Dáil Éireann debate -
Wednesday, 17 May 2023

Vol. 1038 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Housing Policy

Deputy Pauline Tully

The consultation that led to the new National Housing Strategy for Disabled People 2022-2027 was inclusive and was welcomed positively across the board by disabled people and their representative organisations. It raised hopes and expectations for civil society organisations and their members. More than a year later, however, the housing strategy implementation plan initially expected in June 2022 has still not been released, in spite of the urgency and despair faced by many disabled people waiting for housing. This forms part of the wider lack of implementation regarding the housing crisis. The disability capacity review published in 2021 called for consequent investments to be made to address the housing support needs of disabled people. However, the promised action plan has also not been published yet.

There is a worrying theme of a lack of timely implementation and funding of disability policies. Article 19 of the UN Convention on the Rights of Persons with Disabilities, CRPD, which commits signatories to "recognize the equal right of all persons with disabilities to live in the community, with choices equal to others," and to ensure that, basically, disabled people have the right to choose where to live and with whom to live on an equal basis with everybody else, has not been realised because we need to resolve the housing issues affecting people with disabilities before we can realise that right. Adequate funding, effective collaboration and robust management, oversight and reporting must form integral components of implementation. In particular, sufficient funding must be provided to all areas of disability housing policy. We have the decongregation process for moving people out of nursing homes and we must deliver sufficient, fully accessible housing and support provision for those disabled people who are currently living in the community but want to live independently. There are so many who live with aged parents, for example.

As for budget 2023, only a fraction of the overall increase for disability services has been allocated to improve the capacity of residential care, while the disability capacity review stated that addressing both demographic change and unmet need would range in cost from next to €230 million to €550 million a year by 2032. There is a huge level of housing need among the disabled population. More than one in four people who are homeless, 27%, have a disability, and 2,419 people are still living in congregated disability settings, despite the initial deadline to complete decongregation by 2018. More than 1,300 people with disabilities aged under 65 are living in nursing homes, as highlighted by the Ombudsman in his Wasted Lives report in 2021, and 6.6% of households on the social housing waiting list have an accommodation requirement due to disability. Some disabled people report being on the social housing waiting list for ten years or more. The waiting time for people with disabilities has increased in recent years, while it has decreased for those on the general social housing waiting list. More than 1,500 people with intellectual disabilities live with a primary carer over the age of 70, and more than 450 of those family carers are now aged over 80. Those figures are likely to be underestimations of the level of need as we hear from many disabled people with housing needs living with families or in unsuitable, inaccessible homes who are not on the social housing waiting list due to not thinking it will be successful or because they do not know the process to apply.

The delay in the effective planning of the implementation of the new housing strategy, as well as the lack of acknowledgment of the delay itself and the lack of clarity on the timeline, is an insult to the thousands of disabled people across the country struggling to access housing.

Minister of State at the Department of Housing, Local Government and Heritage (Deputy Kieran O'Donnell)

I thank Deputy Tully for raising this very important issue.

The new joint National Housing Strategy for Disabled People 2022-2027 was developed by the Department of Housing, Local Government and Heritage, the Department of Health and the Department of Children, Equality, Disability, Integration and Youth and was published, as the Deputy said, on 14 January 2022. The strategy places an emphasis on disabled people having choice and control over their living arrangements. It demonstrates the Government's commitment to providing equal access to housing for all.

The strategy is operating within the framework of Housing for All, which is committed to ensuring that affordable, quality housing with an appropriate mix of housing design types provided within social housing, including universally designed units, is available to everyone in Irish society, including people with disabilities. The plan sets out, over four pathways, a broad suite of measures to achieve its policy objectives together with a financial commitment of in excess of €4 billion per annum. The joint strategy sets out the vision for the co-operation and collaboration of Departments, State agencies and others in delivering housing and the related supports for disabled people over the next five years.

