Tommy Broughan (Dublin North East, Labour)
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As the Acting Chairman, Deputy Terence Flanagan, knows, the St. Michael’s House group is an excellent organisation providing care, residential services and respite to persons with intellectual disabilities and their families living in Dublin and north Leinster. The organisation has been operational for more than 57 years, and in my time as a public representative, I have been consistently reminded of the vital contribution St. Michael’s House makes to the lives of people with intellectual disabilities and their families.

St. Michael's House is the largest provider of intellectual disability services in Dublin and the third largest provider of such services nationally. It currently provides day services to 1,679 citizens and residential services to 454 citizens. The majority of the group’s services are in the HSE north east region. Its budget from the HSE, which has been savagely cut in recent years, is approximately €68 million.

It is operating under extraordinarily difficult circumstances. It has the largest residential waiting list nationally, with 330 people on the priority list for residential services. It accounts for 18% of the national waiting list, with just under 6% of the possible beds. St. Michael’s House maintains that 52 of the families with people on the waiting list are in serious difficulty at present. In recent weeks, constituents whose family members receive vital services from St. Michael’s House contacted me in a state of distress because of the potential consequences for their families of the most recent proposed cuts to funding to the organisation.

Since 2008, the budget for St. Michael’s House has been cut by more than €12 million. This has posed an almost impossible challenge for the organisation because of the continued high demand for its services. In contrast to the declining budget, the number of people using St. Michael’s House services has increased, with 250 more people using the day services and 45 more people in its residential services than in 2008. On top of this, St. Michael’s House continues to accept all new children referred to its services, and the current referral rate is 14 infants per month. Another challenge posed is the decline in staff numbers owing to the moratorium on recruitment. There are approximately 1,100 staff in the organisation, but since 2009, St. Michael’s House has had to carry on providing more services to more people with 240 fewer staff.

On 9 August, the organisation received information that, on top of the 1.36% cut applied to its budget allocation for 2013, a further €1 million was to be taken from the organisation’s budget. There was also the impact of the Haddington Road agreement on clinical and other staff. I am heartened to note that following efforts from our constituents - I hope and trust the Acting Chairman is involved in this - some of the €1 million cut has been rowed back. Families of those availing of the services are terrified, however, that cuts to the service could include contraction of residential and respite services, the closure of residential services for one Sunday per month, the ending of the St. Michael’s House rent subsidy in residential services, the end of the trainee allowance, reductions in transport so that staff and families will be required to provide transport, and no new residential places or long-term placement. As we approach 15 October, the families of those availing of St. Michael House's services may be faced with some such menu for 2014, which would be appalling.

I recently spoke to Ms Patricia Doherty, its chief executive officer. She has been forced to advise families of the grave fears among her management team that there will be an unavoidable impact. As in so many other areas, the people are begging the Government in two or three weeks to end austerity and get out of the horrendous rut of cutting which is damaging our economy. These are the most vulnerable of our fellow citizens. We have a duty of care to them and their families, who may have looked after them for 20, 30 or more years. In the budget for 2014, I urge the Government not to make further cuts and to ameliorate the impact of existing cuts.

Ciarán Cannon (Galway East, Fine Gael)
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I am pleased to outline the Government's position on the situation at St. Michael's House disability services. I begin by recognising the valuable contribution St. Michael's House makes to the provision of services to people with intellectual disabilities. In 2012, St. Michael's House received more than €70 million in funding from the HSE to provide a range of services to approximately 1,660 children and adults with an intellectual disability in more than 170 centres in the greater Dublin area and Navan, County Meath.

The range of services provided by St. Michael's House include individualised services, clinical therapies, early services, special national schools, inclusive education, vocational training, adult day services, employment support, residential independent living, and respite, social, recreational and specialised Alzheimer services.

The HSE and St. Michael's House always work in close collaboration with regard to the funding and delivery of services to people with an intellectual disability. As a voluntary agency, St Michael's House is obliged to work within the resources available to it and in that regard it has introduced significant efficiencies in recent years to remain within budget. The HSE has advised that these changes to date have not resulted in service contraction.

