The purpose of today's meeting is to consider the Health (Miscellaneous Provisions) Bill 2022. I welcome the Minister of State at the Department of Children, Equality, Disability, Integration and Youth and at the Department of Health, Deputy Rabbitte. I remind members that should a vote be called, they must physically come to the committee room in order to vote.
Since no amendments are tabled, we will proceed to our consideration of the Bill.
I thank the committee for having me here. I am pleased to have the opportunity to address it on this Bill, which facilitates the transfer of specialist community-based disability services from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. The Bill was published on 9 February and, as Deputies will be aware, commenced its passage through Second Stage in the Dáil two weeks ago. I welcome the support received in the House for the core principle underlining the Bill, namely, to consolidate and centralise responsibility for disability policy under one Minister and Department. 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 to an holistic, rights-based one that supports people with disabilities to live autonomously.
After the transfer, the HSE will continue to deliver the services and, therefore, the organisation will report to two Ministers on different elements of its functions. The Bill seeks to put in place a legislative basis to ensure that both Ministers have the necessary authority in their respective areas of responsibility. I thank Deputies for their continued support for the Bill.
The purpose of this exercise is to bring the responsibility under two Ministers. Is that correct?
Yes.
From past experience, is that a good idea? We will have two Ministers responsible. Will this lead to divided responsibilities, which will mean no responsibility, or is the Bill better than that? I am just throwing this question out there. It is fundamental to the consideration of the Bill.
I thank the Deputy for his question. The purpose of the Bill is to move responsibility for disability matters from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth and, as I called him throughout Second Stage, the Minister with responsibility for equality and to give him autonomy. This transfer means that the Minister of State role will move, as will the relevant functions, which are essentially the interaction with the HSE. The money needs to transfer as well.
We are going from a medical-based model to a more inclusive one of social care. Since the Taoiseach appointed me 16 months ago, this is what has been going on and I have been working with the Ministers, Deputies O'Gorman and Stephen Donnelly. Disability services are best placed within the Department of Children, Equality, Disability, Integration and Youth. There is more to people's health than just the medical approach. This area sits perfectly within the Department of Children, Equality, Disability, Integration and Youth.
I welcome how the HSE will report to two Ministers and seek a budget separate from the Department of Health. I also welcome that disability will no longer be the Cinderella in the Department of Health. It will have the largest budget within the Department of Children, Equality, Disability, Integration and Youth, which will put disability front and centre when negotiating budgets. While the HSE will report to two line Ministers, it will report on its specific responsibilities for disability matters to the Minister with responsibility for equality and make specific requests in that regard. We will not be discussing other elements at all.
Does that answer the Deputy's question? I do not believe that this matter will fall between two stools. Instead, this is a welcome move to put people at the centre. In line with the UN Convention on the Rights of Persons with Disabilities, UNCRPD, this will give a home to a rights-based approach. We will be taking a rights-based approach to disability and not just looking at it through the medical lens.
Does the Minister of State mind taking these questions now?
If it helps.
We can get them out of the way at the start instead of during our discussion on various sections.
I welcome the Minister of State. I am supportive of the Bill but I have a couple of questions. This Bill is rushed. We waited a good while for it but it was only published on 9 February and we are now on Committee Stage. There has not been much opportunity to scrutinise the Bill, especially for the many advocacy groups working in this area.
The dialogue forum was established under the recommendations of the report from Dr. Catherine Day in 2018. Now that the area of disability is transferring to the Department of Children, Equality, Disability, Integration and Youth, will that Department be represented on the dialogue forum?
My second question concerns the disability capacity review. We know that over 90% of people with disabilities are supported through general community health and social services. All of these services will remain under the remit of the Department of Health when the transfer takes place. What is often needed is a combination of specialist disability services and mainstream services, particularly for people with progressive conditions, meaning they will need to make significant changes over time. What mechanisms will be put in place to ensure strong linkages and integration between disability services and mainstream health services?
The disability capacity review involves a whole-of-government approach. The framework and action plan are being finalised with the support of funding because we know there is a lot of unmet need within that. It is not just unmet need within the health element but also with regard to recruitment, training, housing provision, access to employment and social protection. From a health perspective, it is a really welcome document. Eithne Fitzgerald is finalising the framework and the action plan with us to go to the Department of Public Expenditure and Reform to seek funding for it. I plan to divide it in three different phases in the first three years as opposed to doing it in a ten-year chunk and to front-load it to ensure we address that unmet need.
We know the expenditure of people who have children with challenging behaviours is no different from that of parents of children with multiple complex medical needs. The expense and the under-resourcing and underfunding for these parents need to be addressed and to be front and centre. At the same time, we need to address the rights of people. The right to housing and the right to access employment are very well addressed, which is why we have the housing strategy and the comprehensive employment strategy. I sit on both. I am confident about the disability capacity review. It has been a long time in the making and was eventually published. The framework and the meat that is being put on the bone are very substantial. It is not just sitting within one Department but must sit across all Departments. I have no doubt that all Deputies here will support the publication and the framework. Does that answer the Deputy's question?
It does.
Regarding the transfer of functions, all areas move across. If a dialogue forms part of that, it will be something the Department of Children, Equality, Disability, Integration and Youth will continue to feed into.
Will the Minister of State be represented on that?
Yes, I can be.
That is really important.
I assure the Deputy that I will take that on board and feed it straight back.
Can the Minister of State tell us something about section 2? Is she satisfied the section contains sufficient safeguards to ensure it does not fall between stools like the determination of the existence of a disability. I forget the exact term. We had a discussion about it in another context. It concerns the definition of a disabled person and recognition of a disability for the purposes of the use or control of a vehicle. Is the Minister of State satisfied that the definition in the Bill is not dependent on a definition under the Disability Act?
I reassure the Deputy that the definition and the 65 amendments to the Health Act are granular. The reason is to ensure the protection within the Health Act recognises the transfer of certain functions from the Department of Health and the roles and responsibilities of the Minister for Children, Equality, Disability, Integration and Youth. I am reassured that we have left no stone unturned to ensure that when disability is transferred, the Minister for Children, Equality, Disability, Integration and Youth will have the same functions and access as the Minister for Health currently does with regard to disability and nothing will be left behind. What we are doing is what I have been doing for the past 18 months, namely, straddling the two Departments. While it has been slow in coming, although perhaps the legislation came very quickly, it gave me the opportunity to see where it is totally interwoven and where there could be slippage between the two stools, as the Deputy mentioned. The Deputy will see as we proceed through the amendments, particularly those relating to the memorandum of understanding, that we have ensured there is no misunderstanding, nothing is left behind and, at all stages, we have a safety net.
Does Deputy Shortall wish to contribute?
Not at this point.
The difficulty is that I do not have the Bill in front of me.
Could the Deputy get someone to go down to the Bills Office to get a copy?
I might.
The Deputy might get it online.
Normally we are issued with copies of the Bills beforehand in order that we can be familiar with what we are discussing. This is not taking place at the moment.
I presume the Bill is online.
It is in the Library and Research Service.
We will send a copy to the Deputy.
No. We have duties that are given to us. We are dealing with the Bill and passing it. I am being told what I can do. I do not have to do anything. I needed to have been issued a copy of the Bill beforehand so that when I say that I agree with a section as proposed, I have evidence to that effect.
It is on the Oireachtas website.
I presume the responsibility is on the member rather than-----
No, it is not. It is up to the system to provide the information beforehand.
The Bill is on the system. We will send a copy to the Deputy. Does he want to suspend the meeting for five minutes to get a copy?
I am not asking for the meeting to be suspended.
What I am saying is that as it stands, the proper procedure is not being observed. If members want to go ahead, by all means do so.
I have asked a question. Does Deputy Durkan want me to suspend the meeting for five minutes so that he can get a copy of the Bill?
I do not mind.
You are making an objection that you cannot proceed because you do not have a copy of the Bill.
I do not object readily. I do not have in front of me a copy of the section of the Bill I am proposing to agree to. That is what I am saying.
The Bill is readily available.
It did not come in the post.
Do you want to suspend the meeting for five minutes? This is ridiculous.
If other members agree, that is fine.
I can either move ahead or not. Give me some direction. Do you want me to suspend the meeting for five minutes?
Five minutes will be okay.
The explanatory memorandum, of which I have a copy, is extremely helpful.
I will get a copy of the memorandum.
We will suspend the sitting.
