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Dáil Éireann debate -
Thursday, 10 Feb 2022

Vol. 1017 No. 7

Health (Miscellaneous Provisions) Bill 2022: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

I will share time with my colleagues, Deputies Tully, Ward, Martin Kenny and Gould. I thank the Leas-Cheann Comhairle and Minister of State.

I appreciate the opportunity to speak on this important Bill, which Sinn Féin will not oppose. It gives effect to the Government decision to transfer responsibility for specialist community-based disability services from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. We can now add "disability" to that Long Title.

The Bill, while largely technical, is quite substantive and will ostensibly bring an additional layer of accountability for the development and provision of disability services once fully implemented. It will give the Minister the power to give directions and set priorities for the HSE in the delivery of these disability services and make it separately accountable to the Minister for them. However, that will not automatically improve disability services. This will require substantial sustained investment and services to train and retain more occupational therapists, speech and language therapists, physiotherapists and other specialists in the empowerment of people with disabilities.

Many challenges in this area need be addressed urgently. The absolute priority must be tackling waiting lists and reducing wait times. This must be done across a range of services to improve access to assessment of need for children and especially young people. We must improve access to speech and language therapy, physiotherapy, counselling and the wide-ranging supports many children and adults need to help them live a full and independent life.

Responsibility for children's mental health remains with the Department of Health but there is an onus on the Minister with responsibility for children and the Minister of State with responsibility for disability not to lose sight of the toll on children's mental health that is caused by obscene waiting lists for disability services and the difficulties that being differently abled in this world can bring. At the end of last year, 4,000 children were still waiting for an assessment of need and more still were waiting for further diagnostic assessment. In the south east, more than 1,000 children are waiting for diagnostic assessment. The Ombudsman for Children cited one case of a 6-year-old who has been waiting for assessment for four years. That is an unacceptably long wait. An unacceptably high number of children are waiting when a child's entitlement to this assessment is, and should be, within three months.

There are also significant concerns that due to pressures services are under as a result of understaffing, assessments are not being carried out as thoroughly or extensively as even the professionals carrying out the assessments would like. We have all heard anecdotal evidence from those professionals in that regard. We see it in many areas in healthcare. We saw it with the child and adolescent mental health services, CAMHS, and see it in other areas where real pressures with regard to staffing capacity can make life very difficult for those trying to provide services. That is without going into the thousands of children and adults on waiting lists for speech and language therapy, physiotherapy and counselling.

In more recent times, a person does not need a diagnosis and, essentially, the assessment for some of the services to follow but in practice, that is not always the case. The experience of many families when it comes to their children is that the range of therapies a child needs are not always provided. It can be very patchy; a bit here and a bit there. Very often, they have to battle with the system to actually get the services a child needs. It is all down to a lack of capacity. We have a system. Those at regional level are trying their best to provide the service to as many children as possible but it is equivalent of the loaves and fishes in trying to do it. We must, therefore, advocate for all those children.

In conclusion, the way in which society currently operates places many barriers in the way of differently abled people. They have been consistently disadvantaged by a lack of State supports to overcome these barriers. This has led to disempowerment, dependence and a loss of control and choice in people's lives. To counteract this, it is incumbent on the Minister of State to ensure a real whole-of-government approach to empowerment and to deliver a new social model of disability inclusion. I hope she will work closely not only with the HSE and Minister for Health in improving the health and social care services people with disabilities need, but also with the Minister for Housing, Local Government and Heritage to ensure appropriate housing provision, the Minister for Social Protection to ensure adequate income supports and the Minister for Enterprise, Trade and Employment to ensure everyone's right to work is not impeded by obstacles that people with a disability have to face because, unfortunately, they are different.

I welcome the Bill and the resulting transfer of statutory responsibility for disability services from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. This transfer is not before time. The Joint Committee on Disability Matters had been requesting information on when this would happen for more than a year and a half and was initially told it was going to happen a year ago. I welcome that it has happened at long last.

Disability is not solely a health matter. It is good then that the transfer is occurring in recognition of that. There is a need to move away from the medical model of disability and embrace a rights-based model. We need to view disability as caused by the way society is organised rather than by a person's impairment or difference. We need to look at ways of removing barriers that restrict life choices for disabled people in order that when these barriers are removed, disabled people can be independent and equal in society with choice and control over their lives.

The ratification of the UNCRPD in 2018 was a step in the right direction in this sense. There is still a long way to go before the social model is truly embraced, however. The optional protocol of the convention has not yet been ratified. While this is the case, disabled people have little or no recourse if their rights under the UNCRPD are not upheld.

The disability capacity review highlights the scale of the work required in specialist community-based disability services. Changing demographics and the current level of unmet need means that major budget increases will be essential. Access to housing and independent living supports are also essential to a rights-based model of disability but so far, approximately 1,800 disabled people are still living in large residential settings. The congregation process has been a failure. Very few people have been transferred from large residential settings to community living since 2012 when the time to move on from congregated settings was published. In fact, the disability capacity review informs us that by the end of 2018, approximately 800 of the 1,500 people who no longer resided in one of these centres had transitioned to the community but approximately 700 had sadly passed away. Approximately 1,300 disabled people under the age of 65 are currently residing in nursing homes because we do not have the supported living settings for them to live with their peers in the community.

In response to the Ombudsman's report, Wasted Lives: Time for a Better Future for Younger People in Nursing Homes, the HSE committed to transitioning 18 people under the age of 65 from nursing homes. That is less than 2%. Currently, the rate of poverty and social exclusion for disabled people in Ireland is one of the highest in the EU at 38.1%. The poverty rate for disabled people was exacerbated by the 2008 financial economic crisis and subsequent response to austerity as the poverty rate for disabled people consistently increased from 9% in 2009 to 24% by 2017.

They are obviously adversely affected by the current rise in the cost of living. A European Commission report on Ireland published in 2019 revealed that Ireland has one of the lowest employment rates for people with disabilities in the EU at 26.2% compared with the EU average of 48.1%. Among disabled people aged 15 to 30, 13.7% have not progressed any higher than primary level education in comparison with 4.2% of the general population. There is a data deficit when it comes to disability. Data from various Departments needs to be married to ensure the most comprehensive person-centred responses can be delivered. Without baseline data it would be very hard to track success or otherwise in disability services.

We were informed that the backlog of children and young people waiting on an assessment of needs increased from 500 in the summer to almost 4,000 in November 2021. I am told by the children's disability network teams, CDNT, that children all over the country are not receiving therapies. Parents are being given courses and told to assist their children at home.

Parents are not qualified therapists and this should not be their responsibility. Children's disability network teams must be properly resourced and staffed.

Ireland is rich in policy and relevant legislation but we are constantly and consistently weak on implementation. There are notable parts of the Education for Persons with Special Educational Needs Act, the Disability Act and the Citizens Information Act, which are the pillars of disability inclusion legislation, that have not been implemented. While I welcome this Bill and the resulting transfer of statutory responsibilities for disability service delivery, it is only right to point out the scale of the work facing us in delivering for this sector is huge. A change in faces, Departments or Ministers will not in itself bring about that delivery if the political will does not exist.

This is largely a technical Bill to give effect to the Government's decision to transfer a function from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth in regard to the provision of specialist, community-based disability services. I hope it not just window dressing. The Government's focus should be on improving disability services and making them fit for purpose. This Bill and all its 65 sections will not achieve anything in the here and now. It is like rearranging the deckchairs on Titanic.

Ireland remains one of only three EU states not to have ratified the protocol to the UN Convention on the Rights of Persons with Disabilities, CRPD, which would give people with a disability the right to take their case to the UN. Psychosocial disabilities are mental health disabilities and people have rights in this regard under the CRPD. Even though most of the disability remit is moving to the Department of Children, Equality, Disability, Integration and Youth, this does not mean the Department of Health will not be accountable under the CRPD for the needs of people with psychosocial disabilities. Neither Department can exclude people with mental health difficulties and the Government will need to ensure their rights are respected and their voices included.

God forbid if children with a disability had the right to take cases to the UN arising from the State's abject failure to provide disability supports. The UN would not know what hit it. At present, there are more than 71,000 children with disabilities waiting for life-changing treatment, including occupational therapy, speech and language therapy, psychology, dietetics, physiotherapy and many others. It is concerning that more than 19,000 of these children are waiting longer than a year, and many of them much longer, with no light at the end of the tunnel for desperate parents. I have pointed out before to the Minister of State that the Ombudsman for Children has described provision in this area as an old-fashioned three-card trick whereby children are moved from list to list without getting the necessary treatment at the end of it.

The Government has abjectly failed to get to grips with the cost of living crisis facing workers and families. I mention this because I want to put it into context in terms of what it means for parents of children with disabilities facing these never-ending lists for treatment. Earlier this month, at a meeting of the children's committee to discuss child poverty, we heard from representatives of the Clondalkin Cares Food Bank, which is based in my area, that parents are accessing its service who find themselves in poverty because they cannot access timely treatment for their children with disabilities. These parents have had to find private providers to give their children the life-changing treatments, such as occupational therapy, physiotherapy and speech and language therapy, which the Government should be providing. They have simply had to make a choice between putting food on the table and accessing the treatments their children desperately need and deserve. No parent should be put in this impossible position. Yesterday, a parent contacted me to say she is way behind on her bills as she has had to pay more than €2,000 this year alone to a private provider for therapy for her child. Will the cost of living measures the Government is to announce address this problem? I do not think so. Will moving the responsibility for provision to another Department address the issue here and now? I do not think so.

