the HSE;

— health and social care responses to the current public health emergency are under continuing review, including specific measures such as those to support vulnerable people; these available supports may change over time and the HSE is aware that the needs of people with a disability and their families will also change over time; and

— in line with the Government's Resilience and Recovery Framework (2020-2021): Plan for Living with Covid-19 (Plan for Living with Covid-19), the HSE regards the provision of disability services as essential to maintaining a response to people with a disability, in the same way that schools and creches are, and importantly, the Government’s intention is that disability services will remain open at each level of the Plan for Living with Covid-19, subject to public health guidance, including the prevention and management of Covid-19 related infection; notes that: — the HSE have consistently worked to engage with individual service providers throughout 2020 citing difficulties in service provision and sustainability due to historical financial deficits and new financial challenges, and the requirement for disability service providers to achieve a financial efficiency target of 1 per cent of their budget in 2020 has been removed;

— substantial additional funding has been allocated to the Health Estimate Vote to meet the costs associated with the implementation of the measures outlined in the National Action Plan in Response to Covid-19 (Coronavirus), and the HSE have put measures in place to address both the financial and non-financial challenges of disability service providers in dealing with Covid-19;

— investment in disability services is significant with an overall budget for disability services exceeding €2 billion in 2020;

— the financial implications of measures taken to mitigate Covid-19 infection are matters which the Department of Health will continue to keep under review in conjunction with the Department of Public Expenditure and Reform, as the situation evolves;

— children’s disability services will continue to progress in all areas, and all CHOs are putting appropriate arrangements in place to resume assessment of need and intervention therapy services in line with public health guidance; guidance documents have been circulated by the HSE to all CHOs to support clinicians in decision making regarding disability assessments in the context of Covid-19 and support the return to more normal levels of service provision for children with disabilities and their families, and funding of €7.8 million has been provided to the HSE specifically to reduce the current backlog in the assessment of need, which will help reduce waiting times both for the assessment and for any therapeutic services required;

— adult day services reopened throughout August and September at 40 per cent of their pre- Covid-19 capacity and to augment this, on Monday 28th September the Minister for Health and the Minister of State with responsibility for Disability, announced that €10 million is being made available in 2020 to support the resumption of day services and enhanced home support services for disability service users and that this funding is being drawn down from the National Action Plan in Response to Covid-19 (Coronavirus);

— of this, €7.5 million will increase disability day services by one day a week for over 14,000 adults, however, capacity in day services will remain at a reduced level; the guidance developed to support the resumption of adult day services has had to take account of social distancing rules which has meant that there is a reduced number of people in each service location and the HSE is committed to maximising the support that can be provided within these restrictions; this involves a balancing of protective measures with as much available access to day services as possible, and the full year cost of continuing these services in 2021 of €30 million will be sought as part of the Estimates process;

— residential services for people with disabilities have continued throughout the pandemic and new guidance issued at the end of September in respect of visits to residential care facilities reflects the different levels of the Plan for Living with Covid-19; as with previous guidance, this emphasises that such facilities are the home environments of individuals residing there and as such the importance of maintaining family connections with loved ones from a holistic person-centred approach;

— respite is an important support mechanism for many families and short-stay residential and emergency/residential respite began to reopen from July to August as the first stage in a three-phase plan, and activity is now increasing for the next two phases – the September to November phase and then the December 2020 to February 2021 phase;

— the allocation of additional funding to disability services is only part of a range of complex barriers to the full resumption of disability services; challenges include the physical limitations of the buildings available and the continued restrictions imposed by social distancing guidance, and the HSE is building increased capacity for day services, including building refurbishment to provide extra space and access to community building and facilities;

— a key commitment in the Programme for Government is the implementation of the National Dementia Care Strategy, which aims to improve how we provide care for people living with dementia, and that in line with the Programme for Government commitment to expand the dementia advisor service on a nationwide basis, an additional 10 dementia advisors are being recruited this year with support from the Sláintecare Enhanced Community Fund;

— there has been a continued focus on meeting the needs of people living with dementia who were impacted by the suspension of day care services during the Covid-19 pandemic;

— the HSE, in collaboration with the Alzheimer Society of Ireland, has developed a range of initiatives and resources to ensure that people living with dementia stayed safe, well and connected during the crisis;

