Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I move:

"That Dáil Éireann: acknowledges that:

— families, carers and service providers have been stretched to incredible lengths, many to breaking point throughout the course of this pandemic;

— the personal toll and long-term impact of the withdrawal of care and supports for people with disabilities, their families and their carers is deeply worrying;

— due to Covid-19, disability services that rely on voluntary fundraising to meet operating costs have been unable to do so;

— services are suffering from chronic underfunding which has resulted in unmet need exacerbated by Covid-19;

— reopened disability day services are operating at approximately 40 per cent capacity;

— service providers submitted their funding requirements to the Health Service Executive in mid-June; and

— the Government’s allocation of €10 million in additional funding to day services and home support services for disability service users is insufficient and will not meet the urgent Covid-19 related costs for service providers, community and home support;

recognises:

— that Ireland’s ratification of the United Nations Convention on the Rights of Persons with Disabilities requires progressive implementation; and

— the innovative and committed response of disability and dementia service providers in the delivery of care and support for people with disabilities and their families throughout this pandemic; and

calls on the Government to:

— provide the funding required to fully reopen day and other essential disability services to implement all Covid-19 related protocols; and

— provide the additional funding, resources and capital investment required to guarantee sustainable capacity within disability and dementia services.”

I am sharing time with Deputy Funchion. I am pleased to propose this motion, which has the support of all Opposition parties and most Independent Deputies. This is a significant motion that demonstrates a collective acknowledgement of the disability and dementia funding crisis. I commend my party leader, Deputy McDonald, on taking the initiative to invite all parties and Independent Members to come together on this issue, but it is disappointing that none of the Government parties responded to the invitation.

From mid-March, day services and respite services were closed, as were most other sectors in society. This proved difficult for many people for a variety of reasons, but it is fair to say that people with disabilities were disproportionately affected. Many service providers have told me how they have noticed since reopening that the people they care for have regressed over the past six months. This sector, through no fault of its own, has been extremely slow to reopen, with most services not resuming until mid to late August or in September. Day services such as training and education facilities are only operating at approximately 40% of the capacity before Covid-19, again through no fault of theirs. I commend service providers on the terrific job they did both during the lockdown and since reopening.

I have consulted service providers and advocacy groups and they have identified a number of challenges that are prohibiting the full reopening of services. These challenges are transport, accommodation, staff and Covid-related costs such as PPE. The issues with transport are a result of the 2 m rule, which means that only a small number of service users can travel at one time. Even if this is reduced to 1 m, it would still present a problem. For example, a bus which could have carried perhaps 15 people before Covid-19 can now only transport a total of five people. This means that either the number of buses or the number of runs by buses must be increased. Either way, investment is needed to cover the cost of hiring another bus or asking existing buses to do additional trips. Some service users are not being offered any form of transport and are depending on family members to bring them to the day services. If that is not possible, they are unable to avail of services.

While some premises are sufficiently spacious to allow social distancing, many are not. Funding must be provided immediately to enable services to acquire additional space, where necessary.

Staffing is a major issue. As a result of distancing rules and to accommodate all service users, additional staff are needed in practically every service. Some services have sufficient physical space to allow all service users to attend, but more staff are needed as those attending services will be placed in pods to comply with public health guidelines. They also have the added burden of replacing staff who might have to self-isolate. Many services have had to resort to employing agency staff, which has proven very costly. The ongoing issue of section 39 pay restoration means that retention of staff is being impacted harder as a result of Covid-19. People in residential units cannot attend day services so staff in those units must provide the day services as well. Service users with underlying health conditions cannot attend services, so home supports should be provided to those people. Again, staff will be the main problem. There is also an urgent need for infrastructure, home care and community support for people affected by dementia. Their sense of abandonment runs deep.

Every service has spent a substantial amount on PPE and sanitation. Providers have not been recompensed for this, and have no idea whether they will be. Business cases for Covid-related expenditure were submitted to the HSE in June. The sector estimates the true cost of Covid-19 is €120 million, but the Government has yet to provide any funding to meet this additional burden on services. Respite care provision was suspended, too, and has only reopened on a much-reduced level recently, if at all. People need a break. For six months people with disabilities and their families have been trying to cope in what are sometimes impossible circumstances. I also note the current inadequacy of the provision of personal assistant hours for people with disabilities. This inadequacy must be addressed urgently.

I have outlined the immediate challenges facing the full reopening of day services and respite and community care. Covid-19 will be with us for some time. The necessary funding to allow the acquisition of additional transport services, accommodation, staff and other essentials must be made available immediately. The Minister's meagre €10 million funding announcement last week was met with shock and dismay by the disability sector. I should not have to remind the Government that policy development and funding of disability services must be rights-based, as determined by the State's obligation under the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. There are numerous reports on the implementation of what needs to happen, but very little has happened. Immediate action is needed across all Departments to ensure accessible transport, a move away from congregated settings to suitable housing for independent living in the community, educational supports to allow people with disabilities have full access to education and more employment opportunities for people with disabilities.

I urge the Government to support the motion.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I commend my colleague, Deputy Tully, on bringing the motion forward. Unfortunately, people with a disability and their carers have been relegated to second-class citizens in this State. In every sector there are delays, waiting lists and, in many cases, a complete lack of services. It has become acceptable and the norm for people with a disability to have to fight for every service that others take for granted. I refer, in particular, to schools, school places in autism spectrum disorder, ASD, classes and transport for both school and adult day services. There is also the issue of the National Educational Psychological Service, NEPS, and the fact that schools have to battle for a handful of appointments every year and must try to pick the children the schools believe need the service most. It is an impossible situation in which to be placed.

I wish to draw attention to an issue in the Carlow and Kilkenny region with the provision of occupational therapy, speech and language therapy and physiotherapy, particularly for children. There is an average waiting time of 18 months to two years for an appointment. There are also long delays in assessments and often people are delighted when they finally get an assessment, thinking they will finally get their services. However, in many cases, they must wait 18 months to two years for a follow-up service. Many people tell me they are getting one appointment per year. I stress that it is not due to the existing staff who are working in that sector. I honestly do not know how they keep going and keep their morale up when all they see are growing waiting lists of children. There definitely must be greater investment in this area immediately. I ask the Minister of State, Deputy Rabbitte, specifically to examine the situation in Carlow and Kilkenny. I was thinking about this earlier.

There has been a lot of media attention recently on the appointment of special advisers and additional advisers. When a need is perceived for such a role it can be filled immediately. However, we are waiting years for occupational therapists, speech and language therapists and physiotherapists to help children in the Carlow and Kilkenny region.

I refer to the optional protocol of the UNCRPD. We need to ratify this without delay as the only way the State is finally going to sit up and take action is because it will be forced to do so. I appeal to the Minister of State because I feel that she wants to do the right thing here and I have seen some statements she has made since taking over this role. I hope she will follow this up with action and do the right thing by all those with a disability and their carers. They are totally exhausted and they need assistance, funding and investment. The sector has been underfunded and has suffered from under-investment for years. Covid has highlighted that and thrown it into stark contrast. Now we have a situation where people are trying to reopen services. If someone finally gets a place or a couple of hours of assistance, the next thing is a battle for transport. There are major issues to be addressed. I do not think anybody is looking for an overnight solution but people want to see that the issue is being taken seriously and services are going to be delivered.

Catherine Connolly (Galway West, Independent)
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I think there might be a misunderstanding with respect to speakers. I am not sure if certain Deputies understood they were speaking. We will move to the Government side.

Holly Cairns (Cork South West, Social Democrats)
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Is it not the case that in the first round, the parties that tabled the motion get to speak?

Catherine Connolly (Galway West, Independent)
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That is normally the case but there was an arrangement by which Sinn Féin would share time with other speakers first.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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We are sharing with the Social Democrats, in fairness.

Catherine Connolly (Galway West, Independent)
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I am told Sinn Féin was sharing with Deputies Pringle and O'Donoghue. I can only go by the list I have.

Holly Cairns (Cork South West, Social Democrats)
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I will use this ten minute slot and Deputies Pringle and O'Donoghue can take mine.

Catherine Connolly (Galway West, Independent)
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Deputy Cairns can speak now if she wants.

Holly Cairns (Cork South West, Social Democrats)
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Deputy O'Donoghue and whoever else can use my time later.

Catherine Connolly (Galway West, Independent)
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Yes, Deputy Cairns will not have that slot later. She will have used her slot.

Holly Cairns (Cork South West, Social Democrats)
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Yes, perfect. Thank you, a Leas-Cheann Comhairle. Here is what we know. Since before Covid-19 arrived in Ireland, people with disabilities have experienced higher rates of discrimination than people without disabilities. That discrimination is more likely to occur and be more serious. People with disabilities are more than three times likelier to experience poverty and deprivation than people without disabilities. Ireland has the lowest employment rate for people with disabilities in the EU. People with disabilities are less likely to attend further education. An estimated 1,300 plus people with disabilities under 65 are being inappropriately accommodated in nursing homes. I say "estimated" because the HSE has not been able to provide me with the actual figures yet. It took Ireland over ten years to ratify the UNCPRD, and the Government still has not ratified the optional protocol. Carers and voluntary organisations do incredible work out of love and dedication and receive very little assistance for filling a gap that the State should have filled and can fill. Disability health and support services were already underfunded, and were due to be cut by a further €20 million earlier this year by the then Government. I could go on. The work of bodies such as the Irish Human Rights and Equality Commission, Inclusion Ireland, and the Disability Federation of Ireland let us all know how disgracefully people with disabilities and their families are treated by the State.

