Disability Bill 2004: Report Stage (Resumed).

Debate resumed on amendment No. 38:
In page 10, to delete line 6.
—(Deputy Stanton).

I am glad the Minister of State has arrived for the debate. Significant bureaucracy is being built up around the Disability Bill and this amendment represents a way of reducing it. There is fear among those concerned that a disproportionate amount of resources will be devoted to administration. An example of this is the provision for the appointment of assessment officers and liaison officers. This amendment proposes that one person should perform both these roles rather than passing files back and forth between different people and so on. I raised this issue with the Minister on Committee Stage.

Notwithstanding my proposal for a new joint role of needs officer, another issue is the question of how the liaison officer is to reconcile the needs of the person with the resource constraints that will arise. The Bill fails to spell out a method or criteria for doing this. Liaison officers will have real difficulty in performing this function because the budgets of the executives will fluctuate. How are they to know what limits should apply? This is an issue that must be considered.

The structure of the legislation may indicate that inadequate weight is given to the constitutional rights of those with disabilities. The Minister of State fudged this point yesterday in his observation that there are people making money through a manipulation of constitutional rights. However, the Constitution is a vital document that outlines the fundamental rights of every citizen. Under the Constitution, the Supreme Court is the body charged with its interpretation. I respect the Constitution and the judgments that flow from the Supreme Court. I would not contend that many people are making money through a manipulation of the Constitution's provisions. We are all in trouble if the Constitution is thrown aside or fails. It is the basic safeguard for every citizen and that is its function.

It might be argued that, by failing to spell out the principles and policies on which a liaison officer is supposed to exercise his or her discretion, these officers are delegated excessive powers. This arises from Article 15.2 of the Constitution. We must be careful about what is allowed, particularly in terms of the role of the liaison officer. These are serious matters concerning bureaucracy and assessment and liaison officers. The degree of bureaucracy might be reduced if one person did the job of both liaison and assessment officers. The question also arises under this legislation as to the method of operation of the liaison officer.

This amendment seeks to make sense of the Bill. It is incredible that the officer who performs an assessment will take no account of the availability of resources. The assessment is then passed to another officer who must take this availability into account. The Minister accepts that this Bill will be dependent on capacity, which we all know is not sufficient. There is not a sufficient number of physiotherapists, speech therapists and psychologists to provide the service required under the service statement — we are all aware of that.

The disability community, which held consultations with the Minister over two years, has also accepted that capacity will not be immediately available but it is prepared to allow it to be developed where shortages exist. I do not understand why, for example, the liaison officer cannot take that into account as part of an ongoing process as opposed to once off. Services which are unavailable will not be itemised, which would permit a return to the issue at a later date, at which time services might be available for one hour or three hours per week, or whatever. I do not understand why that provision cannot be included.

The Opposition is making genuine efforts to prevent the bureaucratic mire, which will be introduced by this Bill, from bogging everyone down. It is incredible that layers of bureaucracy are being created, with no indication that services must be provided. That amazes me. The Minister of State will tell me about the €900 million in the roll-over programme for the next five years.

I will not.

Has the figure increased? I would accept that argument if the money which was supposed to be made available this year was allocated, but the Minister of State accepted that did not happen. Areas now experience cutbacks because money is not flowing as it should. I am not saying that the money is not available, but that it is not allocated as it should be. There is already a difficulty with funding. If, as a representative group, we were discussing rights for women, men or children, we would be jumping up and down and screaming that this is not good enough.

The psychology of the consultation process was devised by an expert in managing people. The disability community has been extremely patient and respectful of this process. We need to recognise that this patience should not be taken as capitulation. We should take the steps necessary in terms of the bureaucracy represented by this Bill. People who, despite having a statement to hand, will be told services are not available. The liaison officer rather than the Government will take the blame for the unavailability of services because there is a natural tendency to blame the person standing in front of us. This structure needs to be addressed because, while the majority of disabilities are physical, a substantial number who suffer from intellectual disabilities will find the process confusing. Despite insisting in a civilised society that such people are treated as adults capable of making decisions, we put in place a system that is designed to delay and confuse people. I support Deputy Stanton in this matter.

