Wednesday, 15 December 2021
Saincheisteanna Tráthúla - Topical Issue Debate
I want to ask specifically how the Department of Health intends to use the cost of disability report finally published last week. This report was published by the Department of Social Protection. Based on the very modest and incremental increases of just €5 across most welfare payments for 2022, it is understandable that I and others are not holding out hope for a fully resourced cost of disability payment to appear, as if by magic, next year.
The Minister of State, Deputy Rabbitte, and the Department of Health are discharged with the lion's share of the €2.2 billion disability budget, yet most of the extra costs incurred by disabled people are essential services and supports that the HSE, technically and in policy, provides, but in reality does not. Day in and day out, I am hearing from people on the ground about their struggles, worries, stress and pressures. The report shows that having a disability can cost anywhere between €9,500 and €12,000 extra per annum. It is a little reductive to celebrate the publication of a report that is telling us what we already know and what the experts in direct lived experience have been shouting about from the rooftops for decades. This year we have had the Irish Human Rights and Equality Commission report and activists and advocates sounding the alarm that disabled people are more at risk of fuel poverty, unemployment, mental illness, lack of access to adequate housing and transport and, therefore, exposure to inadequate housing and many other deprivation factors.
How will this report inform future disability services policy for 2022? Will another year pass where we feel we have to accept that many disabled people, between means testing and limited earnings, are stuck in a poverty and dependency cycle?
I welcome the publication of the Indecon report on the cost of disability, which was published last week after months of waiting. We were informed last summer that this report was completed. It is regrettable it was not presented to the Government prior to budget 2022 as it might have influenced how spending on disability would be managed in the coming year. I hope the next few months are used wisely to consider the findings in the report and how best to address them as the year progresses and that budget 2023 will reflect these findings.
The report confirms what was widely known but frequently not acknowledged, namely, that there is a significant cost of disability. The cost of disability is the extra spending a person with a disability must face in dealing with day-to-day life that able-bodied people do not have to face. It is what a family with a member who has a disability must spend to achieve the same standard living as that of a family without a member with a disability. People with disabilities have extra costs such as taxi expenses, particularly in rural areas where there are few, if any, public transport options and these are frequently not accessible where they are available, and extra fuel and energy costs, especially where the person is not mobile. They also require adaptations to properties, specialised footwear, assistive technology, additional medication and so on. Unfortunately, many of the services that should be provided in the community through the HSE or other organisations sanctioned by the HSE are non-existent and, again, families must pay privately for these supports.
The report states that the average additional cost of disability for a person with a severe disability is between €9,600 and €12,300 per annum. For those with a less severe disability, it is between €8,700 and €10,000 per annum. That is an average cost. Some people are paying less but there are many who are paying considerably more. The cost is dependent on the level of severity of the disability, but also where the person resides. There are unmet costs for many because some things are not currently affordable. How is the Government preparing to address the findings of this report?
I thank the Deputies for raising this issue today. The cost of disability can be measured by the costs faced by people with a disability in their day-to-day lives that others in society do not face, that is, the direct costs approach. It can also be measured by the amount of additional income a household containing a person with a disability would require to achieve the same standard of living as a comparable household that does not contain a person with a disability, that is, the equivalence approach.
To get a better understanding of these costs and the way they affect people differently, the Department of Social Protection commissioned Indecon International Research Economists to conduct an independent cost of disability study. As the Deputies will be aware, the report was published by the Minister for Social Protection, Deputy Humphreys, on 7 December. There is no one single or typical cost of disability, but rather a range of costs from very low to extremely high depending on a person's individual circumstances. Indecon estimates this range, using both a cost studies method and an equivalence approach. The cost studies method is based on over 4,734 responses to a survey of people with disabilities. The equivalence approach applies econometric techniques to data from the annual survey of income and living conditions from the Central Statistics Office.
Indecon estimated that the overall average annual costs of disability in Ireland ranges from €9,482 to €11,734 per annum. The report recommends that additional costs of disability should be addressed through a multifaceted approach, involving increased cash payments, enhanced access to service provision and specific targeted grant programmes. It also recommends that disability payment levels should reflect the very different costs that arise according to the type and severity of disability. Furthermore, the concentration of any additional supports should be targeted at those most in need and facing the greatest additional costs of disability. The report also highlights that increasing employment opportunities for people with disabilities should be a priority.
