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Seanad Éireann debate -
Wednesday, 23 Mar 2022

Vol. 283 No. 11

Health (Miscellaneous Provisions) Bill 2022: Second Stage

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

I am pleased to have the opportunity to bring the Bill before the Seanad. The Bill will facilitate the transfer of specialist community-based disability services from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. Broader disability equality policy is already the responsibility of the Minister following the transfer from the Minister for Justice in late 2020. Following this transfer, responsibility for disability equality policy and specialist community-based disability services will be centralised in a single Department for the first time. The HSE will retain responsibility for delivering the services. The location of disability equality policy and specialist community-based disability services in a single Department will facilitate strategic policy development, including implementation of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, which Ireland ratified in 2018, as well as the significant reforms envisioned under the transforming lives programme.

Under the convention, and following the transfer of the equality function, the Department of Children, Equality, Disability, Integration and Youth will be the national focal point and the co-ordination mechanism for implementation of the UNCRPD. The centralisation of the equality, health and social care dimensions of support for people with disabilities will facilitate the transition from a medical model of support towards a holistic, rights-based approach that supports people with disabilities to live autonomously.

Reflecting this change in philosophy in disability policy and service delivery will be crucial for meeting Ireland's obligations under the UNCRPD. The transfer of these key responsibilities provides an opportunity to look anew and critically review how specialist community-based disability services are being delivered. It will allow us to examine how the service offering can be improved to facilitate greater flexibility, choice and control from the service user's perspective. After the transfer of policy responsibilities takes place, the governance arrangements for the transfer are that the HSE will retain service delivery responsibility and provide a framework for close co-operation between the Department of Health and the Department of Children, Equality, Disability, Integration and Youth. This will ensure that people with disabilities will continue to have access to integrated and mainstream health and personal social services. It will also ensure that specialist community-based disability services benefit from, and are in line with, ongoing reform efforts including under Sláintecare. As the HSE will continue to deliver the services, the transfer therefore requires it to report to two Ministers for different elements of its functions. The Bill seeks to put in place a legislative basis to enable this. I shall briefly summarise the main elements and key features of this legislation.

The Bill is comprised of five Parts over 65 sections. I will highlight a few of the more substantive provisions. Of course further specific detail on each section can be found in the explanatory memorandum that accompanies the Bill. In Part 1, sections 1 to 3 include standard provisions relating to the Title and the definition of Acts referred to in the Bill, and insert a definition of the "specialist community-based disability services functions" into the Health Act 2004.

Part 2 provides for amendments to the Health Act 2004 to ensure both Ministers have the requisite authority and accountability in respect of the HSE, in their respective areas of responsibility. Section 7 amends the 2004 Act to provide for the Minister for Children, Equality, Disability, Integration and Youth to have the power to issue general and specific written directions to the executive in respect of specialist community-based disability services. Section 8 amends the 2004 Act to provide for the Minister for Children, Equality, Disability, Integration and Youth to have powers in the setting of priorities for the executive's service plan in respect of its specialist community-based disability functions.

Section 12 amends the 2004 Act to provide for the accountability of the board to the Minister for Children, Equality, Disability, Integration and Youth in the performance of its specialist community-based disability functions. Section 16 amends the 2004 Act to provide for consultation with the Minister for Children, Equality, Disability, Integration and Youth in respect of the appointment of the CEO of the executive. Section 17 amends the 2004 Act to provide for the CEO of the HSE to assist and provide the Accounting Officer of the Department of Children, Equality, Disability, Integration and Youth with information in respect of the specialist community-based disability functions.

Section 21 amends the 2004 Act regarding the obligations on the executive to prepare and submit a corporate plan to both Ministers. Section 22 requires the laying of the corporate plan before the Oireachtas within 21 days of the plan being approved by both Ministers. Sections 23 and 24 amend the 2004 Act to provide for consultation between both Ministers in respect of the determination of maximum net non-capital expenditure that may be incurred by the executive for a financial year. Section 25 amends the 2004 Act regarding the obligation on the executive to prepare and submit a service plan to both Ministers for approval.

Section 29 amends the 2004 Act to provide the Minister for Children, Equality, Disability, Integration and Youth with the power to determine the capital funding in respect of specialist community-based disability services and for consultation between the Ministers regarding the determination of capital funding for the executive in a financial year. Section 33 amends the 2004 Act and provides the Minister for Children, Equality, Disability, Integration and Youth with the power to specify the information to be included in the executive's annual report in respect of specialist community-based disability services functions.

