Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I welcome the opportunity to address the House on the important matter of the cost of disability. I, along with my colleague the Minister of State, Deputy Rabbitte, welcome all those who have travelled here this morning. They had an early start.

At the outset, it is important to state that this issue spans government and several Departments. Several Departments have contributed to the Government response to the motion and that is indicative of the breadth of cross-departmental working involved in addressing this issue. As Minister of State with responsibility for mental health and older people, I am acutely aware of these challenges across my brief. One of the things we learned very quickly in the context of our new policy for mental health, Sharing the Vision, is that responsibility for people with mental health difficulties, in the same way as that for people with disabilities, does not only lie with the Department of Health. It is important that we have input from the Departments of Social Protection, Housing, Local Government and Heritage, and Education. It lies across all the different briefs. It does not only rest with the Department of Health, although a significant part of it does. We certainly need that cross-departmental support for people, whether that is in the context of disability or mental health.

It is important to state that the Government is committed to informing future policy on disability through research such as that on the cost of disability, which touches on many aspects of the life of persons with a disability and the lives of their families. That was mentioned earlier. This is why a whole-of-government approach is required. It is why the cost of disability in Ireland research report was commissioned and published by the Government in December 2021. The report provides important and much-needed research that enables a better understanding of the extent and composition of these costs, and the ways in which they affect disabled people. The cost of disability report, prepared by Indecon international research economists, identified that additional costs of disability run across a number of areas of public expenditure. Those costs includes housing, equipment, aids and appliances, care and assistance services, mobility, transport, communications, medicines and additional living expenses. Furthermore, Indecon found that there is not a single typical cost of disability. Rather, there is a spectrum from low to high additional costs of disability, depending on individual circumstances. The analysis showed that, on average, the costs faced by individuals with profound disabilities range from €9,600 to €12,300 per annum, while for those with limited disabilities they range from €8,700 to €10,000 per annum. Although some of the costs reported through the survey are already met by the State, further improvements cannot be delivered through income supports alone. Indecon identified that solutions will require a multifaceted and broader perspective, covering areas such as housing, transport, education and health.

As the findings of the research have implications for many areas of public policy, a whole-of-government perspective is needed to address the cost of disability. That is why the Government referred the report to the national disability inclusion strategy steering group chaired by my colleague, the Minister of State with responsibility for disability, Deputy Rabbitte. The group comprises relevant Departments and agencies, a disability stakeholder group and disabled people themselves. It will consider and monitor recommended actions required by the various Departments on a biannual basis. In light of these findings, I can confirm to the House that all options will be explored during the preparation of budget 2023 measures.

Another of the conclusions reached by Indecon is that any additional supports should be targeted at those who are most in need and face the greatest additional costs of disability. Given this conclusion, and in line with the Government's roadmap for social inclusion and the Pathways to Work strategy, the Minister for Social Protection, Deputy Humphreys, and her Department have committed to developing and consulting on a strawman proposal for the restructuring of long-term disability payments. The main objective is to simplify the system, remove anomalies, take account of the continuum of disability and support employment. A public consultation on the strawman will commence at the end of this year or early in 2023.

In July 2021, the disability capacity review to 2032 was published by the Government. This report outlines how levels of service provision will have to be increased to meet growing demand into the future, as well as the necessity to address levels of unmet need that currently exist. It contains invaluable data that shine a light on the level of need for disability services which we, as a country, have a duty to address. It allows us to plan for increased capacity in our services and ensure that we meet the needs of those requiring specialist disability supports and services now and into the future. In the programme for Government, we committed to working towards the recommendations of the capacity review as its findings are simply too urgent. That is why we published the framework action plan alongside the capacity review and established an interdepartmental working group to develop a detailed action plan to put the capacity review findings into practice. This working group comprised senior officials from the Health Service Executive, the Department of Health, the Department of Children, Equality, Disability, Integration and Youth, the Department of Social Protection, the Department of Further and Higher Education, Research, Innovation and Science, and the Department of Housing, Local Government and Heritage.

As I said, the cross-government approach to this work is, and was, key. Ensuring appropriate supports and services for our citizens with disabilities is not simply a health matter, but one that reaches across the whole of government, ensuring that the totality of the individual is taken into account. It is also key that we listen to the voices of those directly affected, namely, those who use disability services and their families and carers. That is an important point. In order to achieve this, an extensive consultation was undertaken which attracted participation from almost 800 people, including people with disabilities, their families and carers, people who work in disability services, and umbrella and representative organisations. This information was then fed into the working group in order to inform its work on the action plan. The feedback received from the consultation was invaluable and I wish to take this opportunity to thank of all those who contributed their time and effort and helped make this such a collaborative piece of work. The working group has now concluded its work and the action plan is currently being progressed through the appropriate channels in the Department of Health for finalisation. The Minister of State, Deputy Rabbitte, will be in a position to publish it and begin acting on its recommendations in the near future.

I wish to pick up on a couple of points raised by Deputy Cairns. She is totally right in respect of home care and how important it is to older people and people with disabilities. I currently have a budget of €672 million to deliver home care supports. Unfortunately, there are challenges. Some 55,000 people receive home care daily, but there are 5,000 other people waiting. Their package is funded but we do not have the staff to deliver it. In that regard, I put in place a strategic workforce planning group that made interim recommendations to me last week. I will be in a position to publish that document very soon. It addresses different measures we will take to try to support more people to move into home care and to see it as an attractive career choice. I am working closely with the office of the Tánaiste, as well as the Minister of State, Deputy English, to consider whether it is possible to allow permits be issued to people living outside the EU to come to Ireland to deliver home care. That is already being done in the context of nursing homes. The problem is that 75% of those who work in home care do so part time. In order to meet the conditions of the permit, the employer would have to guarantee a minimum working salary of €27,000 per year and also guarantee two years of work. I am anxious to progress this, even as a pilot programme, to see whether it is worthwhile. We are moving on that at the moment.

I will be bringing forward a Bill on standards in home care, regardless of whether they are delivered through public, private or voluntary means, fairly soon in quarter three and coming into quarter four. I look forward to the support of the House on that matter.

We had a very good debate two weeks ago in the Dáil on respite care and older people. I know the Leas-Cheann Comhairle will be interested in this. I have undertaken a review of the number of respite beds across all nine community healthcare organisations, CHOs, to see where we are. Not all of them have reopened since Covid and I am very anxious to get all that up and running to support older people, people with disabilities and their carers.

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