Behind every one of the statistics I mentioned is a child. These are children who, because of the Government's failures, have missed many opportunities in life. They are children who are not reaching their full potential or their developmental milestones. Last week, we had a long debate in this House on the misdiagnosis and mistreatment of children by the child and adolescent mental health services, CAMHS, in south Kerry. I met some of those parents in Tralee last week and their stories are absolutely heartbreaking. Parents, and I include myself in this, trust medical experts when it comes to our children's care, but trust seems to be at an all-time low in this regard. These parents and children were so badly treated that words fail me. The problem is not confined to south Kerry. We have heard similar stories in north Kerry, Cork and Wexford, and I suspect they are just the tip of the iceberg. While the responsibility for mental health provision will not be moving Departments under this Bill, one of the common themes from the parents to whom I spoke was their belief that one of the reasons their children were overmedicated was that they were not receiving the therapies they needed, including occupational therapy and speech and language therapy, simply because those services are not available.

As other speakers have noted, this legislation is about moving responsibility for a particular sector from one Minister to another. It will not have the effect we would very much like to see, which is the provision of additional funding and resources in this area. There will be clarity now in that responsibility for disability services will be under the Minister for Children, Equality, Disability, Integration and Youth, with the Minister of State, Deputy Rabbitte, retaining her function in that area. There is still a great deal of work to be done. The optional UN protocol has not been implemented, which would give people legal recourse. That move needs to happen urgently.

As the Minister of State is aware, the North West Parents and Friends Association in my constituency provides many services for children and adults with disabilities. I have spoken to her before about how that organisation is continually under-resourced. It is based in Sligo and has outreach services in Leitrim and other areas. The stories I hear of the difficulties it faces in getting service level agreements in place to provide adequate service to the children and adults it deals with are heartbreaking. The service is continually in battle with the HSE. I encourage the Minister of State to step in and play a positive role in changing that. I invite her to the constituency to meet with the people involved, particularly the staff of St. Ciaran's service in Carrick-on-Shannon, which provides both day services and respite services. I am aware of a situation whereby one service user will have to go into full-time care, which is having a knock-on effect in that others are unable to access respite care.

This type of situation is a reflection of an ongoing problem whereby we do not have in place the facilities and services that are needed. There is a genuine sense of fear and apprehension among parents who are ageing and are very fearful their adult child who lives with them and whom they want to care for and look after for as long as they possibly can may well outlive them and what will happen then. The stress and mental torture of that is one of the key issues. Those parents look at the current service and wonder where it will be in five or ten years' time when they are not able to cope or are no longer here. This is the issue that needs to be addressed and new facilities must be put in place. Action is what we require. There have been numerous plans but what is needed is action. I encourage the Minister of State to ensure that happens. I trust she will come to my constituency and meet the parents involved.

We all recognise we are dealing with a technical Bill to move certain functions from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth. Following on from some of the conversations I have had with the Minister of State, there is obviously a logic to what is being done here. I know she had intentions to go to Dundalk and has planned for a further visit. We have dealt with certain issues in regard to disability but what we are lacking, as per normal, is a service for children and adults with disabilities that is fit for purpose and operates for the entirety of their lives. Not only was there an anomaly in terms of where certain powers lay within the Department of Health, which should perhaps have been with the Department of Children, Equality, Disability, Integration and Youth, but we are also dealing with the fact that some of the issues relate to housing, local government and other areas. I refer to instances, for examples, where people are trying to access housing that is suitable for children with particular acute difficulties.

I am very thankful for the work the Minister of State is doing in bringing forward this legislation.

It is also about providing the services, whether those are under the local authority or whatever, with a roadmap for delivery. That is the big thing we need across the board. Everyone has been clear that we are all inundated with parents, families and, particularly, mothers who are under severe pressure, whether they are seeking autism spectrum disorder, ASD, services, occupational therapy, physiotherapy or speech and language therapy. This is about making sure we can make those services much easier to access and that it can be done in a much more streamlined fashion. We all know the difficulty even to get on the list for assessment of need, never mind the difficulties that can occur when somebody gets the service.

We have seen the recent issues relating to CAMHS. Generally, the complaint is that a person cannot get into the service, but in these cases the issue was that the service was not fit for purpose. That is not good enough for the citizens and the people. A huge piece of work needs to be done, from family supports to community supports for disabilities right across the board. We just need to get to the heart of it.

We welcome this Bill. I would be interested in hearing from the Minister, Deputy O’Gorman, and from the Minister of State, Deputy Rabbitte, if she is summing up at the end - I am not sure if she will be - because there are concerns when there are such changes. Everyone has said that this is a technical Bill etc., but technical changes can and do have real impacts.

One of our concerns is that the brief of the Department of Children, Equality, Disability, Integration and Youth is a big one. While we have an able Minister in that brief, and there is no doubt about that, it is a huge brief and disability is a massive area. We have been discussing disability thus far in this debate through the prism of health because we are separating the functions from the Minister for Health in some areas. However, we are looking as a society to disability-proof transport. We spoke at the transport committee yesterday about our new fleet of buses and trains, access to train stations, and active travel through a disability lens. When we look at housing and we are talking about congregated settings and decongregation, we must make sure there are houses in which people with disabilities can live and not just access. That is something I have learned over recent years: the difference between people with disabilities having access to a house and actually having a house or home in which a person with a disability can live. There are also the issues of access to jobs, access to the labour market and implications in that regard, industrial relations matters as they pertain to people with disabilities, and workers in that area, such as section 39 workers. Therefore, this is a massive area of policy for the Minister who has responsibility for disability.

We spoke to the Minister in recent months since I took over the health brief about the disability capacity review, the cost of living for people with a disability, all the waiting lists and the services. These are all massive issues. We can go down the list, which I have here, but we will discuss it again.

In this particular debate, given the content of this Bill, I want to hear what concerns are held on the Government side about how the new system will work? On the HSE side of things, service delivery will be under the responsibility of two Ministers. It will rely on two Ministers, as well as the Minister of State, having good working relationships. Whoever the Ministers are now and whoever the Ministers will be in the future, when it comes to budget time, how will this work? Will the Minister with responsibility for disability have to go cap in hand as a senior Minister to the Minister for Health before going to the Minister for Finance? These are the practical things I would like to hear about. I am not trying to catch anyone out for anything, but I just want to be clear on these things. One of the worst things that can happen in any area of public services is siloing, whereby one section, organisation or Department does not talk to another. This is one area where we can have no siloing and where people really have to work together. We are talking about robust communication and reporting mechanisms.

This is a long Bill. The Minister read out many sections. Therefore, this is not a quick technical Bill; it is a detailed technical Bill. To give comfort to those who are at every level of the disability sector, be they service users or service providers, as well as those in the disability sector who are in areas unrelated to the delivery of health, such as in transport or all of the other areas I laid out, it is important to outline how that reporting will work? How will those relationships be managed? How can we ensure we are not taking a couple of steps backwards due to new bureaucracies and that, instead, this will actually help us move forward, cut down the waiting lists and bring a disability focus on policy to all those other areas?

I look forward to hearing what the Minister has to say and, indeed, to the summing up at the end of the debate, whenever that may be.

I warmly welcome the publication of this Bill, which marks a significant milestone in the transfer of specialist community-based disability services from the Department of Health to my own Department. This transfer is an important step towards achieving a more equal Irish society and towards honouring the human rights of all people in Ireland, including people with disabilities.

I look forward to working closely with the Minister of State, Deputy Rabbitte, on this new and important area of responsibility. Equally, I will continue to engage with the Minister for Health, Deputy Donnelly, to ensure integrated policymaking and governance of the HSE. While my Department will be responsible for approximately 56,000 specialist community-based disability service users, the Minister for Health will remain responsible for a range of mainstream services that are used by more than 600,000 people who have disabilities. Both Departments are united in our commitment to ensuring people with disabilities continue to access health and social care services from the HSE in a seamless manner, regardless of which Department has policy responsibility. This Bill provides a strong basis for ongoing co-operation and collaboration in this regard.

As the Bill moves through the Houses, it is important to recall the intended purpose and the benefit of this transfer. My Department will have responsibility for specialist community-based disability services, which provide some for some of the most complex health and social care needs of people with disabilities. This will obviously be in addition to our current remit for disability equality policy, which transferred from the Department of Justice in late 2020.

The consolidation of these features into one Department presents a significant opportunity to improve the lives of people with disabilities in Ireland. The transfer will facilitate the transition from what is sometimes, as many Deputies here have described it, a more medical mode of support, towards an holistic, rights-based approach that supports people with disabilities to live autonomously. It will support the HSE to continue to develop a more person-centred service. This evolution philosophy is crucial for Ireland to meet the obligations to which we signed up in recent years when we signed the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. That document provides a blueprint for strengthening the rights of people with disabilities and promoting their inclusion in all aspects of society.

The Minister of State, Deputy Rabbitte, and I are committed to delivering real and tangible benefits for service users throughout the country. A number of Deputies have spoken about the UNCRPD and particularly about the optional protocol. The Minister of State and I have been clear that we want to see Ireland sign up to the optional protocol. Key to doing that and to bringing about the legal changes, because we need to change our existing legal regime to bring us into compliance with that, is the Assisted Decision-Making (Capacity) (Amendment) Bill, legislation that is overdue. Everyone accepts that is overdue, but it is now at pre-legislative scrutiny, PLS. It is before the Oireachtas joint committee on children. The Minister of State, Deputy Rabbitte, and I are eager for that to be examined quickly. We want to have that in place by June 2022 for the decision supports service, which is a vital new service that will replace wardship. Wardship is a very outdated approach to dealing with the decision-making rules and capacity of persons with disabilities, particularly those with intellectual disabilities. That needs to be replaced. We have this system and we just need to get that Bill through PLS quickly so that we can get it into the Houses and get it passed.

