Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the Senators for raising this issue in the House today. I am glad to have the opportunity to restate this Government's commitment to supporting people with disabilities and their families.

I will begin by acknowledging the significant impact Covid-19 has had, and continues to have, on people's lives. I have visited a number of day services since taking office and have heard at first hand just how difficult the past eight months have been as we have dealt with the consequences of the pandemic and the current restrictions. Covid-19 has presented an unprecedented challenge to our disability services, and most particularly to our day services, which are essential to a great many people. While we all want our services to return to pre-Covid levels, the collective aim of the Department of Health, the HSE and service providers has to be to restore services in a safe way. Today, I would like to update Senators on the significant work that is under way to achieve this within day services.

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

I would like to describe to the House what day services looked like before Covid-19. The HSE and service providers have been working for a number of years to implement a reform programme called New Directions. The aim of the New Directions policy is to ensure that day services are focused on giving people the supports they need to live the life they choose and to use mainstream services in their community. The core values of person-centredness, community inclusion, active citizenship and quality underpin the provision of day services. In practice, this means that, depending on a person's wishes and preferences, he or she may only spend a small part of his or her day at a day service location. People in day services are supported to discover their interests, which could include things like training courses, sport and leisure activities, or the simple act of meeting friends for lunch in the community. New Directions aims to embed people in day services in their communities.

As the House is aware, as part of the overall national effort to contain the spread of Covid-19, and in line with public health advice, disability day services locations that closed in March have now reopened, although not at the level at which they operated pre-Covid. The HSE began planning for the resumption of adult disability day services in May. A group representative of families, service providers and other relevant stakeholders, including Inclusion Ireland, was convened and tasked with the development of a resumption plan.

On May 31, the framework for the resumption of adult disability day services was published and the guidance to support this framework was published on 8 July. The guidance was developed with the aim of enabling the provision of safe and person-centred disability day service supports, which are in line with current public health advice and infection control guidance. It is not overly prescriptive in terms of detail as there is a wide diversity of disability among the 19,000 adults who receive day service supports and as day service locations vary enormously in size and capacity. Of this 19,000, approximately 5,000 people receive a day service as part of their residential placement.

While I would like to fully reopen services to pre-Covid levels, we have to be mindful of public health advice and protecting service users and staff. We should be thankful that the spread of the Covid-19 in disability day services has been relatively low compared with other sectors. Unfortunately, there have been 14 deaths associated with disability day services, which is 14 deaths too many. I pass on my condolences to the families who have had to say goodbye to loved ones. We must ensure that the spread of the virus is kept low. The stepped approach to building the services back up allows us to do this. I genuinely do know that this is not ideal and that it is a hard balance to strike.

In July, I tasked the HSE with setting up a portal on its website detailing when each service would open and the level of service it would be providing. This allowed people to see what level of service providers would be able to offer as a baseline. It was just a baseline to see what could be done to just open the doors after coming through Covid.

Day services reopened at approximately 38% capacity throughout August and early September and school leavers who require a day service were also introduced to their new services during this period. The guidance developed to support the resumption of adult day services has had to take account of social distancing rules, meaning that there are a reduced number of people in each service location. Ongoing challenges include the physical limitations of the buildings available, the lack of mainstream community activities, and the continued restrictions imposed by social distancing guidance.

Social distancing is only one factor in the reduction of capacity in services. As I have said, day services have been developed in line with New Directions, which advocates that, where possible, supports to people should be provided in the wider community. For example, a day service hub may have 50 adults in attendance but there may be only 25 people in the building at any one time. The infrastructure is therefore developed to accommodate 25 adults in the building at any time. With social distancing, this may result in a situation where perhaps 12 to 15 people can now be in the building at any one time. Attendance at gyms, swimming pools and other community settings is, of course, subject to restrictions based on public health guidance. This means the capacity of these locations to accommodate day services users is also reduced. All locations are different in size and serve adults with different needs, so there will be differences in the amount of community-based supports that people can now get during the Covid pandemic. This has also contributed to the reduced service capacity we now see, about which Senators are now getting representations and about which they are talking to very frustrated parents.

The HSE is, however, committed to maximising the support that can be provided within these restrictions and a number of innovations have been developed to augment traditional service provision, such as online and in-home support. When we talk about day services, we are talking about in-service support and the outreach model. This outreach model was developed during the lockdown to allow the most vulnerable and their families to be supported.They have continued to be supported and enhanced since the reopening of day services. The HSE is also constantly monitoring the relevant public health guidance, and other developments in this regard may increase day service capacity in the future. As the guidance changes, service levels will evolve accordingly.

I understand the frustration of day service users and their families because services have not resumed to pre-Covid levels. My office has been inundated with queries about adult day services and the main question people ask me is when day services will increase. This is a complex question to answer. However, finding a solution has been my absolute priority since taking office.

The programme for Government makes extensive commitments to improve the lives of people with disabilities. I can assure the House that this is always to the fore. In July, the Government reversed the 1% cut to the sector which was worth approximately €20 million. In September I allocated €10 million for the reopening of services and increasing services by one day for users. That came on the back of the portal where we knew exactly what was required for services to open at a baseline. We built in the one day and that was provided for in the budget to the tune of €100 million.

The amount involved was not just € 7.5 million. Buying an extra day of services costs €30 million over a full year. Service users who got two days should now be getting three days and those who got three days should now be getting four. The objective at all stages is to return us to, at minimum, 50% capacity.

Another €7.8 million was provided to tackle the assessment of needs backlog. This totalled an investment in disabilities of €37.8 million before the budget was announced. I could not talk about that figure before budget day for fear that it would undermine what I got in the budget. What I secured before budget day was €5 million above what was allocated in the previous year's funding. 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 office.

Budget 2021 was announced last month. Significant money was secured to start delivering on the programme for Government commitments. I secured an additional €100 million for new initiatives in 2021, bringing the total disabilities budget to an unprecedented level of around €2.22 billion.

Regarding day services specifically, the additional investment will continue to build the capacity of our adult disability services and increase day services by one day a week. It will also support around 1,700 young school leavers who are part of training programmes in 2021.

I would also like to note that, in line with the Government's resilience and recovery framework for 2021, the provision of disability services is regarded as an essential service. This is the same as schools and crèches, and it is our intention that day services will remain open at each level of the resilience and recovery framework, subject to public health guidance. While I have spoken about day services today, we are still working to ensure that we can deal with respite and overnight care.

When I took up this office over the summer disability day services were closed. I am pleased to see the fruits of the intensive work between the Department, HSE, service providers and co-operation with parents. Day services have now been opened and are seen as an essential service.