Part 3 provides for the revision of sectoral plans under the Disability Act 2005. The transfer of functions requires the sectoral plan that is currently under the responsibility of the Minister for Health to be divided between him and the Minister for Children, Equality, Disability, Integration and Youth to reflect the transfer of responsibilities between the two Ministers. Sections 49 to 51, inclusive, amend the Disability Act 2005 to provide for this.

Part 4 provides for the expansion of the powers of the Minister for Children, Equality, Disability, Integration and Youth in respect of investigations by the Health Information and Quality Authority, HIQA, under the Health Act 2007. Section 52 amends section 2 of the Health Act 2007 by the insertion of the definition of "specialist community-based disability functions". Section 53 amends section 9 of the Health Act 2007 to allow the Minister for Children, Equality, Disability, Integration and Youth to require HIQA to undertake an investigation in the context of specialist community-based disability services. Sections 54 to 58, inclusive, amend relevant sections of the Health Act 2007 to extend the power to make regulations to the Minister for Children, Equality, Disability, Integration and Youth in respect of those areas which are transferring.

In Part 5, section 59 provides for definitions that appear in Part 5, including "health and personal social services", "specialist community-based disability services" and "specialist community-based disability services functions". Section 60 provides for administrative co-operation between the Minister for Health and the Minister for Children, Equality, Disability, Integration and Youth to allow them to enter into arrangements which will facilitate administrative efficiency and co-operation, the avoidance of duplication of activities by the executive and the sharing of information relevant to the employment of persons. Section 61 provides for a review process to include an evaluation of the delivery of specialist community-based disability services to be carried out no later than three years after the commencement of this section. Sections 62 and 63 are quite technical sections relating to functions being deemed to have been valid in certain circumstances if, at the time of the performance or purported performance of the function, the relevant Minister believed that the function was vested in him or her by virtue of the amendments to the principal Act effected by this Bill. Section 64 provides for the determination of disputes in connection with the amendments in this Bill and the performance of functions in this Bill.

The purpose of this Bill is to allow the transfer of specialist community-based disability services to the Department of Children, Equality, Disability, Integration and Youth to take place. I believe this will be a positive step for the reasons I outlined earlier. I have focused on some key amendments today. There will, of course, be an opportunity to discuss all the amendments on Committee Stage. I look forward to any contributions.

I am certainly not going to delay the progress of the Bill on Second Stage. I welcome the Minister of State to the House and congratulate her on all the great work she is doing in her Department. She has certainly shaken things up. She has a fresh approach to working in the Department. This is proof of it. There has been talk for quite a long time about trying to consolidate all the disability stuff. Indeed I had a very long conversation with my good friend, Senator Conway, about this some six months ago or so. I am delighted to see it progressing. I am certainly not going to delay it any longer in the House.

Cuirim fáilte roimh an Aire Stáit. I agree with Senator Davitt and thank him. His interest in this area is very practical and focused. It is a do-good approach. Since getting to know him in the House nearly five years ago I see his approach in action. The respect he has for people and the manner in which he goes about his business, in a quiet and unassuming way but very focused in terms of delivery, is something I have come to admire and respect greatly.

Since the Minister of State came into the Department two years ago, she certainly has made a difference. She is a straight talker. That is what is needed. Sometimes people who talk straight get into trouble. I know it myself. She must keep talking straight and when she gets into trouble it means she is actually doing something right. I am often baffled by these largely technical Bills but functions are moving from the Department of Health to another Department and legislation is needed to give effect and recognition to that.

Speaking of the Department of Children, Equality, Disability, Integration and Youth, I have to mention my friend and colleague, Senator Seery Kearney. I congratulate her on the work she has done in respect of surrogacy.

We have seen considerable focus on it, unfortunately, over recent months. However, what Senator Seery Kearney has been doing in this area has been going on long before there was an issue in Ukraine. This is her area now as it moves from health to disability. Senator Seery Kearney is a champion and straight talker, like the Minister of State, and gets things done. We are here to get things done. That is the reason we are elected to this House. Sometimes, it can be frustratingly slow.