Sections 3 and 59 appear to use different definitions of the term "specialist community-based disability services", which is strange. While the section 3 definition is provided, the section 59 definition states the term "has the same meaning as it has in the Principal Act". I could not find this definition in the Principal Act, which is, as I understand it, the Act of 2004. I would like clarification on that.
I thank Deputy Shortall. I am assured that the definition is the same. Section 59 inserts it in the Principal Act, in section 3. I want to ensure I answer that correctly for Deputy Shortall. In section 59, we are amending the definition and in section 3, we are inserting it in the Act. It is to have the same meaning.
That is fine.
Is there no danger of the use of one definition in preference to another in relation to the points raised by Deputy Shortall? Is there no possibility of that? The most appropriate one, from the Department's point of view, is likely to be used.
No. When we get to section 59, if we approve the same definition, it will be exactly that.
I thank the Minister of State.
In the event of a dispute arising in the incurring of expenses in administering any functions under the Act to such extent as may be sanctioned by the Minister for Finance, payable out of money provided by the Oireachtas, is there any danger that there is likely to be a dispute over money in that case and who calls the shots?
Will Deputy Durkan explain what he means?
Is the Minister's function likely to be watered down by virtue of the ability of anybody, under any heading, to raise issues in relation to costs and finance in the administration of any functions under the Act, to such extent as may be sanctioned by the Minister for Finance payable out of moneys?
In other words, the shortage of money is not going to become an issue, or is it?
There is no watering down of functions. The Minister for Children, Equality, Disability, Integration and Youth will have the same function as applied in respect of the Minister for Health but both Ministers will negotiate directly with the Department of Public Expenditure and Reform in respect of their own budgets. As of now, the budget for this piece was part of another budget but the Minister for Children, Equality, Disability, Integration and Youth will now negotiate directly for disability under his budget. There is no watering down whatsoever. The Deputy can be assured of that.
I thank the Minister of State.
Under this section, a new section 10E is being inserted to provide for limits on the Minister for Children, Equality, Disability, Integration and Youth in regard to the exercise of powers under sections 10C and 10D. Would the Minister of State like to comment on this limitation and restriction on powers?
No different than in the previous Bill, this means that a Minister cannot instruct the HSE to deal with a specific individual case. For example, if the Deputy telephoned me to ask that I do something for him in regard to a particular case and to contact the HSE in that regard, I do not have that particular power. That is the limitation referenced.
If I am in receipt a complaint from a constituent to the effect that there is no comprehensive service in place to meet the needs of an individual, can I intervene and ask a Minister or Minister of State to ensure the provision of a service that should be provided under the Act or are we being conditioned to accepting the inevitable? In other words, nothing happens. Following on from Deputy Shortall's point about Sláintecare, we need to recognise we have to change how we did things in the past that were not satisfactory. We have to do things better, more effectively and more quickly. In not doing those things, we are not living up to the expectations of Sláintecare.
In that context, I agree with the Deputy. To return to how engagement and policy is delivered, which is my core function, it is about that piece the Deputy spoke about around breakdown in the delivery of service but in regard to a particular area as opposed to a particular case. I have monthly meetings with the heads of disability and weekly meetings with the Department of Health at which we continue to raise and address such issues. We will continue to do that. It is important we do it, but through the proper process as opposed to by way of telephone contact day in, day out. It is about having in place a system whereby I meet with the heads of disability, by which I mean the leads in the nine community healthcare organisations, CHOs, every month and with the Department every week. Good communication is key to addressing issues such that they do not fester. That is not shying away from the problem. We do have issues. There is no doubt we have a lot of issues within the disability area. It is hoped that, through this process of engagement, we can get delivery in a timely fashion.
I thank the Minister of State for her comprehensive reply. It is to be hoped it will cover the issues I have in mind. One such issue, which the Minister of State anticipated in her response, is that of the person who has to visit a hospital and does not receive the treatment he or she requires, is not attended to and spends up to 20 hours or two days on a trolley and nothing happens. We cannot stand over that. It flies in the face of Sláintecare. We should have dealt with this at the previous meeting. We need to put in place the fundamentals of Sláintecare and give it the imprimatur of Sláintecare as well. I am not sure if people understand the point I am making. I may, perhaps, not be making a very clear case. I have sat with parents in hospitals while their child with a disability did not receive treatment. I am sure I am not the only one of the members here who has had to do that. We did that on the basis of needs must. I am concerned the Minister cannot intervene.
I hear what the Deputy is saying, as I do all Deputies on this call in regard to the long waiting lists for therapies. I hear from all Deputies about the lack of access to services. I acknowledge that. I am working with the heads of disability, the lead on disability within the HSE and the Department to put in place a proper process. Sláintecare funding was afforded to the Department of Health. We used it very wisely to address a specific issue raised by all Deputies on the assessment of need. We will need to use that process again. When we used the Sláintecare model on the assessment of need, we successfully dealt with the issue. We need to use that model throughout all of the therapies. I will not shy away from that. We need to access the Sláintecare model and funding to ensure we have a targeted delivery.
There is no point in only having targets. We need a lifelong plan of delivery. When we raise the boat, we need to give it a steady direction such that it does not fall off again, so to speak. There is no point in a having a short-term solution. We need a short-term solution but a long-term gain. That is what I want to see happening, particularly in regard to the therapies, which is an area of concern for all Deputies. That is exactly the plan in terms of the reform that took place in recent months. We are putting in place the progressing disability services, PDS, model, which by all manner and means is very testing. I am engaging continually every month at a national level with the HSE - it is very structured engagement - and every week with the Department to ensure this policy direction we have taken will work, most importantly for the families. We will need to take a Sláintecare approach to that in accessing funding to address the diagnostic needs within autism.
This section provides for consultation with the Minister for Children, Equality, Disability, Integration and Youth in respect of appointments of the executive board members and that people with experience of advocacy in matters affecting recipients will be selected. It is a very welcome development that people who have lived experience of disability will be represented. Will the Minister of State give an undertaking that she will ensure the broadest possible spectrum of disability will be represented on that executive board?
I support that.
Absolutely. We will take on board the broadest possible acknowledgement of disability. It will not just be the physical or medical piece.
This is one of the strongest parts of the Bill. It sets out the clear indication of the Government in respect of the transfer of powers and functions. It is welcome. It could not be clearer.
On the reference to people with experience of advocacy, is that to state that people with lived experience can be on the board?
If they have the other quantum of skill sets as well, they absolutely can. The board is made up of people with acumen relevant to the management of billions. They can have lived experience that can be part of other skill sets they can bring to the board. It does not rule anybody out; it rules everybody in. There is an important piece within the board as well. We have asked that the broadest term in the context of disability be acknowledged.
The Minister of State is probably aware of the ongoing difference of opinion regarding what a disabled persons organisation, DPO, is. It would be important to have a register of DPOs and that the DPOs be the ones consulted, rather than the service providers.
The Deputy can be assured I will do that within disability in the Department of Children, Equality, Disability, Integration and Youth. That needs to happen.
It does.
These sections are particularly important because they reinforce what the Minister of State is saying and what the intention of Government seems to be in relation to the transfer of powers and functions. It is that the Minister for Health legally cannot act in any of these areas concerning disability without consulting with the Minister of State with responsibility for disability stuff. It is a real transfer. There are a number of examples in the sections we are going through that clearly illustrate that transfer of functions to the Minister of State.
This section provides that the Minister will be consulted on superannuation schemes relating to employees of the HSE. In the context of section 39 organisations and all those bits and pieces, is the section designed to provide that the Minister of State will have an input?
Absolutely. If there were any proposed changes, I would have an input.
Will the Minister of State give more background on the purpose of the section?
Sections 18 and 19 would together amend the principal Act to provide for consultation with the Minister for Children, Equality, Disability, Integration and Youth in respect of the terms and conditions of the employees of the executive and associated superannuation schemes. In answer to the Deputy's question, at the moment the Minister for Health has all the powers. With this transfer of function, I will have the say in relation to the section 38 and section 39 organisations. That comes over to me, where it pertains to disability.
Many of us hope that, with the transfer of responsibility, the Minister of State will indicate her thinking in relation to section 39 organisations and the gap in pay and superannuation entitlements. We all know that those who work for section 39 organisations effectively do the same work as people working for section 38 organisations, but there is a significant pay anomaly. We would welcome some indication from the Minister of State that she intends to fight the case for people working in section 39 organisations. Will she comment on that?
