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Dáil Éireann debate -
Tuesday, 11 Feb 2003

Vol. 561 No. 1

Other Questions. - Services for People with Disabilities.

Richard Bruton


99 Mr. R. Bruton asked the Minister for Health and Children the assessment of the needs of institutions catering for people with an intellectual disability before responsibility of which was transferred from his Department to the health board; the scale of the needs gap in staff and in funding identified in absolute terms and as a percentage of existing services for each health board; and the extent to which that gap has been filled to date in each health board area. [3299/03]

The first health strategy, which was published in 1994, proposed that responsibility for certain voluntary organisations, funded at that time by the Department of Health and Children, should be transferred to the health boards. In the area of services to persons with an intellectual disability and those with autism, this process began in 1998 with the transfer of the relevant organisations in the Southern and Mid-Western health board regions. The process continued in subsequent years and was completed in 2000 with the transfer of formerly direct-funded organisations in the Eastern Regional Health Authority region.

In addition to providing funding to put in place new service developments to meet identified needs in relation to residential, respite, day and other support services, funding has been provided to meet identified needs in existing services. These needs arise as a result of the changing profile of persons with an intellectual disability or those with autism in the services, in particular the residential services, which has resulted in an increasing number of older and medically fragile persons. They also relate to issues such as underfunding of base budgets, including the need to consolidate elements of services previously funded from sources such as fundraising. My Department has sought over the years to address these issues as resources have permitted. It was agreed that this process should continue, albeit through new, more appropriate mechanisms, as part of the transfer process.

Between 1998 and 2002, additional funding amounting to €27.2 million was allocated to services to persons with an intellectual disability and those with autism to meet identified needs in existing services. The estimated costs associated with meeting those needs in respect of the former direct funded voluntary intellectual disability services is approximately €26 million. This is based on the costings agreed at the time of transfer with each of those agencies. Between 1998 and 2002, approximately €17 million of the €26 million was allocated specifically to meet those needs. The balance was allocated to services provided by the health boards and other voluntary service providers to meet similar needs within their services.

Additional informationI have asked the health boards to provide my Department with the more detailed information by health board region which the Deputy has requested and I will forward it to him as soon as it becomes available.

The overall economic position in 2003 has had implications for all aspects of public investment, and this is reflected in the Estimates and budget adopted by the Government for 2003. Within this overall framework, however, two thirds of the additional funding available for non-capital investment in services has been allocated to the health services. This funding is being applied largely to maintain existing levels of service across all service programmes, including services for people with an intellectual disability.

Between 1997 and 2002, an extra €188 million revenue and €139 million capital funding has been provided, making a total additional investment of €327 million for the maintenance and development of services to persons with an intellectual disability and those with autism. In the current year, further additional funding of €13.3 million has been allocated to services for persons with an intellectual disability or autism to meet the full year cost of the 2002 developments and to further enhance the health related support services to children with an intellectual disability or autism. This funding brings the total extra investment in these services to €340 million over seven years. Of this total, more than €200 million has been built into the ongoing budget base. This funding has brought about very significant and unprecedented developments in the services.

Between 1997 and 2002, approximately 1,700 extra residential places were provided, with most of these based in the community. This figure includes new residential respite places which were developed in 1997 and 1998. Between 1999 and 2002, approximately 465 dedicated respite places were also provided. In addition, the period 1997-2002 saw the provision of approximately 2,950 new day places.

Despite the significant investment over recent years, demographic factors are contributing to growing waiting lists for residential services in particular even though the number of people in receipt of services, including full-time residential services, continues to increase. The increased birth rate in the 1960s and 1970s has resulted in large numbers of adults in their late 20s and early 30s requiring full-time residential services. In addition, people with an intellectual disability are living longer than previously, adding to the need for services compared to previous generations. This has also been the international experience in service provision for this population.

While it is regrettable that the level of investment in these services achieved in recent years could not be maintained in 2003, my Department will work closely with the health boards and other service providers in relation to service provision this year.

I thank the Minister of State for his reply. The question arises from my experience of agencies such as St. Michael's House and the Order of St. John of God, but the worst case relates to Drumcar. Is the Minister of State happy that sufficient progress is being made to fill the funding gap of €26 million for existing services? Is he saying four years into this process that there is still a shortfall of €10 million, which should be provided to ensure services reach an acceptable level? Will he give a commitment that the gap will be filled rapidly? Will he assure the House there is absolute equity in regard to the allocation of the moneys because there is a sense that some health boards, blessed by the presence of a Minister in their area, have better access to resources than others?

I have sought more detailed information from the health boards and I have requested that it should be sent directly to the Deputy. I am happy that all health boards have been and will be treated equally. They will not be responded to on the basis of whether there is a Minister in their area. I am happy with the progress that has been made but there have never been sufficient resources for people with disabilities and the progress, therefore, is not acceptable to any of us. However, over the past five years substantial progress has been made, much more than in any other period in the history of the State. I am happy that the Government will continue to make extensive progress in this domain.

I must explain to a constituent whose 29 year old son is in Drumcar, for example, that the institution is 90 staff short. How can the Minister of State say acceptable progress is being made when such people ought to have access to an acceptable level of service to meet their base needs? This is the bedrock with which they should be provided. How can he accept a scenario where the providers of these crucial services must turn people away because they have nowhere to place them and are under-resourced? This issue must be given greater priority. Will the Minister of State, who is new, and the Minister make com mitments that funding will be made available for institutions such as Drumcar?

I inherited the Drumcar case. There have been problems in that institution for several years. Discussions have taken place between officials in my Department and the relevant health board and I am satisfied progress has been made. There will be more meetings this week and I am confident sufficient progress will be made, although perhaps not on the 90 vacancies.

Perhaps the Minister of State will also forward details of those meetings if he can.