Joint Committee on Disability Matters debate -
Wednesday, 17 Jan 2024

Planning for Inclusive Communities: Discussion (Resumed)

An Cathaoirleach

We are in public session. The purpose of today's meeting is a resumption of the discussion of planning for inclusive communities. On behalf of the committee, I welcome representatives of the HSE: Mr. Bernard O'Regan, Mr. Brian J. Higgins and Ms Anne Ennis. From the County and City Management Association, I welcome Ms AnnMarie Farrelly, Mr. Michael Rainey, Mr. Barry Lynch and Mr. Liam Hanrahan.

I remind witnesses of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person or entity outside the House in such a way as to make him, her or it identifiable. If witnesses are asked to discontinue their remarks, it is imperative that they comply with any such direction.

Members are reminded of the self-same practice that they should not comment on, criticise or make charges against a person or entity outside the House in such a way as to make him, her or it identifiable. Members must be within the confines of the Leinster House precinct to contribute remotely in the public meeting. I call on Mr. Bernard O'Regan to make his opening statement.

Mr. Bernard O'Regan

I thank the committee for the invitation to meet with it this evening. I welcome the opportunity to engage with the committee on the topic of planning for inclusive communities. I am joined today by my colleagues Mr. Brian J. Higgins, head of healthcare strategy - disability and mental health services, and Ms. Anne Ennis, general manager - national lead for the decongregation programme.

In my opening statement, I will address transitions from congregated settings, aligning housing and support services and inclusive communities and local area co-ordination. HSE specialist disability services strive towards the full delivery of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. Pertinent to today’s meeting is Article 19, which states that all individuals have the right to live independently and be included in the community. It is the equal right of all persons to live in the community and have choices equal to others. Article 19(c) states that people must have an opportunity to choose their place of residence and where and with whom they live.

The HSE Transforming Lives programme was established to implement the recommendations of the value for money and policy review of disability services 2012. The programme is a national collaborative effort to build better services for people with disabilities. It is part of the wider national effort for building a better health service. Time to Move on from Congregated Settings - A Strategy for Community Inclusion was established under the Transforming Lives programme. It is a model of support whereby people with disabilities are supported to move from congregated settings, often large institutions, to their own homes in the community with the supports they need. It is about supporting people to "live ordinary lives in ordinary places".

The 2011 Report of the Time to Move on from Congregated Settings, TTMO, working group defines a congregated setting as a residential unit where ten or more people with disabilities live together in a single unit or on a campus.

The working group ascertained there were about 4,000 individuals living in 72 centres which qualified as congregated settings. Progress since the TTMO report shows that 4,099 people were living in congregated settings at the end of 2009; 3,397 people by the end of 2012; 1,953 people remained in congregated settings by the end of 2019; and 1,532 people remained in congregated settings at the end of 2023. Using the HSE figure of circa 1,500 individuals remaining in congregated settings and in keeping with the TTMO policy of no more than four people per house, approximately 375 houses will be required to complete the programme of decongregation.

The Department of Children, Equality, Disability, Integration and Youth recently published a disability action plan to set out the developments that are needed across a range of services and supports to meet the needs of disabled people. It includes a significant requirement for housing and services to meet the needs of those transitioning from congregated settings and those inappropriately placed in nursing homes and to meet demographic needs. The development of the action plan included the Departments of Housing, Local Government and Heritage; Children, Equality, Disability, Integration and Youth; and Health and the HSE, among others. This reflects the necessity for a co-ordinated approach to ensure that housing and supports are developed in tandem. Critically, housing needs to be developed in local communities and those providing supports to meet the health and social care needs of disabled people must strive to ensure that people are being supported to be connected to their communities, to be able to access those communities and to attend work, education, leisure and other community activities, based on their individual will and preference.

The HSE is supportive of the local area co-ordination model and has been engaging with international leaders in this area to explore how it might be applied in Ireland. The disability action plan commits to this being piloted. Experience has shown that simply locating residential services in the community does not, of itself, lead to integration, inclusion and participation. Determined by the will and preference of individuals, it also requires effective supports that prioritise both the social and care needs of the person. It requires a whole-of-system approach that includes education, employment, social activities and recreation, along with housing and health and social care supports.

That concludes my opening remarks. Together with my colleagues I will endeavour to answer any questions committee members may have.

Ms AnnMarie Farrelly

I am a member of the County and City Management Association, CCMA, housing, building and land use, HBLU, committee and I am also chief executive of Fingal County Council. I am joined today by Mr. Michael Rainey, the planning and economic development director of service in Carlow County Council; Mr. Barry Lynch, housing director of service in Meath County Council; and Mr. Liam Hanrahan, economic development and planning director of service in Galway County Council. On behalf of the CCMA, I welcome the opportunity to attend the Joint Committee on Disability Matters to discuss planning for inclusive communities.

The CCMA is the representative body for local authority management. Our membership includes the chief executives of each local authority, as well as the assistant chief executive of Dublin City Council. We operate through seven committees, each of which is concerned with specific policy areas. The responsibility and remit of the CCMA HBLU committee includes housing, planning, building control and management. Local authorities, as housing authorities, provide a range of homes and supports to those with a housing need, including people with disabilities. Local authorities work in partnership with approved housing bodies, AHBs, the charity sector and other stakeholders to assist individuals and families to ensure their accommodation needs are met via social housing or accommodation provided through subsidisation via the housing assistance payment, HAP, or the rental accommodation scheme, RAS.

From a housing supply perspective, the overall delivery of disabled persons housing is a key area of focus for the sector. As such, figures obtained from the Housing Agency indicate that a total of 2,472 allocations were made nationally in 2022. The allocations are broken down into four categories: physical, sensory, mental health and intellectual disability. The figures for the allocations under each category are outlined in the table provided to members.

The capital assistance scheme, CAS, provides a capital funding mechanism through the local authorities to AHBs for the delivery of accommodation, either by construction or acquisition, for priority groups such as elderly people, homeless persons and people with disabilities. The CAS is a valuable scheme and we encourage our AHB partners to utilise it to provide accommodation to meet housing needs. The Department of Housing, Local Government and Heritage has recently published figures for the CAS to quarter 3 of 2023, detailing that 52 units were completed and 217 units were acquired, which means 269 units were delivered.

Housing and disability steering groups have been established in all local authority areas. Membership of these steering groups consists of representatives from the HSE, disability service providers and housing service providers. The aim is to achieve a co-ordinated and integrated approach to meeting the housing needs of persons with a disability. The housing and disability steering groups are tasked with preparing a strategic plan for their local areas to develop specific local strategies to meet identified and emerging needs. These plans, along with the annual summary of social housing assessments, allow local authorities to plan more strategically for the housing needs of persons with disabilities and support the delivery of accommodation using all appropriate housing supply mechanisms. Housing and disability steering groups continue to have a key role as the forum for delivery of the strategy’s outcomes at local level.

We included six case studies from local authorities, including those in Galway, Meath and Wexford, in our written submission. They give details of initiatives that support the needs of people and they are included in the appendix.

I will move on to universal design. The adoption of the principle of universal design provides for greater sustainability of our housing stock, especially in the current circumstances of dramatically rising construction costs. It should be noted that the Department of Housing, Local Government and Heritage remains the sanctioning authority in respect of the adopted design standards, funding and project approvals. A new design standard is being developed under the auspices of the National Standards Authority of Ireland, NSAI, with the participation of, among others, the Department of Housing, Local Government and Heritage, the National Disability Authority, NDA, and Age Friendly Ireland, which will be a common standard for the use of universal design and universal design+. Meath County Council is carrying out a pilot project in Kells, where 30% of the units will have a universal design. This project is subject to planning approval and initial indications from the architects involved are that there will be a cost differential of circa 6.4% for these units.

Regarding housing supports for people with disabilities and older people, with funding from the Department of Housing, Local Government and Heritage, local authorities provided the following three separate grant schemes: the housing adaptation grant for older people and people with a disability - I will not go into the detail of that - the housing aid for older people grant, and the mobility aids grant scheme. The figures for the various grants show that 4,995 housing adaptation grants for older people and people with a disability were approved, which is the equivalent of €38 million nationally; 5,999 housing aid for older people grants were approved, costing €24,258,000 nationally; and 1,804 grants were approved under the mobility aids grants scheme, costing €6,375,000.

The CCMA welcomes the current review of the housing adaptation grants for older people and people with a disability scheme by the Department. The ability of the sector to co-fund these schemes is limited and can be a barrier to delivery. The CCMA would welcome additional Exchequer funding in this area. In addition, it is important to highlight that there are significant staffing requirements in the sector in this high demand area, as applications continue to increase year on year. Like all areas of housing development, construction inflation has hit this area, with difficulties arising in the availability of contractors to carry out the necessary work to meet the required standards. The ten-year period to 2023 indicates a significant retrofit cost of €644 million to private housing including local authority match funding. It should be noted that since the inception of the scheme in 2007, grants in excess of €1 billion have been paid out with 20% of this being funded by the local government sector. The CCMA believes this is a significant burden on the sector and supports the need for 100% Exchequer grant funding

The table provided to members indicates that cumulatively local authorities have drawn down the funding allocated, albeit with variations in individual years. The cumulative drawdown was 99.73%, which represents a total drawdown of €644 million.

The cumulative drawdown indicates a drawdown of 99.73% and total drawdown of €644 million. That is in excess of the allocated amount. Figures obtained from the Department regarding the housing adaptation grant for older people and the people with a disability scheme show that for the year 2022 €65 million in funding was allocated. As I said, €68 million was drawn down by the sector. These figures are based on 80% Exchequer funding and exclude the local authorities' contribution of 20%. The Department is currently in the process of finalising the figures for 2023. These figures do not include the cost of resources for local authorities to run the schemes.

In conclusion, all public bodies in Ireland have a responsibility under the public sector equality and human rights duty or public sector duty to promote equality, prevent discrimination and protect the human rights of their employees, customer service, service users and everyone affected by their policies and plans. In addition, relevant issues linked to the UNCRPD are identified and included as individual departmental action plans.

Commitments to implementing the UNCRPD, Disability Act 2005 and human rights and equality and related legislation are threaded through corporate plans, county development plans, equality and human rights frameworks and all of the council plans and strategies. In line with Housing for All, the CCMA is committed to delivering an appropriate range of housing and related support services in an integrated and sustainable manner which promotes equality of opportunity, individual choice and independent living for people with a disability. It is important to note that for those people with a disability the co-ordination of housing provision with the delivery of key health and social care support is paramount. The CCMA continues to work with the necessary stakeholders in that regard. We welcome the opportunity to engage in dialogue on these complex issues and are happy to answer any questions.