That is the point I will make about this Bill. We are almost halfway through this Oireachtas term and this legislation is only coming before us now. Why does a technical Bill take so long? Why in the name of God could this not have been done within six months of going into government? We all knew that disability was moving to the Department of Children, Equality, Disability, Integration and Youth. The Minister of State knew it, but unfortunately, for the past two years, she has had to work to manage two Departments. She knew disability would go to the Department of Children, Equality, Disability, Integration and Youth and that she had to work with the Minister, Deputy O'Gorman. At the same time, her senior, essentially, was the Minister, Deputy Donnelly. It was a no man's land to some extent. In that scenario, all of the providers, support staff and civil servants down the line know they will move to the Department of Children, Equality, Disability, Integration and Youth but do not know when it will happen. That type of bubble creates uncertainty and a certain lethargy because people will move Department. It tends to slow things down and even grind them to a halt.

In doing her job, the Minister of State is pushing up a hill because this Bill has not been passed. However, when we do pass it, and we will do so, the Minister of State will start motoring in a straight line and achieve much more. The frustrations she has experienced over recent years will, it is hoped, evaporate.

Why in the name of God can we, as an Oireachtas, not be a little bit more efficient in the way we do our business? What is the reason? I do not expect the Minister of State to have the answer to this.

I would love to answer it.

I know the Minister of State would. What is the reason? Are we that inefficient? We expect the public service to be efficient, get out there, do a job and deliver, and yet the Oireachtas takes two years to pass a largely technical Bill. Nonetheless, the Bill is welcome.

Significant progress has been made on the more important issue of delivery of services for people with disabilities. We have seen the bringing together of services and the engagement the Minister of State has had with the NGO sector. We have seen incremental wins; not the type of wins we would like, but certainly incremental wins. I consider disability a whole-of-government issue where the Departments of Education, Social Protection and others need to work together. Memorandums of understanding are needed. We saw it in action when the lady from Achill Island who was on disability allowance, got the opportunity to do a PhD and was faced with the prospect of losing her allowance. The Minister, Deputy Humphreys, intervened to make sure that did not happen. Similarly, the Minister, Deputy Harris, made an intervention for Mr. Tom Clonan's son to ensure he got the supports he needed.

These are positive examples of Departments working together and of a whole-of-government response. The Minister of State has led many such examples, which I do not have the time to go into, but I have worked closely with her on a number of issues she has driven forward significantly. While I wish these services well under the Department of Children, Equality, Disability, Integration and Youth, I hope we will continue to see the forging together of a whole-of-government response so that, when there are difficulties, Departments step up to the plate and work together to resolve them.

I have no issue with what is happening in this legislation because I know it is technical. It happened when the Department of Public Expenditure and Reform was created and when other Departments were created subsequently. However, going forward, the Houses of the Oireachtas have questions to answer as to why this has taken so long.

The Minister of State is very welcome. It is always a great joy to see her, work with her and admire the great job she is doing. She is exceptional in her role.

While I very much respect the vast experience of my colleague Senator Conway, I understand why this has taken time. When we go through the sheer breadth of authorities that needed to move into the other Department, and while I am delighted to be able to call on HIQA and to make demands of the HSE in terms of accountability and requesting support, I can understand how it is so in depth.

The natural place for disabilities is in the Department of Children, Equality, Disability, Integration and Youth. The Minister of State very graciously came before the joint committee when she was only a short while in the job and had no obligation to do so. From day one, she has had a great relationship with the committee. The joint committee and the Joint Committee on Disability Matters have received reports about the cost and experiences of disability that show the intersectionality in terms of the social, demographic and geographical challenges that arise. We also see intersectionality within marginalised groups and gender and the challenge of that. Having equality, integration and disability under the same roof, so to speak, makes absolute sense to make sure there is progress.

We had a children's committee meeting that involved the HSE and the Ombudsman for Children, Dr. Niall Muldoon. It was a very robust and fruitful three hours. Everybody was clearly very passionate about and committed to making sure people with disabilities live their best lives. What also came across very clearly was the challenges within that. While the HSE was criticised for naming the issues without necessarily having a clear plan of action, I also heard about intentions and the considerable amount of work ongoing in that regard. The Minister of State has prompted an honesty in the debate in meetings she has facilitated recently that I have also heard. It is very important we have this coming together of understanding that children have a right to services and to access them in a timely manner.

In my constituency in Dublin South-Central, in particular, there is a massive gap in service provision which comes down to the issue of vacancies. Children have had diagnoses of being on the autism spectrum and having a disorder such as a developmental co-ordination disorder. There have been numerous dual diagnoses, and dual does not even capture the extent of it. They may have been born in 2013 and still not have received services.