It is fair to say that the group most profoundly impacted by the pandemic is people with disabilities. That is on top of all the existing issues I mentioned, and now Covid-19 and the Government’s response have added considerably more challenges. Day services have been closed for months in many cases and some are still closed, leading to regression, isolation and distress for people as well as additional hardship and a lack of respite for their families and carers. As in other sectors, contacts between services and people moved online in some cases. However, Inclusion Ireland research shows that many people with disabilities cannot use or do not have access to IT equipment. There are increased rates of anxiety and loneliness. The nearly 3,000 people with disabilities residing in settings of ten or more people have been put at unnecessary risk by the State during the pandemic due to their living arrangements. School and college students with disabilities have additional needs that were not adequately addressed by the online systems. Many people with disabilities who work in hospitality and other industries either lost their jobs or cannot attend work due to health concerns, which affects not only their income but their independence and personal dignity. Disability services staff, medical therapists and dentists are among those who have been redeployed to contact tracing, which has seriously affected the capacity of the State to provide essential services. Furthermore, for workers in this sector, the inequalities between section 39 and section 38 organisations have been highlighted, with section 38 employees being eligible for Covid sick pay while section 39 employees are not.

This is the cumulative reality for people with disabilities in Ireland. Before Covid people faced innumerable hurdles which have been magnified during the pandemic. Our challenge and our job is to immediately respond to these issues. This sector needs the resources to ensure a range of supports is provided to enable everyone to live dignified, independent lives. The impact of Covid continues to resonate for people with disabilities. Here is just a snapshot of issues I have been contacted about in the past week. A young man who cannot access speech and language therapy in west Cork has to travel almost two hours to the city, including stops because he cannot be in a confined space for too long, to get 30 minutes of vital therapy. People in west Cork need to be able to access therapeutic services locally. It is completely unreasonable and, to be honest, outrageous to expect people to travel two hours for 30 minutes with a speech and language therapist. An occupational therapist highlighted the chronic lack of hoists and other supports without depending on the physical strength of family members or carers, which in any case is not advisable. As a result, one family is unable to travel more than 20 minutes from home due to toiletry needs. With the easing of restrictions during the summer, the rest of us could travel around but families like this one remained in a de factolockdown.

While the addition of outdoor dining has saved many small cafés and restaurants, a lack of consideration for people with disabilities in mobility or those with visual impairments has resulted in new and additional barriers. A woman with a visual impairment contacted me to highlight this issue as it creates uncertainty and erodes independence. In towns like Bandon, seating has been put on reclaimed street space so that it leaves the footpaths free, which is great. These matters were highlighted during Make a Way Day two weeks ago. Any actions from national or local government need to be implemented through a disability lens to ensure basic mistakes like this do not arise. There are countless other examples I could give from across west Cork and beyond from people who have contacted me since I was elected. The common thread in all these stories is a State that is unwilling to accept its responsibility to address the needs of all citizens and residents.

The motion rightly calls for funding to fully reopen day and other essential disability services and to guarantee sustainable capacity within disability and dementia services. This responds to the calls from people with disabilities. They are the experts and we have to listen to them. The Government prioritised the opening of schools and colleges in roadmaps and "living with Covid" documents. It needs to do the same for people with disabilities. We need healthcare services locally at the point of need, therapeutic supports in schools and training centres, vastly improved accessibility in transport and towns, and to see an immediate move from congregated settings to community-based housing. We also need to properly pay medical and support staff, including carers, and provide employment opportunities for people in all communities.

Funding is central here. The State outsources its responsibility to charitable organisations and the goodwill of communities. However, the weakness of this model has come to the fore since fundraising capacities have collapsed, with an average loss of 40% in income for members of the Disability Federation of Ireland. These losses are even more significant for small to medium community-based disability organisations that rely so heavily on fundraising when they should be able to rely on the State. These organisations need those funds matched, at the very least, to maintain services. They will need even more to be able to operate under Covid protocols and to develop innovative approaches to providing services. For example, CoAction West Cork, a support service for children and adults with an intellectual disability and-or autism, needs money to recruit, retain and fully pay its staff. The Government will need to invest in CoAction and other smaller organisations to cover the full costs of Covid expenditure in disability services.

An issue I have raised before, and will continue to raise, is the shameful lack of appropriate housing. Article 19 of the UN convention guarantees the right to live independently in the community with a range of in-home, residential and other community support services, rather than in institutions. Successive Governments have failed to ensure this right is provided for. In west Cork it is practically impossible to access independent supported living.

Ordinarily, this is a breach of people's rights but during Covid-19 this puts people, some of whom have underlying medical complications, at greater risk. This is not a symptom of the pandemic but of poor policy decisions and priorities over decades.

As Dr. Frank Conaty of the Irish Human Rights and Equality Commission outlined to me at the Special Committee on Covid-19 Response last July:

It is not the pandemic that has caused this, but the pandemic is giving rise to greater risk for people in these congregated settings. ... The fractures in the policy architecture we now see this pandemic showing up have always been there, but it is clearly within our gift to address and correct them.

The Convention on the Rights of Persons with Disabilities is the means by which many of these issues can be addressed and I look forward to working with many Deputies on the Committee on Disability Matters when it is formed. A rights-based approach is absolutely essential. However, in the meantime, the Government must commit to providing the funding and resources necessary to support people with disabilities and their families in living with Covid-19, and with dignity.

Almost 70 Deputies from across the Opposition benches are behind this motion. I thank Sinn Féin for enabling us to do this. Deputies from across the political spectrum may not agree on many things but we are all united on this and I find it hard to believe the 80-plus Deputies in government do not agree with us.

People with disabilities and their families deserve more and are also entitled to more. It is their right and is a right the Government must fulfil.

The pandemic has been hard on everyone. It has brought suffering, loss, unemployment and upset but a disproportionate burden has been placed on people with disabilities and it is essential we do everything we can to lighten that burden.

Anne Rabbitte (Galway East, Fianna Fail)
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I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following:

“acknowledges that: — the Covid-19 pandemic has had significant impact on the delivery of all health funded services, and services for people with disabilities have been particularly affected;

— since the onset of Covid-19 the focus of service providers has been to mitigate its immediate impact on the disability community and the World Health Organization (WHO) anticipates that Covid-19 will be with us for a further 12-18 months;

— the implementation of Covid-19 restrictions has led to the reduction and suspension of services for both children and adults across disability services and while these restrictions have been introduced as protective measures, they have resulted in significant stress for individuals with disabilities and their families;

— the reintroduction of services is now underway, as detailed in the Health Service Executive’s (HSE) roadmap to reopening services, in line with public health guidance;

— since the outset, the HSE Community Healthcare Organisations (CHO) and disability service providers worked collaboratively with families using creative and innovative models of care to support service users where the need was greatest;

— the Government is very aware of the impact of the pandemic on people with disabilities, their families and their carers;

— children’s services, respite services and adult day services are all resuming, having been reimagined and redesigned to be delivered in line with new guidance published by the HSE;

— health and social care responses to the current public health emergency are under continuing review, including specific measures such as those to support vulnerable people; these available supports may change over time and the HSE is aware that the needs of people with a disability and their families will also change over time; and

— in line with the Government's Resilience and Recovery Framework (2020-2021): Plan for Living with Covid-19 (Plan for Living with Covid-19), the HSE regards the provision of disability services as essential to maintaining a response to people with a disability, in the same way that schools and creches are, and importantly, the Government’s intention is that disability services will remain open at each level of the Plan for Living with Covid-19, subject to public health guidance, including the prevention and management of Covid-19 related infection; notes that: — the HSE have consistently worked to engage with individual service providers throughout 2020 citing difficulties in service provision and sustainability due to historical financial deficits and new financial challenges, and the requirement for disability service providers to achieve a financial efficiency target of 1 per cent of their budget in 2020 has been removed;

— substantial additional funding has been allocated to the Health Estimate Vote to meet the costs associated with the implementation of the measures outlined in the National Action Plan in Response to Covid-19 (Coronavirus), and the HSE have put measures in place to address both the financial and non-financial challenges of disability service providers in dealing with Covid-19;

— investment in disability services is significant with an overall budget for disability services exceeding €2 billion in 2020;

— the financial implications of measures taken to mitigate Covid-19 infection are matters which the Department of Health will continue to keep under review in conjunction with the Department of Public Expenditure and Reform, as the situation evolves;

— children’s disability services will continue to progress in all areas, and all CHOs are putting appropriate arrangements in place to resume assessment of need and intervention therapy services in line with public health guidance; guidance documents have been circulated by the HSE to all CHOs to support clinicians in decision making regarding disability assessments in the context of Covid-19 and support the return to more normal levels of service provision for children with disabilities and their families, and funding of €7.8 million has been provided to the HSE specifically to reduce the current backlog in the assessment of need, which will help reduce waiting times both for the assessment and for any therapeutic services required;

— adult day services reopened throughout August and September at 40 per cent of their pre- Covid-19 capacity and to augment this, on Monday 28th September the Minister for Health and the Minister of State with responsibility for Disability, announced that €10 million is being made available in 2020 to support the resumption of day services and enhanced home support services for disability service users and that this funding is being drawn down from the National Action Plan in Response to Covid-19 (Coronavirus);