I thank the Deputy for giving me the opportunity to comment. In the 2021 budget, I secured €100 million and used some of that to ensure pay restoration for the employees of section 39 organisations. I would like to see that as my first indication. I am aware of the gap between the employees of section 38 and section 39 organisations. We have the same people doing the same work. That matter will be addressed when I transfer to the new Department. We are going into the Department with responsibility for equality. I would like to see equality, in its broadest terms, being adopted.
That is welcome. I thank the Minister of State.
Well said, Minister of State. People have been waiting ten years for an increase. Hopefully, the Minister of State will be a champion for change in that area and, as she has indicated, she has already started that.
The corporate plan should anticipate Sláintecare in order that the two are not at cross purposes. That is my only comment there.
As I am going through the sections, I am giving time before we agree it. If people have comments or whatever, can they come in then?
The section provides for a service plan. Given that the functions are being transferred, to what does that relate? Is it that the HSE must also submit a service plan to the Minister of State for approval?
At the moment, the HSE draws up a national service plan within which are subsections, be they on disability, older persons or mental health. Now, as well as to the Minister for Health, it will have to submit the service plan separately to the Minister for Children, Equality, Disability, Integration and Youth, specifically in the context of disability.
Where does this section sit in the context of directions? From whom will the directions come? Will they comes from the Minister in the context of the operation of the Bill, as amended?
It is to amend the 2004 Act to provide the Minister for Children, Equality, Disability, Integration and Youth with the power to issue directions in relation to the implementation of an approved service plan in respect of a specialist community-based disability service and for consultation between Ministers prior to the issuing of directions. That in itself says that the Minister for Children, Equality, Disability, Integration and Youth will have the power to also issue directions to the HSE.
Sections 27 to 30, inclusive, all relate to the same theme. I am a little confused. The delivery of many of the services will still be held by the HSE, but they must consult-----
They will be held by the HSE. The delivery of the services and the responsibility will still be held by the HSE. However, some will fall within the Minister for Health's responsibility. We talk about that and about the primary care function. That falls within the remit of the Minister for Health. However, in relation to specialist disability services, they will fall within the remit of the Minister for Children, Equality, Disability, Integration and Youth. Specialist disability services are what are transferring over, but the functions and responsibility of accounting in relation to certain aspects of the HSE will still fall back to the Minister for Health. That is why there will be two separate service plans - one for the Minister of Health and one for the Minister for Children, Equality, Disability, Integration and Youth. However, the delivery of it will still be by the HSE. Nothing will change in that regard. The delivery of services will all be through the HSE. If the HSE, from community specialist point of view, provides them through the section 38 and section 39 organisations, subcontracting them out, that will be part of the its service plan return to the Minister for Children, Equality, Disability, Integration and Youth.
However, the CEO of the HSE has these three or four sections and it is very clear that it is accountable to the Minister of State, Deputy Rabbitte, for those parts of the capital expenditure that are under her remit.
Absolutely.
Let us say an issue arises in regard to whether or not funding should be going towards the disability services-----
Yes, that is the question.
-----how would a dispute be resolved in that scenario? I know there is a clear budget from each Department to the HSE in relation to services. Could there be a scenario where there is a disagreement regarding which should be providing funding for a specific area? If so, then how will that dispute be resolved?
That is the question I was going to put.
It is very clear as to what is primary care and what are specialist community disability services. That is very clear. We know my budget and we know the budget line that it falls under. Currently, there is a budget line there of €2.3 billion. The HSE makes submissions to the head of disabilities on an annual basis for its requests for support. It will now be the Minister for Children, Equality, Disability, Integration and Youth doing that. He will be negotiating his budget directly with the Department of Public Expenditure and Reform for the funding. However, on the delivery of the aspect, the HSE will be accountable to the Minister for Children, Equality, Disability, Integration and Youth. That will be going directly into the disability specialist teams, to fund the therapies, day services, the respite and residential care. The lines are very clear within in.
The Minister of State must accept that there is a cross-over of services in certain and an issue could arise in regard to which budget it comes in under. Is there a process to resolve that issue?
There absolutely is. There is a very clear process if a dispute was to arise within the HSE or between the two Ministers as to who funds what, right all the way up to the Taoiseach.
I wish to ask a further question.
Sorry, Deputy Durkan is next.
I wished to ask the same question Deputy Burke raised. In the event of there being a division of responsibility and viewpoint, who concedes and who is the arbiter?
On that last question and on primary care services, at the moment under the progressing disability services, PDS, model, some children are being deemed less complex and as having less complex needs than others and are being referred to primary care. How is the division within primary care made? Obviously, it deals with a wide range of different health related issues as well as-----
That is a very important question. Any of the children who would be coming through the PDS model and who would be on it would be seen as having complex multidisciplinary needs. The child referred back into primary care would be seen as needing a singular need, whether it be the speech and language need or the occupational therapy need. It would not be the need of a multidisciplinary piece, so they should slot across. That is why, in the roll out of PDS, we have 91 PDS networks and 96 primary care networks, so one will not overlay the other so there is that fluid transition across.
Would the budget clear cut-----
Yes, it is quite clear cut.
-----in the primary care sector-----
Absolutely.
If the Minister of State takes a view that a non-HSE body can provide a better service in a particular area than the HSE, specifically in relation to the area she has jurisdiction over, how does she see that working out?
It is different from how I see it at the moment, where a service-level agreement would evolve out of that. In fact, if it has the capacity and is in a location that meets the needs of what is required then it would be to ensure that a service-level agreement would be put in place. The funding model will still always go through the HSE, but the delivery of service could be through another provider, no different from a section 38 or section 39 organisation, where a service-level plan would be put in place to ensure that the provider meets the needs and has the capacity to deliver it. We have service-level plans in place at the moment with some groups around the country.
Could the Minister of State see a scenario under this where a service-level agreement could displace an existing HSE-funded service?
Yes, if it has the capacity and meets the needs of the people in the community. It is all about a person-centred approach. We are moving to the Department of Children, Equality, Disability, Integration and Youth, where the person is at the centre and where we are aligned with the UN Convention on the Rights of Persons with Disabilities, UNCRPD. Therefore, it is meeting the needs of the individual. The service provider best placed to deliver the service, be it a section 38 or section 39 organisation or the HSE, will deliver that service.
There is a situation at the moment and I just want to ask a question about whether it will it be addressed in the course of what we are doing. There is no maternity leave cover for speech and language therapists at present. Who decides whether that will be funded or not? Will it be funded under the model of Sláintecare or will it be funded under a multiplicity of models? In other words, will it be resolved?
I thank the Deputy for the brilliant question. In a care setting that is predominantly female, it is an issue to think we do not fund, cover or back maternity leave. I do not find it acceptable. We would not do it in teaching and I do not know why we would not do it in disability and, most importantly, in the therapeutic delivery of care where early intervention is key. It is something I have taken up with the HSE. Currently, it is a conversation. I have funded and started that. Three of my children's disability network team leads are or will be on maternity leave this year. I am funding those posts. I am working very closely with the HSE to ensure we can build in the capacity so as to have that capacity budget to be able to cover maternity leave. That is across all different grades. If a senior speech and language therapist is out on maternity leave for 12 months and a child does not see a speech and language therapist in that time, that is not a delivery of service. Sometimes that is not communicated to the family and they do not know why. We need to ensure we have that continuation. I am looking at having relief maternity panels with the skills available to support the teams who are able to deliver the service of the relevant grades.
It is an important issue and I am glad to hear it is being resolved.
It is being addressed anyway.
I welcome what the Minister of State said about maternity cover. This section is about access to information. I received a reply this morning from the HSE. I was looking for details of the waiting lists for early intervention teams because we are all dealing with children who age out of this. The provision of services is very problematic at the moment. I sought details on the waiting lists. The reply came back that the HSE does not have that information. This is information that is with the various section 38 and 39 organisations. How on earth can services be planned for if you do not have basic information and data on the waiting lists? We are told that it may be ready at the end of the first quarter. This goes back to the whole issue in the HSE around its appalling IT systems and how at any one time it cannot say how many staff it has in any particular area or how many are on the waiting list. I am asking the Minister of State to recognise that this is a major obstacle to providing adequate services. What you do not measure does not count, as the saying goes. We need to put proper data systems in place so that we actually know the level of need. Then efforts can be made to match that with the provision of services. I would ask the Minister of State to please prioritise the provision of data so that services can be adequately provided.