There is a need for something to happen urgently. My concern in the moving over is to ensure the Minister of State has the budget. We have the passion and the Minister of State has the leadership. She recently broke down her budget, and while it seemed vast, a figure of in excess of €1 billion was suggested yesterday as the shortfall in funding in terms of the personnel and roll-out of services we would need. I call on the Minister, Deputy O'Gorman, to fight hard and I will support him to fight hard to ensure the Department has an adequate budget to ensure that, when accountability is called for, there is no impediment to ensuring a roll-out, especially as we ratify the optional protocol and do all of that within the context of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD.

I want to end by thanking the Minister of State very sincerely.

This week we will visit WALK and I am really looking forward to it. There is no doubt the Minister of State will be a champion there. I believe that tomorrow there will be a documentary or interview with families who have come from Ukraine and are being serviced by WALK and its fantastic work in Drimnagh and Walkinstown. We will meet them there. The passage of those families, which will be the beginning of a lot more to come, was eased by the work and intervention of the Minister of State and my own intervention. We worked very well. We had late-night calls last Friday night. There is something of a spontaneous response and it is led by the Department of Children, Equality, Disability, Integration and Youth. A powerful amount of work is being done and is planned to be done. I thank the Minister of State very sincerely for her work in this regard.

I hope the Minister of State will forgive me in the first instance. Sometimes I have to read my notes off my phone. I hate doing it and I hope the Minister of State does not think me ignorant. It is me and the relationship I have with the printer in my office. Sometimes it is not good.

As several of my colleagues pointed out in the debate in the Dáil, this is a very important Bill. Colleagues in the Seanad have acknowledged this also. It transfers responsibility for specialist community-based disability services from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. The Bill is quite substantive. Once it has been fully implemented, it will bring an additional layer of accountability for the development and provision of disability services. Many challenges in this area need to be addressed urgently, including tackling waiting lists and reducing wait times. We must improve access to speech and language therapy, physiotherapy, counselling and the wide-ranging supports many children and adults need to help them to live full and independent lives.

Although responsibility for mental health remains with the Department of Health, there is an onus on the Minister with responsibility for children and the Minister of State with responsibility for disability not to lose sight of the toll on children's mental health caused by inexcusable waiting lists for disability services and the difficulties that being differently abled in this world can bring. At the end of last year, 4,000 children were still waiting for an assessment of need and more still were waiting for further diagnostic assessment. Professionals in the system are concerned that due to understaffing, assessments are not being carried out as thoroughly as they should be. Parents are also concerned their children are not receiving the range of therapies they need. Very often parents have to battle with the system to get the services their children need. It is all about capacity. The professionals are doing their best and parents are also doing their best.

We all must become advocates of what is best for the children. The Minister of State should become an advocate for a whole-of-government approach to deliver a new social model of disability inclusion. I hope this is something the Minister of State will agree with. A new social model needs to take into account that disability is not solely a health matter. This is acknowledged in the intent of the Bill. There is a need to move away from the medical model of disability and embrace a rights-based model. Disability needs to be viewed as being caused by the way society is organised rather than by a person's impairment or difference. We need to look at ways of removing barriers that restrict life choices for disabled people so that when these barriers are removed, disabled people can be independent and equal in society with choice and control over their own lives.

The ratification of the UNCRPD is a step in the right direction. The Government needs to complete this process by ratifying the optional protocol of the convention. This legal foundation will make it easier to develop the social model and protect the human rights of those people who are disabled. The task before us is formidable but nonetheless doable. The scale of the task is reflected in the findings of the disability capacity review of specialist community-based services. It identified the need for a major budget increase to handle the demographic changes to provide access to housing and independent living supports to phase out the old system whereby 1,800 disabled people are living in large residential settings and 1,300 disabled people under the age of 65 are living in nursing homes.

There is a data deficit when it comes to disability also. Data from various Departments need to be married to ensure the most comprehensive person-centred responses can be delivered. Without baseline data it would be very difficult to track success or otherwise in disability services. The State is rich in policy and relevant legislation but it is constantly weak on implementation. Implementation is crucial to the success of a new social model dealing with the disabled and their much-needed services.