— of this, €7.5 million will increase disability day services by one day a week for over 14,000 adults, however, capacity in day services will remain at a reduced level; the guidance developed to support the resumption of adult day services has had to take account of social distancing rules which has meant that there is a reduced number of people in each service location and the HSE is committed to maximising the support that can be provided within these restrictions; this involves a balancing of protective measures with as much available access to day services as possible, and the full year cost of continuing these services in 2021 of €30 million will be sought as part of the Estimates process;

— residential services for people with disabilities have continued throughout the pandemic and new guidance issued at the end of September in respect of visits to residential care facilities reflects the different levels of the Plan for Living with Covid-19; as with previous guidance, this emphasises that such facilities are the home environments of individuals residing there and as such the importance of maintaining family connections with loved ones from a holistic person-centred approach;

— respite is an important support mechanism for many families and short-stay residential and emergency/residential respite began to reopen from July to August as the first stage in a three-phase plan, and activity is now increasing for the next two phases – the September to November phase and then the December 2020 to February 2021 phase;

— the allocation of additional funding to disability services is only part of a range of complex barriers to the full resumption of disability services; challenges include the physical limitations of the buildings available and the continued restrictions imposed by social distancing guidance, and the HSE is building increased capacity for day services, including building refurbishment to provide extra space and access to community building and facilities;

— a key commitment in the Programme for Government is the implementation of the National Dementia Care Strategy, which aims to improve how we provide care for people living with dementia, and that in line with the Programme for Government commitment to expand the dementia advisor service on a nationwide basis, an additional 10 dementia advisors are being recruited this year with support from the Sláintecare Enhanced Community Fund;

— there has been a continued focus on meeting the needs of people living with dementia who were impacted by the suspension of day care services during the Covid-19 pandemic;

— the HSE, in collaboration with the Alzheimer Society of Ireland, has developed a range of initiatives and resources to ensure that people living with dementia stayed safe, well and connected during the crisis;

— the Government’s approach to meeting the terms of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) is one of sustained and on-going improvement, and work is continuing on the reforms needed for an optimum level of compliance with the UNCRPD's requirements; and

— the Programme for Government also commits to the development of an implementation plan to coordinate implementation of the UNCRPD, and furthermore, the Programme commits to work with other parties in the Oireachtas through an Oireachtas Joint Committee to assist in monitoring and implementing the provisions of the UNCRPD, and work will commence on the development of an implementation plan shortly; and commits to: — a continued whole of government approach to improving access to and quality of services for people with a disability in line with the HSE’s Transforming Lives Programme and the National Disability Inclusion Strategy 2017-2021;

— preparation of Ireland’s Initial State Report to the Oireachtas Joint Committee, which is at an advanced stage of drafting and, in addition, the consultation phase on the State Report is being planned; key to this is the involvement of, and consultation with, persons with a disability on the State Report;

— the ongoing establishment of A Disability Participation and Consultation Network which will move Ireland towards meeting its obligations under the UNCRPD to consult and actively involve persons with a disability and their representative organisation, and one of the first tasks for this Network will be to partake in the consultation process on the Initial State Report;

— the full implementation of the Sustainable, Inclusive and Empowered Communities: A Five-Year Strategy to Support the Community and Voluntary Sector in Ireland 2019- 2024, which sets out a long-term vision for communities in Ireland and a general direction of travel for Government policy in relation to the community and voluntary sector for the coming years;

— strengthening the State’s relationship with the voluntary sector through meaningful participation in the new dialogue forum between the Department of Health, relevant health agencies and representation from voluntary organisations in the health and social care sector; and

— moving to a population-based planning approach to service delivery, in line with the Sláintecare vision, based on demographic and geographic considerations that reflects both the health and social care needs of those within our population, including those who require specialist disability services; this will afford the opportunity to prioritise and design the health and social care services that need to be developed for each region, so the population can get the right care, in the right place, at the right time in line with Health Information and Quality Authority standards and available resources.”

I thank the Deputies for raising this motion in the House. Although I will be opposing the motion as it is set out this evening, I welcome the chance to restate the Government's commitment to supporting people with disabilities and their families, particularly, at this time when we are dealing with the consequences of the Covid-19 pandemic and the current restrictions it causes.

I wish to start by acknowledging with sincerity how difficult the last few months have been for people with disabilities and their families. The impact of Covid-19 on their lives has been and continues to be significant. I am aware that families across the country have had their routines upended.

Covid-19 has presented a huge challenge for disability services. While we all want our services to return to pre-Covid levels, the collective aim of the Department of Health, the HSE and the service providers must be to restore services in a safe way. Tonight, I wish to outline the significant work that is under way to achieve this.

The HSE provides and funds a range of day services and rehabilitative training. We engage with approximately 19,000 adults with disabilities in almost 1,000 locations across the country. These services are essential for adults with disabilities and their families who avail of them.

As the House will be aware, because of Covid-19 the majority of disability services closed in March. They have now reopened. They have not, however, resumed at the level at which they had been pre-Covid. The impact of social distancing inevitably limits the number of people who can be present in any service, as well as the numbers in community settings.

I can completely understand the intense frustration of the day service users and their families at this moment. The fact that day services have not resumed to pre-Covid levels is far from ideal. My office has been inundated with queries about adult day services. The main question people ask me is when services will increase. Answering the question has been my absolute priority since taking office. I was pleased last week to announce that €10 million is being made available in 2020 to support the resumption of adult day services and enhance home support for people with disabilities. Of this funding, €7.5 million will increase the level of day services by one day a week for over 14,000 adult day service users.

The resumption of day services has been a welcome and hugely necessary development for service users and their families. The additional day of service it will provide is a step in the right direction. It will improve the situation for people using day services, and their families, as we face into tougher winter months. Ongoing challenges we face are things like the physical limitations of the buildings available and the continued restriction of social distance guidance. The HSE is building increased capacity for day services and will maximise the support that can be provided with these restrictions.

The allocation of additional funding to day services is only one way of addressing the complex barriers to the full resumption of services. Children's services, respite services and adult day services are all resuming. They have been reimagined and redesigned to be delivered in line with the new HSE guidance. Crucially, the Government's intention is that similar to schools and crèches, disability services will remain open at each level of the resilience and recovery framework subject to public health guidance.

Residential services for people with disabilities have continued throughout the pandemic. Approximately three quarters of those in disability residential care live in group homes in the community. The remainder are in congregated settings or campus settings where there are ten people in a group. Smaller settings have proven to be safer when it comes to Covid-19. Other protective factors are a shared proactive response to the public health teams and service providers working together.

People in disability services are, on average, younger than those living in nursing homes but they do not have an average number of people with clinical conditions. Those conditions could increase their vulnerability to serious illnesses if affected. Sadly, 13 people living in residential disability services have died due to coronavirus. There have been no further deaths since early summer but that does not allow for complacency. We owe it to our vulnerable family members to observe public health guidance to keep this figure as low as possible. We must also remember that these residential facilities are people's homes. We must not and nor should we forget the importance of maintaining family connections with loved ones from a holistic person-centred approach.

The Government recognises that there is a need to address the financial sustainability issues facing the disability sector and is committed to publishing the disability capacity review. We also intend to use the recent research into the cost of disability to individuals and families to properly inform the direction of future policy. However, moving forward towards a more sustainable model of service provision will also mean finding out what factors are causing sustainability challenges and I encourage disability service providers to work with the HSE to address these underlying issues.

Investment in disability services is significant with an overall budget for disability services exceeding €2 billion in 2020 with additional funding allocated to meet the associated costs of dealing with Covid-19. The HSE has consistently worked to engage with individual service providers who are having difficulties in service provision and sustainability due to historical financial deficits and new financial challenges. The House may recall that over the summer, I asked the HSE to relieve section 38 and 39 disability service providers of the obligation to achieve the 1% cut. This was to ease the burden of service provider challenges in the context of Covid-19, which was worth €20 million to the sector.

I do not underestimate the scale of these challenges and I have previously acknowledged the commitment of these services in supporting and protecting those with a disability who attend health and social care settings. When I addressed the House last month, I mentioned during statements on disabilities that my colleague, the Minister, Deputy O'Gorman, and I had asked that the establishment of the proposed Oireachtas joint committee on disability matters be prioritised. I am pleased to note this will happen soon and that our colleague in this house, Deputy Michael Moynihan, has been appointed Chair. I know he will be an excellent and dedicated Chair. I advocated for the establishment of such a committee. I believe it is our responsibility as public representatives to hear from people with disabilities, their families and their advocates. Legislation and policy must be sculpted with their input.

I have heard and absolutely understand exactly why this motion is here before us tonight. I understand and feel the frustration of the families, their advocates and the service users. It is also, however, important to realise that when I took office last July, all these services were closed. We have slowly and within guidance worked with the Department and the HSE to ensure the services could open up and keep people protected.

I have travelled around the country. I started in St. Joseph's in Charleville where I discussed respite in Cooleens House. I travelled to Wexford and Kilkenny. I have been in Galway. I have been around, and I have been listening.