Deputy Dessie Ellis

I thank the witnesses for their contributions. We have had a lot of disability groups before the committee. From speaking to disabled persons organisations, DPOs, it appears that Ireland is not a good place to ask people with disabilities for their views. To fully implement the UNCRPD, there is a need for effective policy-making forums to be established to collaborate with people with disabilities and develop and implement effective policies locally and nationally.

Can the CCMA and HSE highlight how they are consulting DPOs? Our experience in the committee is that DPOs do not feel they have been listened to, especially single people who are advocating on behalf of those with disabilities. They do not feel they are being engaged with enough. How are local authorities identifying disabled people in their local areas who need housing? What is the mechanism? How are their needs being documented and provision made for them?

I have experience of medical applications. How are they being addressed? Who examines them? What qualifications do they have? Dublin City Council uses three GPs to make a judgment as to whether a medical priority should be applied. Do all local authorities follow a similar rule? I do not always feel that we get the best results with the GPs when making assessments.

When people are prioritised by local authorities, the period for which they have to wait for a place is terrible. Some are waiting for years while others are fast forwarded. I am curious about how this is being addressed because my experience has been mainly with Dublin City Council and Fingal County Council which take a long time to deal with cases.

I would love to know what actions are taken in respect of local authorities. The recommendation is that people with disabilities are allocated a percentage of each development that is completed. How is that proposal being implemented? Is it happening in respect of houses or apartments?

I refer to overcrowding. A lot of people are looking for extensions to houses for people with disabilities. They want to build a room, toilet or other such things. That system seems to have collapsed. Certainly it has collapsed in Dublin City Council. Nothing is happening. A lot of these building works are for people who have serious disabilities. Is the same happening across the board in local authorities? Does every local authority have a disability technical adviser or co-ordinator? I assume they do.

We all want to see people with disabilities living in their homes with all of the necessary supports. Are all the stops pulled out to do that? There are people who are elderly or disabled and want to stay in their homes. I am a great believer in keeping people in their communities. How are such cases followed up with local authorities?

Ms AnnMarie Farrelly

I thank the Deputy. I will bring in some of my colleagues. In terms of the figures presented to the committee today, in 2022 there were 2,472 new social housing allocations for people with a disability. It is a significant number. Not only that, since 2019 that number has been quite steady and I expect it to increase as more supplies come on board with the new Housing for All targets. In addition, 12,000 grants have been paid to private homes. That is with the intention of keeping people in their homes and doing the best we can to support them.

In terms of medical priority, I can outline to the Deputy the example of Fingal. In excess of 300 applicants have been designated a medical priority. That is a challenge in terms of meeting people's needs, especially where a particular type of dwelling is needed, such as an adapted dwelling or whatever the case may be. In addition, there are different sizes of dwelling depending on whether it is for an individual or a larger family whose needs have to be met.

It is true to say that every development we deliver would include units for those with disabilities. More and more often, units are designed specifically with families in mind where people are waiting to be allocated a home. That is happening.

The new trial of universal design is where real progress can be made in the future. I will bring in Mr. Lynch to discuss the pilot in Kells. The adage is that if we design for the old we include everybody. If the order of cost is about 6.4%, as seen in a trial, perhaps that is something we can do with the Department. We are all involved in that trial as a sector, including the Department and others. That is probably the future.

It is true to say that there is a lot happening. I appreciate every individual who is waiting for a suitable offer of accommodation may not feel like that. I will ask Mr. Lynch to come in on the pilot.

Mr. Barry Lynch

On the broader disability strategy, I sat on the national advisory group and the strategy was being formed and there was quite extensive consultation, starting initially with local authorities which fed their local disability plans into the national one. There was also extensive consultation with DPOs and accessible consultation methodology. There was a determined effort to reflect the voice of experience when the strategy was adopted last year.

Obviously the implementation plan followed from that in 2023. We have now lined up our strategies to agree with the implementation plan. Quite a challenging target, in terms of 15% of allocations going to people with disabilities on the list, has been set. From our experience, the figure was 12% a quarter of the way through the year. We are aiming for that target in order to deal with the backlog.

There is obviously a communications piece in terms of awareness of the strategy. A communication strategy was published before Christmas and is on the agenda for our steering group to adopt later this month. It gives certain commitments as to how as a public sector body we will go about communicating.

Regarding universal design, which Ms Farrelly referenced, a number of things are happening. The pilot in Kells arose out of the housing options for our ageing population. The objective is that 30% of the units in each development will be universal design. Detailed work is being done on the costing and the Housing Agency will undertake a research project on the scheme. A substantial research project is also being done by a centre in Galway to investigate the differential in costs. That is key information that we need nationally. If it only costs 6% or 7% more, for example, we will be able to see how that will be funded.

In terms of standards, Part M only calls for buildings to be visitable. Universal design and UD+ are where we need to go in terms of adequate provision. The NSAI is preparing a standard in that respect, which I expect to see next year. Some research coming out later this month will suggest that the densities of UD and UD+ do not adversely affect overall numbers in developments. Detailed checklists are being developed for universal design through the Centre for Excellence in Universal Design and the National Disability Authority, in conjunction with Age Friendly Ireland. A great deal of work is under way to try to improve the provision of housing.

Deputy Dessie Ellis

I do not know what way medical examinations take place when assessing housing. Dublin City Council takes a three-doctor approach. I will provide an example of something that I find frustrating. If a person who is down for a two-bedroom house is looking to get priority and that priority is a two-bedroom house, it is virtually dismissed because it is like for like and the medical element is not taken into account. The extra spaces and so on could be of benefit to a child with autism, ADHD, etc. I do not know how the other local authorities operate. Do they work in a similar way? Do they each have three doctors assessing cases?

Ms AnnMarie Farrelly

It is a similar system. The most common issue with medical priority is that there are sometimes medical conditions but the housing element is not necessarily affixed to the problem, so to speak. There can be a bit of confusion about the purpose of the medical priority scheme. The idea of the scheme is that a social housing allocation would help to address the medical need, and that is not always the case with applications. An independent panel reviews applications and decides whether to award priority, with some involvement by our housing department.

Mr. Michael Rainey

I worked a great deal in Laois, Carlow and other small rural authorities. Unlike the Dublin model, they would not use GPs as such. Rather, the evidence is submitted by the applicant and the person is assessed by a senior social worker or other social worker. Depending on the allocation scheme in each local authority, points or priority are awarded based on what is determined.

I will follow up on the point Deputy Ellis made about consultation with disability groups. I agree that consultation is important. Much of what we are delivering on the ground is set at national level. In particular, there is considerable value in the grant schemes, for example, mobility aid and housing aid for older people and adaptation grants. As elected Members, the Deputies and Senators will see that. We can usually make a valid impact through these schemes. There was a review of the schemes in, I believe, 2014 when there was active engagement with the various representative disability groups. Another review of the schemes is ongoing, and it is important that disability groups be included in it so that what comes down to local authorities for implementation and delivery reflects people’s needs.

Senator Fiona O'Loughlin

I hope I can read my own writing when asking these questions. This is an interesting topic and one with which we need to get to grips. I thank Mr. O’Regan, Ms Farrelly and their teams for attending and trying to tease out the various issues.

Mr. O’Regan spoke about housing needs in local communities and how we needed to provide supports to meet the health and social care needs of disabled people. In my experience in Kildare, Kare and the Muiríosa Foundation are doing a good job in putting in place community housing, but there are blockages to inclusion. Mr. O’Regan referred to a consideration of the new local area co-ordination model and to how there were steering groups in place. I would have expected this piece to fall under the LCDC part the local authority. We need to get it right. I have direct experience of people who, many years after moving into this housing in an area, want to work and become part of their communities. There is much to do in this regard. I acknowledge all of the good work that has been done in moving people out of congregated settings into community housing, but I am concerned about those who have not even got to live in congregated settings and whose families cannot cope or whose parents are elderly. It is a question of trying to find a balance between what local authorities can do. What I have increasingly found is that disability agencies and the Department are telling people to join their local authority housing lists. Families then feel that, once someone has been accepted onto a list, their problems are over and the local authority will provide a physical space and, in conjunction with the HSE, meet their family members’ needs, but that is not happening. This is a concern. I am interested in the witnesses’ views on this matter.

Ms Farrelly spoke about the four areas that were covered. Does addiction fall under mental health? It is a matter we need to deal with in this regard. We cannot ignore it. From particular areas that I represent, I know of certain issues.

I thank the witnesses for supplying us with the case studies in Galway, Meath and Wexford. They are important. Are those the best local authorities in terms of delivery? Is best practice being shared around? We need to know who is and is not doing well.

I agree on the need for extra Exchequer funding for mobility and housing aids and the housing adaptation grant. We want people to continue living in their own homes as autonomously as possible.

My final questions are on the housing targets for people with disabilities. How are they defined? Is it as a percentage of population within a local authority’s area? How is progress reported? Are targets being met by each local authority? Are there barriers to collaboration with the HSE? If so, we need to know what they are. I appreciate that a mapping exercise will be done. When will we see it? It would be important if the committee got that information. In terms of local demand, and apart from setting targets, how are local authorities identifying disabled people in their areas? Is it done through agencies such as Kare and the Muiríosa Foundation? There are people in each area who are not linked in with their local providers. How do we define the choice that is being offered and how is that documented?

Mr. Bernard O'Regan

I agree that the challenges around inclusion are real. It is not a simple matter and it requires a number of measures. When we consider examples of where this works well, many of these issues are evident.

First, it is about having an absolute commitment to the rights of the individual and to having them protected, exercised and supported. That is about leadership and an absolute commitment. The two organisations the Senator mentioned, and others we could list, are examples of organisations that demonstrate these and make them happen. However, we cannot say that because we got it right today, we will automatically get it right tomorrow. Someone has to wake up in the morning and say we are intentionally going to get it right for people again tomorrow. Also, it is a matter of recognising that if we are really serious about how we support people, we should not engage with them only today to identify their priorities and leave it at that for the rest of their lives. It has to involve a continuous process and we have to be able to adapt and respond to changing priorities, preferences and needs as we go along. That requires a bit of vision and good leadership, management, training and support for staff, but it should not just be the housing authority, local authority or HSE that has to do what must be done. It has to be about communities harnessing local supports and working together. We have identified that local area co-ordination offers much potential. We see examples of it but just need to do it more systematically. We absolutely agree on that.

