Vol. 874 No. 2
6. Deputy Ruth Coppinger asked the Minister for Health the number of seizures of mifepristone and misoprostol, which had been ordered online by women, placing Ireland in the position of banning access to their bodily autonomy and forcing them to go abroad (details supplied). [14707/15]
Will the Government reconsider its policy on mifepristone and misoprostol which are safe pills that can be used in cases of medical abortion? I am asking this because the Customs service is seizing these drugs which have been ordered by women online through Women On Web and prescribed by doctors. In years to come, we will cringe and look back on this policy, under which we are censoring and preventing women from accessing safe health care.
The Health Products Regulatory Authority, HPRA, is the competent authority for the regulation of medicines in Ireland. Under the Medicinal Products (Prescription and Control of Supply) Regulations 2003, as amended, the mail order supply of prescription medicines is prohibited. The HPRA, in co-operation with Revenue’s Customs service, in the period 2011 to 2014, seized a total of 2,577 tablets containing the medicines in question in 138 importations. I am arranging to provide the breakdown by year for the Deputy.
There are significant public health concerns associated with the purchase of prescription medicines over the Internet. There is no guarantee as to the safety, quality or efficacy of medicines purchased online. Medicines purchased in this manner are often found to be counterfeit and-or with inaccurate labelling or product information. In addition, any prescription medicine should be taken by a patient only when it has been prescribed for him or her by his or her medical practitioner or other appropriate health professional who has taken his or her medical history into account.
It is illegal to procure an abortion in Ireland outside of the circumstances specified in the Protection of Life During Pregnancy Act 2013 which regulates access to lawful termination of pregnancy in accordance with the X case and the judgment in the European Court of Human Rights in the A, B and C v. Ireland case.
Because of the position under the eighth amendment and so on, the Government has banned these pills from the country. Who are the women who are looking for them? They are our sisters, cousins, friends and neighbours. They are ordinary women who have been driven to desperation because of a crisis pregnancy. If the Government is banning abortion in this country, will the Minister of State at least let the women concerned access these pills via the Internet and take their chances? What is happening is that doctors have to sit in surgeries, hand-holding, and tell women that they will help them afterwards if there is a problem. I remind the Minister of State that until the 1980s, contraception was illegal in this country. I remember that time when people had to sneak around back streets looking for family planning clinics. I also remind her that vasectomies were illegal. Doctors had to perform them illegally in order to challenge the law. I also remind her that homosexuality was illegal. These are laws that we now look back on and call disgraceful. In a few years time we will look back on this policy and say it was a disgrace.
The Deputy knows my position on this issue, but the law is that one cannot buy prescription medicine over the Internet. I have concerns for the health and lives of women who are driven to take these desperate measures, but that is the law, as laid down by the people. There was a referendum in which they spoke very clearly. I am sure the next Government will take a different view of that referendum, but right now it is the law and the Customs service is simply implementing it. It is extraordinary that people are being driven to take these measures, but I have concerns about ordering these prescription medicines over the Internet. If one looks at the background information, as I have, one will see that sometimes the medicine is not as identified on the packaging. That also concerns me.
I have looked at the issue in depth because women contact me regularly about it. I remind the Minister of State that those who have to resort to this measure are the poorest women: illegal immigrants and those who cannot afford to shell out €1,000 or €1,500 to travel abroad for a surgical abortion. I also reassure the Minister of State that the doctors who prescribe these pills for those on Women on Web are not reckless. There is a 1% danger rate, less than that for Viagra. Taking it is safer than driving a car. If the Minister of State does not have the guts to change or allow people to repeal the eighth amendment, she should let women take their chances. There is an excellent article written by a doctor, Dr. Juliet Bressan-----
This is Question Time. Will the Deputy, please, put questions?
Dr. Bressan makes the point that in the not-too-distant future we will look back on the shameful bans on contraception, divorce, homosexuality and movies such as "The Life of Brian". Will the Minister of State at least ask the Customs service to stop preventing people from ordering packages online? Why is she perpetuating this disgraceful ban? She will have a third chance to repeal the eight amendment in a Bill on 8 May which is being brought forward by Deputy Joe Higgins and me. I hope it is not a case of the Labour Party rejecting three times women's autonomy over their own bodies.
It is not within the gift of any Minister to tell an arm of the State not to abide by the law. That cannot be done. The Customs service is simply implementing the law, as is stands, which is in line with the constitutional imperative. I know that the Deputy does not take much notice of what the people decide in referendums-----
Not 31 years ago.
-----but the Labour Party does. The constitutional imperative was decided by the people. I know that is not something for which the Deputy has a great grá, but it was the decision of the people.
The Constitution - no, I do not.
