Mary Moran (Labour)
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I welcome the Minister of State to the House. I wish to raise the severe cutbacks to the service provided by St. John of God services in Drumcar, County Louth, and the effect this is having on the users of the service. St. John of God north-east services provides for the care of people with an intellectual disability and this year alone the cutbacks to the service amounted to €1.5 million. Since 2005, the cutbacks have come to over €4 million.

I have first-hand experience in witnessing how the staff there have continually implemented increased efficiencies, including taking on additional responsibilities. One of the respite care workers told me that shower facilities, including gel and shampoo, used to be provided but the staff, on their own time, now buy shampoo to take in for the children or adults in respite. They have done everything possible but at this point they can no longer deliver the previous levels of service. The users and their families are now being hit with these cuts.

In the residential services alone, it will not be possible to accept any more admissions without specific funding for such places, and I and other colleagues have raised this in the Seanad in the past couple of weeks. Currently in Drumcar there are 60 people on the waiting list, with seven in need of immediate placement. There are people in need of residential care and I am fighting hard for one particular family where a daughter is paraplegic and needs percutaneous endoscopic gastrostomy and 24-hour care. However, there is no place for her and age is not on the parents' side. The mother's health is also suffering, although she is providing 24-hour care for the daughter because there is no residential place available.

Since 12 June there is only one respite house in operation, while previously there were two working. As a parent of a child using the respite services, I am gutted, as are the other parents who have come to me. The children would have had access to respite every month before but respite for children is now down to ten days in the month and available for 20 days for adults. Dividing that between the 80 children seeking the services, it results in one day every eight months. People live for respite as it is the only break they get. With all the implementation of such cutbacks, if we do not seek something to alleviate the pressure in St. John of God, it will only add to the mental health issues of families and people helping to care for the service users.

The places for day services are now full; specifically, the Drumcar Park Enterprises and Venegas centres, where students would traditionally go, are full. In a recent letter received by parents from the St. John of God services, it was hesitantly indicated that there were suggestions in some forums that a way around the difficulty would be for a client to have two days of day services one week and three days the next. Thank God, it was mentioned that it is not their intention to implement this system immediately, as it would be a detrimental move. Any children leaving school at 18 know that if they fill in a CAO form or college application, they know where they are going. It is awful that the most vulnerable children are being hardest hit.

The St. John of God services also used to traditionally give a weekly allowance to clients. It was a pittance but it meant much to those people, bringing a feeling of independence. The clients cannot understand how they have lost what they call their money for their work, or the part-time jobs in some of the service units within the St. John of God service.

I fully support the Minister of State, Deputy Lynch, and the Government in the policy in the programme for Government to maintain people in their own homes and communities for as long as possible. In order to do this, there should be adequate support. That is where respite options come in, and people can do it if they know they will get a break. That might only be one or two nights a month. Traditionally, respite services used to be able to offer parents of children and adults two weeks holidays during the summer that could be spread out but that cannot happen. If there is a family emergency, there is no guarantee that respite will be available. When a person cannot feel there is somebody to help in an emergency, it can be very scary.

Brian Hayes (Dublin South West, Fine Gael)
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I thank Senator Moran, on behalf of the Minister of State, Deputy Kathleen Lynch, for raising this matter and I am pleased to take this opportunity to outline the current position regarding St. John of God north-east services. As the Senator is aware, St. John of God services provides services to adults and children with an intellectual disability. These services include residential, respite and day services. St. John of God north-east services is funded by the HSE under section 38 of the Health Act, 2004. Services are provided through a service arrangement which is signed on an annual basis and reviewed continually. St. John of God north-east services received significant funding from the HSE of €27.7 million in 2011.

As the Deputy is aware, the disability budget nationally was cut by 3.7% in 2012. The Health Service Executive national service plan states that at least 2% of this should not impact on services and needs to be generated from other savings and increased efficiencies. The HSE has advised me that there will be a maximum reduction of 1.7% in the funding for day, residential and respite services in the north east. The HSE is working in Dublin north east to address the 2% savings required by improving integration of staffing levels and skill mix between day, transport and residential respite services to achieve cost reductions safely, with minimal impact on front line services. The HSE has assured me that it will endeavour to ensure that residential, day, respite and personal assistant services are protected where possible from reductions in front line services. However, some reductions in services will be unavoidable, even with such efficiencies. The aim will be to tailor such reductions in a way which minimises the impact on service users and their families as much as possible.

As a first step, the HSE has indicated a general reduction of 3.7% from the budget of disability agencies, pending the outcome of its discussions at a local level with individual agencies. I recognise the valuable contribution St. John of God services make to the provision of services to people with intellectual disabilities in the Louth, Monaghan and Meath areas. The HSE is very much aware of the challenges service providers, including St. John of God north-east services, are experiencing, and the particular difficulties facing all health services in 2012. It is vital that all providers work creatively and co-operatively to ensure the maximum level of services is maintained for service users within the funding resources available. In this context, the HSE is in ongoing active discussions with St. John of God services to minimise the impact of the budget reductions on services and clients.

Mary Moran (Labour)
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The Minister of State spoke about minimising the impact, but a huge impact is already being felt. We are trying to keep everybody at home for as long as possible but reductions in services such as this will very often push families into making decisions about having to seek residential care for elderly parents who need care. They would prefer to look after them at home but cannot do so without support.

Brian Hayes (Dublin South West, Fine Gael)
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The Minister of State, Deputy Kathleen Lynch, more than anyone understands.

Mary Moran (Labour)
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Absolutely. She does and I agree with the Minister of State on this. I know how difficult the situation is but we need to keep highlighting it.

Brian Hayes (Dublin South West, Fine Gael)
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She more than anyone else understands the importance of respite care and its necessity in the range of services being provided for people in this situation. I know this from my constituency. The crucial issue is how to maintain front-line services while ongoing cutbacks are being made. Many of these decisions should be left to local areas to determine. In so far as the Government is concerned every effort will be made to minimise the impact on local communities. I appreciate the difficulty faced with regard to the budget and the impact it has across a range of services, particularly on providers. This is why the view of the Minister of State, Deputy Lynch and the Minister, Deputy Reilly, is to examine how to ensure people work creatively with the budgets that exist. The reductions being made are significant but they are smaller than in other areas. The question must be posed as to how we reconfigure the service and examine the issue of pay again to ensure the front line remains in place and the services exist for those who need them. This must be the priority for us all.