I thank the Deputy raising that very important issue. I completely concur with her. If we do not have the data, how can we measure? I will bring her up to speed on two things. The contracts have been signed for a new ICT system for the progressing disability services, PDS, model. I am pushing this and want to see it done. I am assured that by quarter 1 of 2023, all the PDS systems throughout the country will have the data and the information technology systems to collect that. Then I will save Deputy Shortall and everyone else on their parliamentary questions because I want to have it live so that we see the waiting lists live - not the individuals but the numbers - so that people have a proper directory of when someone enters a particular CDNT team, what is ahead of them and where it is moving. It is not in relation to accountability but it has to be in relation to seeing what is getting done. We need to know there is a throughput but the clinicians themselves will want to see that too. We must move away from a paper-based system because it does not serve any purpose waiting three months to get an answer.
On the response the Deputy received to her parliamentary question, early intervention is gone and it is all part of the PDS now. That is the answer she should have been given. We no longer have that because we have all our PDS teams in place. It is from birth to 18 years, so there is no ageing out. Since the reform, the days of ageing out of a service has gone. That is of little comfort to those who thought they were on an early intervention team. I can only apologise to the families who might not be aware of it for poor communication on that. Early intervention ageing out teams are gone.
Okay, but the same principle applies and I could not get any data.
No, the Deputy could not.
At all. They are saying that it might be the end of the first quarter. I hope it is. I accept what the Minister of State is saying. Data is essential. You cannot measure anyone's performance unless there is clear data. I would also ask the Minister of State to confirm she is supportive of what is contained in Sláintecare on the allocation of resources to the various areas, whatever boundaries we are using, and it is to be hoped we will be using the new regional health area, RHA, boundaries soon, that the allocation of resources would be done on an objective basis - looking at the population in each area, the socioeconomic profile, the number of children, the number of older people and all that kind of thing - and that it would be transparent.
The Department of Children, Equality, Disability, Integration and Youth is heavily involved with the Department of Health on that. Yes, it is has been something I have focused on in the Department of Health and will continue that in the new Department. The data system is already in trial and being rolled out in the mid-west. That is how it is being tested and broken in to have full delivery by quarter 1 of 2023.
Will it be the case that, where a team is broken and key personnel are missing, the parents will be given or be able to access that information?
It will be when the system is up and running. That is the whole idea. I see the number of parliamentary questions that come in and how long it takes to get responses to them. I believe in reporting in real time because that means parents have the power and they have the information. It also gives Departments the opportunity to support, fund and address the issues Deputy Durkan raised around maternity leave, long-term absences or whatever needs arise. We will have a live helicopter view. There is no point in finding out about this six months later and we have not delivered services for six months. There is an appetite in the HSE to be very fair within disabilities, but it needs the tools to do the job. That is the appetite and the policy direction within the Department of Health and within the new Department. Yes, there will be a funding ask to make that work, but that will mean the delivery service will be brilliant. It will also mean that we know the shortfalls. Further, it will mean elected representatives will know the CDNT teams in their areas and how they are functioning.
I have a question relating to a sectoral plan outlining the programme of measures proposed for the provision of services to persons with specified disabilities. Will that tie in seamlessly with the Sláintecare plan?
Absolutely. That is our core plan.
I have a query about this. This is about co-operation and arrangements for co-operation by the executive with housing authorities and the Ministers for Health, Social Protection and Enterprise, Trade and Employment. That is fine. That kind of co-ordinating role is essential. There are many aspects to the disability issue and it crosses many Departments. I think there are other Departments that are equally relevant, if not more relevant, to people living with disabilities. I do not know why this involves housing authorities rather than the Minister for Housing, Local Government and Heritage. The Minister for Transport is a key Minister with regard to providing access and mobility for people. The Department of Transport is also key and is relevant to people with disabilities.
Besides just employment, messages relating to education and training are important. The proper training courses need to be available and accessible. Why is the Minister for Further and Higher Education, Research, Innovation and Science not referred to too? There is a big challenge in getting all of those Departments on the same page and keeping the focus on meeting the needs of people with disabilities. Why are some named when others, which seem very relevant, are not named?
What the Deputy is seeing here is the transfer of matters relating to the Health Act 2005 to the Minister for Children, Equality, Disability, Integration and Youth. I take on board what the Deputy is saying. Whenever I talk about disability, I speak about it in the round. I agree with the Deputy that education, higher education and transport all have a role to play. There is not one Department that does not have a role to play when it comes to disability. That is why it is being moved to the Department for Children, Equality, Disability, Integration and Youth. Moving it to the Department responsible for equality is the baseline, person-centred approach. That is why it is mirrored to the old Act.
I understand that. Why is this legislation not going further than just mirroring what was in the original Act? Why is it not going to include those other relevant Departments? Has the Minister of State any thoughts on how she will bring those other Departments into line or get them to focus on the needs of people with disabilities.
This is a transfer of functions from one Department to the other. I am already doing what the Deputy refers to with the reconfiguration of the transport committee, which I am chairing. I have brought in the Departments of Finance, Public Expenditure and Reform, Social Protection, Enterprise, Trade and Employment, and Education. They are all present. A person with a disability has the right to go to work, to be educated, and to travel. I am looking at it in the round. I also chair the national disability inclusion strategy group. Every Department sits on that, along with a stakeholder group. That is where I see accountability. I am no more a hard taskmaster than the Deputy is, with what she set me today. We need to look at the suggestions and how we can make it more inclusive and fluid. Not everything should be a battle. Every Department must attend and must have an action plan. In the past, they have used the traffic light system. It is getting very narrowed down.
What is really meant when one talks about transport? To be fair to the relevant Ministers, they have provided their officials to address the transport issue. Everybody on this call, including the Deputy and I, knows that much is going on in transport that needs to be addressed, from the mobility allowance to the primary medical certificate to as simple a matter as parking bays. Local government has a role. It is not just a matter for the Minister for Housing, Local Government and Heritage, but also the local authorities. We have somebody from the county councils attending that transport meeting. I am looking at it in the round. This is just a transfer of functions. If it was not just a transfer, I would have been broader with it.
I welcome what the Minister of State said about bringing together a wider group of Departments. What are the reporting arrangements to the Minister of State and for the public and service users? How do people know about the performance of various Departments individually and in meeting commitments?
We have two reporting mechanisms. The National Disability Authority reports on specific issues. The most recent report, which I hope will be published soon, relates to Irish Sign Language, which went in under the bonnet in every single Department across Government. That undoubtedly threw up challenges, but I am glad to say that they are being addressed. It is the same with the national disability inclusion strategy. The stakeholder groups, representative organisations and disabled persons' organisations are there. They are able to provide feedback about progress to their representative bodies. They also have members on the various sub-committees of the national disability inclusion strategy, including education and transport. Some of those positions might not all have been filled in the past. With the sixth disability stakeholders group, we have an ambitious cohort of representative groups on board. They all provide feedback to various organisations. Wonderful work has been done by the fifth disability stakeholders group. We now have a new cohort, which is the sixth disability stakeholders group.
One of the primary functions in the national disability inclusion strategy, at the top of its agenda, is to address the cost of disability. The cost of disability is a concern that is considered with regard to education, housing and social protection. All the key players from relevant Departments are present. It is welcome that the Department official does not change from quarter to quarter. The same lady has been involved with regard to education since I became Minister of State. She is a fantastic woman who has continued to do this.
The same has happened with local government. We have consistency in attendance at the meeting from the representatives of the relevant Departments so they can feed straight back into their line Ministers.
I thought the Minister of State said earlier that some Departments were not exactly enthusiastic or fully participative.
All Departments are participating fully. Perhaps some Departments are facing a steep challenge when it comes to disabilities and doing the whole equality piece. However, I believe in the buy-in from the Departments. Disability is front and centre across all Government Departments at the moment.
That is okay. I thank the Minister of State.
On the issue of housing by local authorities, I find there is very little co-ordination. Say, for argument's sake, a housing authority is dealing with an estate of 80 houses, which was something I saw recently. I do not believe any house in that development was specifically set aside for people with disabilities. Could there be far more co-ordination in that area? Where a housing scheme is being built by a local authority or a statutory agency, such as Tuath Housing or Respond, can there be more co-ordination in setting aside units specifically for people with disabilities? I do not think that has been put in place in real terms.