Deputy Tully is right. The same issues of staff, transport and accommodation come up repeatedly. However, we could not turn on the switch overnight to ensure this happened because we needed to have staff and find the accommodation that meets HIQA requirements. For it to work it needs to be done on a piecemeal basis, which is happening. To be fair, the providers have worked with the HSE and the Department. I spoke to the chief executive of the HSE, Paul Reid, yesterday and I now understand that I will no longer have to rely in respite units to be isolation hubs. They are being stood down and the HSE will use the €5 million to ensure we have isolation hubs and that we no longer need to draw on valuable respite services to ensure that people are protected.

When the €20 million saved by scrapping the 1% cut, the €10 million for reopening services and the €7.8 million to tackle the assessment of needs backlog are added up, I have secured a €37.8 million investment in the sector since I took office 98 days ago. That is far from small money. Everyone in the House knows the disability sector is the poor cousin in health. I fought for every euro of that €37.8 million for the families, the services users and the providers, and especially for the children who are awaiting assessments of needs. This is a clear demonstration of the Government's commitment to the disability sector and a tangible example of my commitment to fighting for people with disabilities during my time in this office.

Alan Kelly (Tipperary, Labour)
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I will share time with Deputy Sherlock.

I thank the Minister of State for her contribution and I thank the Deputies who tabled this joint motion. I must comment on the way the Minister of State finished. I know she is a formidable person. I like her style and I compliment her on getting the €37.8 million. However, it says a lot about the Government that she had to fight so hard to get it. If the Government was going to prioritise people with disabilities in the way in which it should, she should not need to fight as hard as she did. Fair play to her. She is unique. It is obvious that the Government does not place a priority on disability in the first place if it took that level of fight to get it. I give my best wishes to the new committee that has been established, members of which are here tonight.

As the Minister of State knows, I have spoken about his subject many times since the start of this Dáil. I have probably spoken more about it than any other topic because I have been fighting for people with intellectual disabilities, about which I am passionate. We live in a republic and the best way to show that we live in a republic is by looking after those who are most vulnerable during this pandemic. The simple fact is that those who are being given day services were just let down. I understand residential services were protected, but day services and respite are gone. They lost the will because they were forgotten about.

On numerous occasions I have spoken to the Minister of State about Philip Kelly, who is not a relation and who lives here in Dublin. He is my friend. He is 29 and has Down's syndrome. He used to beg me to come in here and talk to "the boss". At the start it was the then Taoiseach, the Minister, Deputy Varadkar, and then it became the current Taoiseach, Deputy Micheál Martin. Then he met the Minister of State on the bridge by the convention centre and now she is the boss to get him back to his day services. He gets four hours twice a week. After I leave here, I will ring him and talk to him because he is watching now.

I have spoken to many families who are watching tonight to see if the Minister of State can deliver more in next week's budget. That is why this motion is so timely. It is not sustainable for Philip and all the other people who deserve the services. They are thankful for the €10 million and the total of €37.8 million. They need capital funding because their buildings are too small. They need PPE and they need many more buses. They need them now. We live in a republic. They cannot be discriminated against. They are the most vulnerable. They were left at the bottom of the pile and it is not bloody well acceptable. We need to have Covid protections, but we also need to provide services for our most vulnerable and particularly day services.

I do not have much time, but I want to make two more points. I spent some years on the Committee of Public Accounts and was also my party's spokesperson on health. The situation with section 38 and section 39 organisations is not sustainable. The Covid pandemic is a disrupter, but this was not sustainable before the pandemic. All the main organisations are in serious trouble. We need a plan that goes beyond the term of the Minister of State and lasts for a decade. We outsourced all these services for the most vulnerable people in this country to private organisations and now we will need to take them back. What is going on is not sustainable. These organisations are beginning to fall over.

I refer to a newspaper article today. It is not because it was written by a Labour man but because his passion for disabilities is more important to him than being a Labour man. If colleagues read one article tonight, they should read Fergus Finlay's article on St. John of God's in today's Irish Examiner. It is not because his daughter is there; in fairness to him he has been passionate about this for many years. We cannot have €155 million given out in services for 2,709 people. This organisation owns considerable property that we all know about. There are issues with workers which we all know about. After years of giving out secret payments with 11 people getting more than €180,000 a year - to give balance because the State cannot always deal with everything - it has decided that it now wants to throw all the services back on the State. We heard a lot this week about frightening people and this frightens people. The reason they are in that position in the first place is we outsourced it all.

There are two issues. First, the Minister of State needs to have a hell of a week. I congratulate her on the €37.8 million. However, it says an awful lot about the Government that she needed to do what she did. She needs to have one hell of a damn week because these people cannot be let down. We need capital and current funding. Second, all of us need to make a plan for the State to take back control and ownership of disability services for people who are vulnerable.

Seán Sherlock (Cork East, Labour)
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I express our sadness at the passing of Dr. Martin O'Donnell of Charleville, father of Deputy Kieran O'Donnell, our colleague in the House. Dr. O'Donnell was one of the founders of the Charleville and District Mentally Handicapped Children's Association, which was the forerunner of St. Joseph's Foundation as we know it today. I was particularly heartened to hear the Minister of State tonight mentioning Cooleens House and St. Joseph's Foundation. I take some solace from her speech that she is very much aware of St. Joseph's Foundation and its work, thanks in no small part to the late Dr. Martin O'Donnell and his team. A lovely article in the Limerick Leader today contained a quote from a local who said that the late Dr. O'Donnell brought children out of the attic in 1968. We are still here tonight discussing these issues, which may be an indictment on all of us.

There has never been a greater consciousness around these issues and around ensuring we can advocate for people and continue in the spirit of a man who was truly respected, who had great passion and compassion for the people he served as a GP. The article speaks of the 50th anniversary celebration of St. Joseph's Foundation where it is said that he remembers Dr. O'Donnell saying the highlight of his career working with those with special needs was when it was recognised they could get their first holy communion. We have come a long way since then but we have a long way to go.

I recognise the Minister of State's integrity. I note that Deputy Michael Moynihan, who will chair that committee, is also present. We can do good work and we are already seeing an evidence base for an increase in resources. That is plain for everybody to see. This is a non-partisan issue. If we can continue in the vein of people such as Dr. O'Donnell, we will do some good work. I am particularly heartened that the Minister of State mentioned Cooleens House. That is evidence she is across that specific issue in north Cork and is cognisant of the impact of the loss of respite care and the effect it is having on, for instance, the 33 people who use it in the context of Cooleens House. I pay tribute to Dr. O'Donnell and his family, to Mrs. O'Donnell and their five children and offer condolences to our colleague, Deputy Kieran O'Donnell, on his loss.

Richard O'Donoghue (Limerick County, Independent)
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I also offer my sympathies to Dr. Martin O'Donnell's wife, Veronica, to his daughters and sons and to Deputy Kieran O'Donnell.

In 1968, Dr. Martin O'Donnell was one of the co-founders of the St. Joseph's Foundation in Charleville. Today I heard many stories of him going from house to house looking for funding to open a place for people to go. The first place they went was the parochial house in Charleville. I have been involved with St. Joseph's for many years and I was one of the people who helped them get Liskennett Farm in Granagh. It has an equestrian centre for people to come to and was built in a forest of 80 acres. It is absolutely fantastic. What St. Joseph's Foundation have stood for in our area is huge.

St. Joseph's has a lot of houses throughout the country, in counties Cork, Kerry and Limerick. What they do is unbelievable but they need supports and funding to go forward. Everything has now changed for them. People who could previously go to the likes of Liskennett in Granagh cannot go there now because of the restrictions. Before the pandemic, some of them could travel there in a bus but now they cannot. They have small minibuses with six or eight seats and they cannot do this with social distancing. It is heartbreaking because it is an absolutely fantastic facility, run by fantastic people. One group we have got to look out for in all this is the volunteers. Dr. Martin O'Donnell was one of the co-founders of the St. Joseph's Foundation in 1968. These people volunteering their time and effort.

More than 1,250 carers in Ireland are over the age of 70, with 400 aged over 80. Capacity in day services has lessened due to social distancing, which impacts centre-based day services. People with disabilities were identified as high risk by NPHET. Services responded extremely quickly and kept the numbers extremely low but this meant restricting day services and providing support in residential settings. The National Federation of Voluntary Service Providers said it is now providing 40% of pre-Covid care. Most people are getting between two and three days of day services per week. Due to the fact that capacity in day services has lessened to meet the regulations, it is not possible to accommodate the pre-Covid numbers in centre-based day services. How many people using disability services are prevented from working because of an underlying condition? We have seen people working in shops and in the restaurant in St. Joseph's Foundation. Everyone is working together like a community. However, because of their underlying conditions they no longer have that service and they cannot go out and meet other people. What is there for them? They have not been able to work and there is no alternative in place for them. This is very difficult for them and their families.

I will conclude by mentioning Dromcollogher and District Respite Centre. It comes under the same regulation as nursing homes. It has been in contact with the Minister of State. It needs to be open, it needs funding and it needs to expand so it can cater for people in need of respite. It has even converted an office to make extra room for respite care. Again however, many volunteers are raising funds for this and we need the Minister of State's help. I wish Deputy Michael Moynihan very well as committee Chairman. I know he and the Minster of State will do their best to help and that their hearts are in the right place.

Thomas Pringle (Donegal, Independent)
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I apologise for not being here for the earlier slot. I was not aware I was speaking in that slot as there was some confusion over the speaking arrangements for tonight. On foot of all that I ended up with two and a half minutes extra so I will have to try to fill that time as well after preparing for two and a half minutes only. I will try to make it up to five minutes now anyway.