Returning to this Bill and to the transfer of functions, the HSE will obviously be a key partner in this regard. I have been in contact with the chair of the HSE board to express my commitment, as a Minister who now has an accountability relationship with the HSE board, to talk about working closely with the HSE to support this delivery of enhanced services for people with disabilities.

My officials meet regularly with HSE senior management in preparation for the transfer, and the Secretary General of my Department will soon be meeting with the CEO of the HSE to advance these arrangements further.

This Bill brings us one step closer to centralising the equality, health and social care dimensions of support for people with disabilities within my Department. This will place us in a strong position to lead efforts to improve the lives of people with disabilities in Ireland. Deputy Duncan Smith said this Bill can have a real impact. We want it to have a real impact. We want this to be a fundamental change in how Ireland approaches the holistic rights of persons with disabilities. The Deputy rightly pointed out there is a large range of responsibilities within my Department, but we also have to accept there is a huge range of responsibilities within the Department of Health and it has a huge budget. It was identified during the programme for Government negotiations, primarily by the Taoiseach, that disability was an issue that needed more attention. That is what we are seeking to give it, while also bringing the various elements together within one Department.

On the budgetary arrangements, funding for community-based disability services will be sought by me or successive Ministers in my Department and the budgetary line will be through Vote 40 within my Department. That Vote is going to transfer over. Good co-operation between me, the Minister for Health and the Minister of State, Deputy Rabbitte, has already been demonstrated by the very successful budgetary allocations Deputy Rabbitte has achieved in both of the previous two budgets. On both occasions there was a significant increase in financial support for community-based disability services.

There is a huge amount more to be done. None of us is under any illusion about the scale of the work that has to be done to provide community-based disability services, to provide more therapists, to continue to reduce the waiting lists and to implement the huge number of legal changes required. We also need to integrate those changes with transport and social welfare. The work the Minister of State, Deputy Rabbitte, has done over the past 18 months in putting a focus on these issues is recognised across this House and across the sector. I look forward to her area of responsibility fully transferring to my Department and us jointly working to continue to advance this issue. There is a huge amount to do here. We are absolutely cognisant of that and that work will continue when there are other Ministers in this role. This Bill is a very important first step towards delivering that better, human rights-based focus and integrated services for persons with disabilities in our country.

This Bill makes the HSE accountable to the Minister for Children, Equality, Disability, Integration and Youth for the management and delivery of specialist community-based disability services. I hope the transfer of responsibilities in this Bill will result in a system that has more focus on providing for people with disabilities in their community. However, the Bill will not change anything in terms of the ability of people and children with disabilities to get timely access to the services they need in the community. The phrase "care in the community" has been misused by the Department of Health ever since it was coined. There are plans to close key services in communities across my county of Tipperary based on the principle that more focus is being given to care in the home. However, this has actually resulted in community services being relocated. Care in the community no longer means care in your own community. The people of Carrick-on-Suir and Roscrea will attest to that. I need the Minister to bear that in mind as he takes on these new responsibilities.

This Bill does not address the fact that children with disabilities are being forced to wait incredible lengths of time for the formal diagnosis that would trigger the supports and services they need. There is a young girl in my constituency who had an assessment of need process in October 2020 and that was completed in January 2021. This identified that she required the services of a children's disability network team, CDNT, and that an autism spectrum disorder, ASD, assessment was warranted. She is still waiting for that diagnostic appointment. In the meantime, the family have been told that despite there being general agreement that she has a disability and needs supports such as the domiciliary care allowance, she does not qualify for it because the formal diagnosis she is waiting for has not been done. This is getting in the way of her family being able to make plans for her at home and for her schooling. In another case, a young man with muscular dystrophy was left without home care supports because his parents had Covid at the time. This has since been resolved but they had to fight for it.

There are pitfalls across the board when it comes to the provision of services for people with disabilities. I recently attended a meeting with the HSE's south-east office. It is undertaking a number of recruitment campaigns for occupational therapists, speech and language therapists and so on because of the huge shortage in this area. While I appreciate this, it is the people with needs who are being impacted. The Government may try to take the heat off by highlighting its good intentions, but this does not take the pressure off people with disabilities and their families. They are forced to wait because successive governments have mismanaged the health service so much that it is no longer an attractive prospect for many specialists. These are the challenges that await the Minister. I appeal to him to look closely at how the idea of care in the community is being used by this Government as a way actually to take care out of our communities.

I welcome this Bill. I particularly welcome the move from a health-dominated approach to disability to an equality and rights-based one. It is a very welcome development. Viewing disability primarily through a health lens has created a very narrow focus, one that is so narrow that it has been rejected by people with disabilities, their advocates and people working in the field. In that respect, I welcome this move. There is no doubt there has been far too much emphasis on people's actual disabilities and not enough on the voices, experiences and abilities of people living with disabilities. As Des Kenny, chair of Independent Living Movement Ireland, put it, the Department must recognise "that it is how society is structured that disables people, and our lack of participation and inclusion in society is not due to our impairments". That is important. It is society, the structures and the system that need to change.

For decades, disability campaigners have sought to ensure the rights of people living with disabilities are addressed at a full ministerial level. The scale of disability in this country, the number of people living with disabilities, the scale of the services to be provided across a wide range of Departments, and the level of funding needed raise the question whether there is a need for a senior Minister. While the Bill is certainly an improvement, we have to ask ourselves what exactly is going to happen now. The fear is that all the Bill will entail is the movement of a Minister of State, albeit one who is able and has been a good fighter for the sector, from one Department to another. Is it much more than that? The detail of what is required to be done and the budget involved raise these questions.

Disability will now be the biggest element of the budget in the Department, at €2.3 billion. Yet, it is still a Minister of State dealing with that massive budget. This transfer will more than double the budget of the existing Department. If disability had a Department in its own right, it would have a budget greater than 11 other Departments. That puts some perspective on it. One has to ask why it is just added onto another Department. Some 13.5% of our population have a disability, yet we cannot find room in a Cabinet of 15 for a dedicated Minister. That is a problem.

Much of the focus on disability over the past decade has related to service provider funding, which has not yet recovered from cutbacks introduced in the recession. I know the Minister appreciates that. While this is undoubtedly an important issue, successive governments have forgotten about the service users caught in the middle of protracted stand-offs between the HSE and service providers. We have often lost sight of the fact that social exclusion is the predominant issue for people living with disabilities. A recent ESRI report found that Ireland has the fourth lowest employment rate in the EU for people living with disabilities, at a mere 36%.

Some 27% of the homeless population have a disability. More than 1,400 people living with disabilities under the age of 65 are actually in nursing homes. It is shameful that we are seeing this institutionalisation and that it still features so heavily in policy. These are the lived experiences of people with disabilities.

The publication of the disability capacity review last July after a long delay detailed the significant unmet needs of people living with disabilities. It estimated that in the next decade there will be a need for a further €550 million to €1 billion investment in disability services. Despite disability being an issue that affects so many families, the capacity review's estimate suggests that disability is generally one of the most underfunded areas of public expenditure.

Budget 2022, in my view, failed to tackle the historic underspend in disability with a more-of-the-same approach to addressing shortfalls. It is not good enough merely to recognise the issues faced by people living with disabilities. We must address them in a meaningful way. Instead, this Government is continuing to let issues fester until they become urgent or, in many cases, an emergency. We need to move from crisis interventions to rights-based supports.

The UNCRPD is clear on the need to eradicate poverty for people living with disabilities. Article 28, which is concerned with an adequate standard of living and social protection, requires states to "ensure access by persons with disabilities ... to social protection programmes and poverty reduction programmes". People living with disabilities in Ireland have among the highest rates of poverty – three times that of the general population. They are at the sharp end of our housing and cost-of-living crises. Additional costs, such as specialist aids and equipment, home adaptations, higher energy costs and extra transportation costs, particularly taxis, are realities of people's lives when they are living with disabilities. These additional costs must be addressed yet, in section 51, there is no mention of the Ministers for Transport; Housing, Local Government and Heritage; Education; or Further and Higher Education, Research, Innovation and Science, or their Departments, having a role in responding to the needs of people living with disabilities.

I do not know what the role of the Minister of State, Deputy Rabbitte, will be in relation to those Departments. She will need a big stick or a good pair of boots to deal with this matter. There needs to be clear roles and responsibilities outlined in relation to that. That raises the issue of the delegation of functions. I do not know if that has yet been resolved but it is traditionally a thorny issue within Departments and between senior Ministers and Ministers of State. It is essential that the Minister of State has clear delegation of functions in relation to not only the new Department but also the Departments of Health; Transport; and Housing, Local Government and Heritage, as well as the other relevant Departments. Transport and housing, in particular, are major issues for people living with disabilities.

In December 2021, the Department of Social Protection’s cost of disability report concluded that the typical annual costs faced by people living with severe disabilities amount to up to €12,300, and possibly up to €10,000 for people with more limited disabilities, in order to get by and have any kind of life that they can live with dignity. The full report details the lack of supports available to people living with disabilities and the severe challenges they face. It is all there in black and white. It cannot be disputed. It is set out and nobody can complain that they did not know. The report must not be allowed to gather dust on a shelf along with other reports on the cost of disability - one in the 1990s and one in the 2000s. It should immediately inform policy to address the extra cost of living with a disability, ensure our public services are accessible and create pathways to employment and other supports.

