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

I thank Deputy Tully for tabling this motion this evening. I welcome the advocacy groups in the Gallery. I wish I had half an hour to answer everything but I have ten minutes. I will try to keep to the script but I will answer other pieces to the issue as well. As the Minister of State with responsibility for disability, I am fully committed to the continuous advancement of rights and the alignment of services with the UN Convention on the Rights of Persons with Disabilities, as are my colleagues in government. As the Minister, Deputy O'Gorman, stated, a total of €3.2 billion has been allocated for disability services in budget 2025. Between 2020 and 2025, this Government increased the HSE’s disability services budget from €2 billion to €3.2 billion. This represents a significant increase in funding of €1.2 billion, or 58%, over the five-year period. I cannot work out how anyone can say that more money actually constitutes winding down. This investment underlines the Government’s firm commitment to expanding services to meet the needs of people with disabilities as set out in the capacity review. It also reflects increasing costs in the sector in recent years related to pay and non-pay inflation but also to the changing need of service users. It is amazing that no one talked about reform, sustainability of services or the inflationary pressures service providers are under in their contributions. The capacity review published in 2021 noted that funding in the region of €500 million to €1 billion would be needed in order to address the unmet needs and demographic pressures in the system. However, we know that costs have since increased and our estimates of need have also changed. Therefore, despite the significant increase in funding in recent years, the Government is aware that much more needs to be done.

In relation to 2025, €336 million of additional funding was secured for HSE services. This includes a significant provision of €290 million in existing level of service funding to help address the increased cost of service provision, pay cost pressures and service provider sustainability. In addition to the existing level of service, the Government will provide for the full-year cost of new services in 2024. This includes funding for service areas where we have exceeded our targets in 2024, such as residential places. Approximately 200 residential places will have been put into place in 2024. In a departure from previous years, existing level of service will also include provision for service expansion in line with demographic growth. A further €42 million is allocated for new development measures to build on the service expansion. Never before was demographic change taken into consideration. This time, it is has been. That is part of the switch from one Department to the other.

Planning is going on whereas in the past, there was none.

While I have set out the high-level allocations here, it is important to note that specific service targets will be set out in more detail in the HSE’s national service plan, which is currently being prepared.

In December 2023, alongside the Minister, Deputy O’Gorman, I launched the Action Plan for Disability Services 2024-2026. The action plan represents the first phase of the Government’s response to the capacity review. It set out ambitious targets for progressive expansion of services and sought to drive reform in how those services are planned and delivered. I am happy to report that good progress is being made with notable developments in the areas of day services places, personal assistance hours, home support hours and the funding to expand respite capacity, including the exploration of alternative respite options.

It is also important to say that older persons were paying a higher rate for home support then we were in disability. I have realigned that in this year's budget.

For other measures, progress is slower and more work needs to be done to achieve the ambition set out in the plan. This is particularly the case in areas where recruitment and retention issues are having a significant impact on residential services where housing supply constraints are an impediment to delivery. It is important to say that working with the Minister, Deputy O'Donovan, and through the Cabinet subcommittee on disability, we have secured an additional 33% capacity increase on occupational therapist, OTs, physiotherapists, speech and language therapists, and dieticians on the various programmes this year and next year, as we are bringing on more supply. We are also working with the education and training boards, ETBs, to put in place the assistant therapists.

Over the course of 2025 efforts will focus on enabling actions that can tackle these barriers and allow for further expansion of services. The action plan was always intended to be a living document which would be reviewed and updated in light of progress achieved or challenges arising that need to be addressed. In that context, it is envisaged that a review will take place in 2025, the mid-point of the plan, to inform any changes needed to the current action plan and to begin planning for the next plan for the period from 2027 onwards.

The UNCRPD calls for transition from a diagnosis-led service to a needs-based service where services and programmes for children and adults with disabilities begin at the earliest possible stage and are based on the multidisciplinary assessments of individual's needs and strengths. The progressing disability services, PDS, programme is a needs-led model of service, as opposed to diagnosis led, and a child does not require a diagnosis to access services.