I am happy to contribute on this motion because it is very important. It is with a sense of pride that I support it but I do so with sadness as well. I feel pride because this is a vitally important motion and it is important that my name and signature is on it. I thank Sinn Féin for offering the motion to all Opposition Members to sign. The sadness is due to my having spoken about disability services 23 times in the previous Dáil. I spoke then with the help of an activist who has since died without seeing the full implementation of the UNCRPD. Perhaps it was naivety as well. We will probably end up speaking about disability services 23 times in this Dáil and 23 times in the next Dáil and, unfortunately, we will still be in the same situation. That is sad. It is no reflection on the Minister of State. She will do the best she can with what she has but as a State and as a Government overall, we do not give people with disabilities the respect they deserve.

Sadly that has been seen with the implementation of UNCRPD which was ratified by Ireland 17 or 18 years after it was introduced. That is an absolute disgrace and we should all be ashamed of ourselves that that is the situation we got into. The previous Minister gave many perfect and great excuses as to why that happened and why the wait was necessary and all of that kind of stuff. I do not believe it was necessary. If we had been serious about it we would have adopted and ratified the convention on the very first day and then worked to implement it. Instead we said we would ratify it and then dawdled along implementing it and every time it was raised we perhaps got a little more until eventually we got to a situation where it could be implemented. That is sad and we should not have to do that. Hopefully, we will get to a situation in this Dáil or in the next where we do things because they are the right thing to do, not because they will cost money or impact on the budget.

We should do them because as a society they are the right thing to do. It would make a huge difference if we get to that.

The motion speaks about the impact Covid is having on services and it is impacting hugely on people with disabilities and disability services. As the Minister of State and all of us in the House know, it is having a huge impact. With regard to the wider dispute in recent days with NPHET and everything else, how we deal with Covid will have a huge impact and it will have an ongoing impact on people with disabilities because at the rate we are going, sadly, we will be dealing with Covid and going into and out of lockdowns for the next three or four years. Will we be sitting here during that time waiting to see whether the Government will get disability services back up and running? I do not think we can wait that length of time. It is important that we do not do so and that we get ourselves together and do this now. They are depending on us to provide the services and we are not doing it. That is sad. I hope we will get beyond that and that we provide the services.

How we treat our weakest members is a sign of us as a society. People need our support to lead their fullest lives and that is all the motion is talking about. What we are doing at present is restricting these people from being able to get the most out of life that they can. We do not have to do this and it does not have to happen. I hope the Minister of State will deal with it on her watch and that it will not move on to the next Minister of State and we will not have to stand here in the next Dáil speaking about the same thing. I hope it will not come to that. This falls on the Minister of State. We will try to make sure it happens.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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I apologise to the Minister of State. I did not hear her opening comments because I was at a meeting. I thank Sinn Féin for tabling the motion and making it an all-party effort. It is absolutely imperative that we discuss the UNCRPD and its full implementation, particularly given the huge impact on disability services that Covid-19 has had. As Deputy Pringle just said, we signed up to the UN convention and 11 years later, only after long hard campaigning by disability activists, with protests every couple of months two years ago by various disability, activist and advocate groups, the Government was eventually forced, and it really was forced, to do what it should have done 11 years earlier and ratify the UN convention.

Even when the Government was dragged kicking and screaming to ratify it, it left out the critical part, which was the optional protocol. I do not know whether this was discussed earlier and whether the Government has given a commitment that it will adopt the optional protocol. I will not say the UN convention is not worth the paper it is written on without the optional protocol but it is not far off it. That is the thing that really forces accountability on the Government and gives a mechanism to people with disabilities to hold the Government to account as to whether it will ensure real equality at every level for people with disabilities, who are clearly denied this at a whole range of levels, whether transport, employment or education. In just about every sphere of life equality is not a tangible reality.

When I think about things that have happened recently in a campaign in which I have been involved with St. Mary's Telford on the Merrion Road, it is shocking that the Government is allowing them to happen. The Sisters of Charity have just decided to get rid of a convalescence centre nursing home for people with disabilities and effectively turf out women, some of whom suffered at the hands of the Sisters of Charity, who have lived there for 60 years with visual impairment and disability. They were just told their homes are going. They have waged a massive campaign and the Sisters of Charity are now speaking about leaving them for a little while but essentially they have been told to get out. This is funded by the HSE with taxpayers' money but because it is the Sisters of Charity they can do this for reasons unknown. The Government is just saying it is not its affair. It is just not on that this should be allowed to happen.

I should mention St. Monica's Nursing Home in Belvedere Place. I do not know it as well. The workers there have just been dumped and are not getting paid proper redundancy. It is shocking. In recent days, I received a letter about St. John of God. I do not know whether this issue has been raised. Disability services should be publicly delivered and not delivered through religious organisations but as it happens St. John of God delivers pretty much all of the intellectual disability services in my area. It is stating they are all going. Such is the level of underfunding from the HSE that there will be no services. They will just have to walk away. At the bottom of it are the austerity cuts that were imposed back in 2008 and the years afterwards. It has never really recovered from them or the failure of the Government to provide the funding. There is the threat to St. Joseph's dementia care in Shankill, which nearly went under other than big campaigning. That is just not on. We are not putting the resources into make equality a reality.

I think about my friends Sean O'Kelly and Bernard Mulvany who run the Access for All campaign to ensure that lifts on the DART line are fixed. A bit of extra money has been given but there is still a long way to go to ensure access to the DART. We have a lot more to do so let us get a commitment on the optional protocol and let us actually put the resources in to make equality for people with disabilities a reality.

Paul Murphy (Dublin South West, RISE)
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Covid is brutally exposing existing vulnerabilities in individuals but also in our society as a whole. This is very true in terms of our disability services and the effect the coronavirus is particularly having on people with disabilities. The pre-existing conditions are there for all to see with regard to the brutal facts of the treatment of people with disabilities in the State. There are close to 650,000 people with disabilities in Ireland and their poverty rates are 10% higher than the average in the EU, with Ireland among the five worst European countries. Ireland has the lowest employment rate for people with disabilities in the entire EU, 20% lower than the EU average. People with disabilities have double the average rate of homelessness, with 27% of the homeless population having a disability.

All of these are the consequences of ideology and of underfunding, underinvestment over decades and a model based on the hollowing out of public services and, in reality, giving responsibility to private organisations. These are partially funded by the State and then have to fundraise themselves because the funding they get is inadequate as opposed to the State taking responsibility itself. Coronavirus hit along with all of the restrictions we know about and as a result services almost came to a total stop. They have been partially restored and now they are approximately 40% of what they were, which is completely inadequate.

There are many issues. Disability services are in crisis and I echo the point made by Deputy Boyd Barrett on Saint John of God services. That is not our model but the fact that it is speaking about withdrawing entirely and transferring responsibility back to the HSE because of continuous underfunding speaks to the level of crisis that exists.

A particular point was drawn to my attention by a constituent, Lorraine, about a meeting that the National Federation of Voluntary Service Providers had with the Minister of State looking for extra necessary funding in light of Covid. I understand €10 million was granted. I heard the Minister of State say that this was €10 million on top of this money and that money. These are the people who know which resources are needed. From their point of view, it is completely inadequate. Lorraine told me that this shortfall is concerning and that words fail her in terms of dealing with it.

I pay tribute to those campaigners who have fought and continue to fight on the issue of disabilities and dragged this State to sign the UNCRPD. I also pay tribute to groups such as Enough is Enough representing carers who have enough troubles in their lives without having to fight for the very basic services to which they should be entitled. They are responsible for coining the slogan "Nothing about us without us". That is the model of disability services and assistance we need in the State. It is based on independent living, along with the right of people to choose the care and assistance most appropriate to them.

As Deputy Boyd Barrett asked, will the Minister of State ratify the protocol to give people the right to complain about breaches of the UN convention and to take legal action on that basis? Will she commence the full Education for Persons with Special Educational Needs Act and the Education (Admissions to Schools) Act fully to ensure equal access to education and health services for people with disabilities? Will she increase the disability allowance? Will she provide assistance for carers? Will she, at a minimum, suspend the reviews of carer's allowance until the impacts of Covid-19 have been fully considered or at least for a year? Will she raise the basic rate of carer's allowance?

Seán Canney (Galway East, Independent)
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I am delighted the Minister of State, Deputy Rabbitte, has been appointed to this area of responsibility. She is colleague of mine in the Galway East constituency. She has taken on a role in which, from her own experiences she knows well, there are many challenges. I also look forward to working with the chair of the disabilities committee, Deputy Moynihan. I look forward to working with all in a proactive way to ensure we make changes that will improve the lives of people.

The programme for Government states what it will do about disabilities. There are two particular funding streams involved. There is the capital funding stream required to provide facilities for our people with disabilities and their families. We also have to look at the fact that there is a growing demand, whether we like it, from two particular streams. First, there are more cases of young children coming forward with more diagnoses. We then have older people who are caring for a special needs person in their family. These parents are getting older and are in need of care themselves, meaning they are trapped. We need to have a two-pronged attack to deal with these issues.

We need to make sure facilities are in place. I congratulate the Minister of State on the amount of funding she is putting into service. However, I term that as reactive funding. We need to ensure we have funding to provide for what is needed, as well as for emergencies. We must be doing that on a multi-annual budget basis.