The Senator's point on the demographic need for residential services is absolutely correct. One of the balances we have to strike from services and State perspectives concerns how we meet the needs of a mix of people coming from different starting points. It is right that we prioritise decongregation and ensure we do what must be done for people living in settings that do not align with the convention. We should be striving to ensure something different for people in nursing homes who should not be in them, but we must also plan and work to meet the needs of the thousands of people who will require residential services. The disability action plan sets out that while 500 people might be in the plan for decongregation over the lifetime of the action plan, another 900 at home will need residential supports. I say residential supports in the broadest sense. It is not about everybody being funnelled into a group home but about determining their preferences and how we support them in having a living arrangement that is aligned with their will and preferences and what the State can provide to them. I hope that answers the Senator's question.

Ms AnnMarie Farrelly

The case studies are put forward as examples. There will be examples throughout the country. At local level, the housing and disability steering groups are in place for sharing best practice but there are regional and national groups set up. The Housing Agency has a co-ordination role in that space, so there should be no reason we cannot all learn from each other. From the steering group perspective, it is important that every member arrive to make a contribution and take responsibility for their membership of the group.

With regard to identifying needs, whether through our social housing needs assessment or the work of the steering group, the first part entails identifying that there is a need, the second entails identifying a property suitable for allocation, and the third entails the supports needed to ensure a successful tenancy. Tenancies will fail if adequate supports, particularly health and other specialist supports, including for addiction, are not available. Addiction is not included as a category of disability but it is probably interwoven into all four categories: physical, sensory, mental health and intellectual. Addiction support is an example of a type of ongoing support that might be needed after allocation. There is not always success in this area. It can be difficult to ensure the right supports are available at the right time. It is an ongoing process and there is much work involved to ensure the tenancies are successful. Everybody coming to the disability steering group needs to come with a contribution and take responsibility to deliver their part in this jigsaw, so to speak.

Mr. Rainey will comment on the mapping exercise and targeting.

On defining choice, it is a matter of supporting the individual to define their choice and, for example, ensuring they are on the social housing list. Certainly in the case of congregated settings, it is probably not true to say they are all on the housing list. Sometimes specialist work with providers must be considered. For example, I visited a launch before Christmas in Fingal of a straightforward four-bedroom semi-detached house in a busy housing estate with houses occupied by families and others. Four individuals were moving from a congregated setting into the house, which was funded through the capital acquisition fund. The individuals were living among the community. The charity involved felt the support of the local community was the first step, along with the fact that neighbours and others could be a support. The individual supports needed for the people living in that house needed to be available. That system had been set up, but, again, there is a continuing obligation and responsibility on everybody to make sure they are in place.

Mr. Michael Rainey

I might talk about delivery. One of the challenges we have with delivery is that, as members know, the number of social houses being provided is increasing, but many of the developments are turnkey developments. This involves a private house design that is coming back through AHBs and ourselves. Therefore, the disabled person housing element is not designed in at the very beginning when the supply comes to us. That is a challenge. As a sector, we responded to that by doing more direct builds ourselves and bringing the disabled person model into direct build. The solution is moving away from turnkey supply and more towards direct build, whether it be by ourselves or the AHB sector, and bringing in bespoke disabled persons housing at the right time.

Deputy Frankie Feighan

I thank your guests for coming to our meeting today and for their hard work over the years. We have a very talented, hard-working, responsible and powerful team here today. It is great to have them. Much good work has gone on here.

I have just a few questions. At the public meeting here on 6 December, Independent Living Movement Ireland stated Ireland is not really good at asking disabled people what they want and instead asks the service providers. Can the CCMA and HSE discuss how they are now consulting the DPOs on new models of independent living?

With regard to the multi-annual funding, the National Housing Strategy for Disabled People noted long-term funding streams must be clarified and connected to deliver appropriate services and supports. Will the witnesses discuss and highlight how needs are being assessed and how services can respond more effectively? Will they discuss what long-term funding streams need to be clarified and connected, and any other funding issues? Will they discuss the position on multi-annual funding for independent living?

We are all familiar with the issue of local demand. How are the local authorities identifying in their local areas disabled people who need housing? How is that choice being provided and documented?

Ms AnnMarie Farrelly

On the last question, it is principally by engagement through the housing and disability steering groups, the providers and the charities involved, and advocates among people with disabilities who are also members of the steering group. The key factor involves broad representation and our having an understanding. Ultimately, there is paperwork involved in identifying the housing need and encouraging and mentoring people to be in a position to complete in respect of the housing need. There is a responsibility on us, the likes of the HSE and charities involved in day-to-day work with people with a disability to mentor and have everybody understand exactly what is required.

I would say we could get better with direct consultation, however. That is something that is evolving. Through the disability steering group we are all learning a lot, particularly as we understand what is happening across the country. More direct consultation is probably needed. For example, as we make housing allocations and run tenant induction courses and that kind of thing, we learn a lot about house design and other issues through that direct engagement.

On multi-annual funding, for things such as the private house grants we already know we can spend up to 65% of last year's allocation without the 2024 allocation being known. To an extent, it is always a rolling programme as we are dealing with individual applications. It does take homeowners some time to progress, including engaging contractors and getting the work done to draw down of the grant. It is a rolling programme and we are engaging with more applications than our allocation will fund to ensure that the home owners will benefit from as much funding as has been allocated. We roll it across years in order to ensure that so that there is no gap in draw down. I will hand over to my colleagues on anything I may have missed.

Mr. Liam Hanrahan

On consultation, it is important to state that as with all parts of the community, whether through the LCDC or SICAP, there is a lot of community consultation and significant engagement with all sectors, including the disability sector, in developing those plans. The disability steering groups and the subgroups that sit under that not only have the HSE and the HSE housing co-ordinator on them but also the disability groups and, in some cases, people with disabilities themselves.

As Ms Farrelly said, as you move into post tenancy and people become our tenants or tenants of the AHB, they get involved in post tenancy residents groups and other community initiatives within their area. The housing disability steering group has been useful from that point of view because as people are being assessed going onto the housing list and being provided with allocations, the parts of the community, whether it is going onto schemes, getting involved in GRETB courses or other types of things or supports, they can be put in place from day one. In Galway, we have supported 52 people through that process. In all cases, there is not only a HSE element around some of the home help care required but there is also community care elements put into the work programme for that person too. It is up to our staff and the HSE staff to support that whole integration with that person into their local community.

With applications and how people make them, we have got much better whether it is with online versions, simple English versions, or, in some cases, working with an advocate for someone who needs that help. That means having a named advocate on file as a contact person for the person with the disability who needs the extra help. That is how we support people in that case. It is about the identification of people, whether they are coming out of congregated settings or people who have lived all their lives at home with elderly people, which is a target group that we have to reach out to more and more these days.

Mr. Bernard O'Regan

There is a significant focus at the moment on ensuring that DPOs are consulted and included in the planning and development of services. It is also important to be truthful that there is a still a way to go to make sure that is consistent and unquestioned. A piece of work is being led by the Department of children at the moment in the context of stakeholders to try to develop some structures that will flow from the Department through the HSE around planning the development and the delivery of services and their design. The work programme being developed to implement the disability action plan over the next three years at all levels has a very clear expectation that the DPOs are fully involved throughout that. As the national disability inclusion strategy is developed, that will be reflected there too. However, rather like the answer I gave to Senator O’Loughlin earlier, we cannot take that for granted. It does need constant review.

While we are engaging with the DPOs, it is also important that we are identifying who are the key stakeholders. The people who will be affected more directly will not always be directly involved with a DPO. We either need to make sure that they are connected to DPOs or make sure that they are involved, whether, as with the example that the Deputy was giving, it is people advocating for themselves or where they need supports that were using the structures of assisted decision making in order to assist them.

On the multi-annual funding for supports, the Deputy mentioned PA supports and supports towards independence in particular. At the moment, the HSE is funded on an annual basis. We have welcomed the development and the publication of the disability action plan because even though it is not accompanied by an absolute guarantee of funding, it is the first time, certainly in my involvement in disability services, where we have had a clear statement of what is needed over a time span and it frames both Government planning, Departments’ planning, planning for the HSE and others in terms of the future need that we need to work towards. How it gets matched with funding will be a challenge over the next three years but at least it gives us a reference point to come back to. If we cannot have a multi-annual funded plan, then it is the next best thing.

Mr. Brian Higgins

Within some of the reform agenda work we are carrying forward within the HSE, such as the review of the personal assistants and some of the other pieces of work we are doing, including the autism service improvement programme, there is very direct involvement with the DPOs. We very directly engage. We acknowledge there are challenges in relation to that but there has been really good engagement and really good guidance from the DPOs and people with a disability on that work. In the reform agenda, when we are opening new committees, it is easier to get that engagement from the outset. We have been very fortunate to get incredible wisdom and knowledge from experts by experience in that regard. In existing programmes of work it is more difficult. We are putting more effort in and we need to continue that.

Ms Anne Ennis

The Deputy’s point about not being good at asking people with disabilities what they need is true. That is why a lot of people ended up in congregated settings and institutions. In recent years, the HSE has been investing in a programme of training called enhancing quality transitions. That is about really listening to people and finding out where they want to go. The Department of housing has partnered with us around getting people their own homes. We have models where people are not simply going to a four-bed house but are actually living in their own homes. Their own homes are either adapted or they find new homes with a combination of support from the Department of housing and the HSE.

Senator Tom Clonan

I thank everyone. It is good to see them again. I have a couple of questions but want to jump in first on something Mr. Hanrahan said that intrigued me. He said disabled people living with elderly parents was a target group that we need to reach out to and meet their needs. He can answer this at the end but how are those people identified in the Galway County Council area? Is it through the public health nurse, the housing allocation officer or the disability services manager? How do they know who is out there in the community that the council can target and plan for them?

I thank Mr. O’Regan again for his presentation. He had some very impressive figures. He said in 2011 there were 4,000 people living in 72 different congregated settings around the country and that as of December 2023, that had reduced to 1,532.

Where have the roughly 3,500 individuals gone to? Does the HSE know where they are? We had HIQA in, and it was talking about time to move on and about transforming lives. When I asked its representatives that question, they said they did not know and that they did not map that.

The numbers of people in what I would be aware of as the greater Dublin area who are inappropriately placed in nursing homes was also mentioned. Does Mr. O'Regan have a figure for how many people are inappropriately placed in nursing homes at the moment?

This is a kind of chicken-and-egg question. A disabled person who puts in an application for accessible housing, whether it is through the online portal or by filling in a hard copy, goes to a city hall, whether it is in Dún Laoghaire-Rathdown or Fingal County Councils, and hands that in. Does a care package have to be in place before the person is allocated the housing unit, or are they allocated the housing unit and then it is up to the family to try to secure hours? In that regard, and Mr. O'Regan might be able to answer this, why is it that the Dún Laoghaire-Rathdown County Council area, or community healthcare organisation, CHO, 6, which spans much of Dún Laoghaire-Rathdown and goes right down into County Wicklow and is a very densely populated area of the country, has one of the lowest number of care hours provided within any CHO? It is only a tiny fraction of the number of hours provided compared with any other CHO. I am curious as to why that might be the case.