On 21 May 2024, the Government announced a decision to finance an assessment of need, AON, waiting list initiative through the procurement of private assessments for long-waiting families. In the first half of the year, 1,841 AONs have been completed, which is a 28% increase on the same period last year. Funding of €10 million has been allocated in budget 2025 to assist with sustainably addressing the assessment of need backlog. The Government is committed to increasing the CDNT workforce through the implementation of the disability action plan and the roadmap for service improvement from 2023 to 2026. Despite an increasing vacancy rate, the number of whole-time equivalent, WTE, posts in CDNTs is increasing year on year, albeit in a very small way, but it is happening.

It is important to note that the total disabilities workforce is growing year on year. From December 2019 to August 2024, the disabilities workforce in the HSE and section 38 providers expanded from 18,273 whole-time equivalent posts to 21,055 such posts, an increase of 2,782. This represents a 15% increase in less than five years. In addition, many thousands more staff are employed by publicly-funded disability service providers in the community and voluntary sector which are funded under section 39 of the Health Act.

The provision of residential placements is a key priority for me. There are approximately 8,596 HSE-funded residential places as of August 2024. Some €106.6 million in additional funding has been provided to specialist disability residential services in budget 2025. This includes €78 million to meet the incremental cost of 2024 and new developments, and €27.9 million in new funding in respect of 2025.

The HSE is continuing its work under the under-65s programme to develop sustainable supported living solutions, providing greater independence and choice in daily life, as an alternative to nursing homes. As of May 2024, a total of 81 people have transitioned to the community since the start of the under-65s programme. A further 51 individuals are in active planning for potential discharge.

It is also important for me to say to the Deputies hat I have also secured funding which will look at that transition pathway, where Deputy Pringle hit it very well, which is by working with our local authorities and with individuals to ensure that if somebody happens to be in a nursing home, or where he or she needs his or her own independent living space, that person will be supported in independent or supported independent living and we will have that transition pathway. That was one of the items that the Disability Federation of Ireland, DFI, had spoken to me about as a collective umbrella organisation. Working with Sandra Broderick and with CHO 3 in the HSE, I managed to get some funding there for that.

Recognising the vital role of local and community participation and involvement for disabled people, the disability participation and awareness fund has been in place since 2021 and a most recent call for applications to the €3.5 million fund was issued at the end of September. Some 40 projects have been supported in that.

In May, a HSE person-centred planning resource was launched to support people with a disability who avail of adult disability services to make their own choices and decisions while planning for the future. This resources includes information on person-centred planning for adults with a disability, information for the role of families and circle of support and a e-learning module for staff with certification.

In July, I announced €23 million in capital funding for disability projects in 2024 and I have asked the HSE to develop the first ever disability-specific multi-annual capital strategy. I was particularly happy to secure additional capital funding for the disability services budget. A total of €27 million is available for capital spend next year, which is an increase on last year of 17%. This will support infrastructure development across respite, day services, children’s services and deongregation. This will also be open to section 39 organisations. Perhaps the section 39 organisations do not realise that it is there but it will be there and they will be part of the mechanism.

In August, the autism innovation strategy was published. It aims to provide the building blocks for a more inclusive society, where autistic people are understood and have equity of opportunity to participate in cultural, social and economic life and lead meaningful and fulfilled lives as valued members of the community. It will be supported by €2 million, which is available through an autism innovation strategy fund in 2025.

I am also funding two one-stop-shops which I hope will be able to expand. When Deputies talk about proper signposting and where to go, the one-stop-shop is based on the Scottish model and has come to us on recommendations from various organisations. I have taken it on board and we are funding it.

At the end of the day the capacity review looked for €1 billion to be put in. I put in €1.2 billion and I know it is still a long way short.

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