No Member will disagree with any of this debate tonight. However, we need to get the funding in place and get over the barriers involved. Transport was mentioned earlier. In our constituency, we had five families who needed to find their own way to disability services every day. That issue has been resolved temporarily until next Christmas. That is not the way, however, we should be treating children who need day services. We must ensure we deal with this in a way that is truthful with ourselves, with the families involved and the people who need the help.

We know the effect of Covid on many people. I know for sure that in my constituency office since Covid arrived, we have had more people contacting us, reaching out and crying for help because they were completely stuck. We left them stuck. I regret that we have done that as a society and we have left them to fend for themselves. We need not ever do that again.

The Minister of State must ask the Minister for Finance why he has suspended the primary medical certificate scheme. I know a legal case had been taken. I questioned the Minister here several weeks ago about this but he did not tell me he had suspended the scheme. I have people who are in need of the scheme. We need to expand the scheme to help people. As the Minister of State knows from living in rural Ireland, not everybody is living beside a service. To be able to access a service, one needs to have a car adapted but there is a huge cost in that. There is a scheme in place and we should get on with it. It is one of the biggest indictments that the Minister has actually suspended this scheme. If that is the policy, we are going no place fast with all the nice talk we have about disabilities. That issue needs to be rectified as a matter of urgency.

I thank Sinn Féin and all the other parties which co-signed this motion tonight. It is an act of solidarity with people with disabilities.

Peadar Tóibín (Meath West, Aontú)
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A few days ago I watched a heart-breaking RTÉ report in which a couple said that they did not know what would happen to their special needs daughter if they died before her. They said no parent ever wants to bury their child but the reality is that they dread what would happen, not if but when, they cannot simply manage. That is an experience for many families across the country.

Another person emailed my office in recent days to inform me that the early intervention services for their three-year old son are non-existent. They explained their son is non-verbal and is not walking. They feel the lack of disability services is having a huge impact on his well-being. The early years of a child are so important, even more so for a child with a disability.

It is not acceptable that highly skilled therapists have been redeployed to Covid-19 testing. I understand that move in the initial stages may be necessary but six months later it is unacceptable. This is a big waste of training skills and experience.

Another woman I know with Down's syndrome with whom I have been working used to have full-time day services. They disappeared for many months. The services have now returned but it is two days one week and three days the next. I know another two women in my constituency who have Down's syndrome but are only getting six hours a week. Another woman who is in residential care has no services provided. There is no stimulation, development or interaction. All of these services have either collapsed, disappeared or are working under par. This is wrong.

Right through the summer, my office was inundated with parents who, because of the Covid restrictions, had a son or daughter who was not getting the services they needed. They saw significant regression in their children's abilities and engagements with the rest of the world. For any individual, that is a difficult situation in which to be. For a parent watching this happen, it is incredibly heart breaking to have to experience it, as well as the physical demands the extra care they have to give takes as well.

What I could never understand in this process is that we could get our hair cut in this country and be in the physical space of a hairdresser, yet a person with a disability who needed to be in the physical space of a therapist, consultant, doctor, nurse or somebody working with Prosper or any of these fine organisations could not be in such a space. It did not make sense that such essential services were being denied while other people could get other simple services such as getting their hair cut.

An issue I have raised over the last six months right through this crisis is that the Government have made decisions to reorientate resources in this country away from the health services towards Covid. It did that on the blind and, at the outset, in response to a crisis that nobody knew how big, difficult and dangerous it was going to be. It was a fire that was rolling across Europe in our direction. It was a natural response back then but during the summer from July, August and September onwards, there is no doubt in my mind that we could have reapplied and reorientated those services back to where they needed to be and that simply did not happen. It still has not happened and there is a radical cost to that. What really drives me nuts is that the Government has made no effort to measure that cost in any way. The British, in fairness to them, have done significant studies with regard to the physical and mental health costs and the costs with regard to disabilities and the health services. In their view, the non-Covid costs could far exceed the Covid costs by the end of this. It is only when you have that level of evidence that you can make evidence-based decisions. Right now, we are not making evidence-based decisions with regard to the orientation of resources.

I welcome the motion that has been tabled and I appeal to the Minister to support the motion with regard to extra funding in the first instance and to make sure that when we take services away, we know the damage and cost it is doing in order that we can bring those services back in time for the families that need them.

Michael Healy-Rae (Kerry, Independent)
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I welcome the opportunity to address this important issue here this evening. One judges any state and any government on how they deal with people with mental, physical or any type of intellectual disability.

In the county I represent, we have a very worrying event happening now, as the Minister of State knows, with St. John of God Community Services notifying the HSE that it will be withdrawing the work it has been doing. I thank St. John of God Community Services for the work it has been doing for many years, taking care of this sector of society and these very important people. It has been running facilities throughout the country such as, for example, St. Mary of the Angels, which I would call a centre of excellence for dealing with people with every different type of disability. I compliment every one of the workers who has been there past, present or future. They have given great service. They are local people drawn from the community and it has been a vocation for them to take care of what I would call special people.

St. John of God Community Services has said it will withdraw services this time next year. Between now and Christmas, the HSE should discuss with that group the financial difficulties that have been ongoing there for a long time, as well as a way forward. I am not here to criticise but the HSE finds it difficult enough to deliver the services it is supposed to and if it is told this group will no longer give this service, who will step into that breach?

The most important thing the Minister of State can do, if she can do it, is take care of what I call special people in their own homes. That can only be done with financial assistance and all the other supports required. I ask the Minister of State to take that into account when dealing with our special people in Ireland.

Danny Healy-Rae (Kerry, Independent)
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I thank Sinn Féin for facilitating this important debate this evening. If we elected representatives are to be relevant at all, we must ensure we do everything possible for people, whether young or old, with physical and mental disabilities. In County Kerry at present - it is likewise around the country but we know about our own county - many day care centres that were closed because of the coronavirus are now only 30% open and that is not good enough. The parents of these children are under savage pressure. The home carers, whether they are brothers, sisters, fathers or mothers are under pressure. I have met many of them going back many years and they are great people for seeing after their children but they are under pressure when they get over 70 years of age. I know some that are moving towards 80 and their worry is what will happen their child when they pass on or who will look after the child. We are short of respite places for these children and when the parents are getting old, they do not know what will become of their child.

The coronavirus has disrupted so many families. These special children need physiotherapy, language therapy and speech therapy. They have lost all that and on top of that their parents are at home minding them 24-7 and they cannot give any time to their other children. It is very sad.

We are in trouble with primary care certificates. They are not being processed. We also have issues with early intervention for children with disabilities and home carers. Home carers are not being looked after at all and we must recognise them. If these children are not getting to day care centres, their parents must be funded to provide and pay for the services themselves.

Carol Nolan (Laois-Offaly, Independent)
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At present in Laois-Offaly, a total of 1,118 children have been waiting in excess of 12 months for occupational therapy while 159 children have been waiting in excess of 12 months for speech therapy. As I am not here to raise the problem but to offer possible solutions, is any way in which therapists from other regions where there is not such a chronic backlog could be brought into Laois-Offaly to clear the backlog, while continuing with recruitment? I would be very supportive of that and grateful if that could be looked at.

As for day care services, it is of concern to many families of adults with intellectual disabilities that day care services are still not fully open. I know the Minister of State is doing her best with that and I commend her on the work she is doing. People have told me that they could not cope if these services were to be shut down again. It had a negative impact on the well-being of adults with disabilities. They asked me to raise with the Minister of State the plea that there would not be a full shutdown of this service in the future because people regressed and those adults and their families need every support they can get.

We ratified the UN convention, and that was the most positive development in this country for a while. I ask that that be matched with actions. For example, Ireland has the lowest employment rate for people with disabilities in the EU. It is almost 20% lower than the EU average of 50.8%. The poverty rates for people with disabilities are 10% higher than the EU average. Ireland ranks among the worst five countries in Europe. We need these things to be resolved, along with the other issues that exist, if we are to be truly inclusive and supportive of people with disabilities.

Michael Collins (Cork South West, Independent)
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Ireland has the lowest employment rate for people with disabilities in the EU. It is almost 20% lower than the EU average of 50.8%. Some 27% of the homeless population have a disability, which is double the rate in the general population.

More than 1,400 people with disabilities under the age of 65 are inappropriately placed in nursing homes. Services are carrying more than €40 million in deficits.

Last week, Mr. Sean Abbott, the chairman of the National Federation of Voluntary Service Providers, said:

People with intellectual disabilities are experiencing severe mental health challenges as they struggle without the services they relied pre-Covid ... Family carers, many of them elderly, have been providing supports to people with complex needs at home - including providing personal care to their adult sons and daughters - for over six months due to the reduced capacity in services, and are now at breaking point.

He was shocked that the Government allocated just €10 million for the remainder of this year, a fraction of the funding required to provide services for people with disabilities.

This is at crisis point. The Government will spend almost €25 million on ministerial advisers over its lifetime but cannot commit to delivering for people with disabilities. It will give approximately €20 million per year to the European Space Agency but cannot give the same commitment to our disability services. The new National Children's Hospital will cost €2 billion, at least €1 billion over budget. The overrun due to complete mismanagement will likely run into hundreds of millions of euro, yet, at the same time, the Government fails to support those with disabilities. The rural broadband scheme was originally estimated at €500 million but will cost €3 billion over 25 years because of completely dysfunctional management. The overrun will eat into the budget for disability services. Those examples make it clear where the Government's priorities rest. Those priorities are certainly not on the side of Ireland's 643,131 people with disabilities.