Among the objectives of the strategy is to meet our commitments under the United Nations Convention on the Rights of Persons with Disabilities to facilitate disabled people to live independently and as part of the community. The strategy aims to ensure that disabled people have equal access to housing and clearer pathways to accessing support services, promoting their inclusion in the community from a housing perspective. Work has been under way since the publication of the new strategy to achieve the objectives set out in it. The Housing Agency, together with all Departments and agencies involved, has also been developing an implementation plan to ensure that a comprehensive suite of actions involving all stakeholders that will ensure the delivery of the high-level objectives is put in place. A national implementation steering group has already been established and is being chaired by the Housing Agency. The group is actively advancing implementation of the strategy and will have responsibility for the delivery of the actions in the implementation plan.

I have only recently got delegated power in this area. I have made this a priority. I have worked with my officials on the document. People know my background. I have a particular commitment to people with disabilities so I want to make this plan up to date and robust. We now have, I believe, a plan that is very much up to date. It is being looked at now in this regard by our co-Departments, namely, the Departments of Health and Children, Equality, Disability, Integration and Youth. We are looking to publish, in conjunction with the launch, an awareness campaign in the coming weeks. I give that assurance to the Deputy and, more particularly, people with disabilities. I really want this Government to be absolutely committed to people with disabilities. However, it is not just about publishing an implementation plan; it is about publishing an implementation plan that is up to date and robust and delivers for people with disabilities. We are, as I said, finalising that. It is with our two partnership Departments, namely, the Departments of Health and Children, Equality, Disability, Integration and Youth.

We will look to launch the document very shortly along with an awareness campaign as well.

Deputy Pauline Tully

I welcome the fact that it is going to be published in a few weeks, and I sincerely hope that timeline is adhered to because we are a year past the expected date of publication. I hope the plan will see the lack of co-ordination which has existed between housing and other supports being addressed as well. Providing housing is one thing but unless one provides the personal assistance service, for example, or the home care supports, people cannot live independently in the community without them. It is important to ensure that the implementation plan addresses all of those issues and ensures there is co-ordination and co-operation across Departments.

Frequently, I hear of people with disabilities typically being on a social housing waiting list for longer than others and the hold-up is often because even if the council provides the housing, the HSE, other agency, Department or whatever is not prepared to provide the home supports or it is vice versa, one blames the other and then nothing gets delivered. I hope the strategy will address that.

Disability must be mainstreamed in all housing policy, including future-proofing the new housing stock that is currently being built under Housing for All by building houses to universal design plus plus. We are getting older, our population is living longer, and many of us will have mobility issues in the future, so if our house is universally designed to start with, it will be much easier to adapt if needed in the future. Part M of the Building Regulations currently only requires housing to be wheelchair-visitable, not wheelchair-liveable. There is an urgent need to review those guidelines and reform the legislation.

A few of the housing adaption grants were started by the Department of Housing, Local Government and Heritage last year, and we have not yet seen the outcome of this review. There are many issues with that grant as well. The maximum grant needs to increase significantly. The current level is €30,000, but that is far below what is required, especially with the current rise in costs of construction. The income threshold and the means test are problematic and do not reflect the extra cost of disability, which we know from the Indecon report published in 2021, which showed the cost of disability is anywhere from €8,700 to €12,300 per year, depending on the level and severity of the disability. I thank the Minister of State.

Deputy Kieran O'Donnell

I thank Deputy Tully for raising this important issue. I will deal with the two items. Regarding Part M, and it providing for "visitable" rather than "liveable", the Deputy might forward to me precisely what she has in mind in that regard.

We have carried out a review on the housing adaptation grants and I am looking at it in partnership with and working with the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien. Once again, I wish to reassure and to give that firm commitment to both Deputy Tully and to people with disabilities that the implementation plan is an absolute priority for both me and my Department. We are working to have it published in the next couple of weeks along with an awareness campaign. That awareness campaign is being developed by the Housing Agency.

