Derek Nolan (Galway West, Labour)
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I thank the Office of the Ceann Comhairle for selecting this topic and in particular I thank the Minister of State for coming to the House to reply. She will be familiar with the issue, as she has responded to a previous Topical Issue question on the matter. Some 700 children with disabilities - some moderate and some profound and severe intellectual disabilities - in the education sector are about to turn 18. The issue is coming to the fore now because these children will no longer have access to those services next month. Great uncertainty is being created for the families and it is causing undue stress for them. What appears to be happening, and Deputy Walsh and Deputy Kyne are hearing this too, is a back and forth between the HSE and the service providers. The service providers say they simply do not have the funding to deal with the issue, cannot cope within existing resources and that they are being forced to do a job they cannot do. The HSE says there is a service plan in place and it must be implemented. The exact details therein are disputed between the two parties.

I have met, with other Deputies and separately, with the Brothers of Charity services in Galway. I have gone through the books with the Brothers of Charity and sat down with their chief financial officer and CEO to look at the cuts they are implementing this year and the cuts that were implemented over previous years. It is hard to see how they can cope with the increased demand if they take on these cases without extra resources. The Leas-Cheann Comhairle will be aware that in County Galway 44 people are leaving this month, eight of whom have severe to profound intellectual disabilities. The HSE and the service providers must come up with a solution quickly and I ask the Minister of State to intervene on the matter.

Brian Walsh (Galway West, Fine Gael)
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I agree with the sentiments expressed by my colleague, Deputy Nolan. Deputy Kyne, Deputy Nolan and I visited the Brothers of Charity services in Galway in the last few days. They provide an exceptional service to the people of Galway city and county. That is replicated by a host of service providers throughout the country. It is an essential service.

We discussed some of the figures involved. There has been a cut of 14% since 2009 across the board nationally but in Galway's case, due to a moratorium cut in 2010, its cut in the corresponding period was 18%. It is a cut to the bone in respect of Galway. Approximately 85% of the budget the service receives is pay related and under the terms of the Croke Park agreement that cannot be touched. Therefore, this year's cut of 3.7% under the service plan actually represents a 24.6% cut in non-pay items. They are, essentially, front line services. All the cuts must be applied to non-pay items due to the Croke Park agreement.

I ask the Minister to examine this issue. It is an area that is close to the Minister's heart and she has shown great leadership in the disability sector since her appointment to office. I am aware there is a question about the number of CEOs in the employment of the Brothers of Charity, which the Minister might address in her response. In the case of Galway, however, and the salary that applies, I am sure each of them would gladly drop the title "CEO" in the morning if it helped the case. It is simply a title. There is a budget of almost €50 million in Galway and somebody at managerial level is required to manage that. There are 1,000 staff to be managed in the services provided in Galway alone. A manager is required to provide that service, whether one calls the person a CEO or otherwise. I echo the sentiments expressed so far and I ask the Minister of State to intervene in this case.

Seán Kyne (Galway West, Fine Gael)
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I welcome the Minister of State. I concur with what has been said by my colleagues. When we met with the representatives of the Brothers of Charity services in Galway last Friday they went through the figures and the cuts they have endured. There have been three consecutive years of cuts amounting to a cumulative reduction of €10.5 million, with €4.6 million of this accounted for in salary reductions for staff and the remainder of €5.9 million in the funding of service delivery. This information is available in their annual report. The Brothers of Charity have endeavoured to protect front line services, and 70% of the budget cuts have been achieved through efficiency, productivity and procurement measures. This includes significant reconfiguration of management structures, rationalisation of administrative supports and savings on such things as transport, maintenance, catering, reductions in staff travel and changes in skill mix.

After three years of cuts, the Brothers of Charity in Galway have utilised the reserves they prudently saved for a rainy day. At this stage, however, they do not know how they will bridge the gap in services. As my colleagues pointed out, eight young adults with profound disabilities are leaving the centre this year. There is huge concern about their future and the families have great uncertainty, which is compounding the challenges which the parents and young adults face each day. Over the last number of years the future of similar young adults has only been sorted out late in the day, often at the end of August. We appreciate the current financial position, but the Brothers of Charity have a number of care staff and thus a high salary bill, which is protected by the Croke Park agreement. They have done all they can to find savings.