I thank the Deputy for that question. I thank the Minister for Housing, Local Government and Heritage, Deputy Darragh O'Brien, and the Minister of State, Deputy Peter Burke, for the disability housing strategy they recently launched. When we talk about housing, we should talk about universal design. A particular property should be suitable for a person with a disability, an older person or whoever else. A property should meet the needs of whoever needs to access it. Deputy Hourigan talks to me clearly and at all times about the need for universal design. Local authorities have a long way to travel on this issue and some are better than others. They must ensure proper allocation and universal design. If more local authorities addressed the need for universal design, more people could access properties and live independently, or could be supported to live independent. A key focus of mine is to support people in independent living and to ensure there is proper personal assistant support for that. We must also bring into the conversation how technology can support people to live independently. Local authorities have roads to travel in this regard. They do not have a target to provide, say, 5% of homes for people with disabilities. In actual fact, they need to meet those people's needs, no different from the way they meet the needs of able-bodied people. They should be able to meet the needs of all.
Has the Department had any discussions with the housing bodies? The housing bodies are now building a large number of houses for people on the housing list. Should we not incorporate all of the players in providing housing? It is not unusual for an organisation that is trying to provide housing for someone with disability, whether intellectual or physical, to run into problems in getting the housing he or she needs. Those organisations can end up purchasing properties in locations that are not ideal. Housing in urban centres, close to shops or services, would be far more beneficial to people with disabilities.
That is absolutely the case and that is where the consultation piece is now taking place with the Department of Housing, Local Government and Heritage for persons with disabilities. The Deputy is right. It is regrettable that in the past we or disability organisations bought properties that do not meet the needs of the individual but which were the only properties that were accessible. We need to have town centre properties with universal access for all persons with disabilities. It goes back to the point Deputy Shortall made. There is no point in having a person with a disability living down the country if he or she does not have access to a transport system.
That is absolutely right.
We need to have the whole circular, joined-up piece. To be fair to the Minister of State, Deputy Peter Burke, and the Minister, Deputy Darragh O'Brien, they have opened that channel and consultation is happening through that channel as we speak. The housing agencies and housing bodies can participate in that, as can the disability providers and the individuals themselves.
May I come in on that point?
I ask the Deputy to hold on for a second. I call Deputy Tully.
I agree with the Minister of State that universal design is very important. Part M of the building regulations needs to be reviewed. All houses should be designed so they are suitable for anyone because as people get older, their mobility-----
We need to be mindful of people's changing needs.
That is right. We are spending a lot of money on adaptation grants and moving people from one property to another. It is not just our houses; our whole environment needs to be universally designed, including transport links. The biggest obstacle to housing for disabled people is the lack of consultation with the health authorities to provide whatever those people need to support them to live independently, including a home care or personal assistant and assistive technology. That seems to be where there is a breakdown. The housing authorities can provide the houses but the supports for the person who wants to live in those houses are not provided.
I thank the Deputy for her contribution. I will say again there will be a central role for the Minister with responsibility for disability. It is about working in a cross-Government manner, across Departments. To be fair to the Minister, Deputy Darragh O'Brien, he has opened that door for me. If he provides the houses and I can provide the home support, the personal assistant or the technology piece, I will come on board. We must travel the road together. There is no point in building properties that people cannot access because they do not have the health supports they need. Joined-up thinking is required, which takes us back to why this transfer is so important. It goes back to the equality piece.
I absolutely agree.
We have touched on the most important part of the proposed legislation, which is consultation about the immediate needs of the people we are trying to help. Has anybody looked at, for example, the duplex housing system recently and how many people are in such accommodation and must access their homes via an outside stairs with only one handrail? There have been numerous cases of people breaking their ankles, legs and so on and so forth. Those people can still be left in those houses for ten years, 15 years or more, becoming more dependent on those around them. They are, unfortunately, not receiving any urgent treatment.
Approved housing bodies have within their lists of tenants at the moment several people who need adaptation grants to change their houses to address the needs of the people living in them. Those needs are fairly extensive. Some older people may have fallen or may have had an experience that has resulted in their being afraid to use the bath and afraid to stay in their own homes as a result of the means of access. We do not readily understand their experiences. I ask, in the situation we find ourselves, that the Minister of State would take responsibility and be in a position to dictate the necessities at design level for the people who are going to live in the houses. We must address the limitations on the extent to which disabled people can enjoy a normal living standard in their houses, insofar as it is possible for them to do so. How can we make it happen for them in a short time rather than telling them we will do something about it when we get time? I am sure everybody knows of cases of people who are in approved housing body houses but had to wait two or three years to get into them. That is crazy.
I realise I am being lax in the way I am allowing people in but I think it is important that we have this discussion.
I absolutely agree.
I will let the Minister of State respond before I call Deputy Cathal Crowe.
May I answer Deputy Durkan?
Yes.
I will tell the Deputy the progress we have made in recent months. One of the pieces was around the housing adaptation grant for disabled and older persons about which the Deputy spoke. The grant system never recognised the sensory needs of young people. To be fair to the Minister, Deputy Darragh O'Brien, he changed the qualifications to acknowledge that sensory needs can be part of the system.
If a room needs to be provided for the sensory needs of a young person, the local authorities now recognise that. That was progress in recent months while this consultation on the strategy was coming through.
I agree the sum given through the housing adaptation grant needs to be reviewed, given that sometimes we do not need to move people from their houses. Perhaps their changing needs have to be addressed, but sometimes the changing need might be a bit more expensive than the €30,000 that is allocated. It might be able to be done over two or three years, but to meet that need, it needs to be done now. That is another issue that needs to be addressed. To be fair on this to the Minister and the Minister of State, Deputy Burke, they have been very open and approachable in regard to listening to people about meeting that need.
I welcome the Minister of State and her officials and thank them for everything they are doing. Theirs is a very energetic team and their office has been very good throughout the time I have been in the Dáil when dealing with complex issues we occasionally encounter in our constituency offices. They have been very engaging in that regard.
To follow on from the point our colleague mentioned regarding housing, we heretofore spoke about percentages of housing in a development needing to be equipped for disability or one's future needs. I fully agree with Deputy Tully and the Minister of State that it is essential all housing stock be equipped for one's future needs. None of us knows what lies ahead. Some of us are born with limitations, while others, unfortunately, acquire them during their lifetime, and it is important the housing stock reflect that.
As a general housing point, this is an issue that arises time and again and it relates directly to Deputy Rabbitte's Ministry. There are many empty nesters who have four-bedroom houses in council estates. The spouse may have passed on, the children may have left and there could be someone down the road, often with a disability, who would love to be able to live in the house. We need to re-examine the configuration of housing and of the idea that, when someone gets the keys for a local authority house, irrespective of when the person got those keys, the house will be his or hers forever. In case the person's needs change, there needs to be flexibility built in. I know of people in County Clare with profound disabilities who are still struggling to get housed. There are ideal units in their town and village but they are taken up, often with many of the rooms vacant. Flexibility needs to be built in to that.
Turning to the housing adaptation grant, the inclusion of sensory rooms last year was really positive. I was a teacher in a former life and I developed our sensory room in Parteen National School. The rooms are fabulous. When a child is in a state of high anxiety or stimming, he or she can withdraw to that space, relax and come back ready to engage. They have been in schools for only a few years, but it is incredible - revolutionary, in fact - that they are now being provided in homes, with Government support. Does the Minister of State have any metrics to determine how that is going?
I do not have any metric other than my constituency office, but the scheme has been very well received. Having talked to my local authority, Galway County Council, I know it has been well supported. For me, what brought to light the value of a sensory room, if the Chairman will indulge me for a moment, was on Sunday night last, when I was watching "Room to Improve" and the value of sensory rooms was addressed. The little man on the programme went into the sensory room in the family's house and was able to regulate himself. Ordinary viewers watching the programme would not have understood this unless they had experience and understood what life is like for a child with sensory needs. We could see the value of that room and how the family could continue to function because they had the space to accommodate the room.
It is welcome that the Department of Housing, Local Government and Heritage has now seen fit, thanks to the Minister, to qualify sensory rooms as a need, and I expect there will be greater take-up of that now. It is also important, however, that local authorities, within their housing stock, would acknowledge we need to build that capacity in to some of it. In the past, for a husband and wife and two children, local authorities would say they were entitled only to a two-bedroom house. Perhaps where there is a sensory need, we will need to designate another room as the sensory room. Local authorities need to be open minded about meeting the needs of the family.