While disabled people continue to access all the various housing options available to them, the ultimate goal is to make our country an even better place for disabled people to live in, to access the right kind of housing or accommodation where disabled people have choices, and be involved with and consulted on matters and decisions which affect their lives. Their independence is hugely important. The new joint national housing strategy for disabled people, as well as the more detailed implementation in line with the emerging implementation plan, will ensure delivery of this goal. This is a matter in which I take a personal interest, as does the Department, and within the next couple of weeks we will publish a robust implementation plan for housing for people with disabilities, together with an awareness campaign. I give that firm commitment here today once again.

Special Educational Needs

Deputy Sean Sherlock

I welcome the Minister of State at the Department of Health, Deputy Butler, to respond to my query in respect of what I perceive to be the lack of special school places, and school places for children with additional needs in the north Cork area specifically. I raise this issue on the basis of the fact that parents have been in contact with me to say there is no certainty for their children in the north Cork area. I refer to the Mitchelstown and Fermoy areas specifically. While there is a willingness on the part of schools to accept children, the capacity is not there and some schools have told me that were the capital investment made to facilitate it, they would gladly take on additional students. Similarly, I find that I am increasingly being contacted by parents regarding access to special schools for children with intellectual disabilities specifically, where more people in north Cork have to go to Cork city to access education. It is a lot to ask parents from north Cork to send their children to some place like, for instance, Rochestown, and have to go through the Jack Lynch tunnel on a daily basis.

Could the possibility of a capital allocation for a site-specific special school for north Cork be considered? Allied to that, perhaps there could be a review or deeper look whereby the Department of Education might review the current allocation of places in autism spectrum disorder, ASD, units in the north Cork area to see if increased capacity could be created for children where there is a demand.

While I have a little time, I will raise an issue regarding the allocation of places. I am sure the Minister of State will tell me the National Council for Special Education, NCSE has responsibility for this area. I recognise that and that the special education and needs organisations, SENOs, are active on the ground, liaising with principals and looking at demand. I know that and respect that fact. However, in Cork, as I understand it, there are only seven SENOs and there are vacant posts there as well. That is having a knock-on relationship regarding that relationship with the SENO. Fewer SENOs must now cover more ground and that is having a bearing and impact on the ability of services to be rolled out. That needs to be addressed. If there are vacancies there, those vacant posts need to be filled and we need to ensure that greater capital expenditure is provided for more places in ASD units. In essence, this is what I am asking for, as well as consideration being given to the prospect of a special school specifically for the north Cork area. This would be in addition to the one in Charleville, where the waiting lists, as we know, are quite long.

Minister of State at the Department of Health (Deputy Mary Butler)

I am taking this question on behalf of the Minister for Education, Deputy Foley, who sends her apologies. I thank Deputy Sherlock for raising this issue and for giving me the opportunity to outline how the Department of Education and the NCSE continue to provide special education placements for children who need them.

At the outset, I stress that enabling students with additional needs to receive an education appropriate to their needs is an ongoing priority for this Government, as I acknowledge it is for the Deputy too. Another priority for this Government is to ensure that all children have an appropriate school placement and that the necessary supports are provided to our schools to cater for children with special educational needs. It is important to remember that the vast majority of children with special educational needs are supported to attend mainstream classes with their peers. To support children with more complex needs, special classes in mainstream schools and special schools are provided.

This year, the Department of Education will spend in excess of €2.6 billion, or over 27% of the Department’s budget, on providing additional teaching and care supports for children with special educational needs. For 2023, the Department has further increased the number of teaching and special needs assistant, SNA posts in our schools. There will be an additional 686 teachers and a further 1,194 special needs assistants in our schools by the end of this calendar year. For the first time ever, we will have more than 19,000 teachers working in the area of special education and over 20,000 special needs assistants.

Together we have almost 40,000 qualified and committed people in our schools who are focused wholly and exclusively on supporting children with special educational needs. The children will undoubtedly benefit, as is right and proper, from the additional focus these resources will bring to their education.