I have written to John Hennessy of HSE West and I ask the Minister to liase with that body to ensure that the front line services in Galway are protected. There is little point in fixing the economic and financial situation in this country if we will not protect the most vulnerable young adults who had no hand, act or part in our present economic difficulties.

Kathleen Lynch (Cork North Central, Labour)
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I assume I have an extra two minutes as well.

Michael Kitt (Galway East, Fianna Fail)
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The Minister has four minutes anyway.

Kathleen Lynch (Cork North Central, Labour)
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I was joking.

I thank the Deputies for raising this issue. As Deputy Nolan correctly pointed out, I am acutely aware of the difficulties we face at this time which, as Deputy Kyne rightly said, is quite late in the day. I hope to deal with that in the supplementary remarks.

I am pleased to take this opportunity to outline, on behalf of the Minister for Health, the position relating to the matter raised by Deputies Kyne, Walsh and Nolan. I recognise the importance of life skills training and day services to people with disabilities who are leaving the education system and every effort is being made within available resources to provide services to all in 2012. Day services for adults with disabilities provide a network of support for more than 25,000 people who have a wide spectrum of need, ranging from those with severe and profound disabilities, who are likely to need long-term specialist service provision, to people with lower support needs and greater potential for community participation and inclusion. Organisations such as the Brothers of Charity play a vital part in providing these services and I acknowledge their contribution not just this year or last year but at a time when the State was not providing them.

The HSE, through its occupational guidance service, works with schools, service providers, service users and families to identify the needs of young people with disabilities who are due to complete their second level education. The aim is to address the needs of individuals in the following ways - health funded rehabilitative life skills training; health funded day services; FÁS funded vocational training; and, extension to education placement for a specified time.

Service providers and the HSE have come together under the auspices of the national consultative forum to identify how the needs of those individuals who require day services or rehabilitative training places in 2012 can be responded to within available resources. I have asked to be kept informed of progress on this issue on a weekly basis. The national consultative forum recognises that the key to ensuring that available resources for people with disabilities are used to best effect is through constructive collaboration between non-statutory providers and the HSE. The demand for services for school leavers continues to grow. The HSE expects that approximately 700 school leavers will require services in 2012, of which 135 are in HSE West.

Disability services will be required to cater for demographic pressures, such as new services for school leavers and emergency residential placements from within their existing budgets. The 2012 budgets have been reduced by 3.7% and the moratorium on staff recruitment gives rise to challenges in service provision. In addition, the physical capacity to provide further services may not be present in all agencies, and that is recognised. However, both the voluntary sector and the HSE are committed to the best use of available resources in a creative and flexible manner so as to be as responsive as possible to the needs of this cohort.

The emerging Department of Health policy direction, namely, the value for money and policy review, coupled with recommendations from HSE national working groups on key service areas, including the review of HSE-funded adult day services, emphasise the need for a new model of service provision that, if agreed by the Government, will further the independence of people with disabilities in a manner which is efficient and cost-effective. New Directions, the review of HSE-funded adult day services, was published on 29 February 2012 with a detailed implementation plan. A working group will be established this month under the auspices of the national consultative forum to ensure that implementation plan is progressed through a collaborative approach. I thank the Deputies and look forward to the questions that arise from this response.

Derek Nolan (Galway West, Labour)
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I acknowledge the Minister of State's comment that she is on top of the brief and is acutely aware of the position. Having discussed the matter personally with the Minister of State, I was aware of that. However, these services are due to end within a month and while, as the Minister of State noted, consultation is ongoing on a continuous basis between the service providers and the consultation body no resolution has yet emerged. No answers or concrete measures are forthcoming and the impression being given to the Members who raised this issue by the service providers is they are not in a position financially to do it. This back and forth between these two bodies is leaving the individuals in a really difficult position. I refer to the cases about which one hears and the people who I met last Monday at the Brothers of Charity annual general meeting, who are in a really difficult position, some of whom have such severe, shocking and saddening disabilities that one cannot stop one's heart from going out to them.