In 2018, 12 years after it was agreed by the UN, Ireland was the last EU country to ratify the UNCRPD. We find ourselves in a situation where there are still major questions about the Government's commitment to the optional protocol. Much of our national legislation remains out of sync with the convention. Disability legislation, such as the Assisted Decision-Making (Capacity) Act 2015, is still not fully commenced. I look forward to further detail on what the senior Minister announced earlier. Is it any wonder that this Government still has not ratified the optional protocol when it and the previous Government dragged their feet so much in relation to these essential elements of dealing with the issue of disability? The Government claims that it needs to do more work before signing this protocol but this is clearly a delaying tactic as the Government does not want to be held to account over its failures to uphold the rights of people living with disabilities.

On a related note, mental health comes under the remit of the UNCRPD. If we are truly committed to implementing the UNCRPD, people experiencing mental health difficulties will be using this convention to exercise their rights but the budget for mental health will sit apart from the Department with prime responsibility for the UNCRPD. That is another organisational issue that needs to be resolved because that responsibility will fall on the new Department.

The second class position of section 39 organisations is one of the key areas that needs to be addressed. People who use section 39 services are significantly disadvantaged over those who use section 38 and HSE services. This is primarily because of public funding and staffing arrangements. Because of a lack of funding, staff are paid at a lower rate in section 39 organisations even though in many cases they do the same work as in the HSE and section 38 organisations. This results in higher turnover of staff and much greater disruption for adults and children using these services. It also means that service providers have extra costs in recruitment, training and other areas. The funding system also leads to uncertainty with no multi-annual funding system, in spite of that being promised for some time. People who receive services from section 39 organisations really value them. The ethos and culture in those organisations is strong and supportive and this drives quality, dedication, commitment, specialisms and, fundamentally, a person-centred approach. However, to make the sector sustainable, the funding and staffing arrangements need to be sustainable.

Specifically on multi-annual funding, the HSE corporate plan published last year included a commitment to multi-annual funding. The Catherine Day report, from 2019, recommended it. The disability capacity review, published last July, recommended it. It was committed to as part of the consultation on the forthcoming disability social care action plan but there are rumblings that the Department of Public Expenditure and Reform is not signing up for this. I wonder if that is the case because there is a strong rumour that it is. It appears that the dead hand of the Department is striking again. Without multi-annual funding it will be impossible ever to plan properly for the services to be provided in the years ahead. It is critical to the success of this new arrangement. The promise of multi-annual funding needs to be kept and it needs to be delivered on this year.

It is positive that a review of the new arrangements is built into the Bill. This will be important for addressing any potential issues that arise.

The Minister of State said earlier that section 10 provides for:

... consultation with the Minister for Children, Equality, Disability, Integration and Youth in respect of appointments of executive board members. People with experience of advocacy in matters affecting recipients of services may now be selected as board members as well as those with experience in advocacy in matters affecting patients.

This is very welcome, as it will bring more lived experience to decision making. The selection of people for this role should seek to represent the very broad spectrum of disability in Ireland.

Section 64 appoints the Taoiseach as referee where there is a disagreement between Ministers. I wish him luck with that. How can the Taoiseach arbitrate on what in some cases will be a question of law? That issue must be resolved. It is all very well for the Taoiseach to arbitrate. I hope he will arbitrate where there are disagreements about the adequacy of funding that is provided. The Minister has the clout to resolve those kinds of issues but in the case of questions of law, that is a harder one to understand.

Sections 3 and 59 appear to use different definitions of specialist community-based disability services. Again, that is something that needs to be resolved. On the question of resolving it, we do not have any clarity on the other Stages of this legislation. The Bill is scheduled to continue next week, and I wonder when we are likely to complete Second Stage. Given that this has been talked about for some time, the Bill appeared very quickly and there was very little time for various disability groups to give it adequate consideration. That is an issue that has been raised with me. I hope that prior to Committee and Report Stages, sufficient time will be allowed for the many organisations, individuals and advocacy groups to consider the full implications of the Bill and to have an input in terms of potential amendments. I hope the Minister of State will be open to considering those amendments.

I will leave it at that. I restate the point about the delegation of functions. It is particularly important. The Minister of State's role is a very difficult one, as she must negotiate between a number of Departments. If the role is to be meaningful, and if she is to have the necessary clout, there needs to be a very clear definition of functions.

I welcome the opportunity to speak in the debate. I also welcome the Bill before the House. It is not before time. I know there has been a significant effort and work put in to bring the Bill to the House. It is a very important part of the programme for Government. The Minister of State with responsibility for disability, Deputy Rabbitte, has taken on the role with great energy, dedication and hard work. I acknowledge that and I have seen it at first hand at a constituency level. Her engagement with the Joint Committee on Disability Matters has shown that she is completely on top of the challenges that lie ahead, which are many, in the disability sector.

The Bill concerns the movement of issues relating to disability from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth. It is right to do that. The disability sector has been part of the Department of Health for some time, but it could be said it has been the Cinderella of the Department. We must accept that. In any debate on the Bill, we must accept the significant challenges that exist across the spectrum. I intend to deal with some of the issues today. I will start with the younger cohort of people. When an issue arises, parents look for an assessment of need and a diagnosis and subsequently therapies. There is a significant challenge in terms of the availability of therapies in the public sector. In most cases, they are non-existent. We must accept that service provision is currently that poor. We must look at the challenges people face daily. The challenges faced by parents include the cost, as outlined in the cost of disability report. They must scrape together the money to provide occupational therapy and speech and language therapy for their children to give them the best possible outlook because they are not available on the public health system. We must accept that right here and now. We must look at the availability of therapists and how we are going to encourage and recruit more therapists into the system and ensure that a framework is built around therapists who are at the coalface. We must ensure they are doing the job they are employed to do in the first instance and that therapies are being provided to children and young people.

Like every other Member of the House, I have parents contacting me who are trying to get assessments of need for a whole variety of reasons. We must ensure special needs assistants, SNAs, are in place in primary and secondary schools. There are challenges getting SNAs even when it is obvious that children have additional needs. Schools have sought exceptional reviews on a number of occasions, but the Department comes back and says they never applied at all. We must examine whether the portal is fit for purpose. I am aware of a school where the staff are very dedicated and hardworking and are trying to do the best for children in all circumstances but they got a kick from the Department of Education. I know we are talking about disabilities and health funding, but it is about people with disabilities and those with exceptional needs and additional needs. It is quite clear that the school has made the application and the courteous response from the Department would be to acknowledge that and to say it has not acted upon it and to do so immediately rather than giving a ham-fisted or ridiculous excuse. Those are the challenges out there.

People with lived experience of disabilities, especially parents, have spent their lives fighting the system in every way, shape and form to try to make sure their relatives have the best possible outcome. We meet them on a weekly basis in the Joint Committee on Disability Matters. Parents come in and talk about the battles they have fought for 40 or 50 years. We can see their commitment. In so doing, they have made it better for others, but it is not their responsibility to be constantly fighting; the State and the Departments must be there, ahead of the curve. They must understand. They have a pile of research, and they must be ahead of the curve and make sure that disabilities are being addressed and that there is a response when help is needed by the most vulnerable in the State.

Section 39 organisations have been the backbone of the disability delivery services throughout the country in the past 50 to 60 years, since the late 1960s. They have had an ethos and have worked on a voluntary basis, with boards in place, and were embedded in every community trying to raise funds. The HSE has undermined the section 39 organisations. I do not know why that is because the HSE has done nothing to show it is better in any way, shape or form, or that it has a better offer or agenda than the section 39 organisations. We need to empower the section 39 organisations and stop challenging them and looking for efficiencies and suchlike, as has been going on for a decade. A lot of the organisations were putting in money at the front for therapies for the people they represent. We need to empower them rather than challenge them so that they can be the vehicle for the State in making sure we have a better service.

On transport, the Departments will come back to say that transport is a huge cost, particularly for the Department of Education, given the challenges that are there. Many of the schools dealing with the Department will talk of a broken system and there are cases going to the High Court that should never be seen in the High Court. I welcome the Bill and I know the Minister of State has huge energy and is fighting as hard as she can, and I applaud her for what she is doing and how she is applying herself to the job. However, this is step one in trying to make sure that, in the years to come, we can say this was a major policy decision to move it from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth, and that then saw a sea change in care by the State of people with disabilities into the future. This has to be seen as step one of a massive volume of work that needs to be done by all of us to have a better system in place.

The Bill makes the HSE accountable to the Minister for Children, Equality, Disability, Integration and Youth for the management of delivery of the specialist community-based disability services and the development of a service plan, a corporate plan and capital plans. I hope this is not just about rearranging the deckchairs on the Titanic. The focus should be on improving disability services. In my opinion, the Act on its own will deliver nothing on the ground. What the people are asking is what it means to the hundreds of thousands who are directly affected by a severe lack of facilities in our communities. People who are struggling to get assessments and services want to see real, fundamental change in how people who need the services are able to access those services. What is needed is massive investment in those services that are now passing to the Minister.

For example, what change will this bring about for the thousands of children who are waiting on ASD services? The wait is so long that many age out or get just one or two sessions. They are four or four and a half years of age, they get one or two sessions and then they age out at five years of age. They then go from early intervention onto the school age team, and I know this personally because I have been involved in school completion for many years. Talk about knocking people’s heads off a brick wall. There is a deep frustration that parents feel when they have to go back on another waiting list. The team is massively under-resourced. I met the disability services manager a while back. They have 120 people in places and another 120 on the waiting list, and they can only take in about ten or 15 a year. There is massive under-resourcing.