I support amendment No. 40, which is an important one that deals with the question of needs and the reasons for needs officers. It also deals with the issue of bureaucracy, about which many of us are concerned. We are concerned about the way in which money has been spent on services over the past nine or ten years. People on the front line, particularly families of people with disabilities, have concerns about value for money and the level and efficiency of services.

Debate on amendment No. 40 should focus on the needs of people with disabilities. The Taoiseach recently announced the spending of €3.7 million on the development of a swimming pool at St. Michael's House, and I wish him well in that, but 548 people remain on waiting lists for the services of that centre. Of these, 263 are categorised as priorities, which means they are urgently awaiting a place. When the broader figures on needs are examined, these account for 40% of the total number awaiting residential placement in the HSA eastern region.

The provision of priority services for adults with intellectual disabilities whose parents are seriously ill or dead is a major issue. People in their 80s and 90s are trying to care for intellectually disabled adults in their 40s. It is sad that the resources and services are not available to guarantee that safe residential accommodation will be provided. Some parents are forced to accept a low level of services. I raise this issue in the context of the needs of people with disabilities. Amendment No. 40 is important because it addresses the issue of needs officers and I urge my colleagues to support it.

I support the provisions set out in amendments Nos. 38 and 40. I had intended in quite a number of amendments to promote the establishment of an independent disability support service as outlined in the document, Equal Citizens. The Ceann Comhairle has ruled all such amendments out of order. While this action may have been correct under Standing Orders as the amendments implied a charge on the Exchequer, I continue to believe that if the Minister of State had considered the proposal on Committee Stage or during drafting, he would have realised a support service would be more cost-effective and efficient and less bureaucratic than the approach in the legislation.

Ruled out of order were amendments Nos. 30, 33, 40, 60, 69, 70, 72, 86, 89, 94, 97, 107, 123, 126, 127, 141, 146, 148, 150 and 155 to 158, inclusive. The number of amendments demonstrates that those who support me on this matter — and I — put time, effort and thought into the promotion of an independent disability support service. It is not something we dreamed up. The service was a key recommendation of the DLCG and should have been a crucial subject of debate on the Bill's provisions. As I have been prohibited from moving my amendments, I indicate my support for the amendments tabled by colleagues on Part 2 of the Bill. I will support amendments Nos. 38 and 40 up to and including amendment No. 154.

We took a different approach by trying to gut the legislation wholesale and revise it to reflect our view that its provisions were irredeemable and that the rights-based model proposed by the Commission on the Status of People with Disabilities and the DLCG in its document, Equal Citizens, should be implemented. I recognise, however, that the proposals of Opposition colleagues represent an improvement on the Government's fundamentally flawed formula as set out in the Bill.

I will continue to fight to raise the issues I have addressed in amendments. It is ridiculous that Standing Orders allowed the majority of my amendments to be ruled out of order on the grounds of a cost to the Exchequer. While everything we debate involves a cost to the Exchequer, the Opposition is precluded from discussing provisions that could prove more beneficial in the long run than those the Government proposed. We should change the relevant Standing Order to facilitate proper debates on legislation and allow us to put forward constructive, far-reaching amendments to improve this legislation in particular and other legislation in future.

I support amendments Nos. 38 and 40 and use the example of a reply I received to a parliamentary question to demonstrate why. The area from which I come is a developing one like most of those on the east coast. I asked the Tánaiste and Minister for Health and Children a question which she forwarded to the Health Service Executive on the failure to fill approved posts in speech therapy, occupational therapy and other front line services in Kildare. Parents have been the advocates while needs officers have represented the points at which advocacy and the putting in place of services was to have happened.