I support the legislation, as did colleagues in the Dáil. I look forward to its progress through the Seanad and to engaging with the Minister of State, officials and other relevant Departments on its roll-out and implementation. I followed the debate from the office before I came to the Chamber. This has to be centred on people with disabilities. They have to feel tangibly the real outcomes of what can be a very beneficial move and step forward. I wish the legislation well and I sincerely hope it can begin the process of effective delivery for the people it hopes to help.

I welcome the Minister of State, Deputy Rabbitte, to the House. I thank her for her work, commitment and engagement. While my contribution will be critical it will not be critical of the Minister of State and I want to make this quite clear at the beginning. This is very important legislation. The Minister of State to her credit deserves our support for bringing it forward and implementing it. The challenges we face in the provision of services for people with disabilities is gargantuan. I say this as somebody who has years of experience and who is very committed to and works closely with a number of organisations in the provision of services and specialist community-based delivery of services.

The conundrum we all face is contained in the legislation and in the remarks of the Minister of State. The transfer to specialist community-based disability services is something we all support. The problem is that the multi-sectoral plan is not working to its full potential despite the best efforts of the Minister of State. In the most recent budget we had the highest ever provision for these services. I do not believe there is a coherent funding strategy once it leaves the Minister of State. There is far too much fragmentation in the provision of adult and child services, such as with regard to respite care and developing housing needs. In the provision of services there needs to be better and more strategic investment by the HSE.

The interdepartmental approach is not working. While the functional movement is technical, this is about the provision of services for people who need them. We very much welcome the young boys and girls in the Gallery. Every one of those children has the potential to reach their full capacity. This is part of our difficulty. Under section 29 the Minister has the power to determine capital funding. We all think this is great. Then we go back to the memorandum of explanation and we see the power to spend money is being retained by the HSE following the transfer.

I have known the Minister of State since she has come to the Oireachtas. I have great time for her. Yesterday, we announced new special education schools in Dublin and Cork. Senator Seery Kearney, to be fair, championed them in her area as I did in my area. Take, for example, a child living in Waterfall in Cork city who is to go to a new school place that has been announced in Rochestown. It is brilliant that a new school has been announced but how is the child to get to the school? Where is the respite care?

Where are the supports built around that? Therein lies our problem. We announce places and funding, but we do not put in place the roadmap to help children and their families to get to that point. In fairness to the Minister of State, and I am not being patronising, every time she speaks at a conference or event on disability, she makes a comment about being comprehensive in this regard. I do not have confidence, however, in the people in the HSE to deliver on this aim. I am being critical from experience.

We have a deficit of school places and of respite care. The issue of education and respite transport is a circle, with the most important part, the child or young adult, in the middle. Planning is needed in the community. I wonder if we have the capacity in the community to deliver in respect of the whole issue of skill sets, respite care and respite beds. I say that because one of the hardest, most difficult and most harrowing parts of our job is to meet parents who are crying out for respite care because they are at their wits' end and cannot continue to give the care to their loved ones that they are providing.

While this legislation is deemed technical, it is not. I hope the Minister of State will take my comments in the spirit they are intended. I love these objectives given in the explanatory memo regarding ministerial powers in respect of "the issuing of directions to the HSE", [the] "Accountability of the HSE board" and the "Corporate plan, service plan capital plan". In many cases, however, the corporate plan and the capital plan appear nearly a year later and that means organisations are working retrospectively.

I will work with the Minister of State. I admire her tenacity because everything she has done and said thus far has been very progressive, but the problem lies with the whole issue of the delivery by the HSE on the ground. Let us look at the Cope Foundation in Cork, for example. It is launching a major recruitment campaign to hire staff because it cannot get any. I wish the Minister of State well because this is important legislation. We need to get it delivered and we must get it done in a manner that is coherent on behalf of the people who need it.

Cuirim fáilte roimh mo chomhghleacaí ó Ghaillimh, an tAire Stáit, an Teachta Rabbitte. As we all know, this Bill essentially transfers responsibility for disability issues from the Department of Justice to the Department of Children, Equality, Disability, Integration and Youth. My first observation is to express concern about the accumulation over time of responsibilities by the Department of Children, Equality, Disability, Integration and Youth. What began as the Department of Children and Youth Affairs in 2011 has now transformed into the Department of Children, Equality, Disability, Integration and Youth, as of the formation of this Government. I am sure I am not the only person who is concerned that the Department is slowly being turned over time into a silo for various insoluble problems hived off from other Departments that might be secretly glad to see the back of them.

