Respite Care

My motion is about the need for the Minister of State with responsibility for disability to clarify whether the €4 million in efficiency cuts in 2010 will still be sought by the HSE in Galway from the voluntary sector such as the Brothers of Charity and Enable Ireland. I tabled this motion last week and since then much has happened. The Minister of State, Deputy John Moloney, has come out — as has the Taoiseach — I believe, to say there will be no cuts to respite care services. However, I am reliably informed as recently as this afternoon by the Galway-based Hope 4 Disability — the Minister probably knows Mr. Eamon Walsh — that they will be cut by 45% when the Brothers of Charity reserves run out by the end of this year. Two community houses will be closed and day care services will be reduced.

There is enormous confusion and uncertainty. As the Government takes its respite for the summer, carers are still not sure whether they will get any break. Let us be clear about what we are talking about. In front of Leinster House last week as well as in Galway and Castlebar where there were other marches, the Minister had an opportunity to see disability with his own eyes. People with disability — in many cases, permanent and total disablement — can only be included in society in some shape or form if they are cared for and if the carer is valued. The carer is a critical person in the relationship with the disabled person. The carer is the abled person who minds the disabled person. It is the duty of the State to mind the abled person, namely, the carer. Otherwise the entire service would fall apart, and most of these people are doing it voluntarily. To cut their respite care services would be the final straw.

In a week that saw people with intellectual disabilities and their families take to the streets to protest against cuts to essential front-line services, confusion and uncertainty still reign about what the Government and the HSE have committed to. The Taoiseach, the Minister for Health and Children, Deputy Harney and the Minister for State with responsibility in this area, Deputy Moloney, all stated that front-line services, in particular respite care, would not be cut as a result of the budgetary cuts that have been imposed on service providers in the sector. They failed, however, to deal with existing cuts to services that have seen respite centres closed, community homes consolidated, people forced to move from their homes to more crowded accommodation and day services curtailed.

The Minister will be aware of the human rights investigation of abuses into the John Paul centre in Galway which showed that such abuses took place among young disabled adults there, whereby young people with autism, for example, were crowded into rooms that were only suitable for children. In some cases their knees were up as far as their chins. This is criminal stuff. If we start closing community houses, they will all have to be lumped in together in fewer houses. Is this the record and the legacy this Government wants for people with disabilities? It is going to put the service back 50 years.

The Government has failed to give any assurances for the future of services when families have already been informed that they are to be cut back seriously or closed by the end of the year. People with intellectual disabilities and their families are still very concerned and scared for their future. Some families are trying to cope with the existing withdrawal of supports, especially respite care.

The Government's attack, via the HSE on the disabled is cruel. The Taoiseach, the Minister of State, Deputy Moloney, and now perhaps this Minister are saying there will be no further cuts to respite care services. Has the HSE in Galway been told that, because it is planning for more than €4 million in efficiency cuts — €2 million in March and €2.5 million announced just two weeks ago? That is double what the McCarthy report recommended. That is how tough this is. We know the recommendations in the McCarthy report were tough but he never recommended anything this size on the disability sector. I want the Minister to clarify the position and give the truth to this sector.

Will he give a guarantee that respite care services will not be cut by the end of the year when the Brothers of Charity funding runs out, that the two extra community houses will not be closed and day services reduced? Some of the language used by the HSE in this case such as the word "efficiencies" is not pleasing. These are real cuts which hurt real lives.

I thank my lucky stars I do not have a disabled person for whom I must care. If I did, the very least I would need would be a two-day break or holiday occasionally to regain energy to continue caring. These carers are incredible, giving their heart and soul to their work, by which they are inspired and the relationship in caring. They need to be supported. Those who will be affected by the cuts are the most vulnerable and voiceless. If the Government continues with the cuts, it will just bring them more pain. The greatest service the Minister could do is to instruct the HSE in Galway not to introduce any cuts to respite care services in the disability sector.

The Taoiseach has made the Government's attitude to the importance of respite care clearly known. I have worked for many years with the Brothers of Charity and Ability West in Galway and I am more than aware of the challenges faced by the sector. I will continue to work with them in helping to overcome the challenges we all face.

The Government's commitment in the areas of disability and mental health is consistent. Overall, approximately €1.6 billion is spent annually by the health service on disability programmes such as residential, day care, respite care, assessment and rehabilitation services. The ways in which services are delivered are examined on an ongoing basis to ensure people with disabilities are provided with the best possible services in an efficient and appropriate manner.

