Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister of State and I very much appreciate the interest he has taken in the issues relating to disability that have arisen in my constituency and which I have raised with him. St. Mary's in Drumcar is run by the St. John of God's order and for many years there has been an excellent relationship between the staff and the order and, indeed, the users. However, as Drumcar moves into a transition phase, going from a congregated setting to different alternative living for those who will become their former residents, its budget is still very significant. I understand it is around €24 million per year.

The Minister of State can imagine my concerns when in the last few weeks I have had a number of constituents ringing me, all of them regretfully in tears and very upset, looking for an increased level of care in terms of the respite their family members need. Their family members, in each case, have an intellectual disability. One of them occupies a respite bed in St. Mary's in Drumcar for three weeks and then on the fourth week of the month they are forced to leave that respite bed in the proper place and to go to a private nursing home, notwithstanding the excellence of care there. It is inappropriate and unacceptable to the family and, indeed, to the person who is in that bed, because they leave their familiar surroundings and they are put into an entirely inappropriate place with people who are much older than them. Some of those people are in their 90s, while the person I am talking about is in their 40s. When the person's mother is on the phone and she is crying and upset, one says this is not good enough. That is followed by another mother, who is concerned about a family member whom she looks after at home. Every three months the family member gets excellent respite in St. Mary's, Drumcar, but it keeps being cancelled. It was cancelled the week before last and I rang up and asked what was happening with this person, then it was cancelled again last week. People who are getting older are unable to continue without the reasonable respite that Drumcar has always offered them. That is another case.

I also have another member of a different family who has an adult with intellectual disabilities and is unable to get an appropriate and proper medical appointment and assessment for them due to behavioural issues which arise in terms of their disability and their inability to communicate. In fact, there are many difficulties in the house because the person with disabilities has increasing anxieties and concerns and needs to be properly looked after. All of them have been brought to the attention of Drumcar and to the attention of the HSE. To date, they remain unresolved.

Will the Minister of State look at the issue, not just the cases of the people who have come to me, but the wider issue of the emerging needs in our communities? As the institutions close, continuing professional respite and help for these people must be available. It is very important to families who look after their loved ones. I am talking about people in their 60s, 70s and 80s who are looking after their children as they grow older, still with concern for them. They love and care for their families and they just feel the State is neglecting them in this hour of need.

When one contrasts the tremendous work of the staff and the community of St. John of God's with the scandal of the under-the-table payments to senior executives that were announced recently, it is absolutely unacceptable that this can happen. I have no doubt that the Minister of State will intervene immediately and urgently, so that the care these people need comes first and always first. These people must be looked after and I look forward to the Minister of State's response and, indeed, his actions. I know they will be appropriate, but it is unacceptable that the scandal of payments under the counter would continue.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Fergus O'Dowd for raising this important issue. I commend him for his work as a strong advocate for people with disabilities in the County Louth area and particularly in relation to this issue of St. Mary's in Drumcar and the PEER project, which I am also working on.

I will outline my position on services for people with disabilities who need residential supports from the health service. This Government - I emphasise it is a partnership Government - is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. I am acutely aware of the changing needs of people with disabilities and understand that many people require additional or alternative services. That is key. The approach I am pursuing is to move away from the old institution model to one of community-based, person-centred services. The programme for Government contains a commitment to continue to move people with disabilities out of congregated settings, defined as a setting where ten or more people with a disability are living, to enable them to live independently and to be included in the community.

This work is already under way and the number in congregated settings has dropped from over 4,000 in 2008, to under 2,800 today. Capital funding of €20 million from the Department of Health is being made available to the HSE in 2016 to move people out of congregated settings. That funding was announced two weeks ago. The funding will be used to facilitate the relocation of some 165 people currently living in 14 institutions around the country to suitable accommodation. St. Mary's, Drumcar, is one of these institutions and St. John of God's is committed to moving 20 residents from St. Mary's into community settings this year. That means 20 people are being dealt with immediately.