The Haddington Road agreement sets out measures relating to productivity, cost extraction and reform. Altogether these measures intend to achieve a required pay bill reduction of €150 million identified in the HSE service plan 2013. The agreement came into effect on 1 July this year and provides a framework and opportunities for managers within the health services, including agencies such as St. Michael's House, to reduce costs associated with agency and overtime and a wide range of other pay costs, especially through measures such as additional working hours and revised rates in respect of overtime.

The Department of Health understands that agencies such as St. Michael's House were requested to submit plans to the HSE outlining how it intended to achieve the necessary cost reductions in terms of the new consolidated pay scales and the additional hours available under the Haddington Road agreement without altering the level of front-line services to be delivered as agreed in the service arrangements.

The HSE has advised the Department of Health that the recent application of additional budget cuts under the Haddington Road agreement has presented a significant challenge to St. Michael's House. A process is now under way between the HSE and St. Michael's House to identify the impact of these budget reductions on services. The HSE and St. Michael's House have met several times and the Department of Health has received assurances from the HSE that both organisations are committed to working within the terms of the Haddington Road agreement to ensure services are impacted upon only as a measure of last resort. In this context, it is vital that all providers of disability services work creatively and co-operatively to ensure that the maximum level of services are maintained for service users within the funding resources available.

Tommy Broughan (Dublin North East, Labour)
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The Minister of State's last paragraph is something that parents and families of the service users of St. Michael's House will be very concerned about. The Minister of State said that cuts to front-line services will only be a measure of last resort. However, everyone knows that many of the services provided by the organisation have been under huge pressure since the budget of 2009 and that there is no more to give, no more than in any other part of the health system. The services have been cut to the bone and the Government is taking away services from people who need them. It is a horrendous situation that must be reversed.

The Minister for Health, Deputy Reilly, advised me in a letter that the HSE north-east division and St. Michael's House were working together to ensure services are not impacted upon. However, he gave no guarantee that there would be no further attacks on front-line services. Given the fact that almost 20% of citizens in the country with an intellectual disability are waiting for services from St. Michael's House, surely the Minister of State should give a commitment in the House today.

The recent cut of €1 million resulting from the Haddington Road agreement came in addition to the €12 million in cuts in previous budgets. Even with this, St. Michael's House has fully complied with attempting to meet the requirements of the HSE. The message I want the Minister of State to get on behalf of the service users is that the cuts are posing real challenges to the services that the organisation seeks to provide. It would be disastrous if, when Government Deputies will, perhaps, be cheering for one or two good things in the budget in a couple of weeks' time, we then see in the detail that further cutbacks are coming. What plans or proposals do the Minister, Deputy Reilly, the Minister of State, Deputy Lynch and the rest of the Department have to address the growing waiting lists for children and young adults who need the services of St. Michael's House?

Ciarán Cannon (Galway East, Fine Gael)
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The spirit underpinning and woven throughout the Haddington Road agreement is that we will try as best we can to work with fewer resources than we have worked with in the past on the basis that we continue to borrow €1 billion per month to run our country. We still have that deficit and it is piling up month after month upon the shoulders of the next generation.

Tommy Broughan (Dublin North East, Labour)
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It is used to pay interest on bank debt that the Minister of State voted for.

Ciarán Cannon (Galway East, Fine Gael)
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That is only a tiny fraction of the €1 billion per month.

Tommy Broughan (Dublin North East, Labour)
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That decision was rammed through this House by Fine Gael and Fianna Fáil.

Ciarán Cannon (Galway East, Fine Gael)
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Only approximately 13% is attributable to bank interest.

Tommy Broughan (Dublin North East, Labour)
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No, it is not. All of it is attributable to the interest.

Ciarán Cannon (Galway East, Fine Gael)
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On that basis, it is incumbent upon all of us to approach the budgetary process in a responsible manner. The Haddington Road agreement suggests that all of us should work in as creative and innovative a fashion as possible to be able to re-engineer the delivery of services such that we do not arrive at the point of requiring to take what the Deputy described as measures of last resort, that is, the point of impacting on front-line services. No one wants to arrive at that point. I am confident that with the process of engagement and collaboration that is ongoing between the HSE and St. Michael's House we will not arrive at that point. I believe the type of management, budgetary and human resources skills available in the upper echelons of management in the St. Michael's House organisation and the HSE will be brought to the best possible use to ensure that the front-line services are maintained while at the same time working within the resources that are allocated to St. Michael's House by the HSE.