With regard to dyslexia and the lack of specialist schools for children to enable them to get the support they need to help them to flourish and grow in mainstream schools, short-term intervention can make a lifelong difference. There must be co-ordination between health and education services to ensure children get the supports they need.

Danu Community Special School in Dublin 15 has been calling for an onsite therapist. Under progressing disability services, unfortunately it has not been awarded one. I am sorry the Minister, Deputy O'Gorman, is not present because both he and I visited the school just before Christmas and we saw the amazing work it does. Unfortunately, it is desperately in need of a therapist onsite to work with it. It is really struggling to deal with the difficulties it has within the school. If there is one thing I ask the Minister of State to take from today, it is to look at the services at Danu school and to try to get a therapist there.

I welcome the provision for a review after three years. I hope we do that review well within that three-year period because there is a dire need for a comprehensive overview of exactly where we need to be in the delivery of services for children with disabilities. I wish the Minister of State well in that task.

This is certainly a detailed and technical Bill. There is a consensus that it will be supported and that disability services need to be reformed. The question is whether it will improve services for those who are in the disability services, their families and all of the workers who provide this very important service. The question is whether it makes the service better because it is reporting to two Ministers, given it has gone from the Minister for Justice to the Minister for Health and the Minister for Children, Equality, Disability, Integration and Youth, or that is my understanding and I stand to be corrected if I am wrong on that.

As I said, this is about improving services in regard to disability, intervention and resources. Last year, a community-based service, St. John of God’s, was in serious difficulty; in fact, it was in so much difficulty there was talk of the liquidation of the service. I used to work with St. John of God’s a long time ago. It is a great service that provides a community-based service and a day service. My former workmates were very concerned and are still concerned about the future of St. John of God’s because there was an enormous deficit of up to €35 million. The service cannot be run if it is constantly having to think about deficits – it just cannot have that. People cannot run a service when they are talking about liquidation and not being able to fund the service. That has to be addressed in a serious way. When we talk about public health in regard to community-based services, I have an issue as to why it is kind of NGOed out. I do not understand that. Even though St. John of God’s, Stewarts and all of those services provide an amazing service, they should not have a situation where funding is a serious issue.

Community-based disability services have a chequered history in this country. People were institutionalised, marginalised and stigmatised. Gladly, we have moved on. It is not perfect by any means but services have got better and people have gone from that kind of institutionalised setting to a more community-based setting and they have rights. For a long time, people with disabilities were marginalised. They faced poverty, deprivation and unemployment, and they were completely marginalised. That has improved, although it is not perfect by any means. Hopefully, this new formalisation will mean things improve for everybody, not only those who are living with a disability but also their families and the workers who provide a very good service.

At the heart of disability is that somebody should not be handicapped by that term and they should have a fulfilled life, like anybody else. That is what this holistic approach is about. Anybody could be in this situation. We want to improve life for those with a disability in regard to all of the things which we sometimes take for granted.

I wish the Minister of State the best in regard to this new arrangement. It is not perfect by any means. I could go on about assessment of needs and the horror stories around that, where people have to approach Deputies. As I said to the Minister of State before, if families and parents are approaching Deputies, we know there is something really wrong because we are the last people they should be talking to. I wish the Minister of State the best.

Tá áthas orm deis a bheith agam labhairt ar an ábhar seo. I congratulate the Minister of State on the work she is doing, which is very challenging.

Approximately 14 or 15 years ago, I suggested that disability and that type of continuing care and support for people, which is not about curing an illness but about affording people with an ongoing condition a good quality of life, should be separated from acute medicine. It was my belief that when the argument came around the table regarding the money, the Minister for Health was in an invidious situation trying to argue on the one hand for acute medicine, which often gets a high profile in the media, and, on the other, for disability. I really welcome that 14 or 15 years later this decision has been taken and that the Minister of State has been put in the hot seat because she has the energy and commitment to make things happen. It is true that, not only in this country but all over the world, people were put in institutions. Thankfully that has changed and our attitude towards disability has moved forward. We still have a long way to go so we need to look forward to a change and an advocate.

It is important to have good structures but good structures without good Ministers do not, of their own accord, deliver anything. I do not believe in the idea that everybody is the same and that the service is the same no matter who is driving it. If I look around the world at everything from sport to medicine, politics or any other activity, people often make the difference, not the structures. Good structures help good people to make a difference. No matter how Ministries are divided up, there will be huge cross-cutting challenges. It is important that the Cabinet is collegiate and that it fights against the tendency of Departments that all of us who ever served in Government are aware of. At times they run the Departments as if they were fiefdoms in competition against each other, rather than one seamless part of a totality that is there with one aim in mind, namely the common good. One former Minister for Health stands out for me on disability and that was Brian Cowen. Things moved forward at that time but in the past ten years disability has not been high on the agenda and we need to change that.

I join with those who have raised the issues with section 39 funding. I cannot understand why sections 38 and 39 are different. That would be a quick win if the Minister of State could make sure that equal work gets equal wages. That is important for structures and it is important that equal bodies do equal work and get equal money to buy services. I mentioned the issue of accommodation to the Minister of State last night. In the past accommodation was simple. It was in congregated settings and it was provided by the HSE. In the past 20 years we have been decongregating the settings and that was a great thing and something I welcome. In doing that, we have not really decided how we will fund them. We have been using capital assistance scheme funding from the Department of Housing, Local Government and Heritage that the various disability organisations realised they could tap into. However, this funding was never structured to deal with disability. For example, on the one hand an organisation might get the standard amount of CAS funding for a house and, on the other, it has to comply with HIQA standards for the buildings. HIQA standards are much higher than the standards any of us would apply to our private domestic dwellings. I will leave it to the Minister of State to crack this one but between the Departments of Health, Children, Equality, Disability, Integration and Youth and Housing, Local Government and Heritage, it is important that a dedicated and agreed process on accommodation in community settings is agreed. We need to make sure that houses as near as can be to the way the rest of us live are provided. The money should be in a ring-fenced fund and the specifications for that funding should match the requirement for the quality of the building because I have seen some fantastic examples of what can be done. There is one particular development in Galway city and some day the two of us will go and look at it if the Minister of State has not seen it already. Each apartment is individual and there are good community spaces. It is ideal because it caters for people who have significant disabilities on the one hand and it also provides for their individuality on the other. It does not have the appearance of a regimental system that does not allow for individual flair.

I only have 30 seconds left but I could talk on this subject for a long time because it is something I am hugely committed to and interested in. We need to move much more promptly on early intervention and therapies. Supporting therapies for people with disabilities are hard to get so we need to move on that. No matter what our political shade is, all of us in this House will say it is cruel and hard on parents, who might already have children with significant disabilities, that they spend so much of their lives advocating for basic rights and services. I have no doubt that if there is anybody in this House who might be able to tackle all that it is the Minister of State, and it is a huge workload. She can make headway in whatever time this Government lasts, and it is due to last three and a half years. I hope she will manage to make significant progress in laying the bedrock for a much brighter future for people with disabilities in that time.

This is a technical Bill and I acknowledge the commitment and hard work the Minister of State puts into her brief. I know she shows huge empathy with the people she works with. That said, I cannot see this Bill making a huge difference, or any difference, to neurodiverse children who are being bused out of their communities with strangers. More than €70,000 per day is being spent in south Dublin alone to transport autistic children out of their communities in this way. That is just south Dublin and it would be interesting to know what the entire national figure is. A freedom of information request went in and it was established that €72,000 per day was spent transporting children to classes outside of their communities each day. How can this be justified? How will this Bill change that waste? Why can neurodiverse children not have the expectation that they will be able to walk to school with their brothers and sisters?

This Bill will not make any difference to the parents in south Dublin who cannot get a place in the same school as their other siblings. Despite a 37-day process, schools in Dublin 6 and Dublin 6W have not opened any new classes. A relatively new school in Sandymount, the Shellybanks Educate Together National School, has not opened a new class even though it has the space within that footprint. Earlier this week I was talking to one parent who was in tears in the middle of the street telling me about the fear and desperation their family had when they were told there was no place for their child in a class in September. This worry and fear is all-consuming for the family and it is crippling them. It is not a debate for today but no school should be allowed to open without having an autism class and that goes for primary and secondary schools. This Bill will not make any difference to the parents who are waiting years to have their children assessed.

If the Bill could make a difference to service provision then parents of neurodiverse children would be delighted but it is hard to see how shuffling around the chairs will make a difference to children with autism and their parents. It is a real challenge for them and spending so much transporting children out of their communities is no way to treat them and their families.

I welcome the opportunity to contribute. I have spoken many times in this House on mental health and in particular, the mental health of our younger generation. The younger generation of today faces many challenges and mental health is one of the main ones. I welcome this Bill and hope that by transferring certain functions to the Minister for Children, Equality, Disability, Integration and Youth, it will improve the provision of mental health services to our younger generation.

Unfortunately, statistics do not lie. The latest figures show that more than 2,500 children and young people are waiting for CAMHS. What is even more alarming is that almost 9,000 children are waiting for primary care psychology treatment. In addition, more than 1,500 adults are waiting on primary care psychology treatment from the HSE. These figures are truly shocking and unacceptable. In this day and age, we should not have any child or young adult waiting on mental health services because the dangers are just too great.