— the Government’s approach to meeting the terms of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is one of sustained and on-going improvement, and work is continuing on the reforms needed for an optimum level of compliance with the UNCRPD's requirements; and

— the Programme for Government also commits to the development of an implementation plan to coordinate implementation of the UNCRPD, and furthermore, the Programme commits to work with other parties in the Oireachtas through an Oireachtas Joint Committee to assist in monitoring and implementing the provisions of the UNCRPD, and work will commence on the development of an implementation plan shortly; and commits to: — a continued whole of government approach to improving access to and quality of services for people with a disability in line with the HSE’s Transforming Lives Programme and the National Disability Inclusion Strategy 2017-2021;

— preparation of Ireland’s Initial State Report to the Oireachtas Joint Committee, which is at an advanced stage of drafting and, in addition, the consultation phase on the State Report is being planned; key to this is the involvement of, and consultation with, persons with a disability on the State Report;

— the ongoing establishment of A Disability Participation and Consultation Network which will move Ireland towards meeting its obligations under the UNCRPD to consult and actively involve persons with a disability and their representative organisation, and one of the first tasks for this Network will be to partake in the consultation process on the Initial State Report;

— the full implementation of the Sustainable, Inclusive and Empowered Communities: A Five-Year Strategy to Support the Community and Voluntary Sector in Ireland 2019- 2024, which sets out a long-term vision for communities in Ireland and a general direction of travel for Government policy in relation to the community and voluntary sector for the coming years;

— strengthening the State’s relationship with the voluntary sector through meaningful participation in the new dialogue forum between the Department of Health, relevant health agencies and representation from voluntary organisations in the health and social care sector; and

— moving to a population-based planning approach to service delivery, in line with the Sláintecare vision, based on demographic and geographic considerations that reflects both the health and social care needs of those within our population, including those who require specialist disability services; this will afford the opportunity to prioritise and design the health and social care services that need to be developed for each region, so the population can get the right care, in the right place, at the right time in line with Health Information and Quality Authority standards and available resources.”

I thank the Deputies for raising this motion in the House. Although I will be opposing the motion as it is set out this evening, I welcome the chance to restate the Government's commitment to supporting people with disabilities and their families, particularly, at this time when we are dealing with the consequences of the Covid-19 pandemic and the current restrictions it causes.

I wish to start by acknowledging with sincerity how difficult the last few months have been for people with disabilities and their families. The impact of Covid-19 on their lives has been and continues to be significant. I am aware that families across the country have had their routines upended.

Covid-19 has presented a huge challenge for disability services. While we all want our services to return to pre-Covid levels, the collective aim of the Department of Health, the HSE and the service providers must be to restore services in a safe way. Tonight, I wish to outline the significant work that is under way to achieve this.

The HSE provides and funds a range of day services and rehabilitative training. We engage with approximately 19,000 adults with disabilities in almost 1,000 locations across the country. These services are essential for adults with disabilities and their families who avail of them.

As the House will be aware, because of Covid-19 the majority of disability services closed in March. They have now reopened. They have not, however, resumed at the level at which they had been pre-Covid. The impact of social distancing inevitably limits the number of people who can be present in any service, as well as the numbers in community settings.

I can completely understand the intense frustration of the day service users and their families at this moment. The fact that day services have not resumed to pre-Covid levels is far from ideal. My office has been inundated with queries about adult day services. The main question people ask me is when services will increase. Answering the question has been my absolute priority since taking office. I was pleased last week to announce that €10 million is being made available in 2020 to support the resumption of adult day services and enhance home support for people with disabilities. Of this funding, €7.5 million will increase the level of day services by one day a week for over 14,000 adult day service users.

The resumption of day services has been a welcome and hugely necessary development for service users and their families. The additional day of service it will provide is a step in the right direction. It will improve the situation for people using day services, and their families, as we face into tougher winter months. Ongoing challenges we face are things like the physical limitations of the buildings available and the continued restriction of social distance guidance. The HSE is building increased capacity for day services and will maximise the support that can be provided with these restrictions.