The analysis has clearly shown that extra costs of disability are incurred across a wide range of areas and can include expenditure such as medicines, care and assistance, equipment, aids and appliances, transport and mobility, costs of social engagement, home adaptation and day-to-day expenses on items like food and home heating. The research clearly shows that there is no one cost, but rather a spectrum of costs that varies across a number of dimensions, including the age of the individual, the severity of disability, as well as the nature of the disability and household type. While some of the costs reported through the survey are already met by the State, it is clear there is a lot more to do. It is also clear that further improvements cannot be delivered through income supports alone but require a broader perspective covering areas such as employment, housing, transport, education and health.
Without a doubt there will be important implications for public policy and service delivery for individuals living with a disability. There is no quick-fix solution here, but the Government is being proactive and will not be found wanting when it comes to actioning this report. It may take some time to address the various issues and cannot be done over the course of just one budget.
I am going to take the Deputies through the next steps of what exactly is being planned. After we do this, I am going into a meeting on the national disability inclusion strategy, NDIS, with the Minister for Social Protection, Deputy Humphreys, and I will take the Deputies through the next steps of the pathway then.
I thank the Minister of State. I especially welcome that last bit of information she provided. The additional cost of €10,000 is, as we all know, an underestimate. This morning I sent a copy of the transcript from last week's Committee on Disability Matters and I implore the Minister of State to read it. There is a family in west County Cork who spend at least double what this report outlines trying to offer supports and therapies for their daughter, who has a rare condition. It is shameful they must do this, as I am sure the Minister of State will agree. The figure of €10,000 extra per year is concrete and significant because we know that, compared with non-disabled peers, people with disabilities have fewer economic opportunities and their community faces some of the worst representation in the workforce across the EU, at a fairly miserable 33%. The report flags additional costs experienced by people with disabilities with equipment, aids and appliances, transport, medicines and assistive services. The Minister of State has alluded to this.
My main question is how this is report going to inform future disability service policy after the Indecon specialists have reported it to the NDIS steering group. Which Department will assume responsibility for ensuring the publication of this report was not just an exercise?
We must recognise that if we are to deal with disability directly, a response by all Departments is required. One of the things that struck me from the report is that Ireland is fourth from the bottom of the list of 31 countries where the percentage of our social protection budget is the lowest when dealing with disability supports. The level of payment and allowances to disabled people must be increased if we are to end the exclusion and risk of poverty for disabled people in this country. However, as the Minister of State said, as well as increased payments, there is also a need for better services and supports. The number of disabled people out of work is one of the highest in Europe, as my colleague has just mentioned, and measures to address that are needed. We need to support people to support themselves. This means more education and training opportunities to enable people to access employment and the provision of more employment opportunities. Personalised budgets are where we are going to have to go if we are to allow people the choice of how and where they live their lives and so on. A complete change of mindset is required such that people with disabilities are not seen as people to be pitied or to be cared for. They need to be seen as people with lives to live and choices to make about how to live that life, so we need to implement the UNCRPD.
On the next step, I am happy to inform the Deputies and the House that the report has now been referred to the NDIS steering group, which I chair. This group will then consider what actions are needed. The NDIS steering group, which is meeting later this morning, will hear from the Minister, Deputy Humphreys, and me as well as Indecon, which will make a presentation of its findings. When we talk about what makes up the NDIS, it is made up of disability stakeholder group, DSG, 5 but I have also invited the new members coming forward for DSG 6. They are not starting until January but I have invited them to sit in so I do not have to rerun the report again and we can hit the ground running. It also includes every other Department, and there is a junior or senior Minister. They all sit within it. There is a very good selection of people, Departments and representatives. The Independent Living Movement Ireland will be there today. There is the National Federation of Voluntary Bodies Providing Services to People with Intellectual Disability, FEDVOL, the Disability Federation of Ireland, DFI, other disabled people's organisations, DPOs, and myriad more to give a cross-section of people who are advocates and strong voices of representation there. On the other side will be the Departments that will take responsibility.
The fifth year iteration of the DSG finishes up this month and the sixth is taking its position from January. This will undoubtedly be the first piece of work the incoming group undertakes. Importantly, by utilising the NDIS steering group, I can ensure the key actors across Government and the wider public sector incorporate the findings of the cost of disability report into their work. That is what the job is. This report now becomes part of every Department to ensure they disability-proof their budgets. As part of it we will set out some of our action frameworks from all the Departments, so when we come back in March, we will have a plan and a pathway for how to action, implement and sculpt future policy.