8. Deputy Billy Kelleher asked the Minister for Health the waiting time targets for scheduled inpatient and day case treatment and outpatient consultant appointments; and if he will make a statement on the matter. [14650/15]
Will the Minister make a statement on current waiting time targets for scheduled inpatient day case treatments and outpatient consultant appointments? Will he also clarify, once and for all, the issue of HSE health statistics and whether there is a certain massaging of figures? Are they all being published, as indicated in December 2014, when concerns were expressed that some people waiting for diagnostics were not being counted in hospitals?
Improving waiting lists for scheduled care is a key priority for me and the Government. Taking into account current pressures on acute hospital services, I have put in place a target that by mid-year nobody will wait more than 18 months for inpatient or day case treatment or an outpatient appointment, with a further reduction to a waiting time of no more than 15 months by year end. The existing targets are that no adult should have to wait longer than eight months and that no child should have to wait longer than 20 weeks for inpatient or day case treatment and that no patient should have to wait longer than 12 months for an outpatient appointment. However, these targets have not been met for many years. In order to bring about an improvement, I am starting with the longest waiters to reduce progressively the period beyond which nobody will wait. This is a realistic approach to achieving a much needed improvement, even while recognising that waiting times are considerably longer than international standards.
The HSE is working on an implementation plan to achieve these targets. This will involve both productivity improvements and rigorous waiting list management. Further increasing day surgery rates for specific procedures will be important in improving elective access within available capacity. Priority will be given to adherence to the guidelines on the scheduling of patients for surgery, including chronological scheduling, which will be monitored by the HSE throughout the year.
I do not believe there is any massaging of figures. If anything, I expect that there is quite a lot of double-counting on waiting lists and quite a number of people who have been referred to three consultants for the same thing or who have already received treatment privately but still appear on a waiting list.
If anything, the numbers are probably higher than the figures suggests.
One area that is not counted is the number of people waiting for diagnostics. Deputy Kelleher is correct in that sense. This is because the figures were not accurate. However, once the figures are accurate the HSE will start publishing them again.
The Minister said that a row over statistics misses the point, but every statistic represents a person. There are 405,000 people waiting for outpatient appointments. That is a statistic, but it is an alarming statistic because there are 405,000 people involved. Clearly, the measures that the Minister is now outlining to achieve targets represents an admission that the targets set by the Government were not achievable and are not being achieved. Rather than addressing the problem the Minister is effectively moving the targets. As I said previously, it would be like Johnny Sexton kicking the ball wide from a penalty kick all the time while saying that the goalposts were in the wrong place. It is a farcical position. This is detailed spin at its best.
The Minister is setting new targets. He is setting targets that are way behind the targets in place previously. In other words, he is camouflaging the fact that the numbers of people waiting are going up. Not only that, the Minister has decided to shift the targets, for example, from nine to 18 months for some people. This is a complete admission of failure. Yet the Minister always applauds himself for the fact that he is being brave to set targets. The targets are in the wrong direction.
The figure of 400,000 people waiting for outpatient appointments probably involves a good deal of double counting. It includes people waiting to see a number of consultants for the same condition. Deputies should bear in mind that it also includes routine appointments and people who are waiting one week or perhaps two or three weeks for appointments. It is not that everyone in that figure is waiting six months, eight months, 12 months or anything like that. The numbers waiting 12 months for outpatient appointments is currently at approximately 77,000, which is a high level but it is certainly not the 400,000 figure that Deputy Kelleher is using.
The reality is that the targets that were set were not met and have not been met. I am trying to set realistic targets that can be met. Deputy Kelleher should bear in mind that Fianna Fáil, as a party, is led by a former Minister for Health who promised to abolish all waiting lists entirely within two years at a time when there was no limitation on spending, but he was unable to do it.
The Minister promised to get rid of the HSE.
Inevitably in health any time we provide a new service, it generates a new waiting list. That is one of the paradoxes of health care. What we are trying to do is set minimum targets and minimum acceptable limits. Even they are going to be difficult to reach.
This gets more disturbing as the Minister tries to explain it. Basically, the Minister is saying that the 405,000 figure is not a realistic figure in the first place and there may be double counting in it. However, there was double counting in the previous figure of 330,000. At the time we were told it would never climb any higher, that the issue could be addressed easily and that we were being alarmist in raising the matter as a challenge in the health services. The figure is now at 405,000 people. The Minister has decided to set targets that will alleviate the pressure on him and the HSE to deliver on in a timely fashion. That is what the Minister has done. He has gone from nine to 18 months. As sure as night follows day the Minister will be applauding himself and will say that the health service has nearly reached its target of 18 months, although the original target set was nine months.
The Minister should bear in mind that among outpatients, some 9,569 are waiting more than two years for an appointment. A total of 2,712 are waiting more than three years. That is where we are. I listened to all the glib talk of my party leader being a previous Minister for Health. Nevertheless, it is four years since the Government has been in office. Something needs to be done about this because it is creating serious pressure on individuals throughout the country.