I ask whether an intervention can take place to force them to agree finally on something, because this cannot continue. It is unprofessional and is a poor reflection on both the service providers and the HSE if they allow this position to continue. I completely support the ideas put forward in the New Direction policy review, which is the way to go. However, if the Minister of State has an opportunity in the future to visit the Brothers of Charity services in Galway, I would be greatly appreciative, were she to take the time to so do and to review their position personally.

Brian Walsh (Galway West, Fine Gael)
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I note the Minister of State's response indicated this must be catered for within existing budgets. I again stress to her that in the case of the Brothers of Charity in Galway, this simply is not there as the budget has been cut to the bone as it is. What will happen is some families who may be receiving two or three nights of respite per month will become the focus of the cuts. Such respite is a lifeline for them and as it is the only respite they receive, I again appeal to the Minister of State. I note that €10 million was found last year to look after demographic funding. The Galway services looked after five school leavers with profound intellectual disabilities, at a cost of €270,000, but that figure now has risen to eight. While 44 people are leaving the Galway services, eight of those children have profound intellectual disabilities and I again appeal to the Minister of State to examine closely the budgets to try to re-establish this fund for 2012.

Seán Kyne (Galway West, Fine Gael)
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I thank the Minister of State for her response and like my colleagues, I welcome the initiatives under the New Direction policy review. The Minister of State indicated the working group will be established this month, which is welcome in respect of implementation of the plan. However, as I stated, the Brothers of Charity have informed the Members present that their reserves are gone. While they had been prudent for a number of years and had been able to put aside money, these reserves now are gone. The families are in a position similar to that which has obtained in recent years, in which a solution always has been found at the 11th hour. At present, they are wondering whether a solution will be found this year and as matters stand, they are contacting us in a state of panic and uncertainty. Deputies Nolan, Walsh and I have been told of the structure these young adults have had in their lives for many years, which is the bus comes for them and that is what they know. They wait for the bus but the day will come when the bus will not and their parents are worried about what will happen then. I again ask the Minister of State to do everything she can to ensure that funding is provided within the Brothers of Charity for these services.

Kathleen Lynch (Cork North Central, Labour)
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In response to Deputy Nolan, I intend to travel to Galway next Monday and as per his request earlier today, I will meet the Brothers of Charity. While I will meet them, it is important to make a clear point. As the Deputies rightly have noted, not alone was a last-minute reprieve granted each year but additional money was given. Incidentally, the additional money, amounting to €1 million per year, was not something to be sneezed at but was a considerable amount of money on top of the budget. Despite this money being provided on foot of signing a service level agreement, every year there is this crisis and no plan has been put in place. It is both known and can be predicted into the future exactly how many children and how many young adults will need a service. I have every sympathy with families and am deeply aware of the type of difficulties into which they now see themselves facing. It is not that I am unaware of it, as I am, but a more structured approach really must be put in place. There is no more money there. I have been through all this and have made it clear there is no additional money. It strikes me that instead of considering different approaches to respite or day services, none of this has been done. Why would service providers not believe additional money would be made available at the last minute, as though there was some sort of golden pot out there? That no longer is the case and those days are gone. A structure really must be put in place that will give families certainty about where their children and adults will be into the future.

Joanna Tuffy (Dublin Mid West, Labour)
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The Minister of State's time is up.

Kathleen Lynch (Cork North Central, Labour)
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That is what is important and the Government is working through that process. It will intensify its efforts and will be obliged to take a serious look at how things are done in the future and how one can make people with disabilities more independent. We must work through that process collectively and must ensure this happens. I will keep a very close eye on it this year and am being briefed on a weekly basis. Things can happen such as, for instance, collaboration on back-office processes and not the front-line stuff. Equally, I note that disability is not a poor service and enormous amounts of money are being spent on disability. I believe it can be done differently and a better service can be provided. I acknowledge a point comes at which one is able to do less with less. I am not foolish enough to believe such a point will not be reached, although I hope not. However, a different service must be delivered that will be more beneficial to people with disabilities and their families.

Joanna Tuffy (Dublin Mid West, Labour)
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The Minister of State is well over time.

Kathleen Lynch (Cork North Central, Labour)
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As a final point, in saying this, Members should be eternally grateful to service providers who gave a service when the State did not. I do not dismiss that either but the Government is working through it and will do its best to ensure people have the type of security into the future they deserve.