I would like the Minister of State to champion the provision of sensory rooms more generally in respect of public buildings. They are now in hospitals and many schools, and they are beginning to be built in homes. There are many people who started their education in primary and secondary school being highly supported with intervention services and special needs assistants, SNAs, and went through our fantastic education system, for which I am a firm advocate. They then go on to fulfilling careers in the public service and other areas, where they can function very highly and do a fantastic job, but there may still be times in the day or during the week when something can throw them. There are staff in the public service, possibly even here in the Houses of the Oireachtas, who may have certain sensory issues. Sensory rooms are very small in terms of the space they take up in a building but their impact is substantial. I would love someone to be a champion for them. A sensory room was recently installed in Shannon Airport. People quietly go in before a flight and emerge feeling rested, calm and ready to board a plane. It should be a feature of most public buildings in the general specification of design, and I ask the Minister of State to push that.
Her Ministry's transfer has been streamlined well and that is welcome. I am conscious she is being flanked during the meeting by two departmental officials. Has there been any departmental resistance or barriers of which we need to be aware as a committee?
Finally, turning to the section 39 charities and organisations that have acquired housing stock with support from the Government, it concerns me - I have said this to the Minister of State previously - that many of the residential houses that are acquired for people with disabilities are former bed and breakfast accommodation or seven- or eight-bedroom houses, which the general market of buyers would not go near. We end up, therefore, with people who have profound needs being supported in an environment where the house is fantastic and the people around them support them but the house may be located 7 or 8 miles outside where they need it to be. I can think of one former bed and breakfast accommodation in Clare - I will not say where it is - that is totally remote from where the needs are. Nevertheless, the Department and the section 39 charities decided that because it has seven bedrooms, they would buy it, but that should not be the metric for whether to buy it. It should meet the needs and, if anything, be town centred in order that the resident can walk out, have a coffee and socialise and mix with people.
I thank the Chairman for his forbearance.
To clarify, I have experienced no resistance within either Department. I am supported well today by the Department of Health and have been warmly welcomed by the Department of Children, Equality, Disability, Integration and Youth. I am supported by both Ministers and both Secretaries General in the transfer. Perhaps one of them will be delighted to see me go and another will be delighted to see me come, but we will say no more about that and it is okay. As for the HSE, as I explained earlier in response to Deputy Durkan, I have put in place a system that may be a little more granular than that which was there in the past. I have a good working relationship with the HSE within the system that exists, because we need to get answers.
On the purchase of properties, it is important to put on record - I think the Chairman will understand why I am saying this - that there are many ageing families who care for people with disabilities, and we do not have enough property to support or meet their needs. At all times, those individuals are trumped by crisis emergencies that come in ahead of them. What I am trying to do with the Minister for Housing, Local Government and Heritage, therefore, is to build in capacity while, at the same time, meeting the emergency needs. When a provider sources a house, it does so in good faith. It could be taking account of its book or its need for respite or residential care, and a property might not be available at that point in time, but it knows the needs of its families. That is what providers are trying to address. They are trying to relieve that anxiety, stress and pressure on families, and sometimes the property might not be at the desired location. While we are building Housing for All and will, through the Government, I hope, deliver the houses that are required, it is my one desire that we ensure there are houses with universal design in town centre locations that meet the needs. For once, we should not work off a key performance indicator, KPI, of debt to meet the needs of families but rather meet the needs and build in the capacity in advance. We should work with providers to ensure the needs and the providers' waiting lists will be met.
That takes planning but it is happening.
I seek clarification on one item, namely, the HSE funding relating to rehabilitative training for school leavers. I am just checking that it will transfer as part of this move. It seems to be the case but I would like the Minister of State to confirm it.
Absolutely, and it will. The number one item within it is that transfer. That transition planning is a priority for me. Deputy Cathal Crowe touched on the transition aspect. A great deal of work needs to be done on this. Career planning must start much earlier in education. To be fair to the Taoiseach, an education sub-committee was convened and this was one of the hot topics discussed at it. We must see a bring future for our young people in special classes, special schools or special units. There should be a pathway through education with any needs met; they should not fall off a cliff edge the moment they exit education. We must ensure they work with providers, the HSE or whoever else. That must happen.
That responsibility is to be transferred as part of the move.
Yes.
I thank the Minister of State.
I agree with Deputy Shortall on the importance of the reporting mechanism. I know we are talking about transference of power in the Bill. In my local authority at one time a person could not get an extension if that person lived in the middle of a terrace. If somebody had a stroke, the onus was then to transfer the family into an area where they might have known nobody or so on. There were all those sorts of difficulties. If a person was in a private house, a grant could be received for a mid-terrace property. It is important to have a system where people can see such a change. That has been going on for decades in that local authority and there are probably other examples as well. It is about capacity and saving money as well as everything else but it is also about the individual. The Minister of State is indicating the individual will be at the centre of this, and that is key.
I have a question on the role of HIQA. My understanding is that the Irish Examiner has been told in the past three or four days that a statutory investigation conducted by HIQA does no carry any enforceable sanctions and therefore could not be guaranteed to achieve improvements in residential care. I am just wondering about the transfer and we are talking about HIQA but where is an individual complaint filed and what is the role of HIQA in trying to deal with an issue. If parents or family have somebody in a residential setting where the person has a disability, they find they get no response from the residential facility or the organisation running it. If they go to HIQA, the authority has a role, but we find that in many cases people end up going down the legal route, which should not be the case. Are we making adequate provisions and could we do something further in making sure that where there is a complaint, particularly with respect to somebody with a disability, there is a proper mechanism to deal with it?
HIQA has the responsibility to monitor and to inspect designated centres regularly to ensure they maintain a high level of care. HIQA's disability inspection team is legally responsible for the monitoring, inspection and registration of designated centres for adults and children with a disability. As of 31 December 2021, HIQA has a total of 1,407 registered centres providing either long-term residential care or overnight care. To be fair to HIQA, I know when it receives a concern, it demonstrates action on the ground. It has a good team. It is a regulatory body and the watchdog. It has the legislative basis on which to act.
It said in a response to the Irish Examiner that it does not the power of enforceable sanctions and therefore could not be guaranteed to achieve improvements in residential care. That is what it said. I am not criticising people or anything else, but I am just saying it feels its powers are limited when it is requested to do an investigation. The authority also argues that for an individual complaint, it is also finding itself restricted. Could that be looked at and, if necessary, could we have a discussion with HIQA to see what changes is it seeking to ensure it has adequate capacity to deal with issues as they arise, and in particular, matters relating to residential care and people with disabilities.
Absolutely. It is also important to say that if the matter is of a criminal nature, the family concerned also the right to An Garda Síochána. HIQA looks after care needs but there may be something else there. I will certainly take that on board.
I am saying to the Minister of State that there is an opportunity to deal with this matter while we are dealing with the Bill. Is it possible for the Department to engage with HIQA and see what additional change in the legislation is required in order to give it the power it wants to deal with individual complaints. That is basically what I am asking.
As I said earlier, this is basically a transfer process, so powers of the Minister for Health are part of that. As a separate addendum, there may be a conversation with HIQA. I absolutely have a good working relationship with HIQA, and I will speak to the people in the authority. This Bill is a transfer piece so we are looking to transfer the powers in question from the Minister dealing with health matters to the Minister dealing with equality matters.
Is it possible while we are dealing with the legislation to incorporate what the authority is looking for in a structured way? If we start over and seek to give additional powers to HIQA, it could be 12 months down the road before we do so. There may be an opportunity to deal with the matter at this stage.
Perhaps I am not understanding the request very clearly. HIQA can be kept under review. Its powers can also come under review if that is necessary. I will take all the Deputy's comments on board. Any time we are dealing with delivery that is to support individuals in long-term residential or respite care, I will do whatever I can to bring more assistance. I will absolutely work with HIQA on that but it does not come under this Bill.
The Minister of State will engage through her Department with HIQA to take on board its concerns and see what needs to be done to deal with them.
Absolutely.
I thank the Minister of State.
Are there measures to carry out unannounced and on-the-spot inspections of residential properties where people with disabilities reside or will the authorities only react to a report of a concern? Does this apply to public and private facilities?
Yes.
They can do on-the-spot and unannounced visits for both private and public facilities.
Absolutely.
We are at a very important juncture with this section and the ability of HIQA or any responsible body to be able to react to a case, whether it is residential, home care or whatever. It can be from Kerry to Donegal to the community healthcare organisations in my constituency in the greater Dublin area and Kildare. There are cases that should not happen in those areas.
Situations continue to happen where people are at risk or where complaints have been made and nothing has changed. People do not take the initiative of responding in the way in which they should and could respond, on the basis that they do not have responsibility or do not have direct responsibility. A divided responsibility means no responsibility at all. I am not suggesting for a minute that the Minister of State is part of that. She is not.