The Department of Children and Youth Affairs was originally established to provide a laser-like focus on the major problems which existed in that area. If people had been told in 2011 that it would eventually have responsibility for dealing with direct provision and for preparing for the arrival of refugees from war in eastern Europe, I think their eyebrows would have gone out on stalks. Yet that is the position we have today. Since January, the Minister, Deputy O'Gorman, has issued statements on issues as diverse as climate change, the gender pay gap, homelessness, Storm Eunice and an OECD report on what are described as gender norms.

I say this not to criticise the Minister personally, but it seems that because the Department covers the briefs of equality, youth and integration and concepts whose definitions are often in the eye of the beholder, it increasingly has a roaming brief covering everything and anything on which it wishes to intervene. I am not sure that makes for good government or good use of taxpayers' funds. I say this and raise the issue following on from Senator Buttimer's laser-like focus on real issues of human welfare just now. That laser-like focus which the Department originally had seems to me to be in danger of being lost in favour of an increasingly scattergun approach.

The handling of the disability brief is of even greater concern. Again, I am making no criticisms of the Minister of State or of the Minister for Children, Equality, Disability, Integration and Youth. The explanatory memo for this Bill states that it was a key commitment of the current Government that the co-ordination of disability-related issues would be "handled by a senior Minister for the first time". On its own, that sounds very laudable, but I think we should be wary of such commitments. Over the last 25 years, calls for an issue to be handled by a dedicated Minister or Minister of State have been seen to be a tried and tested way for successive governments to be seen to be doing something rather than bringing about any fundamental change in how an issue gets dealt with.

Responsibility for disability has been passed around from Billy to Jack over the last 15 years. It has gone from the Department of Health to the Department of Justice and now on to the Department of Children, Equality, Disability, Integration and Youth, in what could be described as a game of political pass the parcel. I somehow doubt that the music has stopped at the Department of Children, Equality, Disability, Integration and Youth. I certainly fear that disability issues will get passed on elsewhere in the years to come, if it becomes politically expedient to do that. Therefore, I hope that the changes being made today will bring about appreciable improvements in how policy is made and that they are not simply being undertaken so that the Government is being seen to be doing something.

As the Minister of State is aware, this Bill amends the Health Acts of 2004 and 2007, which outline the internal workings of the HSE's governance. I will raise an issue in this context that I have raised before and that the Minister of State addressed when I raised it before. It is an issue that I think could perhaps be solved by amending this legislation. Under sections 38 and 39 of the Health Act 2004, the HSE provides funding to groups and organisations to assist them to provide certain services. In May last year, I raised a case where the HSE continued to funnel money to a particular organisation despite it being in flagrant breach of basic company law requirements not having filed audited accounts for three years. The group is not providing any essential services and yet the HSE paid out more than €750,000 over those three years, despite being fully aware that the organisation in question had not produced audited accounts. I think the Minister of State will remember this topic because I think she took my Commencement matter on this issue. The organisation in question, Transgender Equality Network Ireland, TENI, eventually had its funding frozen last summer. As recently as last week, it was the subject of a report in The Sunday Times, where it admitted that payments to former directors had not been properly accounted for. As I said before, I do not raise this issue because of the particular organisation or issue involved; I raise it because what we are talking about here, and what we all should be concerned about, is good governance. The HSE has apparently issued TENI with an ultimatum that it will seek a refund of moneys paid unless the organisation's accounting issues are resolved this month. Under the Electoral (Amendment) (Political Funding) Act 2012-----

I am not being dismissive, but how relevant is this?

I think the Senator is being dismissive. It is relevant because this Bill amends the Health Act. That is a cheap shot and a weak Government reproach, instead of dealing with the substance of what I am bringing up, which is important. This might enlighten the Senator. Under the Electoral (Amendment) (Political Funding) Act 2012, any political party which does not produce audited accounts for a given year will get no funding from the State for the following year. Why should the same not apply to lobby groups funded by the HSE? The Senator should understand that as a politician. It is simply a case of sauce for the goose being sauce for the gander. The legislative bar on funding political parties that fail to file audited accounts should extend to all bodies in receipt of State funding, with appropriate discretion for leeway caused by delays of a few months which occur in the normal course of events. Bringing this about would require simple amendments to sections 38 and 39 of the 2004 Act, which this Bill also amends. This is the relevant point in respect of Senator Davitt's query. I wonder if the Minister of State could express a view on this? Does she agree that no group or organisation should be in receipt of significant State funding without being in full compliance with basic company law requirements? Would she support such amendments if I brought them forward to this Bill?