Due to the failure to fill approved posts, a child in my area who is in school in a neighbouring county could not access speech and language services in her home area while other children attending the school could access such services in theirs. In trying to unravel the problem, I asked the Tánaiste and Minister for Health and Children why staffing for front line therapy services in County Kildare delivered by the eastern regional area of the Health Service Executive has not increased since 1996 and whether an embargo is in place. An embargo would make a very direct difference to the ability of people to access services. The reply informed me that the public service had to be reduced by 5,000, which statement seems to be chapter and verse. I have read it several times elsewhere. According to the reply, the staff employment ceiling notified by the Department of Health and Children has lessened the numbers employed on 31 December 2002 and it has not been possible for the Health Service Executive to fill approved posts.

As the approved posts in question are in speech and occupational therapy, it is difficult to understand how the Bill will make a difference when other Government decisions create an impediment to its implementation. While I have other examples of practical problems, that one is especially illuminating. As the child to whom I referred would do very well if she received speech therapy, I cannot understand why its provision is not seen as an investment with the potential to deliver a return. While we have no difficulty in seeing a return on assets, it does not appear that there is any expectation of a return on investment in the adoption of a rights-based approach. If an investment were made in her needs, the child in question would have the potential to live a much more independent life.

While a needs officer is required to press for such services, it will be especially difficult to achieve in developing areas in which an embargo on recruiting obtains. Whereas in other areas populations are in decline, in Kildare needs are expanding but services are not. It is a crisis. While we do not have a problem adding another Deputy to the constituency, which is welcome, on foot of the increase of 50,000 in the population, we cannot add an extra speech therapist due to the embargo on public service recruitment. It is not the approach to take.

Hear, hear.

The amendments seek to unite the functions of the assessment officer under section 8 and the liaison officer under section 11 under the title "needs officer". While I have certain sympathy with the thrust of the arguments put forward, the House will be aware that an assessment officer has statutory independence to identify the individual needs arising from an assessment without regard to resources. The DLCG argued forcibly that the person who carries out the assessment should be independent of the person who provides the service. If the same persons did the two jobs, there would be an inevitable tendency to match assessments to available resources. It was specifically at the demand of the DLCG that we made the assessment officer statutorily independent so that the assessment would not in any way be affected by or predicated on resources. The liaison officer on the other hand must take a range of practical considerations into account to determine how needs can best be met within the resources available. To do this the liaison officer would be operating as part of the HSE, taking into account the practical limitations that exist in providing services. The two roles are fundamentally different. I hold the view that it is in the best interests of people with disabilities that they remain separate.

I take the point made by Deputy Stanton and other Deputies that to ensure we have a seamless system that is not overly bureaucratic both roles could be combined in the person of a needs officer. The whole thrust of the roll out of the regulations is such that every effort would be made to ensure a person-centred approach to the assessment, the liaison role and the creation of the service statement.

In the roll out of the regulations the HSE is most anxious to ensure that the least possible bureaucracy is in place so as to ensure a seamless approach to those roles. It is important given the demand of the disability organisations that we do retain the statutory independence of the assessment officer from the more practical implementation role that the liaison officer will have. I have listened carefully to what was said. We are in discussion with the HSE on how this would happen. I did promise to keep the House informed of the progress that is being made and I hope to be in a position to refer to some of that at a later stage in the debate this afternoon or tomorrow.

I congratulate Deputy Catherine Murphy on her election to the House. In one of her first contributions she has raised the important issue of the impact of the embargo on the appointment of staff in this area. I will ask the Department of Health and Children to give us specific advice on the issue raised. The embargo applies across the spectrum. However, due to the major reorganisation of the health service that is taking place under the HSE which will bring about a reduction in certain kinds of posts it will facilitate the creation of posts in the disability sector. I accept her point and will refer the issue to the Department of Health and Children. As the debate proceeds I will keep her informed as to how the embargo will impact on the appointment of staff to extra posts, which as she stated have been approved by the Department of Finance as a result of the investment package in this sector. All of us want to ensure that if posts are approved we can get around the embargo difficulties in some way. I will address the matter on foot of further advice from the Department of Health and Children.