The World Health Organization, WHO, states that a minimum of 14% of a country’s overall health budget should be allocated to mental health services. Sláintecare recommends that the mental health budget should be a minimum of 10% of the overall health budget but the latest Government figures show that only 5.2% of the overall health budget was allocated to mental health. To put this in perspective, our mental health budget is nearly two thirds less than the minimum recommended by the WHO. The Mental Health Commission told the Oireachtas Special Committee on Covid-19 Response that Ireland's mental health system is not fit for purpose, is out of date and substantial additional investment is needed. This is a serious issue and one that the Government needs to address as a priority.

Prior to the Covid pandemic, waiting lists for mental health services were at crisis levels. Now that we are coming out of this pandemic, I fear that those waiting lists have gotten even worse. I call on the Minister for Children, Equality, Disability, Integration and Youth to tackle this problem immediately.

Time and time again we hear the Government talk about the challenges of tackling mental health and the many actions it is taking to deal with the issue. The bottom line is that not enough is being done to tackle mental health problems, particularly among our younger generation. The Government needs to take this seriously and invest more resources so that more than 2,500 children are no longer waiting for access to CAMHS. We need to dramatically reduce the number of children waiting on primary care psychology treatment. At present, almost 9,000 children are waiting for such treatment and this is unacceptable.

In my role as a Deputy and through my involvement in the GAA, I see at the first-hand the challenges faced by the younger generation in particular. I also see that mental health issues in this generation are getting worse. We cannot have a situation where we are constantly dealing with these issues too late. We need to address mental health issues at a very early age. We need to teach children in primary school that mental health issues and challenges will occur in their lives and that there are ways and means to deal with them. Children must be taught how to deal with the many challenges that they will face in life. Stress, anxiety, and fear among our younger generation are growing all the time and we must put systems and supports in place to enable them to deal with these challenges. The stigma attached to mental health issues must be removed. It is okay to say that you need help or that you cannot cope. These are not weak but strong actions to take. The younger generation must be supported in these challenging times. The bottom line is that if we can provide this generation with the proper supports and systems, they will support each other. When a friend is struggling, it is very important that people rally round and support each other. Often when teenagers are feeling under stress they turn to their peers for support. This is where education and a proper understanding of mental health issues will really help. As I have said, the figures for mental health are truly shocking.

I call on the Minister to acknowledge that we have a crisis on our hands and to commit to ensuring that proper and adequate funding and resources are allocated to mental health issues. It is disgraceful that only 5.2% of our annual health budget is allocated to mental health services when the WHO recommends a minimum of 14%.

This time last week I spoke to the Minister of State the Department of Health, Deputy Butler, and to staff in her Department about a very serious case involving a 14 year old girl in Dundalk. In fairness to them, they contacted the girl's mother and they tried their best to help. The child did see a psychologist and she spoke to CAMHS staff, including a social worker and the team leader. They are all trying their best but the child has said that she wants to commit suicide. At present, the child is at home with her mother and three other siblings but that is not the right place for her. I contacted the Department and explained that this child is banging her head against the wall and is looking for help. Are we going to keep passing the buck? This child is crying out for help. The psychiatrist told the child to come back in one week but her mother cannot take any more stress. She cannot take it any more. She has three other children at home and she is trying her best.

I was told that I must be very careful in what I say and do. The only place I seem to be able to say what I want to say is in the Chamber, thanks to parliamentary privilege. If I go on my local radio station or to my local newspaper, it is me they will come after and, in fairness, I cannot put that on my family. Do I have to come in here every week and keep raising the same issues? I have the contact details of this child and I will pass them on to the Minister of State. I am not trying to pass the buck to anybody but the child is crying and is looking for help. Her parents are looking for help but everyone seems to be passing the buck and that is not fair. We are talking here about a 14 year old child. Her mother took her phone from her and she locks her in her room. When she went to check on her last week, her face was all cut. She is crying out for help. I asked the Minister of State, Deputy Butler, to help last week and I am asking the Minister of State, Deputy Rabbitte, this week. Do I have ask the Taoiseach next week? Do I have to ask the Tánaiste the week after that? I am not saying that this girl could commit suicide and could be dead next week but I am crying out for help here. If she goes to see professional people but they do not listen to her or to her mother, what is the point of that? When she went to see the psychiatrist, he did not even check if she had any marks on her body. He just asked her some questions. She said to him, "I don't want to be here", but then she said that she wanted to be helped. She is very conflicted.

When I am finished speaking I will send the details that I sent to the Minister of State, Deputy Butler, last week to the Minister of State. I do not care who gets involved or what is involved. All I want to know is that we can help this girl. If we can save one life, it will be well worth it.

I am delighted to have the opportunity to speak on this legislation, which provides for a transfer of functions. I welcome the Bill and support it. However, like other speakers, I am worried about what happens when it is passed. The most important issue with regard to disabilities is funding. Responsibilities going from one Department to another is fine but the funding needs to follow the service. I also have concerns about the HSE still retaining some clout in this area, although that may be for very good reasons.

I am a member of the Oireachtas Joint Committee on Disability Matters, as is Deputy Hourigan, and the Chairman of that committee spoke earlier. We have been engaging with people with disabilities, advocates and representative groups for the past 18 months. Some of the stories we have heard have been pretty traumatic. There is a serious concern among parents as to what will happen to their son or daughter when they pass away. That concern starts when a child is born who is found to have special needs.

Early intervention seems to be very haphazard. The parents start a journey where they are fighting and they are in a battle from that day on. There is no clear pathway where they see a plan formulated or have a caseworker with them for the entire journey in order that they know what to expect, what will happen next and how it will happen. We have reconfigured some of these services in our region in Galway but we are now being told that we need to give it time to bed in. That is no good to families whose children need interventions. We need to make sure that there is a clear pathway.

Today, the committee was talking about the other end of the spectrum, namely education and employment. There is a huge learning curve for us all. Maybe our generation is not as well up as the younger generation. People with disabilities, insofar as possible, should be educated in mainstream schools so that people who do not have disabilities are able to grow up with them and understand them and it becomes a norm. Employers are cautious about taking on people. There can be a fear factor around what they are taking on. We have to take that away from people and make sure that when employers are hiring that there is a quota. We can start ourselves in the public service. In my time as a lecturer in GMIT, I have experience of people with disabilities and getting third-level education, getting their level 8 degrees and going on to full-time employment, becoming a beacon of light and hope. We need to see a lot more of that so that parents can have some reassurance that their child will grow up and be able to fend for themselves financially.

Personalised budgets is a very important area. The Indecon report showed that the cost of living with a disability is between €9,500 and €12,000 more than the cost of normal living. We need to make sure that when we bring in schemes that they are adaptable and flexible to deal with the specific needs of the person who needs them. We see that with the housing adaptation and mobility grants that are administered by the local authorities. They are great grants and schemes but they are only contributions. It is the same sum regardless of the type or severity of disability. The budgets need to be addressed towards the personal needs of the person who needs it.

We often talk about disability and maybe in the past we were paying lip service but I think the Minister of State, with our support, will make sure that it gets beyond that. Sometimes I feel that it is just a box being ticked to make sure that things are right. We have also created a great deal of mystery of how the pathway should be for a child or adult when moving services.

I must also raise transportation supports for people with disabilities. There is effectively no scheme to support people with disabilities because the primary medical certificate scheme has been deemed unfit for purpose. The courts concluded that almost two years ago. Instead of fixing the issue the Department of Finance, in its wisdom, adjusted the criteria to suit something else. Now the appeals board has resigned en masse because it cannot work with it. There it is left. Whether it is the Department of Finance or Health, everyone is saying that it is somebody else's responsibility. I think it is our responsibility. We should not entertain leaving these people without proper supports for transportation. Something that is thrown at me and the Minister of State, who comes from the same constituency will understand this well, is that we are working on providing public transport that people with disabilities cannot access. However, there are a hell of a lot of places that I know of in our constituencies where there is no public transport, let alone a bus with wheelchair access. Let us cut to the chase. The mobility grants and the transportation support grants are gone. People are not getting that support; they are getting absolutely nothing. While people who did qualify for it are being supported we have created an unequal society. The retiring Ombudsman, Peter Tyndall's latest report before Christmas, was called Grounded. He did not call it that for any reason except that there is a huge number of people with disabilities who are grounded in this country because we do not give them the supports that they need. We have been talking about this a good while. It is important that we get on with it.

Thinking of all the money that goes to health, we need to see the disability budget being transparent around what it is going to do, who will be responsible for spending it and who will be responsible for delivering the services. That is what this Bill is supposed to do. I will support the Minister of State on this and I hope she will keep in mind that we do not want a plethora of laws and so on and then for things to start happening in three or four years. The Bill has taken 18 months to get here. It cannot take another 18 months or for people saying it needs time to bed in. That phrase needs to be removed from the agenda for the sake of the people with disabilities.

In respite for families of children parents and families still do not have what they deserve. It is important that we provide overnight respite services that are accessible to people so that we do not have people travelling from Galway to Limerick to get respite care overnight where they have to bring the child down and pick them up again the next day. That is not respite. That is actually hardship upon hardship and anguish.

I wish the Minister of State well in getting the Bill across the line. I do not know how many times I have said it at the Joint Committee on Disability Matters that after talking to people, we, as politicians, feel after that we are inadequate because we are not actually making the difference. We all come across things in our clinics and constituencies that we as politicians should not, and cannot, be proud of. Much of it comes down to a case where we have just told people with disabilities, "Yeah, you'll be okay". That is not the fault of the Minister of State, of course, but we need to make sure that while we are at it, and the committee will help with this, we will make a tangible difference to people who have disabilities. It is most important that when we finish with this legislation that then we get on with the real job. If there is any kind of monkey business going on in the Department of Health, we have to call it for what it is. We need people with disabilities to be served properly, in a way to which they are entitled under the UN convention. It is important that we embed that in everyone's minds, not simply in law.