I will mention services in west Cork, which are absolutely shocking. I twice approached the Minister of State prior to the summer recess and told her I would like to speak about the services and see where changes could be made. She did not get back to me. I understand she is busy, but she must not take her eye off the ball when it comes to west Cork. The services there are shocking. Parents throughout the constituency, from Kinsale to Mizen Head and up to Castletownbere, are pleading with me. Their children are losing services or have lost services and Covid-19 is being blamed for everything. It cannot be blamed for everything and certain services could have survived. Hubs were being opened in Drimoleague and efforts were being made to open another hub in Schull and places like that. Those involved in opening those hubs needed the assistance of the Minister of State. I plead with her to work with us, going forward, on this issue.

Bernard Durkan (Kildare North, Fine Gael)
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We move now to the Independent Group. Deputy Harkin is sharing time with Deputy Connolly.

Marian Harkin (Sligo-Leitrim, Independent)
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That is right.

Bernard Durkan (Kildare North, Fine Gael)
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Will the Deputies be taking five minutes each?

Marian Harkin (Sligo-Leitrim, Independent)
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We will. I am proud to be a signatory to this motion, which unites Opposition Members on the absolute and immediate need to reopen day and other essential disability services. There is also a need to provide additional funding that is required to guarantee sustainable capacity within disability and dementia services. I thank Sinn Féin for facilitating this motion.

I listened to the Minister of State and know she is genuine in the efforts she makes. She reminded us that when she took office, all services were closed. I recognise that everything cannot be done at once. However, we all know these are unprecedented times and unprecedented actions need to be taken. Resources need to be put in place to support the most vulnerable in our society. We all know that Covid-19 has been especially harsh on people with disabilities and their carers. The Minister of State and the Government, therefore, have a responsibility to deliver in the upcoming budget. I know that there are competing demands and that both Ministers of State, Deputies Rabbitte and Butler, will fight for this sector but the response of the Government will tell us a great deal about how we value people with disabilities and their carers.

Some €10 million has been allocated to date. The Minister of State, Deputy Rabbitte, spoke of the €20 million that was saved because the 1% levy was scrapped. What in God's name does it say about our State that we were looking for 1% efficiency from a voluntary sector that, before the arrival of Covid-19, was stretched beyond its means? The sector relies partly on fundraising and wholly on volunteers and voluntary boards. Its staff, as section 39 workers, are still in 2009 and 2010 pay scales and most of them do not receive increments. I know that the Minister of State is not personally responsible for this, but to look for a 1% cut in the first place was scandalous.

I know that the €10 million was fought for hard but the National Federation of Voluntary Service Providers was shocked at that amount. Inclusion Ireland recognised that it was a fraction of what is needed. As the Ministers of State will be aware, Family Carers Ireland today launched The State of Caring 2020 report dealing with pre-Covid times, and another report, Caring Through Covid: Life in Lockdown, was published previously. The two reports should be required reading for every person in this House. More than that, they should inform decisions taken in the upcoming budget.

The reports make harrowing reading in places. One carer described Covid as "a lockdown within a lockdown". Pre-Covid, 23% of carers had already seen a decrease in the level of services offered to their loved one in the past year and now 43% fear that normal services will not be restored after the pandemic. This does not surprise me because I remember reading the initial HSE guidelines on restoration of services, which referred to a reduced quantum of services. That kind of verbiage strikes fear into the hearts of family carers who have fought long and hard to get these day services up and running in the first place.

My time is limited but before I finish, I want to remember two tireless disability advocates who have died in the past few years and who taught me so much during my 15 years in the European Parliament. They are Donal Toolan, with his easy smile and razor-sharp intellect, and Martin Naughton, who took no prisoners. Those two tireless advocates helped me to recognise that life for people with disabilities is not a dress rehearsal; it is their one and only life. We, in this House, have a duty to support them and their carers to live that life.

Catherine Connolly (Galway West, Independent)
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I thank Sinn Féin for tabling the motion and involving all of us. I have no doubt that the Minister of State's heart is in the right place and I do not doubt her bona fides because I have attended meetings with her. I look at this motion, which is short and signed by 68 Deputies, if my maths are correct, and it asks for very little. It simply asks the Government to provide the funding required to fully reopen day and other disability centres, subject of course to complying with Covid-19 guidelines and requirements. The Minister of State could not possibly disagree with that. It also seeks to provide the additional funding, resources and capital investment required to guarantee sustainable capacity for people with disabilities and dementia. How could she disagree with that? She does not. I see her nodding. I am not sure what happens to Deputies when they sit on the ministerial side of the House. I am not being smart when I say that. I know the Minister of State's bona fides. Here we have a three and a half page reply, putting an amendment to a motion that is simply saying we should reopen services and provide adequate funding. I begin to doubt the bona fides of the Government when I see that type of reply. I wonder why is it necessary. I would appeal to women to do it differently, to be honest. I appeal to the Minister of State to stop being captured by Department speak.

This is so simple. It is not simple to implement, but the motion itself is simple. Let us join together as women, while absolutely including the men, and provide services that the Minister of State knows are not there on the ground. Tá Áras Mhic Dara, san Ceathrú Rua, i gcroí-lár na Gaeltachta, dúnta gan aon seirbhís ar fáil. Tá dhá sheirbhís i dTuam, i Claregalway agus i nGaillimh atá dúnta freisin.

I thank the Minister of State for a written copy of her speech. There is a little bit of self-congratulation in it about the funding. I congratulate her on the funding but would congratulate her more if she put it in context.

The Oireachtas disability group pre-budget submission puts it in context. It is two pages and very simple to read. It tells us that 13% of those in receipt of carer's allowance are aged over 70. Can one imagine that? They are doing the hardest work with the least amount of pay. Some 643,000 people in Ireland are involved and the figure will increase by 2026. I will not read out all of the figures, but they are there. The submission outlines the specific things that are required.

The speech from the Minister of State makes me wonder what is going on and who has done an analysis of how many centres have been closed. I have asked these practical questions, as have other Deputies. She has not told us how many centres there are in Galway, how many have and have not reopened, why they have not reopened and what is necessary instead of me giving anecdotal evidence.

I refer to people who are caring for loved ones at home. I think of somebody near where I live in Galway. The person has no respite. The Minister of State was probably sending emails about respite before she took office. What is she going to do about that? She will have our full support. Let us have an analysis of the problem in the first place. What is the scope of the problem and what do we need to do to deal with that as women who see things differently? I hear my colleague laughing, but there are very good men in the world. I would be delighted if they worked with us and I wish Deputy Moynihan the best as the new Chairman of the committee.

Deputy Alan Kelly referred to what Fergus Finlay wrote about the outsourcing of services. I ask the Minister of State to read it. I would like if she had referred to it in her opening statement because it raises serious questions. Services are in crisis and are being handed back with problems. The amount being paid in salaries in excess of €100,000 and the problems that have been identified mean that services that are not making money are being handed back to the State. Property and services that are making money are not being handed back. The HSE internal review was not referred to by the Minister of State. We are again reliant on newspapers like the Irish Examinerand The Irish Timesto tell us these things.

The HSE is carrying out an internal review and told us that the current model for the provision of services for people with disabilities is not sustainable. I will finish up. I will not go over time because I am always giving out when I am in the Chair. Will that report be published? Can the Minister of State please give us the date of the publication of the capacity review she referred to?

Michael Moynihan (Cork North West, Fianna Fail)
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I am delighted to contribute to the debate. I would like to acknowledge, and offer my sympathies to, the family of Dr. Martin O'Donnell in Charleville, whose son, Kieran, is a Member, and his wife Veronica. Dr. O'Donnell set up what is now St. Joseph's Foundation in Charleville, which the Minister of State visited in July. It is his legacy. He gave his time to setting up the section 39 organisation that is St. Joseph's Foundation. We should pay tribute to him and many others around the country who gave valiant service to the community and voluntary sector to provide services for those with disabilities. Services 50 years ago were primitive and it was difficult to get funding and break into a world that was kept behind the curtains. We salute him.

By saluting him, we have to accept that a deadly crisis is facing the disability sector and people with disabilities of every kind. I am honoured that Dáil Éireann has appointed me to chair the committee on disability matters. A raft of issues need to be dealt with. All I can tell the House is that I will give it my all, whether that relates to dementia or disabilities. In each and every aspect, I will give it my all and try to bring as much light as possible into the challenges that are facing the disabilities sector.

Many articles in the The Irish Timesand the Irish Examinerrefer to funding. The State has offloaded the need for services to section 39 organisations and has completely under-resourced them over the decades in terms of providing people with disabilities with proper services. Young children are waiting for assessments. People are waiting for occupational therapy or speech and language therapy, which are currently non-existent in the public sector. Parents are waiting years for proper services.

Adult service users attend many fine facilities for which people have fundraised voluntarily around the country, such as the Cope Foundation and St. Joseph's Foundation. Such organisations have been underfunded. We have to accept that what the State is providing at the moment, through all of its funding models, including the HSE and everything else, is not delivering properly. We have to get to the bottom of this and be brutally honest with ourselves and say that there is a monumental challenge.