On the packages, because this is about the national housing strategy for transition from congregated settings, a disabled citizen needs supports and a care package. As the witnesses are aware, there is a crisis in trying to get carers to carry out that work. Specifically on that, why does the HSE vary across CHOs? Some CHOs accept a brokerage model for the provision of carer hours. Some of them accept a mix of the corporate model, for example, Rehab, Bluebird Care and Home Instead. Some CHOs refuse to accept that. It seems to be a local decision taken by the disability services manager. Unfortunately, certainly in my experience, if you seek a carer through a brokerage model, there is no problem whatsoever getting a consistent, predictable and quality service. However, if you go through a corporate model, for example, Rehab, Bluebird Care, Woodbrook Care or Home Instead, it is inconsistent, unpredictable and not reliable. The disabled citizen then internalises that inconsistency and it becomes a real inhibition. Why is there that inconsistency and where are we at in having the brokerage model recognised on a national level? I am sorry about the long-winded question but I think some of the answers are pretty short.

With regard to Fingal, Meath and Galway, and I know it is probably a hard question to answer, if I go on a waiting list for accessible housing, roughly how many years will I be waiting in the various areas for an accessible housing unit to be made available? Would the average wait be three, five or ten years? I believe it is improving but I would be curious as to whether there is a regional variation in that. Again, in the witnesses' experience, does the HSE offer a unit and it is then up to the disabled citizen to try to secure supports or do the supports have to be in place? How does that work?

On disabled citizens in the community, because of greater levels of integration, the SENOs in the various county council or corporation areas, which map over the CHOs, will know how many disabled children there are in the community. Does the HSE compile a list, even in terms of numbers of those children who will be adults, and start to plan? In other jurisdictions, for example, in Schleswig-Holstein in Germany, they identify disabled citizens in the community as soon as they come on the radar. This is when a public health nurse refers them to a specialist, they go on the register and they have a primary medical certificate of some sort. They begin to plan for that citizen so that when they are 18, they have a unit there for them with the keys and the care package organised. There are about 18 years to do this in most cases, although some disabilities announce themselves when kids are a bit older. Who is it that does that planning? Is it the public health nurse? Is it the HSE that is driving that? Is it the housing allocation officers, the disability services managers, or the various disability and equality officers? Who drives it? Is it, in fact, the disabled citizen's family that has to drive that, push for it, chase it and move it along?

I think Ms Farrelly said - I may have misheard her - that last year there were 2,742 disabled accessible units made available to people in the Fingal County Council area?

Ms AnnMarie Farrelly

No, nationwide.

Senator Tom Clonan

Nationwide. I was thinking of moving there. Ms Farrelly would want to keep that under her hat if that were the case. That is great to hear. In terms of the overall numbers, even if it is nationwide, it is great to hear that.

That was the point I was making. Who is the person? Does it vary across the different areas or is there someone you can turn to and say, "You are the person who is making the plan"? It is a predictable outcome. I thank the witnesses for their attention.

Mr. Bernard O'Regan

I thank the Senator. I will answer some of the questions and then Mr. Higgins will come in on some of the others. Regarding decongregation, Ms Ennis is going to come back to the Senator on that.

Regarding the number of people under the age of 65 in nursing homes, the last figure we had was 1,237. That figure will be updated shortly and I can give the Senator that number once we have it. Over the past 18 months, the number has remained relatively steady. Even as people have moved out, other people have moved in, and it stayed around the 1,225 mark.

It is important to say, and it goes to some of the earlier conversation, we have been doing some work in engaging with some of the residents - not all of them yet but we will get there - and asking them about their will and preference and what they want to do. One of the things that is quite striking is that while there are significant numbers of that cohort of people who say they are not happy where they are and they want something different or are very clear about what they want, there are also a very significant number of people saying they do not want to move and are happy where they are. While you have to respect what somebody is saying to you, at the same time, one of the things we have been reflecting on is whether we have been good enough in making sure people understand what alternatives might look like or what support might look like. Are they saying they are happy where they are because they have no confidence we will be able to deliver an alternative and they do not want to have a bit of hope because they do not know what the system can deliver? We have a lot to pay attention to.

The Senator asked about the alignment of housing and support. When a person needs support and the paperwork and applications are being completed with regard to, let us say, CAS funding, there is a requirement that the HSE would also give a commitment to the support somebody would need. There is some history of housing being developed and made available to somebody and the supports not being there so they could not move into it anyway and, on the flip side, support being available and no housing. The intention behind that requirement is to make sure there is some alignment. That matches up well sometimes and sometimes it does not with regard to timing.

One of the things that we are trying to do in the context of the disability action plan, even though we do not know with certainty what additional funding there might be in 2025 or 2026, is look a bit more confidently at being able to do a bit of risk-taking and say, "Yes, let us make some commitments within a reasonable set of parameters of what funding we might be able to anticipate so that people are not waiting unnecessarily."

On data and where it is collected, one of the key tools for the HSE will be the NASS. I cannot remember what the acronym stands for, but it is the new national database administered by the Health Research Board on which the needs of all disabled people are to be captured and recorded. There used to be two databases - one for people with intellectual disabilities and a separate one for those with physical sensory issues. People with autism were either in or out. It was all vague. This is bringing those two databases together. That is developed but it is still in the process of being fully populated and there is ongoing work on that. That will be the critical tool for the State in terms of being able to identify. As the Senator said, once a child is identified as having a disability, we should be able to future plan. It would be really important that we are using tools like that as effectively as possible.

I will ask Ms Ennis to respond to the Senator's query around decongregation.

Ms Anne Ennis

In the context of where those people have gone, there has been a reduction of approximately 2,500 since the programme began. That includes RIPs, namely, people who have passed away. Roughly 2,000 people have moved to houses in the community that are funded either by the HSE or via CAS. For example, 74 people moved last year. Twenty-four went to houses with four bedrooms or fewer that are funded by the HSE and 46 went to housing acquired from the CAS funding through approved housing bodies and the service providers.

Senator Tom Clonan

I thank Ms Ennis. Before I go on to the local authorities, I asked a question about the brokerage model and another about the low number of packages being supplied in Dún Laoghaire-Rathdown.

Mr. Bernard O'Regan

Mr. Higgins will talk about the brokerage. On Dún Laoghaire-Rathdown, I will come back to the Senator in terms of the numbers. We are involved in work at the moment to look at how we will allocate the new development moneys for 2024 across the CHOs. In our analysis of that across a number of headings, including PA, there is variation. Some of it has to do with legacy decisions that might have been made going back as far as the days of the health boards when different priorities were set. Then there is the legacy of how services have evolved. One of the things that we are trying to do is achieve a balance by using population information to help us to apportion the new developments that we get in order to try to raise the boat a little. We will not be able to do that in any one year and fix a problem, but we are intent on trying to level things up and match it to the population base as much as possible. Also, it would be easy at one level to, using PA as an example, look at it, say there is one area that is so disadvantaged in comparison with others and put all the money into it for next year and level it off. Given the needs in other areas, it cannot be done in one go. It has to be done over a number of years in order to ensure that we do not solve one problem and inadvertently create another elsewhere.

Mr. Brian Higgins

In the context of the brokerage model, for a number of years we have been operating a demonstrator project for personalised budgets. Within that, there was intended to be three different models that we would test. There was a personal managed fund. There was a co-managed fund, which is the one the Senator referred to, with the providers and the individual. The third was the broker-managed fund. What is evident at this stage is that the broker-managed fund has never actually come into play. That is due partly to the timeframe that Covid took from the project and a number of other issues, but it certainly is an identified challenge for people who are interested in joining the personalised budget demonstrator and those who are already on the programme.

The intention behind the demonstrator is really to prove concept, and what we are discovering is that it is working. There are circa 40 people currently living with personalised budgets and the independence that it brings, and there are a number, we would hope in and around the region of 40, that we might be able to move into the stage 4 full independent living. It is interesting that the target originally was that we would have 180 people living with personalised budgets by the end of the demonstrator. We have had much bigger numbers than the 180 who have taken part, many of whom have exited the programme. That is partly due to some of the complexities where a budget has to be uncoupled from a CHO area to be applied to the individual and in many cases, because of the length of time that that person has been in service, the budget does not represent the needs that the person would have independently. There is a major lesson that we want to glean from that and to address. It certainly is something that we want to look at and address moving forward, and evaluate what our learning needs to be from the disabled people themselves who sought to enter and who entered the programme.

Senator Tom Clonan

Since 2019, I have been writing to those who operate that pilot programme. I have never received a reply. Also, I would say that the waiting list to even make contact with Áiseanna Tacaíochta can be measured in years. I suggest that those involved should talk to companies such as Home Care Direct and people like Michael Harty, because it is a very successful model. It helps the people. It is disability centred; it is not administrative or otherwise. I appreciate the answer. I thank Mr. O'Regan and Mr. Higgins.

Ms AnnMarie Farrelly

In terms of projecting housing need, it is what we do. It relates to our county and city development plans where we project the six-year need in line with the development plan we are delivering. That is looking at social and private housing need. It is a fairly macro-assessment and it does not go down into the five categories of disability. Of course, some of our standing housing meets the needs of those with a disability. For those with a physical disability, we think the future stands with universal design and universal accessibility. If all of our housing supply meets that standard, to an extent we are future-proofing for all of our counties and cities. We are not there yet but it is good to have the pilot started. It is becoming more recognised through our steering groups that that is the future for meeting the needs of social housing for those with physical disabilities.

Certainly, there have been many instances, as the previous speaker mentioned, where the care package is not available when the housing allocation is ready. Typically, we can work through that. The interagency responsibility obviously kicks in well in advance of a house being ready for allocation. There can be exceptions but we generally work it through so that it does not cause an undue delay with an allocation, but it should not cause any delay. Social workers engaged by us and funded by the Department can work in that space in terms of making sure that care packages are available. We are getting better at that. I do not think it arise as regularly as it might have in previous times but our position would be that it should not happen at all.

The Senator asked Mr. Hanrahan a direct question. I might ask him to respond.

Mr. Liam Hanrahan

I thank Ms Farrelly. Senator Clonan asked how do we identify those who are living at home with elderly people. It is not only getting them onto the housing list, but the type of supports they need. Sometimes that support may be in terms of a grant to allow some level of independent living within their own home with their parents. That could be a wet room or an extension for their own living room, etc. Typically, that type of contact comes either from a family member or from a local councillor who knows the family and applies for a grant. When we are carrying out the assessment, in some cases it may become evident that the person should apply for a housing allocation, complete the form and get on the waiting list. In the short term, the solution may be to provide a wet room, an extension or some works in the family home. In the long term, however, it would involve working with our social work team and the HSE team around making sure that person's housing form is filled in, that he or she is on the waiting list and that he or she goes through the allocations scheme as necessary.