I am going to put all this together. I have a rule that I respond to whomever is sitting in the House.

I thank Senator Davitt for his short and swift support for the Bill, which is greatly appreciated. I also thank him for the work done in assisting us to get to this Stage.

Senator Conway asked why this has taken so long and there are two answers. I have the official answer from my good colleague with me, Barry, and my answer; I will give my answer. There is no doubt this is a complex process and there are 65 amendments in this. There is no doubt it is a technical Bill. When the Taoiseach gave me the call back in June 2020, it was the only job he asked me to do. He asked me to remove disability issues from the Department of Health and bring them to the Department of Children, Equality, Disability, Integration and Youth. His final and parting line was that he expected me to do it right. Expecting to do it right means we had to bring the money, and that is what I ensured I did. On the very first day I could have turned to Barry and the acting Secretary General and said I needed to go but I chose not to until I had the money sorted as well as the transfer of functions. To be fair to Barry and the team back in the Department of Health, I have annoyed enough people in the place so that they are opening the door to let me out quite willingly. Barry was put on duty very quickly and we have it nearly over the line and done.

The important lesson I take from the time it has taken is that I understand how this works. I could have gone and not understood the multidisciplinary piece between specialised disability services and primary services, how they must operate and how an integrated piece might work. I could have gone without knowing anything about aids and appliances within the disability conversation. I could have gone without understanding the relevance or role of primary medical certificates within the Department of Health. Everybody thinks primary medical certificates sit with my good self but they do not sit near me at all. They all sit under the senior Minister and Minister for Finance. At the same time, primary medical certificates are associated with disability.

I got a really good understanding as to how the HSE operates and I built a really good relationship with people. We have reformed our 91 network teams. This means I have a really good basis for when the functions transfer. The most wonderful aspect is that both Ministers - Deputies Stephen Donnelly and Roderic O'Gorman - allowed me to operate from both Departments, having function in one and none in the other. I was allowed to shape and sculpt the process so that when we move, it will be seamless. This technical legislation will be the final piece required, warts and all.

It is important to say the primary legislation put in place is to ensure governance and oversight powers transfer to the Minister for Children, Equality, Disability, Integration and Youth and to define the scope of what is to transfer. That took time and to be very fair, the Department did a good job on it. At the same time, I was not going without having the money.

The Minister of State was right.

I was. That was the most important point.

There is much to be learned from a smooth transfer and having a good working relationship with Ministers in both Departments. There is much to be learned about how both Departments had to work in a collaborative way and a relationship developed. Perhaps in the past we would have always worked in silos but at all my meetings Department of Health officials must appear and officials from the Department of Children, Equality, Disability, Integration and Youth must appear. They are watching me all the time for fear I land the other Department in trouble.

I thank Sinn Féin for its support of the Bill. I agree that it is all about services and removing barriers. I certainly will not deny that and it must be about the removal of barriers. It is about moving from the medical model to the social model.

Senator Mary Seery Kearney is on both the sectoral committees and understands very clearly the complexities involved in this process. We acknowledge the Bill is technical and complex but it is the undercurrent of work that must be understood. It goes across so many sections and it feeds so far into the community. It is a varied area but, at the same time, the budget is divided very clearly. Perhaps in the past we had a particular focus of delivery but the members of both committees, along with me as Minister of State, are trying to move the dial and change the cultural approach so we can look at a social rather than completely medical model. We are also trying to be very open-minded in the transfer, and this is about equality and rights to housing, work, education and inclusion. There is a right to the optimal protocol in the overall game. That is what we are looking to achieve.

In the context of this Bill much good work has gone on in both committees. Only earlier this morning I spoke about the standard operating procedure and the children's committee yesterday had a very robust discussion of that. I thank the Senator for that. We got many answers and now there is a conversation on all sides. Disability is no longer tokenistic and just about being well-intentioned. Disability is about action and anybody who enters into its arena is expected to do something, including me, elected Members in the Oireachtas, the paid members of the HSE and the Departments. It is at the front and centre of the Department.

When we move to the Department of Children, Equality, Disability, Integration and Youth, it will be the largest budget there. It is no longer the Cinderella of a Department but front and centre. It is where we want disability issues to be. When we achieve our goals within the Department of Children, Equality, Disability, Integration and Youth, we will set our sights on other Departments to get disability matters very clearly front and centre within transport and employment. The Senators might let the Tánaiste know I am coming for the Department dealing with enterprise and entrepreneurship. This must go right across society. People have rights to inclusion. If we understand the spirit of such action, we must back it up by action and funding.