I thank the Minister for his response. The issue is that two functions are involved. One function will be delegated to the assessment officer who shall be independent in his work. He or she will have to take an overall view of the needs of an individual with a disability. The Minister has not explained how the liaison officer will perform his or her functions. How is he or she to reconcile the needs of the person with the resource constraints? The proposed legislation does not spell out how that can be done and it is important that we would be informed as to how liaison officers would operate. Liaison officers are being given extensive powers under the Constitution which, in effect, are ministerial powers. Many different issues are involved in this regard. How will resource constraints be reconciled with the needs of the person? We are dealing with the budget of the Health Service Executive. Many people will be drawing on this budget at any one time and it will fluctuate. The Minister must provide clarity on this issue and tell us how it will be done.

A professional person should not have difficulty in carrying out an independent, objective assessment. Neither should he or she have any difficulty in examining what services can realistically and practically be provided.

There will not be.

I want to keep my train of thought on this point. What will happen is that a family or a person with a disability will have to interact with two officials when one person could easily do the work. It would be preferable for one person to get to know the family and the needs involved rather than for a second person to have to go over the same ground. We should examine the possibility of having one person do the two jobs outlined in the Bill. According to the wording in the Bill the HSE could appoint one person to do both jobs. That is not prohibited in the Bill.

The amendment is sensible. A person with disabilities would meet an assessment officer who would draw up a service statement. A liaison officer would not be sitting outside the door of the assessment officer so that he or she could immediately act on the service statement. The proposed system would cause delays, additional journeys and confusion. In the first instance a person would be presented with a statement meeting all of their needs. He or she would then have to wait a month or two months to get an appointment with a liaison officer who would inform him or her that it is not possible to provide everything that is specified on the service statement. That does not make sense. I would prefer if we did not have to take account of what resources are available. However, people would manage to deal with that. It appears to be a waste of effort and money to do it in this manner when there would clearly be no benefit to the client.

I will reiterate what I said at the outset of the debate on this amendment. What is being suggested is a compromise on what the DLCG sought which was a disability support service that would have the dual functions, which Deputy Stanton outlined, of advocacy and needs assessment and ensuring that the required services are delivered. It is a pity the Minister of State did not adopt that approach. Had he done so, a considerable cost would not be imposed on the Exchequer and there would not be such a considerable amount of bureaucracy, nor would there be such a delay between the making of an assessment and the delivery of service.

If a single body were responsible, it could carry out both functions at once. It would be able to source the services required and indicate the nature of these to the individuals being assessed and their families. This would prevent the assessor from having to type up the assessment and consult somebody else thereon, after which, at some future stage, the services would be delivered. In some cases, they might never be delivered because they might not be available. It is a pity that the Minister of State did not accept the proposal for a disability support service. By way of compromise, I fully support amendments Nos. 38 and 40.

On Deputy Stanton's question, which embraces the issues raised by the other speakers, the role of the assessment officer is to operate within the Health Service Executive system to identify the series of services that can be provided from within existing or planned resources. The HSE is working out the detailed arrangements for the practical implementation of the legislation. It is responsible for defining the relationship between the assessment officer and the liaison officer.

Nothing in the Bill precludes the HSE from ensuring a relationship exists between the assessment officer and the liaison officer. The HSE has already pointed out that the assessment is the initial stage of intervention and that it is therefore important that the assessment and the intervention are not divorced from each other. It is also important that those carrying out assessments are aware of and involved in current practice. As I said on Committee Stage, it is emerging from the HSE — its discussions in this regard are at an early stage — that there will be a person-centred, seamless approach to the assessment, the liaison procedure and the preparation of the service statement.