Senator Tom Clonan

I have become aware that, for example in the Dublin corporation area, if you modify your home to make it accessible to a disabled child or adult, you are exempt from local property tax. Is that universal or is it on a case-by-case basis? Are the witnesses aware of it?

Mr. Liam Hanrahan

It is very much on a case-by-case basis.

Ms AnnMarie Farrelly

Discretion for local property tax is not with the local authority. It is with Revenue.

Senator Tom Clonan

It is difficult to find a one-stop shop where I can get all the information. Quickly, because I know we are under pressure for time, how long is the average waiting list in Meath, Galway and Fingal?

Mr. Liam Hanrahan

Most local authorities do not operate a time-bound waiting list. It is a priority scheme of letting, which means that if someone comes with a significant level of disability and a significant housing need and the housing package, their need goes further up the list than that of someone who may be living in a congregated setting that does not have more than ten people and does not have an immediate housing need.

Senator Tom Clonan

Apart from the variables, approximately how long does it take? Is it a year, two years, three years or five years?

Mr. Liam Hanrahan

It can be anywhere between two and three years at least.

Senator Tom Clonan

That is a significant improvement on what I heard from people in the past. I thank the witnesses.

Deputy Pauline Tully

It is good to have both agencies in the room because we regularly hear the local authority blaming the HSE and the HSE blaming the local authority for accessible housing and support packages not being in place and for not working in tandem. I acknowledge the situation has improved with the new steering committees and I hear of good working relationships on the ground between a local authority and the HSE or disability manager on the ground, though I have been told that the national level of the HSE can be inflexible at times and a degree of flexibility at that level would be important to allow disability managers to do as they see fit on the ground. They are not going to make decisions that are not necessary.

Some of my colleagues already raised this. It was mentioned in Ms Farrelly's opening statement that the steering groups have disability service providers on them. It is important that it is disabled people's organisations, DPOs, that are engaging with the steering committees as they are speaking for themselves. It is important local authorities are cognisant of the different forms of disability. Disability is not only physical; it is sensory, intellectual and relates to mental health. Those people should be engaged with at design stage, rather than later. Sometimes we hear from disabled people at this committee who talk about engaging in consultation, for example with the National Transport Authority or another organisation. They say they are brought in to tick a box and that the decision has already been made. Sometimes the design is wrong from the start and they are brought in when it is already at an advanced stage. That is important. I heard about a housing scheme, not in this country, but elsewhere, that was built on a hill. No thought went into that, that houses for wheelchair users would be on a hill.

Universal design is welcome. Ms Farrelly said a new design standard is being developed. Currently, the minimum standard for universal design is only wheelchair visitable. There are calls for that to be changed. Is that what Ms Farrelly was talking about, that the standard should now be wheelchair liveable? It is important that a percentage of houses in every development going forward are accessible because it is more cost effective than adapting a house later.

What are the witnesses thoughts about a programme of downsizing? I have come across individuals who have a local authority house. They had a family. The family has now grown up and moved on and the individuals are living in a three-bedroom house, may have developed mobility issues or an illness and they want to downsize to a two-bedroom house, but it is not happening. I am sure the three or four bedroom house would benefit a family. I am told the reason is that there is a shortage of two bedroom houses. It needs to be addressed. In other countries, this is done as a matter of course and it is quite good.

Organisations that were before the committee in December spoke about the CAS funding. They said it does not support independent living for disabled people. There is no funding for disability in housing or focus on disability in the CAS. There is funding available for the CAS but it does not take account of the additional supports people will need if they move into a house. That needs to be built in.

There is no Revenue to support specialist services such as respite. Could the CAS be widened to support respite services in an area? I do not know whether that is possible. It was just mentioned by them as well.

I also emphasise that accessible housing is not only about the house itself. It is about the whole environment, making sure there are accessible transport links to education or employment, whatever is the case.

The HSE talked about people younger than 65 being in nursing homes. That figure is not coming down and the reason is that while people are being moved into the community, more people are still going into nursing homes. The practice continues. Is there a plan in place to stop that practice? Will enough accessible houses be built in housing developments as we go forward? The same could be said about congregated settings. Again, moving people out of congregated settings into the community has been quite slow. There has been some progress and that is welcome, but there is still a long way to go.

Ms AnnMarie Farrelly

The disability strategies at a local level include the representative organisations, the clients themselves and disability advocates. The three categories are involved in the development of the strategies, in order to have a strong strategy that will meet the needs of everyone involved. Ongoing consultation is important and some improvements could probably take place there. As we mentioned earlier, tenancies give us a direct method of consultation with our clients. Good work is happening from a housing perspective.

I will ask Mr. Rainey to speak about the CAS and care packages.

Mr. Michael Rainey

I have a couple of points. The Deputy is correct that the supply of one and two bedroom units for downsizing is a challenge for local authorities and the one and two bedroom units we obtain are often multistorey, so there is an accessibility issue. Members will probably be aware from their constituencies that the one-storey maisonette properties are in high-demand. It goes back to the point I made initially. We need to go back to direct build. At the moment we are still dependent on using turnkey properties coming in from private developers. If you look at our county development plans, you will see that we support disabled person's housing. A consideration of targets would be useful for us so that when planners meet individual developers at the pre-planning meeting, there are targets to be achieved on universal design or disabled persons' housing, perhaps to force their hands and see that kind of housing built into the models of housing that eventually come through to us as turnkeys.

As we said in our opening statement, we are very supportive of the CAS. We depend on the AHB sector to come forward and engage with us on the CAS. We would like to see more engagement from the AHB sector on the CAS. It really does deliver for disabled persons because it is housing specifically designed for disabled persons.

Deputy Pauline Tully

They build the houses but they do not take into account the additional supports at that stage. A more co-ordinated approach is needed. That is the point they were trying to make.

Mr. Michael Rainey

Yes, our piece is housing. If the issue is the support services, we are talking about remodelling or reviewing the CAS to broaden it to the support services the HSE provides. From our perspective, which is housing, it is a good funding scheme that provides the kind of housing we are not getting in other streams. Not only individual units, but the whole estate can be designed to be disabled friendly.

Ms AnnMarie Farrelly

I will come in on the private housing delivery. We have some good examples during pre-planning on Part V units. We have worked with a developer to design units to suit people who are awaiting social housing. I can think of three examples in Fingal, in recent delivery where basically the Part V was designed to meet the individual need. On the care package with CAS, the reality probably is that the care-package cost goes up when the allocation is made and that is more than likely what is causing the difficulty for individuals, that this negotiation needs to happen with the HSE.

Mr. Barry Lynch

On the universal design piece as well, that is obviously very important. We try in our individual schemes. We obviously have generically accessible housing but we also tailor it specifically to the individuals. The other piece about lining up the care package, which has been referred to several times, is something we try to achieve at the disability action teams. We are taking a similar approach as we would have with, say, severe homeless cases where we would work through Housing First cases. At our homeless action team, we try to achieve a similar result with people with high support-needs with disabilities. Certainly, the standard that is there for universal design will cover everything, including the circulation areas, all the accessibility and the environment around the house which the NSAI is developing. The other thing is that there is quite a bit of focus through the Age Friendly shared service and being age friendly in the public realm, which would be similar to what is needed for disability. Again, we are working through the network of age friendly and disability technical advisers to try to improve that awareness in each local authority around the country to make sure the projects are designed with that in mind. There will be a lot of information coming out over the next 12 months on universal design, which hopefully will get into the mainstream.

Mr. Bernard O'Regan

I will comment on the first point made on the role of national and local and on what is support and what is an obstacle. The very clear intention of the CEO regarding the redesign of the HSE and its structures is absolutely about making sure that local decision-making, local structures in the context of the health region, is the way forward, that the national roles are there to support the health regions in the delivery of services, and that the decision-making will be increasingly located in the health regions. That is welcome. Decisions made as close as possible to the citizen are always going to be better.

Regarding the nursing home numbers, it is right to say they have remained static and while that is better than them increasing, it is certainly not anything that anybody is celebrating. There are a couple factors to the reason the number remains static and these are areas on which we are actively working at the moment. Part of the difficulty is that we are not able to make a policy decision at this point, to say no more admissions of people inappropriately into nursing homes because we do not have the alternatives in place. We need to support people to move from places like the National Rehabilitation Hospital when they are ready for discharge because there are others who need to access those services. We are working to develop some models around step-down facilities and then developing the community services that people need with the level of support they need and to be able to do that safely. We are talking sometimes about people with quite complex needs and we need to do it safely. Having available housing and support is certainly part of it but in terms of some of the models of service we have between let us say the National Rehabilitation Hospital and a supported community placement that people might need, we are using nursing homes to bridge the absence of appropriate other services. Until we can develop some of those models, we are not going to see a dramatic reduction in the number we should be working towards. Once we have those step-down facilities in place, we will see much more appropriate stepping stones for people and less use and reliance on nursing homes as part of the model. It is good that number is not increasing. It will be better when we can get the point of making no more inappropriate admissions to nursing homes and we are confidently able to do that because we are able to provide an alternative.

Deputy Jennifer Murnane O'Connor

I welcome Mr. Rainey who I know from Carlow County Council. I know Ms Ennis who worked in the HSE in Kilkenny and Carlow for years, and Mr. Bernard O’Regan. Therefore, I have to be very nice today.

I was just thinking, when we spoke about the local area and networking and aims to improve services, we were very lucky on Monday when we had the Minister of State, Deputy Butler, in Carlow to open what is the dementia café called The Cabin Café. It really is a very supportive café for families and carers and this is part of all the networking mentioned through the HSE and local authorities which aims to make sure everybody is working together. It was a really successful morning and the Minister, Deputy Butler, did a great job. That is what we need to do. We need to have more things happening like this. I can only say that Carlow Older Persons Forum is probably one of the best in the country. It was good to see.