The National Council for Special Education has responsibility for co-ordinating and advising on education provision for children nationwide. Over the past three years, the Department of Education and the NCSE have introduced a number of strategic initiatives to plan for and provide sufficient mainstream, special class and special school places. These initiatives are bearing fruit with more than 600 new special classes sanctioned at primary level, almost 300 new special classes sanctioned at post-primary level and five new special schools established over the last three years. Just recently, on 12 April, the Minister, Deputy Foley, announced the establishment of two new special schools as part of a comprehensive update on enhanced education provision for students with special educational needs. These two new special schools will be established in Carrigtwohill, in east Cork and in Dublin 7 for the 2023-2024 school year. The Deputy spoke about the Mitchelstown and Fermoy area and the challenges of going to Rochestown and going through the tunnel, so hopefully having a special school in Carrigtwohill will make a significant difference to families.

Along with the two new special schools, 328 new special classes have been sanctioned by the NCSE for opening in the coming school year, with more to be confirmed in the coming weeks. There will be 217 special classes at primary level and 111 at post-primary level. Also, capacity will be expanded in 11 other special schools around the country. There are currently 421 special classes in County Cork. Of these, 300 special classes are at primary level and 121 are at post-primary level. Of the 328 new special classes announced for the new school year, 71 are in County Cork, with 53 at primary level and 18 at post-primary level. It is estimated that 15 of these new classes sanctioned for the coming school year will be in the north Cork region, with 11 at primary level and four at post-primary level. Hopefully that will go a long way to supporting families with children with special and additional needs.

Deputy Sean Sherlock

I thank the Minister of State for her response because it is the first time we have a real metric and set of figures in respect of north Cork, which is to be welcomed. I appreciate and acknowledge that a new special school will be allocated for Carrigtwohill. I am not striving for perfection here but I have a slight worry. We seem to accept the fact that children have to travel long distances to get to school of a morning when they are trying to access a special school. I reiterate my call for consideration to be given to north Cork specifically because the demand for places in Charleville is unsustainable and we cannot continue to heap more pressure on Charleville. If you have students who would ordinarily go to Charleville now having to go to some place like Carrigtwohill or Cork, it is still not ideal. Again, I am not looking for perfection but we are looking for better provision if we can have it.

I appreciate the fact that 15 of the new classes sanctioned for the coming year will be in the north Cork region. We will see how that works through and I will continue to liaise with parents. I am hopeful that if parents continue to contact me about the lack of school places coming up to the summer break and if there continues to be uncertainty about school places for September, then we will know that those numbers are not working. I appreciate the Minister of State's reply and I accept that there is action on the part of the Government and the Department to sanction more places. That has to be acknowledged and we will see how that works out.

Deputy Mary Butler

I agree with the Deputy that the Minister for Education’s response was comprehensive, which is welcome. As demand for new special classes at post-primary level is expected to increase significantly over the coming years due to increasing demographics and increasing prevalence rates, the Department of Education and the NCSE are engaging with post-primary stakeholders on the provision of special classes. In October 2022, the Department wrote to all post-primary schools to advise them of the need to begin planning to provide additional special classes. Essentially all post-primary schools can expect to open special classes over the next three to five years. That is welcome because when the special classes started across every constituency they were in primary schools and then when students get to sixth class they have to move on. This will ensure that children can access a special class in their local post-primary school, rather than having to travel a significant distance to another school.

At local level the NCSE is continuing to engage with schools on the establishment of additional special classes for the next school year. Every support will be made available to schools to progress the opening of special classes in the shortest possible time frame. The Department continues to engage intensely with the NCSE on the forward planning for new special classes, which is really positive. I know the Cork area well, including Mitchelstown and Fermoy. I know Cork is a big county and it is difficult for families when they have to travel. I think of my constituency of Waterford which has three special schools, two in the city and one in Dungarvan, and that is the norm although it is hard. I will bring the Deputy's comments back to the Minister and I am cognisant of how big a county Cork is. Travel for a child with additional and complex needs is not always easy.