One of the difficulties is that the process of assessment is to be independent. The DLCG demanded this. Therefore, there must be a gap between the independent statutory officer making the assessment and the liaison officer who is rolling out the service. In response to a fair point made by Deputy Stanton, in the practical roll-out of services one can retain the statutory independence of assessors and, at the same time, ensure that a very good working relationship exits between them and the liaison officers. There is no doubt that, in some cases, assessment and intervention will be inseparable. We will discover this as we engage in the practical implementation of the legislation.

The Bill seems to demand that we have two separate people doing the two separate jobs. This means a person with a disability will have to interact with two separate people although one person could, quite reasonably, do both. Under the law, the assessment would be carried out impartially and objectively. The liaison work would also have to be carried out as laid out in the legislation.

This Bill has been criticised for its cumbersome administrative framework. We are all concerned about this and Deputy Lynch expressed this concern extremely well. We all have experience of bureaucracy feeding on itself. I am not finding fault with the people involved but once one sets up a bureaucracy with different layers, one is invariably creating circumstances in which an increasing number of people will be writing and sending reports to each other and doing extra, unnecessary work although one person could do it all. One person could become familiar with the case of a disabled person rather than having a second person become involved also. We are creating a monster for which there is no need. I will be pressing my amendment. The amendments we have discussed are reasonable. We need only one needs officer to interact with the disabled person.

I will ask the Minister of State once more a question that I have asked him three times but which he has not answered. How is the liaison officer supposed to reconcile the needs of the person with the resource constraints? The legislation spells out no criteria for doing so. Is there any answer to my question or is it just a sticky wicket which the Minister of State is glossing over? The issue is important. Much discretion and many powers of delegation are left to the liaison officer. The budget exists, it is a moveable feast and we do not know how the process will work. People are concerned about this. I intend to press my amendment.

With respect to Deputy Stanton, I have answered the question. The liaison officer must take account of resource constraints when putting together the service statement.

If a person with an assessment statement requires services that cannot be provided because of a lack of resources, those services must be left out of the service statement. That is the reality.

Since we entered into discussion on amendments, the DLCG was quite adamant that it wanted an independent assessment of need. It is for this reason that the independent assessment of need must be governed by a statutory provision for such independence while the remaining parts of the process are not.

I have no doubt that the HSE will address this issue during the practical implementation of the legislation. In principle, there is no reason the assessment officer, having his or her statutory responsibilities, could not perform part of the liaison officer work which is not statutory and which must accord——

That is the point I am making.

There is nothing in the Bill that does not allow for that. That is an important clarification, which perhaps I had not made sufficiently clear before this.

Question put: "That the words proposed to be deleted stand."
The Dáil divided: Tá, 59; Níl, 53.

  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Brennan, Seamus.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carty, John.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Dempsey, Tony.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Grealish, Noel.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kirk, Seamus.
  • Kitt, Tom.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Donnell, Liz.
  • O’Donoghue, John.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Malley, Fiona.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Treacy, Noel.
  • Wallace, Dan.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.

Níl

  • Broughan, Thomas P.
  • Burton, Joan.
  • Costello, Joe.
  • Cowley, Jerry.
  • Crowe, Seán.
  • Cuffe, Ciarán.
  • Deenihan, Jimmy.
  • Enright, Olwyn.
  • Ferris, Martin.
  • Gilmore, Eamon.
  • Gogarty, Paul.
  • Gormley, John.
  • Gregory, Tony.
  • Harkin, Marian.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Lynch, Kathleen.
  • McCormack, Padraic.
  • McGinley, Dinny.
  • McGrath, Finian.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Moynihan-Cronin, Breeda.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Perry, John.
  • Quinn, Ruairi.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Stagg, Emmet.
  • Stanton, David.
  • Twomey, Liam.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Question declared carried.
Amendment declared lost.

I move amendment No. 39:

In page 10, line 20, to delete "(including a personal social service)" and substitute the following:

", including a personal social service, such as home care, respite care, personal care and social supports,".