The HSE has advised the Minister for Health and Children, Deputy Mary Harney, that it is very much aware of the valuable contribution Brothers of Charity Services Ireland makes to the provision of services for people with intellectual disabilities across the country. In 2009 the HSE provided over €176.9 million for the organisation, an increase of €39.6 million since 2005. This sustained level of additional investment reflects the significant growth and development in Brothers of Charity Services Ireland in the recent past.

The Government is very aware of the importance of respite care and front-line service provision for families of both children and adults with disabilities. It is actively working to ensure these front-line services are protected.

Following the introduction of cost containment and efficiency measures in the 2010 budget, the HSE advised all agencies providing services on its behalf of their financial allocations for 2010 and the required adjustments. The reductions in the allocations for disability service providers in 2010 related to staff pay reductions in line with national guidelines, the Government moratorium on recruitment and a 2% efficiency saving to be applied to non-front-line services such as non-pay expenditure, transport costs, rationalising management structures, merging service functions, merging service providers, etc., without impacting on users of such services. The HSE is required to apply these efficiencies across all service areas within the HSE and all HSE funded service providers under section 38 of the Health Act, including Brothers of Charity Services Ireland.

The Government is fully aware of the challenges which the reduction in allocations will present to organisations in ensuring they meet the needs of service users and planning for emergencies that arise throughout the year. It also recognises that maintaining service levels within available resources will require significant levels of co-operation, change, flexibility and creativity but firmly believes that it can be done.

My colleague, the Minister of State at the Department of Health and Children with responsibility for disability issues and mental health, Deputy John Moloney, met the HSE assistant national director responsible for disability services on several occasions in recent weeks to discuss the emerging challenges in the voluntary intellectual disability sector. The HSE was asked to confirm that the reduction in financial allocations to the voluntary agencies in the disability sector was applied consistently across all HSE regions and in line with the reductions applied elsewhere in the health service. The HSE was also requested to validate, as a matter of urgency, the methodology used by it to calculate the reductions in allocations for the various agencies. The Senator is aware of what arose in Galway.

I look forward to the HSE clarifying the position.

It is noted a majority of service providers are continuing to provide respite care services, despite the reductions in their allocations. The arrangements for the public sector moratorium apply across the publicly funded health services and there can be no question of exempting voluntary service providers or providing them with additional funding. This would undermine the strategic objectives of the Government's policy to reduce staffing levels and achieve payroll savings to bring the public voluntary finances into sustainable balance. Voluntary providers, in common with the HSE, need to identify and implement under the public service agreement whatever changes in staffing levels, skills mix and work practices are necessary to protect services within the reduced level of funding available.

The Minister and the Minister of State met Brothers of Charity Services Ireland on 7 July, together with senior officials from the HSE and the Department of Health and Children, to discuss the importance of maintaining front-line services for people with disabilities. The outcome of the meeting was a clear undertaking on all sides to work in partnership in order that services such as respite care could be maintained. I know Brothers of Charity Services Ireland is anxious to work in partnership in resolving these issues. It is as keen as the Government to ensure services are protected.

The Minister is actually saying the cuts will be implemented. Brothers of Charity Services Ireland is covered by section 38 of the Health Act and must adhere to the efficiencies the Government is seeking in the sector. This year 26 of its staff will retire and, accordingly, will not be replaced. How can the service avoid the public service adjustments the Government requires from affecting its provision of front-line services? The Minister has not given me any good news tonight. How will we protect these services?

The Minister has sought clarification on the even distribution of savings as they were constructed in such a way that they should not impact on front-line services. As this is an ongoing process, the Minister will only be able to pursue the matter further when the information is received from the HSE. The intention is to ensure services such as respite care are maintained.

People were marching last week in protest against these cuts because they were concerned that they would not be maintained. They are under threat.

The Minister to continue, without interruption.

I met the representatives of the Brothers of Charity last week. We are all committed to ensuring front-line services are maintained, in particular respite care.

Was the Minister assured services would be okay?

The Minister to continue, without interruption.

The Minister has requested information and when it is received, the matter will be discussed further. The Brothers of Charity indicated the issue of continuing respite care services would come to the fore at the end of the year. They told me that some months ago. Apparently, it was indicated to them at a recent meeting that further cuts were to be implemented. The Senator will be aware I have not mentioned further cuts this evening.

The Minister has not reassured me.