Nursing Homes

Deputy Colm Burke

I want to raise the issue of the discrimination that is occurring in the moneys being allocated for private nursing homes compared with public nursing homes. As the Minister of State is aware, we have a situation in Cork where a nursing home with 73 beds has decided to withdraw from the fair deal scheme. It is interesting to go through the figures on this. The average cost of a public nursing home bed per week is €1,823. The average cost of a private nursing home bed is €1,079 per week, so the difference is €744. One of the figures I have come up with is that in County Laois, the average cost of a public nursing home bed is €2,585 per week whereas a private nursing home is only getting €1,039 per week, a gap of €1,546. In three counties, namely, Laois; Longford; and Westmeath, the amount paid for a public bed in a public nursing home is double what is allowed under the fair deal scheme to a private nursing home. In Cork the average cost per week is €1,734 for a public nursing home and for a private nursing home it is €1,073, a gap of €661.

What is frightening is that in the last round of adjustments, percentagewise as regards the increases allowed, in Cork the public nursing homes were allowed a 10.4% increase and the private nursing homes were allowed a 2.7% increase. This cannot continue. Private nursing homes cannot continue in the current way that fees are calculated. It is also important to realise that a private nursing home has additional costs that a public nursing home does not have. For instance, there is public liability insurance, which on average costs well over €50,000 to €60,000 per nursing home. They also have to pay commercial rates to the local authority, which a public nursing home does not have to pay. Private nursing homes have to calculate the cost of building into what can be collected in fees as well. Private nursing homes have a huge amount of additional costs that are not there for the public nursing homes and we are finding that nursing homes are going out of business. A number of smaller nursing homes closed last year and this trend will continue with the present structure. The average increase allowed recently for public nursing homes across the country was an 8.9% increase in fees, whereas in the private sector the average was 3.1%.

Deputy Mary Butler

Not correct.

Deputy Colm Burke

Those are the figures and I have a full table for every county. Unless this matter is tackled we will have fewer beds available for people. In the past three months I have been trying to get people out of Cork University Hospital.

People were in that hospital three to four months longer than they should have been because they could not get an appropriate bed in a step-down or nursing home facility. That is costing time for everyone. We need hospital beds and there are huge pressures in that regard. If we cannot get people out in a timely manner, we will have even more congestion in our hospitals. I ask that this matter be reviewed.

Deputy Mary Butler

I thank the Deputy for raising this matter. I note his interest in the private nursing home sector. The fair deal scheme was designed to protect and support vulnerable older people and to ensure equal access to nursing home care based on what they could afford. This gives certainty to people and families. To be very clear, Government funding for the fair deal scheme aims to support vulnerable older people at a time in their lives when full-time care is essential. This is a very difficult decision for families and their loved ones that often takes place at a time of crisis. That is why I, as Minister of State with responsibility for older people, find it essential to ensure that the budget for the scheme, to which a massive almost €1.5 billion has been allocated this year, will last from 1 January to 31 December for the 22,700 people who may need nursing home care.

It is imperative that nursing homes manage potential cost pressures in line with their regulatory and contractual responsibilities, maintaining quality care so that residents’ lived experience and comfort is not affected. However, the Government and I are conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups. I note that 15 companies control 10,700 beds in Ireland. The Government has provided substantial support to the private and voluntary nursing home sector over the course of the pandemic. More than €149 million in financial support has been provided to private and voluntary nursing homes through the Covid-19 temporary assistance payment scheme. The provision of free personal protective equipment and oxygen to private nursing homes continues - not that I hear that very often - and has cost approximately €75 million to date. In light of inflationary cost pressures, a new €10 million scheme was established last year to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home over the period from July to December 2022. At that stage, a nursing home could claim up to €31,500. I extended that scheme up to the end of March. It is now under review for extension for a second time up until the end of June 2023.