The witnesses spoke about local area co-ordination models, and signposting and things like that. I am not aware if there is much of that in Carlow, so Mr. O'Regan may come back to me on that. We all have to be practical here. There are huge challenges within the HSE and section 39 organisations. I am aware there are issues with staff retention, funding and services. There is no question about it. I am someone who is fighting for services every day and trying to get work done and I spoke before to Mr. O'Regan about one family I know so well. They are getting older and they have a son who needs 24-hour care. They did it for years but just could not do it any more. I had been working with the Minister, Deputy Rabbitte, and a very good provider of a service in Carlow. We got the funding and then the bed, but then we could not get the staff. There was no staff. The son needed to go into the service. The mother and father were distraught and I have had a few cases of this now. What can we do in that line to try to help a family which are so tormented but who have always been there? They did not want to do this but they had no other choice. That is a huge issue. Many people are getting older and we see it ourselves. It is great that people are living longer but that is bringing huge challenges to the system. It is bringing huge challenges whether is through the HSE, services, or even local authorities. We have a lot of challenges now. Our emails trying to get a bit of information are not being answered by the HSE at the moment but that is okay. However, there are challenges within the HSE. Within my own area of Carlow we really need to get more funding. We need to have a lot more services for children with disabilities. We were promised a building for Holy Angels which provides an absolutely excellent service to young children. I know Mr. Rainey is aware of this, as is Ms Ennis. It was to be built on Kelvin Grove and is in the capital plan but I cannot get a date and I do not know when it will start. The building the centre is in at the moment is not fit for purpose.

There are huge challenges within the HSE. However, I am aware this is about housing today so now I will come to Mr. O'Regan. At the beginning of the meeting, Ms Farrelly spoke about the 2,472 allocations nationally. Does the CCMA have the breakdown for Carlow-Kilkenny and if not, could I have it? I have had a few cases recently of children with disabilities whose mother and father may have their own private home and who apply to Carlow County Council for a grant. They cannot access a children's occupational therapist. Carlow County Council does not have one. Does any of the 30 local authorities have one?

We have occupational therapies - there is no question about that - but it is a matter of actually getting a child occupational therapy. We are working with children here. We are talking about young children with disabilities who are looking for grants. I know you can apply for a sensory room. That is done through the local authority. That is grand in the case of a local authority house. If you go through the local authority, it comes out to you. If, however, you own your own home, say, and have a child with a disability, you need to get a child occupational therapist. All local authorities across the country should have a child occupational therapist - that is just common sense - but my understanding is that that is not the case. Across all sectors, we need that communication. It is great, as Pauline said, that everybody is working together, but I see this daily. I can honestly say, having worked with the local authority, the HSE and all the different Departments, that they are very good. You might have to scald them, as Michael would know, and you might have to ring them a good few times, but they do all work together. Could that be looked at? I feel that would do really well.

Mr. Rainey spoke about the grants, and they are really good. I really welcome them. He said a review was ongoing. There needs to be a review ongoing. I will give the witnesses two cases. I could give them a hundred but I will go with just two. I am sure all of them are aware that this is through all local authorities. For a local authority, for your grant, whether it is an older people grant, a housing adaptation, a bathroom or whatever else, to apply for, say, an older people grant, you have to be 66. There is no leniency there. If you go for windows and doors and are six months off 66, you might have a really bad ailment, but there is no give-and-take there whatsoever. Only at 66 can you apply. Leniency needs to be looked at there. Maybe that is part of the review. I am sure that will be looked at.

I am sure the witnesses are all aware that we have all seen huge challenges in the system since the Covid pandemic. Whether it is a bathroom adaptation grant, a bedroom or a bathroom built on, the cost of materials has absolutely soared. What I find when people come to me is that they just cannot afford to pay the extra money now to get the works done. They just do not have it. The grants themselves have not changed, the maximum being €30,000. That is what you get. In Carlow anyway it is €30,000 for a bathroom adaptation grant or a bedroom. Then the bathroom adaptation grant could be different depending on the size, but there is no way you will be able to pay it. The issue is whether there will be extra funding through the work being done with the HSE and the Department. The grants now available to people applying for them have nearly doubled. They will have to go up at least €10,000 anyway. It is just unreal. That is another thing. These are simple things. A lot of the questions I was going to ask have been asked. These are questions that I believe really need to be answered.

This is my last question because Erin and I have a PP meeting as well. If a family with a child or an elderly person with a disability is on the housing list, I ask the witnesses to define for me how they move up the list. Normally, they are told, "We will look at that under medical grounds, but there is a waiting list." How do they define that? How do they themselves decide, as people who represent the local authorities and work through the HSE?

I had a woman in yesterday. God, she was very upset. She is from a rural part of Carlow, and her son will have a housing interview next week. The local authority rang to say he will have the interview. The chap is being assessed. We are trying to get him into services. How could I say to her, "I do not know, when he goes on that housing list, if I can get him an apartment where he can be near his services"? I know there is no housing there - I understand that, and we have to work on that - but we see challenges daily. They are challenges I see, as would other Members of the House. How do we overcome them? We need to start on the ground and we need to start fixing things on the ground a little better, working with all the other areas.

Again, I thank all the witnesses. I was not too hard on Mr. Rainey because I know I have to ring him tomorrow.

An Cathaoirleach

Very good. Thank you, Deputy Murnane O'Connor. I will not comment. Mr. O'Regan might respond.

Mr. Bernard O'Regan

Deputy Murnane O'Connor is absolutely right about the staffing. It is a core part of how we support people, and recruitment and retention of staff are very challenging.

As regards section 39, there is a WRC agreement. I think that had two parts to it. One was a commitment to pay, to begin to bridge the gap, and the other was a commitment to a renewed process. From a HSE perspective, in terms of the agencies we fund, we are actively working with the Department to release the funding that has been approved to meet that. The new Building Momentum talks were intended also to incorporate the next phase. We will have to see what the outcome of that is, but I certainly have hope for the commitments that were made towards ensuring that people are paid a fair wage for fair work, equitable to what others have done. Until we do that, we are constantly going to be dealing with this challenge. We have a very rich section 39 sector that can offer a lot of potential in terms of service delivery and has a long track record of doing so. I think there are things we can do that-----

Deputy Jennifer Murnane O'Connor

They are so important, are they not?

Mr. Bernard O'Regan

Absolutely, and we will certainly help in terms of recruitment and retention for those organisations, while at the same time saying that the kinds of developments that we need to happen and that we are looking to make happen over the coming years in disability services will require significant numbers of additional staff. It is challenging at the moment. Members will have heard that from sectors other than health and social care. We are all competing for a pool of people that is quite limited and we have to look constantly to our international recruitment and be innovative in terms of work design in order to ensure we have the people we need to provide the services.

I will have to come back to the Deputy on Holy Angels. I know that it is on the capital plan and that we are working on the capital plan at the moment. That will set out what we are committing to for this year. Once I have a bit of information on Holy Angels, I will come back to the Deputy. I know it is on that plan, but as to what extent or what will happen this year, I will come back to her to confirm what the position is.

An Cathaoirleach

I call Mr. Rainey.

Deputy Jennifer Murnane O'Connor

No pressure.

Mr. Michael Rainey

The Deputy has me targeted. I will have to come back to her with specific figures for Kilkenny and our county in terms of the allocations. She is right when she talks about the challenges of getting in occupational therapists. As a local authority, we do not have that skill set in house so we are dependent on those reports. I recognise that it is difficult for some families to get those OT reports. What I do know on the ground, though, is that when there is a really challenging case, there is a good relationship between us and the HSE to get those OT reports brought forward or prioritised for specific cases.

The Department is in the middle of a review of the grants. Cost inflation is one of the key considerations. The Deputy would know that well. I have had many cases where there is that specific rule as regards the age limit of 66 and there is no discretion as a local authority to go beyond that. We are bound by the rules and regulations set out and whatever comes out of this review, but if the rules are broadened, if the number of people who can come forward and get funding under the schemes is broadened, you also need to broaden the overall funding net. Otherwise, you just end up with more applications and not enough money going out to the key people.

Deputy Jennifer Murnane O'Connor

I know.

Mr. Michael Rainey

That would have been one of the considerations in the review because that issue did come up before, but there is a finite amount of money there. It can be seen from the figures that it is oversubscribed. More money is being spent than was originally allocated. There is quite a lot of demand on this funding stream in every local authority. If the terms are broadened, if it is made more available, you need to look at the overall funding envelope and then, as we said, there is a challenge for us as local authorities because we have to provide the matching funding. That is why we are looking for the 100% funding from the Department that would take that pressure off us.

Deputy Jennifer Murnane O'Connor

I will be up to Mr. Rainey with my other cases tomorrow.

An Cathaoirleach

Emer Higgins is substituting for Mary Seery Kearney.

Deputy Emer Higgins

I thank the CCMA and the HSE for being here with us today.

It is very important to have our local authorities and our health services here because they are the key enablers of people with disabilities to become part of a fully inclusive society. That is what we are here to talk about today and I thank them and all of their teams for all they do.

My own local authority team suffered quite a big loss about ten days ago when our disability liaison access and equality officer, Selina Bonnie, passed away, sadly. Selina was a champion for people with disabilities. She was an absolute advocate for equality and inclusion and she dedicated her professional life to making my local authority, South Dublin County Council, a better and more inclusive place to live. She dedicated a huge amount of her free time to supporting the work of DPOs. She was a witness at this committee and was a witness on the special committee on international surrogacy. I use this opportunity to pay tribute to her on the record of the Houses of the Oireachtas. May Selina rest in peace.

Following on from the last contribution from Deputy Murnane O'Connor on housing adaptation grants, that is something which comes up for me repeatedly. I welcome the inclusion of hoists in the housing adaptation grants. That has been very useful and progressive. I agree that the €30,000 is not adequate in a situation where we know there are increased prices and costs in any kind of construction work. I appreciate that is a matter for the Minister. Perhaps what might be a takeaway for the CCMA is that it is my understanding that local authorities employ different criteria when dealing with housing adaptation grants. I believe in the case of Fingal it does not necessarily cover full retiling for bathrooms or the costs of skips for jobs. In South Dublin County Council, that is covered, but then South Dublin County Council has a particular maximum for bathrooms which I do not see in any circular and which is very much out of kilter with where costs are at the moment.

I thank Ms Farrelly for outlining the disability allocations numbers earlier. They are not necessarily where we want them to be but I suspect they are not even where they look like they are either. What I mean by that is that I would be very curious to know how many homes that have been allocated to a person with a disability are lying empty. I suspect there are some. I know of one in my area, in particular, and I suspect where there are such cases, it is because of the HSE's inability to provide an adequate support package to people. These are people who want to get on with starting to rebuild their lives in the case of an acquired disability, or whose family circumstances may have changed.

