Tommy Broughan (Dublin North East, Labour)
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As the Minister of State well knows, St. Michael's House, an organisation based in Dublin 9, is the largest provider of intellectual disability services in Dublin and the third largest provider of services on a national basis. Some 80% of St. Michael's House's services are on Dublin's northern side in the HSE north-east region and the remaining 20% are on the southern side in the HSE Dublin mid-Leinster region. Day services are provided on average to 1,616 citizens per day and residential services, with dedicated full-time care, are provided for 450 citizens in homes across the north side.

Although there are 114 additional people receiving day services and 44 additional people in St. Michael's House residential services than in 2008, the organisation has suffered swinging cuts to its budget over the past four years. In addition, it has lost 104 staff members who cannot be replaced due to the moratorium in recruitment in the public sector.

Over 2009, 2010 and 2011, St. Michael's House funding has been cut by €8.7 million in total. The 1.8% cutback imposed on St. Michael's House in 2011 has left the organisation at the absolute pin of its collar. Through the incredible work and sacrifices of the dedicated St. Michael's House staff, led by the CEO, Ms. Patricia Doherty, the organisation has managed to maintain and expand its services over the past four years. However, any further significant cuts would devastate the organisation and would mean the closure of critical day and residential services. This is at a time when the services provided by St. Michael's House have never been more necessary.

At a recent briefing that I and a number of other Deputies received in Dáil Éireann from CEO Ms Patricia Doherty and her deputy, Mr. David Kenefick, Ms Doherty reported that St. Michael's House has the longest waiting list for residential care in the country. For example, there are currently 240 parents over 70 years of age caring for their son or daughter at home. St. Michael's House reports that 147 of these families are in serious difficulty. There are 263 parents from 61 to 70, 283 from 51 to 60, and 410 from 41 to 50 whose children use St. Michael's House day services but who more than likely will eventually need residential care support.

The Minister of State will agree that St. Michael's House has performed the extraordinary feat of keeping services going under immense budgetary pressure due to the commitment of its whole team of staff to a programme of streamlining the organisation as much as possible and to keeping costs at an absolute minimum across the board. There is very good flexibility in all areas of the operation. I understand that St. Michael's House was the first health care organisation to sign a comprehensive agreement under the Croke Park agreement, which has resulted in enhanced flexibility across the organisation and a significant reduction in absenteeism, to just over 3%. St. Michael's House understands that, in the Department of Health's current value-for-money cost-per-client group review of intellectual disability services, it is below the national average on costs and value for money across the board. The Minister of State will probably confirm that.

St. Michael's House's staff greatly fear that a cut greater than last year's cut of 1.8% will be imposed in budget 2012. I understand there are suggestions from the HSE that the budget for mental health and intellectual disability services may be cut by up to 4% or 5%, which would devastate organisations such as St. Michael's House. I hope the Minister of State will, on behalf of the Minister of State, Deputy Kathleen Lynch, be able to provide some reassurance to the St. Michael's House community and its magnificent workforce that no cuts will be imposed on the organisation under budget 2012.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy Broughan for raising this matter. I am responding on behalf of my colleague Deputy Kathleen Lynch, Minister of State at the Department of Health, who is not in a position to attend today. I will bring Deputy Broughan's concerns to her attention.

Under the Health Act 2004, the HSE is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services, including disability services. The integral role of the non-statutory agencies such as St. Michael's House is of particular relevance to the provision of health and personal social services to people with a disability. These agencies provide a very significant and broad range of services in partnership with and on behalf of the HSE.

Expenditure on health services for people with a disability in 2011 will be around €1.5 billion, with an overall staffing level of 15,800 whole time equivalents. The majority of that funding is used by the non-statutory agencies providing services, such as St. Michael's House.

The HSE's national service plan for 2011 includes the maintenance of core disability service levels, 9,200 people in residential places, 20,000 day service places, 7,500 people receiving respite residential support and 3.34 million hours of personal assistant or home support hours.

I am very aware of the excellent work done by St. Michael's House, generally and in the north side of Dublin. Its facilities are in my constituency and the Deputy and I regularly have an opportunity to express our appreciation of the outstanding work of the organisation. We know how much this work is valued by our constituents. We are very conscious of the wide range of services St. Michael's House provides, including community-based day, respite, residential and early services for people with an intellectual disability on behalf of the HSE under section 38 of the Health Act 2004. Services are provided through a service level agreement which is reviewed on an annual basis. The HSE provided funding of €72 million to St. Michael's House in 2011.