I have listened to some scepticism regarding the import of the Bill but I am quite hopeful that the transfer of the disability portfolio to the Department of Children, Equality, Disability, Integration and Youth will be effective and worthwhile. As we move towards a rights-based approach to addressing the requirements of persons with disabilities and the provision of services around that, this new context for policy and legislation will be quite important. In fairness to the Minister of State, she has an excellent approach to her brief and I can see her working incredibly hard to meet the challenges that the sector faces. I believe that the Minister, Deputy O'Gorman, will support her well in that. Deputy Canney mentioned the Joint Committee on Disability Matters, which is tasked with overseeing the UNCRPD. It can assist the Minister of State in this. I have learned in the few years that I have been here that there genuinely is a cohort of Oireachtas Members who are totally committed to the issue. I can reflect on Deputy Canney's feeling of inadequacy when hearing of the lived experience of people but that is not down to a lack of commitment because there is serious commitment from Members on both sides of the House.

However, I take the opportunity to situate the policy work we have to do in the next few years in the lived experience of persons with disabilities and their families. Especially as we are moving to this new context, we should be thinking of it in the context of financial independence and inclusion for those with disabilities.

We have heard lots of numbers this afternoon, but the Central Statistics Office, CSO, figures from 2017 suggest there are more than 130,000 persons with disabilities who are living in danger of consistent poverty. In the past two years, Covid-19 has had a specific effect on persons with disabilities. It has been incredibly hard on some people, and we must factor that into our plans for the next few years. We could also see Covid-19 as an opportunity to put persons with disabilities and their rights at the very centre of action and direct funding to support accessible and inclusive communities. We have all realised in the past two years how much we rely on our communities. It is important that measures are strengthened to support persons with disabilities to transition out of and prevent them from falling into poverty. I am saying that with particular reference to the level of inflation we are seeing at the moment. Levels of poverty inevitably interact with other components of our family and community life. We know only 30% of persons with disabilities are in paid work, and for persons with visual impairment it is only 24%. In general, our numbers of persons in employment from the disability community are around 20% lower than the EU average. That is a stark number.

We know persons with disability consistently struggle to find suitable and secure housing and some people wait for five to ten years for State-provided housing. The housing situation for persons with disabilities is of course just a crisis within a crisis, that being the broader housing crisis, but it demonstrates a housing sector that is not really working for persons with disabilities. There are huge levels of uncaptured need on top of this because there are many young persons with disabilities who are living with parents, who would not necessarily be captured within those numbers, who have no prospect of moving out and living independently or who are living with elderly carers. A core problem there is access to the HSE support package.

I could continue highlighting those issues through education, health and mental health. As we are doing this changeover, it is important to recognise the history of persons with disabilities in this State has been one of poverty and social exclusion. That is a legacy that is very important for us as parliamentarians and especially parliamentarians on the Government side to recognise. On average, as other Deputies have said, other EU countries spend about 2% of their GDP on social protection for disability and Ireland has in the past spent far less than this. The disability capacity review gives some indication of the level of investment that will be required, and those numbers are considerable. To make the changes we need for persons with disabilities, we will not only need to be ambitious but also very diligent and comprehensive. I welcome the proposed Assisted Decision-Making (Capacity) (Amendment) Bill 2021, which would include measures to further realise the UNCRPD in Ireland, including, and very importantly, legislating for the Irish Human Rights and Equality Commission to be a national monitoring body for the convention. That is an important move. We are going to need serious oversight to keep ourselves honest because it is incredibly complex and sits across several Departments.

Returning to the idea of seeing through the lens of disability, poverty is a relentless and hungry opponent for many people. It can steal their energy, ambition, hope and make every task, every goal and every day feel like a Herculean undertaking. It is the mandate of this Government and of everybody in the House, because so many people care genuinely about this, to ease that burden for persons with disabilities. The short version of what I wanted to flag in this debate is I am asking that this change be a kind of mandate to reach out, not just to the various representative groups of persons with disabilities, the service providers and the individuals themselves who experience disability but for us in this House to reach out to Departments.

Issues around disability reside in the Department with responsibility for housing, and here I reference the Irish Wheelchair Association's call for a change to building regulations and access. They reside in the Department of Social Protection, as with what we just heard from Deputy Canney about the request for the €20 recognition of poverty payment, which has been highlighted by the Disability Federation of Ireland. The issues reside in the Department of Public Expenditure and Reform, where there is a need for equality budgeting and well-being indicators that would be so important for persons with disabilities as a means of going beyond the traditional metrics of GDP. It would be a way of measuring progress and assisting in reducing poverty and strengthening economic and social rights for marginalised groups, of which persons with disabilities are one. It must also reside in the Department of the Taoiseach, where major nation-building decisions are made, such as the creation of the national development plan, on which the Committee on Disability Matters made a submission. In addition there is the Department with responsibility for employment which has a role when we talk about section 38 and 39 organisations.

I can think of few parliamentarians better suited to the task of reaching out beyond the boundaries of their brief and making their influence felt in all sorts of decisions from other Departments than the Minister of State. I wish her well and look forward to supporting her in that.

I am glad to see the Minister of State here and that she is responsible for this area. She seems to be responsible for everything because she seems to be the only Minister or Minister of State I see in Parliament taking anything and everything that is going. Fair play to her. If one positive comes out of this legislation, it is probably that the Minister of State is the one who is responsible for it, because she will actually make something of it. That is the weakness of it as well. We must rely on people like her to ensure this will work. The danger is that if she moves on, through a change of Government, promotion or whatever, this will fall down again. That is the problem. It is the problem with everything. Other Members have highlighted that disability matters have homes in so many different Departments. Trying to get one Department to do something is bad enough but when you have two, three or four Departments with responsibility, you may forget about it. That is the reality. Even though we bring in legislation here and this Bill is good on paper and looks good, I have serious doubts about how it will operate in reality. That is the real problem we all face. Somehow, we must face up to it and deal with it. I do not know what the solution is yet. If I get that knowledge, I will let the Minister of State know.

I am thankful for the opportunity to speak on this Bill. I understand it will amend the Health Act 2004, the Disability Act 2005 and the Health Act 2007 to transfer policy, functions and funding responsibility relating to specialist community-based disability services from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. The Bill will also provide for consultation in joint functions of the Ministers to provide for revised corporate governance and accountability arrangements of the HSE. Seeing how that operates will be interesting in itself. There is definitely something badly wrong with the HSE as an organisation and I do not know how that is going to be addressed. I appreciate this transfer makes sense on paper. However, I note that responsibility for the delivery of specialist community-based disability services would be retained within the Health Service Executive following the transfer. This would mean the HSE would be expected to report to two Ministers about different aspects of its functions. I am sceptical of how this will work. The HSE fails in being accountable to one Minister. What makes us think it would properly accountable to two? That is a real problem.

The Minister of State is aware of this and I will speak a wee bit more later on about our own interactions on the Brandon report and how that shows up what is wrong with the HSE. That is the crux of the problem. Unless we deal with the HSE, by kicking it up the arse or kicking it out the door and getting something else in place, then we are on a hiding to nothing from here on in. I often think if you were an alien coming down to look at Ireland, you would think it a great country if all you could see was the legislation we had. You would think this was a great place with great legislation. It says everything and does everything and it is on the box. However, if you looked at the implementation you would say this is a completely different country and ask how this could be. That is the crux of the problem.

As I said, a very recent example of this is the Brandon report, which details multiple incidents of sexual abuse that took place at Ard na Gréine in Stranorlar, County Donegal. The National Independent Review Panel was commissioned to carry out the report, which was then submitted to the HSE in 2020. When the Minister of State asked for a copy of this report in 2020, she was told this was not possible and that she would get it in due course.

When the HSE provided the Minister of State with a list of recommendations stemming from the Brandon report in April 2021, to ensure the recommendations were appropriate, she again asked for a copy of the report and was again refused. Following this, she continued to request a copy of the report. However, the HSE was not forthcoming and at one point thought it would be enough just to show the report to her on a screen, as far as I know. The HSE did the same thing to me in respect of a different report that had no bearing on the Brandon report. I will take this opportunity to commend the Minister of State, as I am certain this report would not have been given to her Department if it were not for her persistence. That is a tribute to her and the work she did to make sure it happened, which is vitally important. This issue will go on for a while yet and will be important to how the HSE does its business.

I hope this persistence continues; I know that with the Minister of State in place it will. Despite what we have been told, the families do want this report published. That is vitally important. The HSE is saying they do not, but the families do. I know that for a fact because I have talked to many of these families regarding this. I also know that some families, whose loved ones were involved in the Brandon report, have not been even contacted by the HSE, despite what it says. This is part of the weaknesses. We have had to rely on the HSE to do much of this, including contacting the families, telling the truth and so on. We are relying on the HSE to do the right thing but it has not. That is shocking, even at this stage, when things have been going on for so long.