The HSE has outlined that we have quite a number of people in nursing homes who do not need to be there. We also have people in the National Rehabilitation Hospital who do not need to be there. I know of a situation where a person is paying rent - I do not know whether it is to the council or to an AHB - on a home that was allocated to them almost a year ago and that person is still in the National Rehabilitation Hospital for no health reason at all other than an adequate care package cannot be put in place. I understand and I am aware that these care needs can be particularly complex, especially when dealing with people with spinal cord injuries who may need assistance with bowels, but quite often those particularly tragic cases are young people who just want to move on and rebuild their lives and who have been given the opportunity by local authorities to do that. I do not know whether it is a lack of resources, expertise or a lack of collaboration but it is happening. It is heartbreaking, and in this day and age it is unacceptable. I have raised a particular case with the HSE and with the Minister in September and I have not had a response. I hope today that perhaps I can get a response from the HSE to that general query of why it is happening that we have people in the National Rehabilitation Hospital taking up what is a very expensive bed that other people may need and are not in homes already provided by local authorities. How can we, as parliamentarians, support the HSE to fix that?

An Cathaoirleach

I thank the Deputy. Maybe we will start with the HSE on that point, please.

Mr. Bernard O'Regan

I thank the Deputy. That is not okay, for the person in the first instance, for us as a service provider nor for partners. It goes to some of the points we were making earlier on trying to get the alignment right between support and housing. It is a good example, in the worst way, of where a system may not be working. Resources are a challenge but this is not a resource issue in the sense that, and I do not know the details of it, we have a budget which is available to support people to transition from inappropriate placements, whether those are nursing homes, or the prevention of people going into nursing homes. Certainly we will look to do that. There may be other factors involved which I do not know about so, to be fair to others involved, I just want to acknowledge that. Mr. Higgins wanted to comment on it as well.

Mr. Brian Higgins

I thank the Deputy for the question. On the issue of the continuum of care and people who are in the NRH who by right should be at home in the community, we are working on the establishment of the managed clinical rehabilitation networks and the community neurorehabilitation teams to effectively have a three-tier level. There is the acute system and the NRH, where in those cases where there is a spinal cord injury or an acquired brain injury, people receive the care they need in the NRH, entirely appropriately, or, within the new model, closer to home in a regional unit. Then there is level 2 which is where that person can move to a step-down unit that prepares them for their integration back into the community, leading to tier 3, which is a community multidisciplinary rehabilitation team in the community that engages, in a similar way to the local area co-ordination, with existing community initiatives to support them to live at home with the care they need.

We are in a position where four of those teams are ready to be stood up in the early part of this year and there is further funding secured-----

Deputy Emer Higgins

Is that for CHO 6?

Mr. Brian Higgins

Yes. In CHO 6, we already have the second level. We have CHO 6 and CHO 7 within the programme. We have 12 beds in the Royal Hospital Donnybrook and we have 15 beds in Peamount Healthcare. They are the step-down for that. Our intention would be to expand the capacity of those beds in those areas. We are in active negotiation with our colleagues across the hospital groups and the CHOs in Cork and Kerry and in Galway.

Deputy Emer Higgins

Peamount Healthcare is a facility in my constituency which I know very well and does incredible work in rehabilitating people and providing long-term nursing care and support. I know resources are always an issue in any of these facilities but is there an opportunity for support to be provided in the interim in an outpatient perspective for people in that situation, if expertise is available, to enable them to get into homes that are allocated?

Mr. Brian Higgins

Is that through Peamount Healthcare with additional support?

Deputy Emer Higgins

Yes, for example.

Mr. Brian Higgins

I can certainly take that back and have some conversations.

Deputy Emer Higgins

Thank you.

An Cathaoirleach

Does Ms Farrelly want to comment?

Ms AnnMarie Farrelly

On the lack of standardisation, where it exists, that is something I can bring back to the housing committee but we can also feed that into the review. I appreciate there may be some lack of standardisation in approach, so I am happy to get that reviewed.

An Cathaoirleach

I call Senator McGreehan.

Senator Erin McGreehan

I thank the Cathaoirleach and all of our witnesses are welcome to our meeting this evening. They may be in Carlow but I hear the Louth accent coming back at me. It is always lovely to hear someone I recognise. The witnesses are all very welcome. It is great to have both organisations in the room. The responsibility that is lined up in front of us is huge, and all those in both organisations have a huge role in so many lives in our communities. The effects of what they do, what is done or what is not done is colossal. We all know that because we speak about it every single day and week here and in our constituency offices, and we hear it on the news and everywhere. That responsibility at both local government and HSE levels is profound.

I have one question. Do the CCMA and the disability services meet, how often do they do so, and what is on the agenda in how both organisations fulfil their responsibilities under the UNCRPD and in their remit in providing healthcare, housing and adequate living and community spaces within our communities?

Is it okay if I tic-tac with the witnesses?

An Cathaoirleach

I am monitoring proceedings in the Dáil. I ask members to put all their questions at once in case our discussion is interrupted.

Senator Erin McGreehan

I will keep going in that case. We heard earlier that someone living at home with an elderly parent or other family members knows that their living arrangement will need to change in time, whether because the parent or carer dies or whatever the case might be. At the moment, people must apply for HAP. Members go through the process of getting that person on the list and there are various little things we have to do. When a person with a disability informs the council that he or she has been accepted for the HAP scheme, we look at choice-based letting and so on. Is there then another avenue or option available? Let us say Erin McGreehan needs accessible housing or Mary McGreehan needs supported living. Would they have to contact the HSE and start making a plan, whether to find accessible housing or supported living? Would that involve, say, making sure the list is taken care of as part of planning for a development of 100 houses? Is it the case that we hope that work has been done because this person is on the list and we do not want him or her to languish on it forever? Is a co-ordinated approach taken at the minute? Individuals have a right to have this sorted out.

On training within councils, does continuous professional development, CPD, for technical staff take account of disability equity, access and auditing? We see instances where lovely work has been done by councils, and it is very attractive and looks well, but there is no proper tactile footing and no paint on the edge of steps. Loads of stuff does not get done but if people had proper training, perhaps it would be done and more money would not be spent rectifying these public ground projects later. It would avoid elected representatives having to ask, after the fact, what the story is because a disabled bay has been placed where people cannot access it, for example. Are staff being trained in these areas? Is that training a focus for the CCMA?

Is a co-ordinated approach taken at managerial level to how staff with disabilities are treated and to encouraging people with disabilities to work in these organisations, for example, by facilitating them with assisted technology and listening to their needs? How open are the CCMA and HSE to doing that?

I was glad to hear Ms Farrelly mention public sector duty. Every year, councils must write a public sector report for submission to IHREC. At the end of each year, do local authorities and the HSE rate themselves and analyse whether they hit their public sector target for the year, improved the lives of people with disability, reduced exclusion, and increased inclusion and accessibility?

What is the CCMA's policy on changing places and accessible toilets? Is it proactive in ensuring that money is spent on these facilities when investment is made in new public realm projects? It is a lot cheaper to make something accessible when it is being built or renovated than it is after the fact.

With regard to the pilot scheme on universal design, it is great news for the people of Kells that the principle of 30% universal design has been applied to housing projects. If these are social houses, people will move into them and one would expect them to live in them for their entire lives. Where the principle of 30% universal design is not applied to social housing projects, is there a risk that more money will be spent in the long term on rectifying this housing, for example, to install appropriate toilets for older persons or creating downstairs bedrooms? Are we spending enough money to apply the principle of universal design now as opposed to waiting for 20 years until politicians, whoever they are, ask local authorities to adapt bathrooms, etc? I know there are huge problems in planning and we do not have enough planning regulation. The witnesses are on the front line and see the problems. There is nothing to stopping local authorities from being more proactive and going beyond current regulations because they are on the front line and can see what is needed.

An Cathaoirleach

I will ask a few questions now as I can see the Minister is on his feet in the Dáil and we may have a vote shortly.

Mr. O'Regan mentioned a 2011 report on decongregation. Is there a co-ordinated strategy or plan for decongregation, which is a major Government policy platform?

When the parent or parents of persons with disability pass on, they find themselves in an emergency. Is there a co-ordinator or one-stop shop that can help in such circumstances?

Some months ago, when the service providers and organisations were before the committee, they referred to capital assistance scheme, CAS, funding. This funding mechanism was widely used 15 or 20 years ago by section 38 and 39 organisations to provide capacity and facilities. The section 39 organisations now find it hugely difficult to navigate the CAS programme. Why is that the case? We see that there is an envelope of funding but it is not being used to provide facilities or capacity for people with disabilities.

In the 1990s and early noughties, many of the service providers developed into housing bodies and used the CAS mechanism to build up capacity. Some of the organisations that span two or three local authorities have told us they find it easier to access funding from one local authority than from others. For example, one local authority will buy a property for them, whereas the other local authorities will not be proactive. That goes back to the universality of the programme being implemented by local authorities, in the first instance.

The HSE has a veto on the drawing down of funding from the CAS programme from local authorities to provide housing for people with disabilities. I am talking about residential housing, decongregation and getting houses within communities to be used to provide residences for people in need. Is there a strategy for exiting decongregation?

Is there a specific one-stop shop when there is a crisis?

You might be able to answer a question on CAS funding for 2023. If you do not have the figures for that year, then you might have them for 2022. Was any CAS funding that was allocated returned to the Exchequer at the end of 2022? If that is the case, it is a crying shame in the context of the capacity of our disability services. We know the unmet needs that exist on a daily and weekly basis.

I would like to pick up on the questions asked by Senator McGreehan. What urgency is given to providing housing or facilities for people with disabilities? We spoke specifically about the CAS programme and the frustration it is causing for charities and service providers. Why can we not have something like we had 15 or 16 years ago when it was relatively easy to access CAS funding rather than, dare I say it, the procrastination that exists at present? People trying to provide capacity are having difficulties with the system, which is a ready-made source of funding.

We will start with the HSE and then come to the local authorities.

Mr. Bernard O'Regan

I thank the Senator. We will try to cover the questions that have been put to us. The primary structure around meetings is the structure at local level, and rightly so because that is where people are and it is the closest point to decision making. There are also national structures, which Mr. Higgins will speak about in the context of the housing strategy and how we work together on those.

I can get a note from our HR department on the issue of the HSE as an employer of disabled people to give the committee a sense of it. There are national targets which we are obliged to work towards in the same way as any other public sector organisation. From our perspective as three representatives of the HSE who have particular remits regarding supporting people with disabilities, the entirety of our public sector responsibility in our work is aimed towards meeting the needs of disabled people. We constantly reflect on how we are doing things. It goes to the train of the discussion right from how we include disabled people in our planning and delivery through to asking ourselves what difference we have made, if any; and if we have made a difference, whether it was the right one. It could be the wrong difference as well. It is something we constantly have to reflect on. We are not always good enough at asking other people to tell us how we are doing. That might be a much more uncomfortable space to be in but it is something we have to be able to work towards.