As the section is worded, it is unclear what constitutes a personal social service. We do not know what constitutes such a service and the Bill does not define it. Will such a service mean the full range of home care, personal care and social supports required to implement the objectives of services for older people and other people with disabilities? The objectives of services for older people aim to restore those people who become ill or dependent to independence at home, to encourage support in the care of the elderly and other people with disabilities in their own communities by family, neighbours and voluntary bodies in every way possible and to provide a high quality of hospital and residential care for elderly people and other people with disabilities when they can no longer be maintained with dignity and independence in their own homes.

Older people constitute approximately 42% of people with disabilities in Ireland and they constitute an important proportion of people with disabilities and the disabled population. The National Council on Ageing and Older People is concerned that this service should be defined. We do not know what "including a personal social service" means, and it is not stated in the Bill. The phrase is broad and it is important that its definition is spelt out.

The amendment attempts to spell out what constitutes a personal social service by specifying that it includes home care, respite care, personal care and social supports. Perhaps the Minister of State will advise us what he intends a personal service to mean. The Bill states, in page 10, line 20:

"health service" means a service (including a personal social service) provided by or on behalf of the Executive.

Many people are anxious to know what constitutes a personal social service. In this amendment I am trying to define it.

I strongly support the amendment because it is a significant one and its inclusion would add to the legislation. When we are talking about social services and basically services for people with disabilities — I am referring to all people with disabilities — we should reflect on what has been the reality for the past 20 years, namely, that this State has been a cold house for people with disabilities. There have been years of exclusion of this sector. It has been accepted by most politicians in this House and people outside it that for more than 20 years people with disabilities have been excluded. We need to do something to bring them in from the cold to the mainstream of Irish society. That requirement should always remain at the core of the legislation.

When we discuss services and talk about assisting people, particularly people with disabilities, from a very young age, I urge the Minister of State to note that all good practice nationally and internationally has shown that early intervention is essential for people with disabilities, particularly speech and language and other such services.

We must acknowledge that some amazing developments have occurred in terms of examples of good practice in Irish society. It has been proven that where services are delivered at an early stage to people with disabilities, major changes have occurred. I know from my experience in the case of Down's syndrome and from being a parent that if a child with Down's syndrome receives quality early intervention services, major progress can be made in the child's speech and language, reading ability and literacy level and in respect of other such issues. These are important aspects of the debate when discussing services. The recent Special Olympics proved that there are thousands of people here with disability who have had major personal achievements over the past ten or 15 years. If one compares the situation now with that ten, 20 or 30 years ago, when many people with disability were left out of mainstream society, it shows there has been major progress. There are examples in this Bill of good practices that should be developed.

I draw attention to the reality for many people with disability and to the many barriers before them. We need to identify ways to overcome these barriers. We must change attitudes to disability and to people with disability because there is still much misinformation and prejudice. We must recognise and protect the rights of people with disability. We must also recognise the benefits of this legislation are not only for people with disability but for society as a whole. When we discuss services for people with disability, we must keep in mind these key important points.

The services about which we talk in the context of this amendment, including home care, respite care, personal care and social supports, are very important for many people with disability. In the disability sector, approximately 861 people need day care service, approximately 1,014 need respite care and 462 are without any service. Approximately 300 people with intellectual disability are in psychiatric hospitals, which is totally inappropriate. These are not huge numbers. We can tackle the problems in the disability sector. It is not a huge issue.

On the way funding is spent providing the services, it seems to be easier to get money for capital projects than to fund respite or day care services about which I am concerned. Is it a political issue? Building a building, an office or a swimming pool for people with disability is grand but there is always a big problem when it comes to the 462 people who are without any service or when it comes to the 861 people in need of respite and day care. I do not know whether the problem is the management or the way the money is spent within the services. However, these are the issues about which I constantly get complaints from people with disability and their families.