The allocation of additional funding to day services is only one way of addressing the complex barriers to the full resumption of services. Children's services, respite services and adult day services are all resuming. They have been reimagined and redesigned to be delivered in line with the new HSE guidance. Crucially, the Government's intention is that similar to schools and crèches, disability services will remain open at each level of the resilience and recovery framework subject to public health guidance.

Residential services for people with disabilities have continued throughout the pandemic. Approximately three quarters of those in disability residential care live in group homes in the community. The remainder are in congregated settings or campus settings where there are ten people in a group. Smaller settings have proven to be safer when it comes to Covid-19. Other protective factors are a shared proactive response to the public health teams and service providers working together.

People in disability services are, on average, younger than those living in nursing homes but they do not have an average number of people with clinical conditions. Those conditions could increase their vulnerability to serious illnesses if affected. Sadly, 13 people living in residential disability services have died due to coronavirus. There have been no further deaths since early summer but that does not allow for complacency. We owe it to our vulnerable family members to observe public health guidance to keep this figure as low as possible. We must also remember that these residential facilities are people's homes. We must not and nor should we forget the importance of maintaining family connections with loved ones from a holistic person-centred approach.

The Government recognises that there is a need to address the financial sustainability issues facing the disability sector and is committed to publishing the disability capacity review. We also intend to use the recent research into the cost of disability to individuals and families to properly inform the direction of future policy. However, moving forward towards a more sustainable model of service provision will also mean finding out what factors are causing sustainability challenges and I encourage disability service providers to work with the HSE to address these underlying issues.

Investment in disability services is significant with an overall budget for disability services exceeding €2 billion in 2020 with additional funding allocated to meet the associated costs of dealing with Covid-19. The HSE has consistently worked to engage with individual service providers who are having difficulties in service provision and sustainability due to historical financial deficits and new financial challenges. The House may recall that over the summer, I asked the HSE to relieve section 38 and 39 disability service providers of the obligation to achieve the 1% cut. This was to ease the burden of service provider challenges in the context of Covid-19, which was worth €20 million to the sector.

I do not underestimate the scale of these challenges and I have previously acknowledged the commitment of these services in supporting and protecting those with a disability who attend health and social care settings. When I addressed the House last month, I mentioned during statements on disabilities that my colleague, the Minister, Deputy O'Gorman, and I had asked that the establishment of the proposed Oireachtas joint committee on disability matters be prioritised. I am pleased to note this will happen soon and that our colleague in this house, Deputy Michael Moynihan, has been appointed Chair. I know he will be an excellent and dedicated Chair. I advocated for the establishment of such a committee. I believe it is our responsibility as public representatives to hear from people with disabilities, their families and their advocates. Legislation and policy must be sculpted with their input.

I have heard and absolutely understand exactly why this motion is here before us tonight. I understand and feel the frustration of the families, their advocates and the service users. It is also, however, important to realise that when I took office last July, all these services were closed. We have slowly and within guidance worked with the Department and the HSE to ensure the services could open up and keep people protected.

I have travelled around the country. I started in St. Joseph's in Charleville where I discussed respite in Cooleens House. I travelled to Wexford and Kilkenny. I have been in Galway. I have been around, and I have been listening.

Deputy Tully is right. The same issues of staff, transport and accommodation come up repeatedly. However, we could not turn on the switch overnight to ensure this happened because we needed to have staff and find the accommodation that meets HIQA requirements. For it to work it needs to be done on a piecemeal basis, which is happening. To be fair, the providers have worked with the HSE and the Department. I spoke to the chief executive of the HSE, Paul Reid, yesterday and I now understand that I will no longer have to rely in respite units to be isolation hubs. They are being stood down and the HSE will use the €5 million to ensure we have isolation hubs and that we no longer need to draw on valuable respite services to ensure that people are protected.

When the €20 million saved by scrapping the 1% cut, the €10 million for reopening services and the €7.8 million to tackle the assessment of needs backlog are added up, I have secured a €37.8 million investment in the sector since I took office 98 days ago. That is far from small money. Everyone in the House knows the disability sector is the poor cousin in health. I fought for every euro of that €37.8 million for the families, the services users and the providers, and especially for the children who are awaiting assessments of needs. This is a clear demonstration of the Government's commitment to the disability sector and a tangible example of my commitment to fighting for people with disabilities during my time in this office.

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