I accept the point Deputy Fergus O'Dowd has made that St. Mary's, Drumcar, is a significant provider of disability services in the Dublin north-east area and is part of St. John of God's services, funded by the HSE under section 38 of the Health Act. In 2010 the St. John of God's north-east services amalgamated their adult and children's respite, thereby reducing the capacity of respite provision in St. Mary's, Drumcar. The respite provision is now three weeks for adults and one week for children. There is currently a waiting list of 40 to 43 clients who have been identified as needing community residential placement due to elderly, frail parents caring for adult clients with an intellectual disability. All of these clients - people with disabilities and mental health issues - have been mapped onto a national housing strategy in partnership with Louth County Council. Capacity to respond to residential and respite emergencies is identified and managed on a geographical basis. This is done in consultation with service providers and taking cognisance of the policy in moving people out of congregated settings.

The emerging residential need in the absence of residential development funding over the past number of years is acknowledged by the HSE and myself as a challenge for all services providing support to clients with a disability. Recognising this, I recently announced an additional €31 million in funding for people with disabilities, of which €3 million is earmarked for new initiatives, including the anticipated cost of a number of emergency residential placements arising this year. In this regard, the HSE will continue to reform service delivery models to maximise the use of existing resources and develop sustainable models of service provision with positive outcomes for service users, delivering the best value for money.

Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister's statement and I again acknowledge his commitment, as well as the extra funding. Drumcar is not doing what the HSE and the parents wish it to do and that is why the intervention of the Department is essential. The HSE has assured me there is adequate funding to provide respite needs, which are required by two of the families to which I have referred. It is not acceptable that an adult can be in a bed for three weeks and is need of respite care for another week but is sent into a private nursing home. It is totally inappropriate and it is equally inappropriate that a person under 18 then takes that service. Extra respite facilities need to be opened in Drumcar.

The person in the HSE who deals with this is actually on holiday at the moment but I spoke to them about this earlier and they said they were prepared to initiate any funding that might be available. I cannot speak for this person but I can speak for the families. They are deeply concerned and deeply distressed. I acknowledge that the Minister's brief is to move people out of Drumcar and into community settings but these people are already in the community. They are not getting the service they received for many years. One mother said to me that the respite care she had been receiving for her son for 40 years was no longer available to her. The mother who rang me about this said she was at her wits' end and could not cope with looking after her adult child at home for three months with promises of respite care having been broken not once, but twice. I urge the Minister to ensure the promise is not broken a third time. I have every confidence in his capacity to intervene and to take on board the points I am making.

Finian McGrath (Dublin Bay North, Independent)
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Deputy O'Dowd made a number of crucial points. He is correct to say we need to listen to the families of people who need respite care. This case is not necessarily about funding but the management of resources. I agree with the Deputy's remarks that we cannot have section 38 organisations being given a certain amount of funding only for us to wake up on a Sunday morning to read in the newspapers of top-ups of €2 million while they are talking about reducing services.

Fergus O'Dowd (Louth, Fine Gael)
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Hear, hear.

Finian McGrath (Dublin Bay North, Independent)
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That is a scandal and something I will not accept as Minister. My focus is on the people with the disability and their families. The cancellations to which the Deputy referred are also not acceptable in this day and age. It is not good enough. Respite beds are also important and I will follow up on the broader issues raised by the Deputy. I am aware of the work that goes on in the St. John of God services and in Drumcar and we need to ensure they get the maximum support. The three cases to which the Deputy referred have to be dealt with individually and I will follow up on them as well. If there are other serious issues with respite care and with residential issues related to those services, I will follow up on those too.

I have a vision for services for people with disabilities and a major part of that vision is to protect the rights of people with a physical or intellectual disability. I will prioritise certain cases such as the Deputy has mentioned. My loyalty is to the people with disabilities and their families and that is where my focus will be in the next couple of months.