This amendment specifically deals with home and respite care. I emphasise the importance of home care. It is better to have support services in a person's home, where possible, than to place him or her in a residential unit. It is also more economic to provide services in a person's home or locality than to send him or her 100 km or, in some cases, 180 km to get a service. That type of scenario, which was acceptable 20 or 30 years ago, is not on anymore. I do not accept families of children with disability should have to travel from Mayo to Dublin to get services or that visually impaired children should have to travel to the North to get services. How dare anybody say that to a family with a child with a disability. Would the family of a child without a disability ship their child out of their family home from Monday to Friday to get a service? That would not happen in a million years. It is, therefore, unacceptable for families of children with disability to accept this level of service. This amendment raises all these issues. I do not like to harp on the economic issue but one hears it regularly when one raises the cost of services and the question of finance. One then watches programmes on television and sees the squandering of public money.

Elderly people, particularly those with physical disability, can be better cared for in their homes than in residential units, which should only be a last resort for the majority of them. We must put the supports into the community. There are examples of good practice whereby small houses were bought in communities, supports and services were provided and people were taken out of residential units. These moves have been progressive but we need to develop these services and stop whingeing about the cost because the majority of people with disability are sick to the teeth hearing about it each time the issue of finance and to where resources are appropriated comes up. One does not raise the issue of cost when demanding a primary school place on 1 September for one's four-year old child. I do not accept families of disability must put up with this type of nonsense.

It has been a cold house for families with children with disability. As a parent of a daughter with a disability, I know how people had to fight, kick and scream for services ten or 15 years ago. Although I am critical of this legislation, I hope it ends those days once and for all, that is, that we end the cold house for children and adults with disability and their families. We should bring them in, turn on the heat and make them part of mainstream Irish society. Amendment No. 39 is part of that inclusion effort and I urge Members to support it.

I support this amendment on the basis that it extends, in a minor way, the services to be covered by a needs assessment. I hope the Minister of State will take it on board and indicate some movement on the issues we have raised. An understanding of our point of view and sympathy from the Minister of State is not good enough in this case. We need action on these amendments for this legislation to reflect the hopes and desires of the many people who contributed.

I indicated previously that my party objects to the circumscription of services which shall be the subject of an assessment of need under Part 2 to health and educational services only. The Ceann Comhairle has ruled out of order amendments tabled originally by Deputy Lynch on Committee Stage which would have corrected this problem and which I endorse. I refer to amendments Nos. 47, 74, 129 and 153. It is deemed that they would impose a burden on the Exchequer when, in fact, they are cost effective and should be regarded as an investment on which there would be a return. Since these amendments were ruled out of order, we must make do with the amendment tabled by Deputy Stanton and Deputy Murphy, which is not a bad one, although it does not go far enough. If the Minister of State were willing to take it on board, it would show some good faith. When we review this legislation in a number of years, what we have pointed out here will have been borne out and at least we will be able to say the Minister of State took it on board.

I am opposed to the Government's patronising, medicalised approach in Part 2, which this amendment tries to change slightly. The Government's approach does not acknowledge nor reflect the reality that people with disability are routinely excluded by design from much more than health care and education-related services. They are excluded from the workplace, independent living, transport, communications, and from participation in many aspects of life which able people take for granted. These structural impediments or obstacles prevent full inclusion on an equal basis. Disability-specific services, which should be provided on the basis of need and as of right, constitute more than could be appropriately provided by the Minister of Health and Children.

The formulation of Part 2, to which this amendment relates, reflects the Government's view that the Department of Health and Children will provide only those services which people with disabilities truly need and for which they should be assessed. I disagree with this. As the disability legislation consultation group pointed out, disability-specific services, to which those with disabilities should have a right, are those which enable them to participate fully as equals in society and maximise their ability to live their lives as independently as possible to their full potential and as equal citizens. They include housing, training, employment supports and transport and can also include access to communications technology and a range of facilities that have no connection with health and basic education. The amendment refers to "a personal social service, such as home care, respite care, personal care and social supports".