The Senator spoke about disability capacity funding. I have only just left my office and have been going down through the area with a fine toothcomb. There is no denying we need more money. If we are serious about it we must change the dial on what we know and our priorities. Personal assistance is huge if we are to support independent living and access to the workspace. That has been a key message coming through all committees. I thank the Senator for her work. Vacancies are also a major issue.

Senator Buttimer is what I would like to be when I sit on the benches. He challenges the system all the time, which I welcome. I know I have his full support in this. He is right. When we speak about putting systems in place, we cannot leave out one part or it all falls down. I have had robust conversations in the Department of Health about how the Bill will move. Some would have liked me to leave the delivery of services for therapeutic services within the Department of Health, for example. That could not be done, however, as there must be a clear pathway.

Senator Buttimer is also right that I should follow the money. The HSE knows I follow the money and it has seen me do it for the past two years. We are in a space where it will be extracted and there will be separate accounts and reporting to two Ministers. It will become very clear and transparent as to where the money is spent, and we can then look to performance-related delivery and measurable outcomes. We must get down to key performance indicators and if we give X, we should know what we got for that. That may be therapy delivery or respite beds but we must know. How else can I ask the Minister for Public Expenditure and Reform for funding? I am with the Senator and we need a multisectoral approach.

Sometimes we outsource too much within the HSE rather than holding on and having confidence in the ability to do the job, deliver and see it done. For all the critical issues I have seen in community healthcare organisation, CHO, 1 over the past number of months, the HSE has delivered the vast majority of healthcare needs very well. That is leaving aside the Brandon report and everything else, which was a different assessment at the time. The HSE cannot stand back.

I thank Senator Mullen for his contribution. I wrote down the reference to laser-like focus. He is right in his belief of what the Department should have in that laser-like focus. I agree on that.

I see a laser-like focus on equality and rights and on the likes of the minority groupings, the rights of persons with disabilities and the children's referendum. That is why we needed to put a laser-like focus on it. We all have health issues. People with disabilities have health issues; I have health issues. However, persons with disabilities also have the right of equality and the right to participate. That is what that Department will do on it.

Senator Mullen used some very powerful language. We absolutely do not have a scatter-gun approach. Sometimes Opposition Members describe Government as being well-intentioned and moving the deck chairs. That is not what this Government is about when it comes to disability. I would like to think it is very focused on delivering and determined to deliver for persons with disabilities. That is why we focused on introducing this legislation, doing the job I was asked to do, seeking the funding to deliver, and now following the accountability and the delivery of it. That leads me back to the last comment the Senator made. Yes, I believe in good governance. I believe in governance for everybody and accountability for all.

The Senator asked about section 38 and section 39 bodies. If the issue arises, the Bill gives the Minister for Children, Equality, Disability, Integration and Youth the authority to request information from the HSE on the activities of section 38 and section 39 bodies in respect of the area transferring. These are the same powers as the Minister for Health currently holds. If we need to amend the governance of the HSE and section 38 and section 39 bodies, we will do that. The Bill is about transferring responsibility. To try to introduce complex changes beyond that aspect of the legislation would certainly cause further delay. I ask the Senator not to table the amendment. I agree about proper governance and oversight. As I have been instructed by my official, if that needs to happen, we will certainly be doing it. I have said very clearly that I am following the money. I want accountability.

Does the Minister of State accept the validity of my comparison in respect of political parties that get more funding if they do not have audited accounts?

It is a good principle, is it not?

It should be the principle for everything. It should not be just for one. That rule and good governance should apply to everything from the parents' association in a national school right up to the highest office.

Including HSE-funded lobby groups. That is the point.

I thank the Minister of State for her comprehensive reply. I was going to intervene, but I decided I would not be the one to step in her way or step on her toes. God love the Departments and Ministers she will take on in the future. As normal, she shows her passion for her brief and that means a lot.

Question put and agreed to.

When is it proposed to take Committee Stage?

Committee Stage ordered for Tuesday, 29 March 2022.
Cuireadh an Seanad ar fionraí ar 1.44 p.m. agus cuireadh tús leis arís ar 2.02 p.m.
Sitting suspended at 1.44 p.m. and resumed at 2.02 p.m.