The fact of the matter is that it reflects on us, as members of the health committee, when we debate a subject now, given the knowledge we have and the situation that exists in, for example, Kerry, in CHOs in various other constituencies and in Donegal, where nothing ever happens. We continue just as we were. It is not attributing blame to the Minister of State, but it is an attempt to recognise that things are happening around us that should not happen in a civilised society. The investigation should be undertaken by whatever is the appropriate body and whoever is responsible. I accept the Minister of State's notion that the health services can inspect private or public institutions without warning at the drop of a hat. It is correct that they can do that. However, they will always respond by saying, "Sorry, that is a private institution and we cannot do that". Where do we go from here?
I believe the Minister of State's intentions are good, but we all are faced with reality. I should mention something that came before us in recent times where an injustice is implied and there are legal implications. I do not wish to identify it, but there is an onus on us, whenever we get the opportunity, to do something that seriously reacts to the situation that prevails, deals with it and gets it out of the way.
I thank the Deputy for raising that issue. He cited Donegal as well as his CHO and so forth.
And Kerry.
Sometimes we get an opportunity where we see a pattern, and when one sees a pattern one has to question the relationships. Sometimes it is the relationship with the provider, with the external, that is very important to understand. It is very important for staff working within that care facility to know there are other organisations from which they can seek support. It is not just the regulatory body, but the support could be from An Garda Síochána, Tusla or social workers. Sometimes that relationship is not understood. In the past, perhaps, we have looked on everything through the medical lens and seen everything as an episode, whereas, in fact, there were patterns establishing. However, because of the way we view the delivery of a disability service, we see it as a medical model. Again, that is why I look forward to its transfer.
That is why I have continuously advocated in the past number of weeks for the publication of a particular report, the Brandon report, although we will not go into that now. That is why in the past number of weeks, where we have seen an established pattern in the north west, there is the need for an independent review to understand that pattern and relationships. I genuinely believe we do not understand patterns and relationships when it comes to the safeguarding of individuals in disability care settings. If there was a comprehensive, independent, external safeguarding review carried out in same said location in the north west, we would take that learning. It is not another report, but an independent review that I would like to oversee and deliver, whereby I would have assurances from my funder, the HSE, and the other providers that they understand safeguarding, patterns, relationships and how they would all work together to ensure the person at the centre gets the best possible care. It is not seen as an episode but is seen, as it is dealt with, in the proper framework. We can also reassure the families and rebuild the trust that when there is an adult loved one in residential or respite care, in the absence of legislation we would have regulation that would govern the delivery of the disability care settings and give back that trust. I believe trust is damaged there at present.
I agree, and I thank the Minister of State for her response. It is serious, which is why I raised it. It is getting more serious as time passes. There is an onus on the providers of the service, wherever the service may be and whether it be the public health service, a private institution or institutions or a multiplicity of either or both, to be able to take responsibility for something that goes wrong or is alleged to have gone wrong and have it investigated in a way that is to the satisfaction of all concerned. I am a long time in this House and I believe I have learned a great deal. One of the things I have learned is that those who are providing a service need to take responsibility for something that goes wrong under their care or under their watch.
We also have to acknowledge that the staff working in those services work incredibly hard. However, we need to know that the people in charge understand their own safeguarding policies and rules.
We should not leave the matter uninvestigated or unchallenged.
Absolutely.
That is the important part.
I wish to query the purpose of this section. It appears to be a little strange. It says that after the commencement of the section the Minister for Health will have been deemed to have performed the functions. That appears to be drawing a line under things, saying that anything that was not done would be deemed to have been done. That is my reading of it. I would like a further explanation of what its purpose is, as it is a little strange.
Like the Deputy, I asked the same question: what does that mean? Basically, my understanding is that legal advice was sought on that. On the day when the transfer would occur, it is who is actually responsible. My understanding is that is why it is included there. It is where the responsibility is, as part of the transfer on the day. The Minister of State will hopefully be doing that work on that day, but that is what it is about. It is the legal piece. They got legal advice on it because of the transfer on a particular day, any day. If it is on the 3rd, the 4th or whatever day it is, if the transfer is taking place that legal piece is in place. It is to provide for a situation where the Minister for Health might be doing something on the same day the transfer is going through.
He did that in the belief that he is still responsible and it is to protect. The Minister for Health has done nothing wrong in actioning what he has done while the Minister for Children, Equality, Disability, Integration and Youth could do it at 4 p.m. that evening. It is a technical legal piece. As we have a great working relationship, the Deputy need not worry. I asked the same question and the provision is just to protect both Departments.
The Minister of State telling me that there is a great working relationship does not really wash and that is nothing personal. One should look at the commentary we have seen in the newspaper recently about the carry-on among the officials in the Department of Health and their dissatisfaction with the HSE and all of that. It seems to imply that any unfinished business will be deemed to have been done and completed. My interpretation of it is that this has been deep dipped and done. There is a vast amount of unfinished business in the Department of Health. Let us take for example the Brandon report, which originated in the Department of Health. It has a long way to go, as the Minister of State has stated. Who will be held responsible if issues arise about failures on the part of senior officials in the Department of Health or, indeed, the Minister? How will these issues be dealt with? It is that legacy stuff that I am concerned about. I want an adequate way to bring either the Minister or officials to account and I do not follow the purpose of this section.
I have similar concerns as Deputy Shortall. There are countless situations where there will be attempts to complain that we are dealing with a different situation now than previously, that there are different responsibilities and that different people are responsible for what happened in the beginning. There is no excuse at all. I do not cast blame on the Minister of State and I believe that the system must answer for itself. In fact, the system in some cases can work very effectively and can answer for itself. Things may happen, things may be brought to public attention and things are dealt with. In other situations, on the basis of real advice, nothing ever happens on the basis that some day the guilt is implied or otherwise.
We have had recent experiences, and members will know more about them next week, whereby members of the public make complaints about things that are not going in accordance with what they see as the norm, and where there is no responsibility taken seriously, where people know when something is going wrong, have been alerted to the fact that something is going wrong and nothing happens again. The question at issue is whether nothing is allowed to continue to not happen, and to prevail in that after the transition and I think that there is a danger that that might happen. People have done it before, and people have done it several times, where in order to protect people various people object to publications etc. on the basis that there is implicit guilt in reports.
To my mind, whatever the feelings of people are, if there is a situation developing where the rights of the individual are seriously undermined or abused, and people of a vulnerable nature are abused, and people are not dealt with in the way that they should be dealt with by anybody, by an individual or individuals, or institutions then we have a duty, a job and a responsibility, as members of the health committee, to respond to it even though others may not think that the response is necessary. We must do so even though others may feel that we cannot do anything because there are legal implications here and so do nothing. We cannot have a situation like that ongoing and going forward, we certainly cannot have it. I completely agree with the points on that issue made by Deputy Shortall. I hope that we do not have to go back again because even as we speak these things are happening so I do not in any way impugn the Minister of State in this regard. The Minister of State is making every effort to deal with, control and take account of what is happening but there are those who do not and who defy the institutions, such as this committee, to do anything about it. We cannot allow that to continue.
I thank the Deputies for their contributions. In a nutshell, when a function transfers, then it transfers warts and all. I have been in the Department for the last 18 months and I have learned a lot from the experience. I have learned that we produce an inert report and I can only see sight of it on a particular screen, as it is not published. I agree with Deputy Durkan that there are times for getting under the bonnet and calling it out. When we move to the new Department, it will be a case of putting the person at the centre, it will be the rights-based issue and it has to come with that approach. The only way one can do that is when one has an open and transparent approach and that level of accountability. I believe in that and I believe that the new Department is all about that.
To be fair to the Department of Health, with which I have worked closely over the last 18 months, its staff have supported me in that policy development piece while not having transferred and while supporting me in my transfer. I have worked out of both Departments, while at all times wearing the rights-based hat albeit while working through a very medical lens. Let us remember that this is what the Department of Health has funded for many years but that does bring problems. There are problems. There is no doubt but that there are systems that meet the medical needs but do not meet the rights-based needs. I have referred to this already when I used the word "episodes". That is how providers and care deliverers see certain things that happen in disabilities. They see it through a medical lens. We now need to see it more through a social care model and need to adopt a more holistic approach.