The point of the recommendation that the legislation should assert the right of people with disabilities to an independent assessment of needs is that such an assessment must be made independently of the service provider, the Health Service Executive or the Department of Health and Children within the inevitable organisational and financial constraints, with some of which the preceding two amendments dealt. Otherwise, the assessment will not reflect the individual's true needs and will therefore become only a statement of what is available to the person, which is not good enough.

My preferred formula, as reflected in my disqualified amendments, was to establish an unqualified right to assessment of need in regard both to disability-specific services and other supports necessary to maximise independent participation in and contribution to society. Some of the supports required in this amendment would help maximise the independence of people with disabilities.

I would also prefer that what constitutes a disability-specific service would be defined by regulation on advice from the National Disability Authority in a published list, organised by category service and updated annually. It is disturbing that my amendment to require all such disability-specific services to be provided in a manner consistent with Articles 3 and 8 of the European Convention on Human Rights has been disallowed. This amendment proposed a minimum standard for service provision. It has been ruled out of order on the basis that it would impose a charge on the Exchequer.

Amendment No. 44, which we are not discussing, also relates to Part 2. Articles 3 and 8 of the European Convention on Human Rights cover torture, inhumane and degrading treatment, the right to privacy and family life. That convention is part of the corpus of Irish law and I do not understand how the Government can refuse to accept an amendment based on the convention, much less rule it out of order.

There are no justiciable rights in regard to minimum standards for service provision in this Bill. Without my amendment a person, by reason of cost, would not be able to challenge the Government on the basis of providing a service that violates standards under the European Convention on Human Rights. That is repugnant and morally wrong.

I support amendment No. 39 because it attempts to improve this legislation. Any change is to be welcomed but I am not confident that the Minister of State will take it on board because he has dismissed virtually every amendment which would improve this Bill in any minor or major way.

This amendment proposes to give examples of personal social services for the purposes of the Bill. Existing health legislation covers some personal social services such as residential care. Any expansion of the scope of such provision by way of defining personal social services would therefore be more appropriately dealt with in that legislation.

Having listened to the arguments of the Opposition Deputies, I am puzzled as to the advantage of including a few areas such as those listed in the amendment. What is to be done about other areas not included in the amendment?

The legislation can include them.

Part 2 deals with all health services as provided by the Health Service Executive. It would not be appropriate to define health services in this Bill. The same applies to personal social services. If Deputy Stanton would outline the advantage of including this limited number of areas in the Bill, I could perhaps refer that to the Department of Health and Children.

That is useful. In the Bill health service "means a service (including a personal social service) provided by or on behalf of the Executive;" but the Bill does not define the personal social service. This amendment proposes that a personal social service will include "home care, respite care, personal care and social supports". These are examples only. Other services could be included.

The Minister of State implies that it refers only to residential care. It would be important to ensure we know what this means because the phrase "including a personal social service" will be in the legislation. Who will define that, how will it be defined and how broad is that definition? The Minister of State implied it refers only to residential care but that is not enough. Does a health service provided by, or on behalf of, the Health Service Executive include home care, respite care, personal care and other social supports that people with disabilities might want?

I wish to tease out this matter because it is unclear. I would like to hear the Minister of State's definition of this service. I have included examples of what it might be but the list is not exhaustive. The list is prefaced by the phrase "such as" and could include others. Some of my colleagues have mentioned transport and housing and so on. I do not know how broad or narrow this will be. It would be useful if the Minister of State could tell us what is a personal social service.

The definition of health service in the Bill is "a service ... provided by or on behalf of the Executive". That means that all services provided by the Health Service Executive are included in this Bill, including those which the Deputy mentioned in his amendment. This includes personal social services, such as personal assistance and so on. I am prepared to return to the Department of Health and Children to clarify this issue. I am satisfied that the Deputy's requirements are included in the Bill. The Health Act 2004 defines health and personal social services to cover the services outlined in the Health Act, such as residential day care and respite care. I am satisfied that the Bill covers the areas the Deputy seeks to cover.

Debate adjourned.
Sitting suspended at 1.30 p.m. and resumed at 2.30 p.m.