It leads us to ask how we will know the HSE will do the right thing in future. The instance of the Brandon report is very important, and there may be less important matters, but it shows how difficult it is for us in this House to ensure the HSE will be accountable in future? The fact that the HSE refused outright to report to a Minister of State is incredibly concerning. It is supposedly a State agency, yet this shows it is not truly answerable to the Minister of State. It makes one wonder who is really calling the shots and why the HSE has been given the power to do this. The HSE has probably gained this power of pottering on and doing its own thing over the years, but it seems it is not accountable to anybody and can do what it wants. That is very concerning. It begs the question how it will be possible for the HSE to be accountable to two Ministers, when it so obviously and openly fails to be accountable to one. This is something that seriously needs to be looked at. These agencies need to be accountable to the Minister who oversees them, otherwise what is the point of that Minister? What is the point of elected representatives, such as us, when our institutions are not even answerable to us? This is a serious matter and it should not be overlooked or brushed under the carpet. I would like to see this investigated further because it is very necessary.

I am wary of Bills such as this that provide for certain functions to be covered by two Departments. While the technical aspect may appear to be an effective distribution of regulation and oversight, I have concerns about how this will be carried out in practice. As I said earlier, in this country, whatever hope you have with one Department, it is very limited with two, non-existent with three and good luck to you with four because it is just a waste of time. That indicates something is badly wrong with our system of government and about accountability to the House. As I said, I do not know exactly how we can resolve that, but a good step would be to make people accountable, whether they like it or not. We are accountable every five years and we can lose our jobs straightaway, but what head of the HSE, or person in one of its sections, or in Departments, would lose their jobs for blatantly doing things wrong, for punishing people, not dealing with families in a fair and safe manner, not informing families about how their loved ones are being treated and so on? These are very serious issues that need to be dealt with and unless this legislation can deal with them somewhere along the line we will be at a loss, despite the good words of the Minister of State.

Like other Deputies who have spoken on this Bill, I would like further clarity on the practical issues that may arise from this, particularly the accountability arrangements of the HSE and how the budget will be set. I am cautious in my support of this Bill. Although I believe it makes sense on paper, I wonder how this may be put into practice. I would like to see my concerns taken on board and addressed, as I believe there have been real flaws in how inter-departmental issues have been addressed in the past. This needs to change in order to properly facilitate the future transitioning of powers from one Minister to another. I would also like to see the accountability issues between the HSE and Ministers addressed. I hope this will be addressed by the Minister of State and that these issues may be discussed on Committee Stage and as the Bill progresses.

I thank everybody who has contributed this evening. I will split my time in two. I will deal with the legislative side of the Bill, in addition to some of the issues that were brought up, in answer to some of the questions. Deputy Smith asked a number of very important questions regarding how it will all work and whether everyone in the Department of Children, Equality, Disability, Integration and Youth have to go back to the Department of Health with the begging cap to ask it for approval and so on. "No" is the answer to that. The Minister, Deputy O'Gorman, will deal directly with all budgetary matters with the Minister for Public Expenditure and Reform, Deputy McGrath. That is the way it will be set out.

The Bill recognises the enormous importance of both Departments working together. This is the key theme throughout the Bill. The HSE will report to both Ministers, but it will do so via one service plan, one capital plan and one corporate plan. This will minimise any silos. The Bill also provides for two Ministers to enter into arrangements for embedded co-operation. This will happen, specifically, on the budget. No Minister for Children, Equality, Disability, Integration and Youth will go through the Department of Health. When the transfer happens, the Minister with responsibility for equality will take over the Vote expenditure and negotiate with the Department of Public Expenditure and Reform in respect of budget 2023. That is an important piece of it.

Deputy Shortall's question was around fears about moving the significant budget. She also talked about the sectoral plan in the context of section 51 of the Bill. The transfer is about a technical exercise and moving policy responsibility between Departments that is turning a page and allowing a fresh focus on this area. The scale of disability that will be related to the new Department means disability will take centre stage. Deputy Moynihan called disability the Cinderella of the Department of Health. It will now get the opportunity to flourish, grow and support people with disabilities and their families. The Bill is a step in the right direction and a very welcome one. The Disability Act 2005 already requires the Minister for Transport to create a sectorial plan. This Bill amends the 2005 Act to allow a transfer of certain responsibilities, but does not alter or weaken any existing requirements on sectorial plans.

Many of the contributions focused on service delivery. We acknowledge that it is a very technical Bill, but it is important that I reassure all the Deputes, and especially people listening in, that I have been doing the job for the past 18 months. I thank the Taoiseach for his foresight in making this decision, but when I arrived and he told me I was taking over as Minister of State with responsibility for disabilities, I was very quickly not on the welcoming email in the Department of Health. Thanks to the Minister, Deputy O'Gorman, I got an office in his Department, so I was out of the gap straightaway on 1 July. I never functioned within the Department of Health; I have always functioned with the equality hat, along with the Minister, Deputy O'Gorman. That is not to say I have not had a great working relationship with the Minister for Health and the team in that Department, but I have based myself where I was always going to end up.

I am delighted it did not all happen on day one because I have learned so much in the past 18 months, including where the pitfalls are. That is something that Deputy Smith asked - where are the problems? The problems are in the integrated piece in primary care and what will happen with aids and appliances. That is what we are working out at present. The memorandum of understanding is that if the two Ministers do not get on, what will happen? As Deputy Shortall said, who will be the referee? That is where the Taoiseach and the Cabinet will have to work it out.

I am very fortunate that since becoming Minister of State I have worked with everybody, including the Department of Health, the Minister for Housing, Local Government and Heritage, Deputy O'Brien, on the disability housing strategy - we have done that in the past number of weeks - and the Minister for Social Protection, Deputy Humphreys, on the ability programme to address employment. In respect of education, I have worked with the Minister, Deputy Norma Foley, and the Minister of State, Josepha Madigan, in the Department of Education on transition planning. I am working with the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Simon Harris, on higher education to ensure more students are taken onto the various course to meet therapy requirements, and with the Tánaiste on enterprise and entrepreneurship. Some 80% of all disabilities are acquired when a person is over 18; those people are not born with a disability. People have to change their focus. We have to look at enterprise and entrepreneurship and I acknowledge the role of Professor Cooney in Dublin City University on that.

We also have to talk about transport. Many of us here are from rural areas, where we do not have access to the DART or the Luas. We have to look at various areas in regard to transport. In recent weeks, I have reconvened the transport team, which has not met since 2017. I have brought all of them back around the table. I am looking at what worked in the past. The issue of allowances was mentioned. Allowances were cut, removed and so on. It is all back on the table.

On expenditure, the Minister, Deputy McGrath, has given me approximately €250 million in the past 18 months to ensure I can do the job within disabilities. Sometimes it is not all just about the money. There is a staffing issue at this time. If I could fill the vacant posts, the children's disability network teams would have a far different experience than what we are hearing about this evening.

The status of the disability capacity review under way in the Department of Health was raised. The framework and action plan on that is being put together. It is about putting the meat on the bones, which is bringing the Department of Public Expenditure and Reform into the room. We know the unmet need. It is now about calculating how much money I need and how much that Department will give me. On the issue of under-65s in nursing homes, while we had only a token allocation in budget 2021, it will be cranked up in budget 2022. On the national disability inclusion strategy, NDIS, the comprehensive employment strategy and the national disability strategy on housing, both are under my remit and I chair both. I keep on top of that.

I am not the Minister of good intentions; I am the Minister of action. I have the money and I want to deliver. Reference was made to "my intentions". I am action-based. I am fortunate that the Minister, Deputy O'Gorman, is a legislative individual because he will be taking over that side of things and I will be getting into the nuts and bolts of putting the practical steps in place. Much of what we are talking about here today is about getting into the HSE and the nuts and bolts of putting in place the network disability teams. Every team works differently and there are 91 teams. What we need is a standard operating procedure in regard to, for example, how a child comes in, the pathway through, how many children are looked after and how many have been seen at the end of the week. It is about key performance indicators, accountability and delivery of service. That is what I am looking for in that regard.

It was stated there is dragging of feet. There is nobody within the Department of Health or the Department of Children, Equality, Disability, Integration and Youth or any of my colleagues dragging their feet. Work is under way on the legislation on the decision support services and we are engaged in this transfer of function. All the while, we are also ensuring essential services are open. The Irish Sign Language Act will test Departments. That is a legal requirement. I worry about that. On the optional protocol, we are 100% committed to it. The Minister, Deputy O'Gorman, demonstrated that in his contribution.

Had this transfer happened on 1 July, I would not have learned how the HSE runs its own process internally. We learned that from the National Independent Review Panel, NIRP, piece. For me, it is about the break in culture and the change in the system. It is also about the powers of the Minister. The Ministers and Secretaries (Amendment) Act 1939 clearly sets out what powers Ministers have and what they can commission. Where I do see a pattern, and this is the important piece in regard to Brandon, it is incumbent upon me as Minister to call for an independent review, to look at issues through the lens of the social model and at how relationships work with Tusla, An Garda Síochána, social care and within the HSE such that people can be supported to do their jobs and they have confidence and trust in the system. I am working on that. I am speaking about where I see patterns, which I have seen. I do not need a NIRP to tell me there are issues in Donegal; I know there are issues there. I am working with the Department of Health and the Department of Children, Equality, Disability, Integration and Youth to ensure we come to a space where we can have that independent piece conducted.

A lot of work has gone into drafting this Bill. It is very technical, but when boiled down it is about making the Minister with responsibility for equality equal to the Minister for Health in regard to functions related to community-based disability services, which are complex needs. That is where the HSE will be answerable to both, but we will work uniformly on everything.

I look forward to the Bill progressing through Committee Stage. If I have missed any of the points raised today, I am sure I will be reminded of them as the Bill progresses.

Question put and agreed to.
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