If we are to be a proper Irish Republic we have to make sure that people with disabilities are looked after from the cradle to the grave, as Dr. Martin O'Donnell often said when he spoke about St. Joseph's in Charleville. We have to ensure that we have the best possible services available. There has been little political argy-bargy in this debate. Everybody who has spoken is genuine about moving this issue forward.

All of us know in our professional work that parents are looking for guidance. One person dropped in a letter to me yesterday. It was being circulated to public representatives to make sure that the voice of the disability sector was raised at the Cabinet table and highlighted prior to the budget. There was no name on the letter, but at the top it stated, "Please help".

I congratulate the Minister of State on what she has done to date. I saw at first hand her compassion and determination when she visited Charleville in July. I ask her to make sure over the next couple of days that, to put it as bluntly as I can, the cage is rattled as hard as possible to get the most money for services so that they can be restored and families can get what we in this Republic should be giving them. I will do whatever I can as Chair of the new committee. I am deeply honoured to have been appointed and I will take it on to the best of my ability. I will do whatever I can.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputies for raising these important matters and giving me the opportunity to speak on them. I would also like to congratulate my colleague, Deputy Moynihan, on his appointment as Chairman of the new committee that has been formed. It is very important that we put a significant emphasis on the disability sector.

There is no doubt that this has been an extremely difficult time for people and their families. We all share a common desire to have the best possible policies and services for all children, adolescents and adults with disabilities. Personally and as Minister of State, I want everyone with additional needs to have access to the necessary supports in every aspect of their lives to enable them to achieve their full potential, maximise their independence and lead fulfilling lives.

There has been an awful lot of talk today about carers. I hosted an online round table with carers three weeks ago. It was supposed to be a much bigger event, but we had to reduce it. I heard from carers, including dual carers who are looking after children with intellectual disabilities, and a parent. I heard from carers about Covid and mental health issues.

In my remit as Minister of State with responsibility for mental health and older people, I met the Minister, Deputy Heather Humphreys, today to discuss carers in terms of the budget. It does not technically come under my remit. The care of carers does, but the finances involved do not. It is very important to put that on the record.

Disability services are provided in many types of settings across many organisations throughout the country, and in the age of Covid-19 these organisations have to adapt and do their best to ensure that services can continue to be provided. I would like to acknowledge the commitment of these services over the past seven months to supporting and protecting those with a disability who attend health and social care services.

The Government is committed to strengthening the State's relationship with the voluntary sector and to the full implementation of its five-year strategy to support the community and voluntary sector in Ireland. The strategy sets out a long-term vision for communities in Ireland and the general direction of travel for Government policy with the community and voluntary sector for the coming years.

On Deputy Connolly’s question, the Minister of State, Deputy Rabitte, has asked me to say that she also wishes to see the disability capacity review published as soon as possible. We need reform and funding throughout the disability sector. She asked me to acknowledge the Deputy’s contribution.

My colleague also spoke earlier about the resumption of day care services, in particular, and I will outline the work under way to support the resumption of other services for people with disabilities. As has been said, respite is a crucial support mechanism for many families. Short stay residential emergency-residential respite began to reopen between July and August as the first stage in a three-phase plan. Activity is now increasing for the next two phases: September to November phase and December to February 2021.

On children’s services, all CHOs are putting appropriate arrangements in place to resume assessment of need and intervention therapy services in line with public health guidance. Additional funding of €7.8 million has been provided to the HSE specifically to reduce the current backlog in assessment of need. This funding will help reduce waiting times both for the assessment and for any therapeutic services required. The €10 million announced by my colleagues, the Minister, Deputy Donnelly, and the Minister of State, Deputy Rabitte, last week to support the resumption of disability services included €2.5 million to provide 210 intensive support packages for children and young people with significant support needs. These packages will help these children and young people with complex high support needs to remain living with their families and this investment will go some way to alleviate some of the pressures and stress on people with disabilities and their families.

I appreciate that the reduced capacity in day services caused by Covid-19 is a considerable challenge and is far from the level of service that we would like to provide. However, services must continue to operate under public health guidance and the safety of all service users is paramount. The resumption of day services has been welcomed by service users and their families and this package of €10 million provided to enhance disability services is but a first step on the road to increasing capacity and expanding levels of service for service users.

Turning to the UNCRPD, we cannot allow the current situation to divert us from continuing our work in improving the lives of people with disabilities and significant cross-departmental work is under way in this regard. We are committed to a continued whole-of-government approach to improving access and quality of services for people. The recent programme for Government also commits to the development of an implementation plan to co-ordinate the implementation of the UN convention. Work will commence on the development of this implementation plan shortly.

The situation we now face is one that requires our fullest attention. I assure all that the Government will remain focused on providing the best services we can, while keeping the health and well-being of people with disabilities as our utmost priority. Once again I thank all for their time and valuable contributions regarding these most important matters.

Mark Ward (Dublin Mid West, Sinn Fein)
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Stewarts Care in Palmerstown is in my constituency. I have an aunt who is a long-term resident there. Over the years I got to know many of the service users. In my previous role as the Mayor of South Dublin, I invited the communities service users council to the mayor’s reception, which was a fantastic day. It is no surprise to me that several day service users have contacted me with concerns that the services have either stopped or have been really diminished. This does not only apply to Stewarts Care but people with intellectual disabilities also experience mental health challenges as they struggle without the service they once relied upon pre-Covid-19. The structure and supports that they relied upon for their individual personal development have disappeared overnight. Not only were these structures taken away from the service users, they were also taken away from their carers. There was no respite for their carers. Family carers who are often elderly have been providing support to people with complex needs at home, including providing personal care to their adult sons and daughters for over six months due to reduced capacities in services. They are now at breaking point. These carers need a break.

The second point I want to make is on St. John of God community services, which has announced the transfer of its services to the HSE. Currently, they provide services to 8,000 people. It also employs 3,000 staff and has a number of volunteers on more than 300 sites across the State. I raised this issue with the Minister for Transport, Deputy Ryan, on Questions on Promised Legislation and asked that the Government formulate a plan so that the people who use St. John of God's do not experience a diminution in services. I also seek clarification that those employed by St. John of God will retain the same terms and conditions in their contracts. The Minister, Deputy Ryan, agreed to send me the Government’s response and I am still waiting for that. I subsequently wrote to the Minister, and submitted questions to the Minister, Deputy Donnelly, but I still have no response. The Government silence on this issue seems to be deafening. The 8,000 service users, the 3,000 employees and the volunteers of St. John of God need answers and clarifications.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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There have been many powerful statements in support of people with disabilities in this House tonight from all political parties. I commend my colleague, Deputy Tully, on tabling this motion and for securing support from across the Opposition benches. The truth of it will be judged by our actions rather than by our words. In my home town of Carrickmacross, the action that people want to see is the opening of a group home for people with physical and sensory disabilities. This facility was committed to in 2006, the building was constructed in 2016 and it has been lying idle ever since. Can the Minister of State give us a date when that facility will be opened?

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I thank all Members for their contributions to this very important debate but I am disappointed by the response of the Government parties to the motion. The Ministers of State, Deputies Rabbitte and Butler, and Deputy Moynihan are just as aware as any of the rest of us are of the circumstances that people with disabilities or dementia and their families are in. They have been informed of the difficulties that they face daily. We all know that tea and sympathy is just not what they need; they need action. It is time to do the right thing. I welcome the fact that a commitment has been given to keep day services open despite what Covid-19 level we are on. That is of great importance. I am aware that safety is also paramount. The reason so many of the services are in difficulty is because they are adhering strictly to the guidelines to keep all of the service users and their staff safe. People with disabilities feel, and not for the first time, that they are the forgotten people in this State.

It is not for the first time that they are the forgotten people in this State. The €10 million allocated last week was met with dismay, disappointment and disbelief by some people within the sector. Others would have said that they have got used to it and do not expect anything different; they expect to be forgotten. Funding was made available to open the schools, and rightly so, but it has been suggested that a similar amount of funding, €120 million, is needed to cover the cost of Covid-19 and open services fully. If we were to rate our country, and this was raised a few times by other speakers, on the way it treats its most vulnerable citizens I believe we would be fairly low down on that scale, and that is all of us together.

I am sure the Minister of State is familiar with the facts on disability in the country, many of which have been alluded to in the debate, but we have more than 640,000 people with disabilities. That number is expected to rise by 20% in the next five years so we need to ensure that the services provided for people with disabilities are in place to meet their needs.

We also have the lowest employment rate for people with disabilities and it is 20% lower than the European average. I meet parents who tell me that their son or daughter who is on the autism spectrum has qualified in college but when they apply for a job, which they are highly qualified for on paper, people do not want to employ them. We need to do more to secure employment for people with disabilities and ensure that the quotas within the public service are met. There are incentives for employers to hire people with disabilities, of which they may not be aware. We need to make them more aware of those incentives.

It is time to fund properly the services and supports for people with disabilities. Initially, it would be to fund the shortfall in the Covid funding for services but there needs to be a change in focus in the way supports for people with disabilities are provided. The optional protocol was mentioned several times in the debate. That needs to be adopted and implemented.

Many reports have been commissioned on the way rights for people with disabilities could be guaranteed but they are gathering dust. We know the right way forward but it has not been implemented. It has to be acted upon.

The Minister of State mentioned that the results of the capacity review will be published soon. Is that imminent? It is very important that we know the shortfalls in terms of what is needed.

The Minister of State has tabled an amendment to the motion. I urge her to support this motion instead.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Is there a response from the Government?