I will pass to Mr. Higgins to talk about the structures and the decongregation discussion.

Mr. Brian Higgins

I will address the Cathaoirleach's question about making the CAS system faster and more readily accessible, and the Senator's point on how the Department of Housing, Local Government and Heritage, the CCMA and the HSE engage. I will give two examples. Within the strategy, the HSE has the lead responsibility for the delivery of 18 actions. In eight of those, the HSE is directly the lead and in the other ten it is the co-lead. As part of that, Ms Ennis and I sit on the national committee for the delivery of the strategy. Feeding into the national committee are regional and local committees, as Mr. O'Regan has referenced. We meet regularly and there are robust conversations about identifying the challenges and seeking to address them. That addressing has to be at the local and regional levels. There are strong engagements there. Ms Ennis might speak about those in a moment.

I will give an example of where that works in practice. It relates to the Cathaoirleach's question. We had a meeting in December with the Department of Housing, Local Government and Heritage, the AHBs and some providers. This meeting was specifically to look at CAS funding, at the blockages that were experienced in reality and at how we could begin a process of trying to ease access to the service. It was a very productive conversation and the beginning of an engagement that we hope will continue. Interestingly, in that conversation, it was very clear that the delivery mechanism is at the local level. For those groups at local level that the CCMA has referenced, it makes a huge difference when the CHOs and the HSE are engaged directly with colleagues in housing and local government.

On the issue of accessibility, the HSE is very much engaged. A high-level senior officials group within the Department of the Taoiseach has pulled together representatives from the Department of Children, Equality, Disability, Integration and Youth; the Department of Public Expenditure, NDP Delivery and Reform; the Department of Social Protection; the Department of Transport; and the Department of Education. I am there representing the HSE specifically to look at transport for people with disabilities and the challenges around accessibility and independence. We are looking at it initially with a focus on public responses to transport and some of the schemes that are available privately. We meet every month or every two months and that is led by the Department of the Taoiseach. There are quite a lot of interdepartmental and very much connected discussions and responses to try to address those issues. Part of my brief is day services and the school leavers programme. That ties in very much to some of the challenges that we have around access to day services, for example.

The TTMO strategy is the overarching one that denotes the direction of travel in decongregation. As the delivery agent, the HSE is very much involved in that. The policy falls within my brief in the healthcare strategy under the disability remit. We have an office, which may be an overstatement in terms of how many people we have, and Ms Ennis is leading that policy. There was a gap for about a year when we did not have the national lead for that position. Ms Ennis has been in place now for more than six months and has been making huge efforts in that regard. Part of the initial piece she has done is to ascertain where the congregated settings are and who the people in them are. That is very much a foot-on-the-ground process. It involves meeting the individuals and staff in those services and trying to understand where they are at. I will hand over to Ms Ennis to provide further detail.

Ms Anne Ennis

The team is me and Mr. Higgins at the moment. It is a dedicated resource, specifically for decongregation. We also have a dedicated budget, albeit a meagre one at times. There is a concentrated effort from the HSE perspective to move people from congregated settings. The real work, however, is done at local level in the steering groups. Part of my role is to link with the AHBs, the local authorities and the HSE disability operational teams at a local level to ensure they are all represented at the local steering groups because that is where the work gets done. That is where the needs are profiled. The Department of Housing, Local Government and Heritage has said that it will work with us 100%. We just have to say what is needed. It is at that local level that we have to map what the need is.

Ms AnnMarie Farrelly

In terms of having the expertise within local authorities, the Department would like us all to employ a disabled technical adviser. Many of us have access officers. The advice generally can be available in-house. We are getting better at designing our schemes, whether it be public realm, playgrounds or indeed housing. We are proofing our strategies to make sure they are fit for purpose. There has been much improvement in that area in recent years, with more to come.

With regard to universal access, the sector agrees that if all our future units had universal access to a large extent we may not have to come before the committee again. At this stage we are not in a position to offer that. We need the Department's sanction for that. However, it is good news there is a pilot under way and that the findings to date show that the cost deferential is not too great. There is more work to be done in that area.

We have had a good local relationship with the HSE and other stakeholders for many years. The fact that it is now driven nationally and regionally, starting with the national implementation steering group right down through the various tiers of inter-agency co-operation, is helpful because it gives the confidence to the local actors to get the job done. Good work is happening. It is not easy to source suitable properties for CAS. It can cause a time delay. Local authorities take on responsibility there where we typically signpost approved housing bodies, AHBs, and charities to suitable properties to benefit from CAS.

The biggest complaint we get is that they would like a bigger allocation for CAS but Mr. Hanrahan will come in with more detail in that area.

Mr. Liam Hanrahan

In terms of CAS and where it is at, we will hopefully have a figure for the end of 2023, which will be between 270 and 300 CAS units delivered by the sector in 2023. The section 39 groups, as was said, have moved into forming their own AHBs and there is now independent AHB regulation. Going through that process has taken significant time, as well as change to the governance models of the section 39s and the AHBs. With that regulation came the need for technical support. Housing for All and local authorities have now been able to put in place engineers who can offer that support through technical services or CAS.

With regard to the capital advance leasing facility, CALF, review, AHBs in particular access CALF much more for schemes of significant size or for CALF turnkey projects. We have completed the CALF review and the AHBs are now back working on CALF applications with our engineers. They are beginning to look at those bigger schemes. We find that they have moved away slightly from CAS to CALF as they move from section 39 to AHBs because it has allowed them to plan for more than one house. It has allowed them to plan for a larger community, integrated living within a new estate or indeed in purchasing a turnkey estate where there may be five or ten houses for people with disabilities, five or ten houses for older people and the rest of the properties may be put aside for general allocation under the priority scheme on letting.

We are beginning to see significant movement in that direction. As Ms Farrelly pointed out, the properties becoming available that are suitable for CAS in many cases are not out there, namely, larger properties with four or five bedrooms and two or three bathrooms. By the time those houses are purchased and adapted to get them back out into the market, the cost can be prohibitive versus going in with an AHB to purposely design four or five units within the estate using the CALF funding model or indeed with local authorities, which we have done in Galway. We partnered up with the HSE and section 39 agencies to deliver community housing improvement programme, CHIP, social housing, delivered by Galway County Council for clients who up till now would have been holding on for CAS-funded properties. We are now designing and putting those houses into our estate and they are going in through the housing disability steering group with the supports that the HSE put in place. We had a good example of that with the HSE in Clifden recently. There is a significant move on from that CAS one-offs into CALF, particularly after the CALF review, but it also coincides with section 39 organisations moving more into the AHB sector and the technical know-how in the AHB sector has ramped up significantly in the past couple of years as well.

An Cathaoirleach

Has money been unspent in the CAS budget over the years?

Mr. Liam Hanrahan

It is made on an application basis so a person wishing to apply for a property is going to have everything lined up beforehand. However, the drawdown can take time because the property may be purchased but by the time it is turned around, it might be a year or a year and a half later. There is always a delay. It is not a neat annual funding model. It is a rolling requirement.

Deputy Ruairí Ó Murchú

I have a specific question that relates to the issue being dealt with. It is about Saint John of God community services. In September 2020, there was a funding crisis. The figure was €32 million. The services gave a year's notice for termination of service and then, in April 2021, the Secretary General started a sustainability and impact assessment that was finished in October 2023 with a number of recommendations. From their point of view, none of these have been acted upon. There were briefings to a number of politicians relating to the fact that there would be a board meeting on 25 January. They are hoping for some sort of information on a way through because they do not have a roadmap for a sustainable operation at the minute.

We are all worried about the 3,000 employees of Saint John of God community services but. beyond that, there are approximately 8,000 children and adults. Some of the service users, although I do not always like that term, whom I met in Drumcar had huge needs. What is in train to deal with this particular issue that is going to impact on a huge number of citizens and their families?

Mr. Bernard O'Regan

Saint John of God served notice to the HSE a number of years ago. We agreed a process that has been ongoing and that concluded last October. There is a report and a set of recommendations that we are reviewing both within the HSE and with the Department.

It is important to say that the HSE has been providing substantial additional funding to the Saint John of God community services. If memory serves me right, that is in the order of €11.5 million per annum, additional to the budget that was provided to it. We will continue to provide support to the organisation. We have engaged with it consistently in reviewing its ongoing budgetary position with a view to ensuring that it always has access to the funding it needs to meet its liabilities. We are doing that with many organisations. It is not the only one. However, we have been providing and maintaining that funding. There are ongoing engagements at the moment within the HSE, including meetings today and tomorrow in light of the correspondences that the organisation has issued. We will meet with the organisation again to try to progress matters. However, I am conscious of the concerns that are there for all of the people the Deputy mentioned. The HSE position is really clear; we will do everything we can to maintain services for people. That has involved many different things in different areas. Sometimes it has been about funding, sometimes organisations have looked to partner with other organisations. Sometimes that has meant the HSE stepping in. The Saint John of God community services are a very significant service provider.

It has a long tradition of providing services. We will do everything we can to ensure we can continue to support services. Whether that is, and it is to be hoped it is, through the Saint John of God Community Services or through some other arrangements, we will maintain services for people, but I appreciate the worry and concern that has been created.

Deputy Ruairí Ó Murchú

I appreciate that. We need those meetings to come to some sort of conclusion. There is Government involvement, but my fear is we are talking about a transfer back of responsibility. We are almost back in the same position we were in in September 2020 and we need this resolved. We need some sort of long-term fix. People will be open to anything that delivers for citizens.

Mr. Bernard O'Regan

We have spoken at this and other committees about we are in a situation where there are reforms that are needed across the sector in how we are organised. We have a rich voluntary sector in terms of service provision. We want to nurture and build on that but we also need a sustainable structure so that we are not lurching from financial crisis to financial crisis, whether for a large organisation or a multitude of organisations, and that has to be part of our reform programme as well.

Deputy Ruairí Ó Murchú

Does Mr. O'Regan see a solution before the 25th?

Mr. Bernard O'Regan

There will be a solution. I do not know what the solution will be, but there will be a solution.

An Cathaoirleach

I thank Mr. O'Regan. It was, strictly speaking, just outside the scope but it is an important issue as well nonetheless.

I thank one and all for their involvement. We will be continuing this because it is an avenue that can deliver capacity within the disability services. To all the members as well, I offer a sincere thanks for their commitment this evening and always. Also, we have replaced temporarily Mairéad with Barry and I thank him for taking the role today. I also thank the team for their ongoing work and engagement.

The committee stands adjourned until 5 p.m. next Wednesday, and we will be launching the report at 5.30 p.m.

The joint committee adjourned at 8.02 p.m. until 5 p.m. on Wednesday, 24 January 2024.