Yes, I am moving in the absence of safeguarding legislation but that comes down to a working relationship with the two Ministers. I also have stated clearly that in the absence of legislation coming through the Department of Health, there is nothing to prevent the new Department from bringing forward its own regulations to address safeguarding in disability care settings. We need to have a positive outlook as to where the shortfalls are and not be afraid to address them. That piece is the technical piece. Yet again, to talk to the piece mentioned by Deputy Durkan, we should not fall between two stools if somebody does something in the morning and it happens in the evenings.
I say to Deputy Shortall that there is a concern that nothing will happen on the day, that everything is done in good faith and that there will not be a twist in the tail. I can only trust and believe in the officials of the Department of Health that nothing will go wrong and that what I have known to date will transfer with me because I know it warts and all and I know that there is nothing extra in it at the end.
Does the Minister of State remember that during the Second Stage debate that I raised the question of the delegation of functions?
Yes.
Unless particular specified functions are delegated to a Minister of State, then legal responsibility remains with the senior Minister. I do not want us to find ourselves in a situation whereby in the case of something that happened six months ago and which ultimately and legally was the responsibility of the Minister for Health and, potentially, senior officials and the Secretary General in the Department, because this function is now transferring to the Department of Children, Equality, Disability, Integration and Youth, we would have the Minister for Health saying it has nothing to do with him any more. I mean especially where there have been things that could be described as scandals in the past and where it took some time to get to the bottom of that and establish where responsibility lies. I am concerned that there would be an attempt to draw a line under that and the Brandon issue is a case in point.
We will not be able to ask questions of the Minister for Health anymore, even though the matter came within his remit at the time. We will be told that it has nothing to do with the Department and that it is a matter for the Department of Children, Equality, Disability, Integration and Youth. It strikes me that there is an aim to this section. The actual wording is quite complex and, as a result, I find it hard to fully understand what that aim is. Does the Minister of State have any more information on the delegation of functions when she moves to the other Department? Did she have delegated functions in the Department of Health? My fear is that there will be an absence of accountability at either the political or administrative level as a result of this section. Can the Minister of State allay my concerns in that regard?
The Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman, cannot delegate the functions until the transfer is done. That is the first piece. Within the Department of Health, I have had delegated functions as Minister of State with responsibility for disabilities. To be fair to the Minister for Health, during the last 18 months for which I have been a Minister of State, he has been dealing with a pandemic so he has let me work on the disability portfolio side of things. I hear exactly what the Deputy is saying. She wants to know who this committee could ask questions of if something was to come up when the transfer is complete. I would ask the exact same question. She is right; a line is being drawn in the sand such that, after the transfer, the reporting Minister for these matters will be the Minister for Children, Equality, Disability, Integration and Youth. If something happened within the last six months, 18 months or three years, the Minister to come before this committee to answer questions will be the Minister for Children, Equality, Disability, Integration and Youth.
Will the Minister of State clarify what her existing delegated functions are? I am not just asking whether the Minister for Health is happy to leave the area of disabilities to her but whether she has legally delegated functions in the Department of Health.
Yes, I do have such functions. The order was signed by the Minister.
An order was signed when the Minister of State initially took up her role.
Yes. It came late in 2020, but "Yes" is the answer.
I am concerned about this line being drawn and it not being possible to establish accountability. As I say, it is ultimately up to the senior Minister and the officials. There is a long tail to many things that have gone in the area of health. I am not really happy about this section.
I agree.
Deputy Durkan agrees. I cannot convince Deputy Shortall otherwise-----
If I may qualify further, I agree with Deputy Shortall and believe there is a danger in this regard. There have been too many incidents and situations in the past about which we can apparently do nothing because we were told there was a legal issue and that nothing can happen. As long as nothing can happen, nothing will happen. We have a serious responsibility to address issues that are emerging as they emerge. There was one situation where colleagues raised a question and, if it had not been raised by them, the matter would not have been raised at all. That particular situation was dealt with quickly, efficiently and effectively because it was raised. I am sorry for going on about this more than once because I promised I would not come in again but I agree with Deputy Shortall. An issue arises when we draw a line and end responsibility. There is an issue there. We had a number of issues before us and we will have more of them before us next week. I have similar concerns about this section.
The Minister of State has suggested bringing in the officials to try to bring greater clarity to the matter.
I thank the Deputy for the question. The policy responsibility transfers on foot of the transfer orders which are to be signed. This section does not impact on that. The whole transfer of functions will move disability policy responsibility, lock, stock and barrel, from the Minister for Health to the Minister for Children, Equality, Disability, Integration and Youth. This legislation goes alongside those statutory instruments. The Ministers and Secretaries Acts provide for the transfer of functions. A transfer of functions order will be signed which will transfer the functions. This legislation provides for accountability to go along with those functions because it would not be appropriate to transfer over €2.3 billion worth of expenditure and all of the significant responsibilities the Minister carries without giving him or her all of these powers. That will happen.
It is not my decision to make the transfer but my understanding is that there is no intent to avoid holding people to account. From legal advice, my understanding is that this section and section 63 are included to guard against such instances as something happening on the day of the transfer, the Minister writing to HIQA to ask for this terrible thing that occurred in this centre to be investigated but that letter being null and void because the Minister did not have the power to make such a request, the transfer having happened that morning. In legal terms, this is called a saver section. It means that something the Minister does is deemed to be lawful provided he believed he had the powers to do it when he did it. There is no intention to somehow allow the Minister for Health to continuing carrying out his functions subsequently because section 65 provides that all of the powers being transferred cease the minute the transfer happens. This is not some sort of back door to allow the Minister for Health to somehow retain these powers. They will cease. If the Minister for Children, Equality, Disability, Integration and Youth decided to write a letter directing that something be done before the actual transfer had not been signed - perhaps it was to be signed a few a hours later - he would not have had the power to do so at that moment. Our legal advice tells us that the inclusion of these sections protects and safeguards against that.
I do not believe the sections will ever be used. I think we would be okay if they were not included. They are just included out of an abundance of caution. It provides a particular safeguard. What the Deputy has talked about will happen as a result of the transfer more generally. As she has said, if the committee wishes to call in a Minister or an official to ask some questions, it will be the Minister or officials of the relevant policy Department who are called in. Once the transfer happens, that will be a different Department. However, it is not these particular sections that achieve that but the transfer itself.
I am still not getting the answers I was hoping for. I have to leave the meeting because there is something else coming up. I am still not getting the answers I wanted. I do not know about Deputy Shortall but I am sure she will speak for herself in this regard. I have to say that I am worried the current unacceptable situation may continue in the future or may not be addressed as a result of this changeover and that this may facilitate and assist wrongdoers. We cannot have that. That cannot happen and should not happen. It would be a sad reflection on the committee if it did happen in the aftermath.
That is all I want to say. I will not come in anymore but I do have concerns because there are those who say that there are things happening throughout the system that are of concern to an awful lot of people, that the system is breaking down, that the system of reportage is not sufficient, that there are too many blockages and stoppages and too many things happening that hold everything up and that we are in some way afraid to investigate certain things. We are not afraid to investigate nor were we every afraid to investigate in the past. I was in the system before, as was Deputy Shortall, and we did investigate, even where we were told we did not have any jurisdiction. We now have to deal with those situations, without exception. That is all I want to say.
May I make a final point on this? The language in this section is quite convoluted. It is open to a different interpretation from that provided by Mr. McGreal. It allows that a function of the Minister for Health under the principal Act to be deemed to have been validly performed by the Minister after the commencement of this section. I am not happy to support this section today. I will not be supporting it. Between now and Report Stage, could we get a note explaining it further?
Absolutely. That is no problem at all.
I will provide an in-depth note explaining it.
Will it be a comprehensive note?
A comprehensive note, absolutely. We will do that.
We understand our concerns are being investigated on that basis.
Absolutely.
The Minister of State has agreed to provide us with a note.
This section appoints the Taoiseach as referee where there is a disagreement between Ministers. How can the Taoiseach arbitrate on what, in some cases, will be a question of law?
This particular determination of dispute was put in as a backstop, which is a famous word at this stage, to protect both Departments. Both Ministers would also be sitting at Cabinet, to be quite honest. In Cabinet, agreement is on consensus. By including the mechanism in section 64, I am being overcautious. Deputy Shortall used the word "referee". I would say that it is a matter of ensuring that an agreement can be reached.
My understanding is that if there was a legal issue, the Taoiseach would be able to get the advices of the Attorney General in dealing with that.
So, technically, it is the Taoiseach as Head of Government, is it?
Yes.
I hope the Taoiseach will be very supportive of the Minister of State in other areas, such as getting a good allocation of resources at budget time and that kind of thing.
