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

I thank the Deputies for raising this important motion. I am happy to have the opportunity to discuss the issue of respite services with them this evening. As my colleague, the Minister of State, Deputy Butler, has already stated, the Government is not opposing this motion on the grounds that we share a desire to see increased respite services for people with disabilities and the loved ones who care for them. I acknowledge there is unmet need in respite. I assure the House that along with the Department of Children, Equality, Disability, Integration and Youth and the HSE, I am doing everything possible to increase respite provision and improve access in a fair and equitable manner. As the Minister of State, Deputy Butler said earlier, there is a level of unmet need that the Government and HSE are working towards meeting. Unfortunately, that takes time but we are making progress. It has been a top priority for me to boost capacity since being appointed as Minister of State. Budget after budget, I have increased the money provided to ensure that children and adults can be supported. The overall investment in respite services went from €53 million in 2018 to €96 million in 2022. As I mentioned last week, over the last three budgets, more than 30,000 bed nights have been added to the system. In 2020, 87,000 overnights were accessed. We must bear in mind that this was during Covid, when respite had been curtailed. In 2021, more than 94,000 bed nights - 10% ahead of the national service plan target - were accessed. In addition, more than 16,000 day sessions were accessed by people with disabilities. Last year, more than 131,000 overnights and 28,000 day sessions were accessed by people with disabilities. The number of respite overnights was almost 42% ahead of the target for the year. This reflects the gradual return to pre-pandemic levels of service. While I read that into the record, I still recognise that more capacity must be added to the system. I must add also that from January to March this year, more than 33,000 overnights and almost 9,000 day-only sessions were accessed by children and adults with a disability. In that regard, I hope the upward trend of respite provision will continue this year. Since budget 2021, my first as the Minister of State responsible for disabilities, I have provided funding of the equivalent of 25 new respite services around the country. This respite has been a mix of services for children and adults. To be clear, I will continue to invest in the development of respite services over the course of this Government.

I wish to address staffing and the general issues of unmet need. Service providers are experiencing an unprecedented crisis in retention and recruitment across all health and social care areas. This is not unique to Ireland; it is an international experience. Ensuring an appropriate pipeline of suitable, qualified healthcare professionals is a top priority but it is set against a global shortage of healthcare professionals. While it is the position that vacancies should be filled by permanent, directly employed staff, it is acknowledged that in certain exceptional circumstances agency workers are needed to ensure service requirements are met. I would prefer to see agency staff going into the likes of St. Aidan's than seeing it closed for 12 weeks. I would not like to see the likes of Ability West children's services closed either. Half a loaf is better than no loaf at all. At the moment, I see many closures of services. We must be agile and pragmatic in our approach to ensure that our services stay open for our most vulnerable. While agency staff are utilised to support certain services, it is important to note that this sector is not exempt from the same national and international challenges regarding recruitment. The HSE advises that agencies are also experiencing issues in recruitment and, especially, retention of staff, whom they can lose to established services once a certain level of experience is attained. That is, unfortunately, why much of this occurs in section 39 organisations. It is vital that we see pay restoration and the pay gap addressed. According to the HSE disability services, after first prioritising staffing for residential services from which people cannot be discharged, next it must give priority to maintaining day services, as loss of service in this area could have huge consequences for families, including for parents who work. It can be a further challenge to maintain staff for respite.

All of this points to the need for workforce planning, on which significant work is under way. The Department of Health is leading on a comprehensive health and social care workforce planning strategy, action plan and planning projection model, which will provide demand and supply projections of health and social care professions, among others, spanning short-term, medium-term and long-term horizons, which will enable detailed planning for the period from 2024 on. In the context of work being led by the Department of Health, the Department of Children, Equality, Disability, Integration and Youth has established a working group from relevant Departments and agencies to work together on the supply issue concerning relevant, professional roles required for disability services. The purpose of the group is to identify which disability grades and disciplines are in need of increased supply, how many staff are needed in each grade and how the grades should be prioritised. Using this data, the group will then assist in examining the capacity of the professional and physical infrastructure of the higher education institutes to provide an ongoing sustainable stream of graduates to staff the roles. The HSE is also undertaking several workforce planning projects and working groups in disability services. A range of initiatives has been developed by the HSE's HR department to enhance and promote retention, attraction, recruitment and workforce planning for disability services.

I will go off script to answer some of the questions that were asked. I think it is important that I do so. Every month since the blow-up about not getting access to the HSE - I think it was in November 2021 - I meet with every single one of the disability managers in the HSE on a monthly basis.

We discuss assessments of need and respite, residential and emergency placements. These topics are discussed monthly, without fail. Not a month goes by when I do not address where we are with the delivery of services and what services are under pressure. Deputy Tully is quite right. CHO 1 is quite complex because it is divided into the areas of Donegal, Sligo, Leitrim and west Cavan, and Cavan and Monaghan. The Deputy is right in what she is saying. We cannot operate children's respite services in counties Cavan and Monaghan if they are only available every second week. This is not successful and it is not what good looks like. What good would look like would be every county having its own children's respite service. This would be at a minimum. It should not be every second week. The same should happen with adult services. This is the capacity I am trying to add in and to demonstrate.

The Deputy also knows how complex it is when an adult or a child goes into a bed. A child could have been left there because the family members were burnt out. That emergency space must then become a full-time residential one. While that child or adult is in that place, until a proper emergency place is found, that bed does not become available to allow other children to be able to use that service. One of the issues here, then, is this pipeline of building in the requisite capacity in respect of residential places and addressing the unmet need in this regard.

Regarding Cork and the issue raised by Deputies Pádraig O'Sullivan and Sherlock, which will undoubtedly also be referred to by the two remaining Deputies here from that county, it is important to address the issue of respite in the context of CHO 4. Last week, a television report by Paschal Sheehy on RTÉ examined where we were with respite care. I was horrified that the response was that other staff could not be used to ensure the ten beds in CHO 4 could be used. I am glad to say I met today with the leads of the education and training boards, ETBs, today. I met Denis Leamy and Pat McKelvey, from Cork ETB. I also met Bernard O'Regan, Yvonne O'Neill, Majella Daly and Tess O'Donovan, the new acting chief operations officer, along with representatives of all my lead agencies. The outcome is amazing. I am so delighted to say that additional capacity has been found in Enable Ireland, St. Joseph's Foundation and the Cope Foundation. All those organisations are working together now to ensure this capacity can be brought online for those children's services we are talking about to ensure the need for these services can be responded to in a more timely fashion in CHO 4. Additionally, it will ensure that children attending Carrigaline Community Special School will also have access to the respite services which will be brought onstream. As one of the representatives of one of the lead agencies said to me today, this will happen in weeks and months. It is anticipated this extra capacity will be brought on stream by then.

I thank Mr. Bernard Gloster and everyone else for the intervention to make the meeting today a successful one in terms of being able to deliver, add and create more capacity in Cork. I would like to think that we should not have to come to a crescendo at all times to be able to address children's services. What I expect is that no beds should be unused in children's respite services anywhere in the country.

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