Both the Department of Health and I have regular interaction with the National Treatment Purchase Fund, NTPF. I met its representatives last week to discuss ways to support the sector, where necessary and appropriate, to complement the normal process of negotiating rate increases when contracts are renewed. Some 425 private nursing homes negotiate with the NTPF. Anyone who has a scheduled renegotiation of their deed of agreement with the NTPF this year has seen a significant uplift. I have met many of these nursing home operators. Neither I, nor the Minister, Deputy Stephen Donnelly, have any role in this negotiation process. Other options to support nursing homes are being explored, particularly in respect of the often costly nature of compliance for nursing homes under necessary HIQA regulations. Budget 2023 saw more than €40 million in additional funding for the scheme, which will provide an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.

When the Deputy spoke about cost differential, he did not mention that the HSE is the statutory provider of last resort and will always step in when a resident’s needs are sufficiently complex that he or she cannot be cared for anywhere else in the community. The HSE needs to be equipped to deliver that kind of complex care. As the Deputy is aware, Nursing Homes Ireland has lodged a state-aid complaint against the Government with the European Commission regarding the State's subvention scheme for nursing home care. That is as much as I am prepared to say at present.

Deputy Colm Burke

I fully accept the Minister of State's commitment to this area, and that of the Government, but there now is a problem. In the Cork area, for example, the amount paid for public nursing home beds is one of the lowest in the country. I fully accept that. However, the increase allowed in Cork for public nursing home beds was 10.4%, whereas the increase for private nursing homes was 2.7%. The Minister of State and I both know that costs have increased substantially as regards wages, salaries and insurance. All those costs have gone up substantially, certainly by more than 2.7%. I am worried about the Cork area. As I said, the issue that has come to a head concerns getting people out of Cork University Hospital where, in many cases, we cannot now get beds. We have had five or six ongoing cases at the hospital over the past three to four months where we physically could not get a facility to take a person who no longer needed hospital care but did need nursing home care. This really needs to be looked at.

I am now very concerned that one of the facilities, which has 73 beds, has stated it is withdrawing from the fair deal scheme. A number of other facilities are also considering their position. This issue needs to be looked at. An average increase of 2.7% in Cork will not deal with the increased costs that have occurred over the past 12 to 18 months. I ask the Minister of State to sit down with the group that adjudicates on increases to review this issue, with a view to getting people out of hospital at a faster pace than currently.

Deputy Mary Butler

The closure of nursing homes can put pressure on other local health and social care facilities. It is vital that the welfare of residents is ensured. The Deputy spoke about the concerns he has about the Cork region, but the fair deal scheme has to work and support 22,700 elderly and vulnerable people who, at a very difficult time in families' lives, may need nursing home care. I have to ensure that the budget does not run out in October or November. There was a situation a few years ago when access to the fair deal scheme took between eight and 12 weeks because the budget was not there. I will not let that happen. When somebody applies for the scheme now, when all the papers are in place and all the details documents are there, we are turning it around in four weeks. The Deputy spoke about not being able to find beds for people but transitional care funding is in place. Last year, it was used 10,000 times to support people who need to leave an acute level 3 or level 4 hospital and find a bed someplace else. In January and February this year, that fund has been allocated several thousand times. The budget for that is substantial.

The Department published a review of the NTPF in June 2021. Its review of the pricing system found it was carried out in long-term residential care facilities under the oversight of a steering group, with representation from various Departments and agencies. The group made four recommendations: the formal assessment of using a formulaic approach in the pricing system; the formal assessment of amending the approach to the assessment of local market price to reflect prices in other nursing homes within a certain distance; engagement by the NTPF with nursing homes and their representatives on enhancing the internal NTPF review process; and amendment of the process for allowing for high-dependency residents where the necessary systems are in place.

The Deputy asked if I would meet with the group that adjudicates on price increases. As I and the Deputy understand, neither I, the Minister nor the Department has any role to play in the amount of money negotiated between the NTPF and any private nursing home that is providing support for older people. As I understand it, engagement continues between the private provider referenced in the details supplied and the NTPF.

Cuireadh an Dáil ar fionraí ar 9.49 a.m. agus cuireadh tús leis arís ar 10.03 a.m..

Sitting suspended at 9.49 a.m. and resumed at 10.03 a.m.