Expenditure on health services for people with a disability in 2011 will be around €1.5 billion. Special consideration was given to disability and mental health in budget 2011 through a maximum reduction of just 1.8% in the allocation for these two sectors. Nobody wants to see any cuts in this area but it is important to point out that the reduction of 1.8%, which is relatively low by comparison with other reductions under the health budget, recognises that these services are provided to vulnerable groups and should help to ensure that existing services are maintained and that priority is given to the delivery of front line services. The HSE has informed me that it is working closely with service providers in 2011 to ensure the maximum delivery of services in an efficient and effective manner.

The HSE was provided with an additional €10 million for disability services in 2011. Taking the reduction in the overall HSE disability budget into account, the HSE was asked to manage the additional resources and engage with service providers to ensure existing support needs, and demands for additional places and supports, are managed most effectively within the overall allocation.

The level of funding available for the overall health budget is being considered as part of the comprehensive review of expenditure and the Estimates process for 2012, which is currently under way. Deputy Broughan is keen to establish the budgetary position on behalf of St. Michael's House. However, deliberations by the Government on the expenditure allocations for next year are likely to continue until budget time and it would, therefore, not be appropriate for me to comment further at this stage pending the outcome of those deliberations. The very difficult financial position facing the Exchequer will obviously require very careful management of the sector in question.

There is a value-for-money review under way at present and it is expected to be completed by the end of 2011. Notwithstanding that, I note what the Deputy said on the streamlining work that has already been undertaken with St. Michael's House and the efficiencies it has achieved. The review will make recommendations that will ensure the very substantial funding provided to the specialist disability sector is used to the maximum benefit for persons with a disability, having regard to overall severe resource constraints that regrettably affect all sectors at this time.

Tommy Broughan (Dublin North East, Labour)
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I agree that the delivery of front line services must be the absolute priority. I wish the Minister of State well in the comprehensive review of expenditure and hope she will do battle for us on the north side and for St. Michael's House and similar organisations. I wish her success in that regard.

Last year, the then Minister of State at the Department of Health and Children, former Deputy John Moloney, issued a directive that funding for mental health services and children with an intellectual disability should be ring-fenced and not cut by more than 1.8%. Had the then Government survived, this commitment would have had to have been honoured. Does the ring-fence still exist? Are we still committed to the figure in question? This is first and foremost an issue for the Minister of State, Deputy Kathleen Lynch.

I understand the Minister of State, Deputy Kathleen Lynch, has met the leadership and board of St. Michael's House. Has the Minister of State, Deputy Lynch, made a response to the organisation or will she do so? Does she plan to meet them again in the final days coming up to the expenditure review?

As the Minister of State is aware I have had first-hand experience of the work of St. Michael's House and other fantastic providers such as the St. John of God services and the desperate struggle that took place to build the current level of services. I impress on the Minister of State that the parents in their 70s, 80s and beyond are the first generation of Irish people to have cared properly for people with intellectual disability. They made great sacrifices to create the St. John of God and St. Michael's House network and this generation and this Government has an obligation not to drop the ball. I urge the Minister of State to go in with her colleague, the Minister of State, Deputy Kathleen Lynch, and the Minister, Deputy James Reilly, and do battle for us and secure no cuts for this great organisation.

Róisín Shortall (Dublin North West, Labour)
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I assure the Deputy that all Ministers in the Department of Health are battling hard to ensure that, to the greatest extent possible, we can protect the health budgets in difficult circumstances. There is an attempt to ring-fence several critical areas within the health sector and that work is underway at the moment. I am conscious that St. Michael's House has experienced severe cuts in the past three years. Its base figure is especially low and we are conscious of this, as is the Minister of State, Deputy Lynch. We are working hard to ensure that these critical areas are protected in the budgetary context. St. Michael's House has been in touch with me, as a northside representative, seeking a meeting and I realise Deputy Broughan raised this matter with me only last week. I am pleased to liaise with Deputy Broughan to set up an early meeting with St. Michael's House. I am happy to meet them and I am aware of the excellent work they do in the area. I assure Deputy Broughan of my determination and that of the Minister of State, Deputy Lynch, to support this work to the greatest extent possible. I thank Deputy Broughan for raising this important issue.