Anne Rabbitte (Galway East, Fianna Fail)
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I wish to thank the Minister of State for raising this matter.

Residential Services make up the largest part of the Disability funding disbursed by the HSE, 58% of the total budget. As of April 2024, approximately 90 service providers provided residential services to 8,484 individuals throughout the country.

As Minister of State with responsibility for Disability, I am aware that there is a need for increased service provision within the disability sector and I have fought tirelessly to bring an unprecedented level of funding for specialist disability services.

The overall increase in recent years from €1.7 billion at the close of 2017 to close to €2.8 billion in 2024, reflects this Governments commitment to improving the lives of people with disabilities, signalling to those with a disability that this Government is serious about making a difference.

Residential Placement Delivery

Across the four years from 2020 to 2023 budget, this Government have provided funding to the HSE for additional residential placements both on a planned and emergency/priority basis through the National Service Plan (NSP), to deliver the following:

• NSP 2020: 56 new Priority 1 (Emergency) residential placements. 86 placements were developed.
• NSP 2021: 44 new Priority 1 (Emergency) residential placements, 68 planned residential places (102 total).
• NSP 2022: 50 new Priority 1 (Emergency) residential placements. 66 planned residential places (106 total)
• NSP 2023: 43 Priority 1 (Emergency), 23 residential packages for young people aging out of TUSLA placements, 18 delayed transfers of care in line with the Winter Plan. At the end of December 2023, 160 Priority 1 (Emergency) Residential Places were developed. This is significantly in excess of the NSP target of 43.
• NSP 2024: circa 100 new Priority 1 (Emergency) residential placements.

It is important to note that residential capacity in the system can be reduced. When residents of congregated settings sadly pass away, their places are not ordinarily re-utilised. This is in keeping with Government policy which is to move away from institutionalised settings.

Under 65’s in Nursing Homes

For some people under the age of 65, nursing homes are not an appropriate setting. The HSE Disability teams are identifying people under the age of 65 currently residing in nursing homes. The HSE are working with them to discuss their supports required to move into more appropriate community settings or to enhance the quality of life for those who will be continuing their nursing home placement in line with their will and preference.

In 2021 Government provided investment of €3 million to enable people under the age of 65yrs to transition to their own home with support. Budget 2022 provided a further allocation of €5.5 million (rising to €13.5 million in 2023), to address the situation of people with disabilities who may be inappropriately placed in nursing homes. Budget 2024 provides the basis to continue to improve access to enhanced disability services throughout the country.

The HSE is engaging with a cohort of 575 individuals for review and assessment for transition into the community or continued nursing home placements. As of April 2024, A total of 74 people have transitioned to homes of their choosing in the community since 2021 (the start of the programme). A further 55 individuals are in active planning for potential discharge. Additionally, 36 individuals have received additional enhanced quality of life supports, while they are currently continuing their placement in a Nursing Home.

Time to Move from Congregated Settings

Time to Move On from Congregated Settings (TTMO) – A Strategy for Community Inclusion was established under the Transforming Lives Programme. It is a model of support where people with disabilities are supported to move from congregated settings, often large institutions, to their own homes in the community, with the supports they need.

Time to Move On from Congregated Settings is progressing and continues to demonstrate very positive results for service users who have transitioned to living in homes in community settings. Progress made since the Time to Move On report (2009) shows that:

• 4,099 people were living in congregated settings at year end 2009
• By year end 2023, 1,532 people remained in congregated settings.
• 74 people moved from congregated to community settings in 2023, against an NSP target of 73 for the year.

The 2016 Programme for Government identified that there should be a one- third reduction in the number of individuals residing in congregated settings by the year 2021. This target has been met.

Assisted Living – Intensive Support Packages

In 2020, the HSE developed Intensive Support Packages, a new development initiative. The rationale behind the initiative was to demonstrate a person-centred approach to targeted supports designed to maintain the person in their own home and community.

These intensive transitional support packages, as referred to in NSP 2020, were mainly aimed at children and young people with complex/high support needs experiencing substantial levels of need, but who do not, as yet, require a long term residential placement. Intensive support packages are provided in addition to the traditional services, such as Day Services; Respite Services; Personal Assistance and Home Support Services.

In 2020, Disability Services committed to provide 144 intensive transitional support packages. However, at end of December 2020, a total of 857 intensive home support packages were developed across the 9 CHOs.

In 2021, €6 million in funding was allocated to Intensive Support packages. Disability Services committed to developing 358 additional intensive support packages and by year end had put in place 497 intensive support packages. This included 437 new packages and 60 packages approved in 2020 against additional Q4 funding, which were maintained in 2021.

The significant increase on the NSP targets was thought to be indicative of the requirement for additional in-home services to compensate for the reduction in the delivery of traditional respite services as a result of the Covid-19 pandemic.

In accordance with the NSP 2022, the HSE was allocated funding to provide 422 in home respite supports for emergency cases; this included 402 packages put in place in 2021, which have been maintained in 2022, plus 10 new supported living packages and 10 new intensive support packages to support transitions and discharges from acute services and the National Rehabilitation Hospital. At end of December 2022, 18 new intensive support packages and 19 new supported living packages were developed. As per the 2022 National Service Plan, funding for this was provided under all new measures.

In accordance with NSP 2023, Disability Services committed to the provision of 447 in home respite supports for emergency cases; this includes 420 packages put in place in 2022 which have been maintained in 2023, plus 27 additional in-home respite packages to children and young adults outlined in NSP 2023.

In 2023, we also developed a further 45 in home respite supports for Priority 1 cases, which added to the packages put in place in 2022 and were maintained in 2023, brings the number of in home respite supports for Priority 1 emergency cases delivered during the year to 465.

In accordance with NSP 2024, Specialist Disability Services is committed to providing 469 intensive support packages for priority 1 cases. This includes packages put in place in 2023 which have been maintained in 2024.

Future Planning

This Government is committed to the expansion of specialist services for people with disabilities. The Action Plan for Disability Services 2024-2026, which I published on 14th December 2023, represents a national strategy for capacity increases and service and policy reform in disability services. It was informed primarily by findings from the Disability Capacity Review, published in 2021. The Action Plan seeks to meet extra need over the 2024-2026 period in residential services through:

• Around 900 additional residential care places to tackle unmet needs and ensure supply keeps pace with demographic change;
• 500 new community-based residential care places to replace disability care in large institutional and campus-based settings, with a view to ending that form of provision by 2030;
• Increase support for people with disabilities to access supported independent living
• Provision of supports to live at home, in order to phase out long-term care in a nursing home for younger people with disabilities
• Around 550 additional intensive support packages to be put in place over 2024-2026, to limit need for high-cost residential care places.

€74 million has been allocated for new development measures in 2024. This will provide for greater investment across a range of disability services and contribute to the progressive realisation of the Action Plan. Of this, €20.5 million has been provided for circa 100 Residential placements for children and adults.