I reiterate the fact that the figure of 400,000 includes people who are waiting for routine appointments for a few weeks. I am focusing on waiting times. When we talk to individual patients they talk about how long they have been waiting, not whether they are placed 1,647 on the list. They want to talk about how long they are waiting. That is why the target should be about waiting times. That is what I am focusing on.
Deputy Kelleher referred to people who are waiting over two years for an outpatient appointment. If I can get my plan through and if it is properly operational by the HSE, then all those people will be called for appointments in the next couple of months. It will be interesting to see how many of them have already had the appointment or have already seen a different consultant. We will see how many of those extremely long waiters recorded in our statistics, for example, those waiting over two years, have really been waiting over two years. That will become evident quite soon.
9. Deputy Ruth Coppinger asked the Minister for Health to set out his views on whether the recruitment embargo and the reliance on staff on temporary contracts was a major factor in the overcrowding crisis in hospitals last winter; and if he will make a statement on the matter. [14708/15]
I am keen to ask the Minister about the impact of the public sector recruitment embargo on the health service. Information is growing that this is leading to a major sucking of resources and costs in terms of agency staff. Moreover, it appears the ban on recruitment has led to serious shortages of staff and has led directly to the bed and trolley crisis as well, because hospitals have been unable to recruit agency staff at key times.
There are many different factors that contribute to trolley waits. Some of those factors vary from hospital to hospital. While there are difficulties recruiting certain specialties of consultants and certain categories of non-consultant hospital doctors and nurses, recruitment was not a major factor in the difficulties faced by the emergency departments in recent months. Indeed, staffing levels were higher in January 2015 than June 2014 and the numbers of doctors employed by the HSE is at an all-time high. Delayed discharges, in particular, have been identified as a critical factor in the difficulties that arose and this reduced effective bed capacity. There was also a higher number of older patients who required a longer stay.
I convened the emergency department task force before Christmas to examine the matter as a priority and to make recommendations. The task force worked diligently on the issue and the report was published at the end of March. The plan being implemented on foot of this work includes additional funding of €74 million to address specific requirements identified, including nursing home places, transitional care beds and community and district hospital beds. I am determined that the task force action plan is put into operation without delay and I will take a personal interest in ensuring this.
In recent years the HSE has had the capacity to recruit where necessary to deliver front-line services. Since the Government came to office, the number of consultants has increased by 150, the number of NCHDs has increased by more than 600 since 2010 and the number of nurses employed by the HSE has increased by more than 500 in the past 12 months. Agency staff was also utilised to support service delivery.
The Minister for Public Expenditure and Reform announced in budget 2015 that he intended to delegate greater autonomy to Departments and agencies to manage their staffing levels within allocated pay frameworks. This change allows further recruitment flexibility, for example, where it is determined that offering permanent contracts can achieve more economical service delivery than agency use. The Department of Public Expenditure and Reform has advised that the HSE and Department of Health are required to submit a 2015 pay and numbers strategy to give effect to this decision. This strategy is currently being finalised. Following approval of the strategy, a letter of delegated sanction for staffing will be issued.
There may have been increases in recent months but staff have been gutted from the health service for six years. There has been a 10% reduction in that time.
There is a relationship between the trolley and bed crisis and the embargo and downsizing in general of our health service in recent years or since 2009. It got worse in 2014 under the watch of this Government. Some 77,091 people had to wait on a trolley in our health services in 2014, while in 2007 the number was 50,000. There has been a major increase of almost 50%.
I have it on good authority from managers of Connolly Memorial Hospital, which is in the Minister's constituency, that the embargo had played a direct role in making that hospital one of those with the highest numbers of patients on trolleys. The hospital could not recruit agency staff over Christmas because they did not want to work over Christmas. Moreover, the Minister has banned hospitals from recruiting staff directly.
A question please, Deputy.
Instead he is forcing them to go through a bureaucratic rigmarole. This has led to Connolly Memorial Hospital, in the Minister's constituency, having the highest number on trolleys in the State and the relevant HSE area on four occasions this week.
The figures Deputy Coppinger is using include people who are not on trolleys and who are not in emergency Departments. If Deputy Coppinger does not believe me, she should go to www.inmo.ie/Trolley_Ward_Watch. It will explain exactly how those figures are calculated. Specifically, in Connolly Memorial Hospital the figures include people who are put on the day ward or the surgical day ward when there is an overcrowding problem. They are not on trolleys.
The Deputy's thesis is entirely incorrect. Her thesis is that emergency department overcrowding was worse this January than last January because of staff shortages, but the facts indicate otherwise. The total number of consultants increased from 3,434 to 3,515, the total number of doctors increased from 4,918 to 5,302 and, for the first time in recent years, the number of nurses started to increase again. The number increased from 34,177 at the end of 2013 to 34,509 at the end of 2014, to 34,993 now, and today it is probably above the 35,000 mark for the first time in three or four years. Therefore, the Deputy's thesis that reduced staff numbers have caused overcrowding is clearly nonsense. There have been increased staff numbers and yet despite that there has been more overcrowding, so overcrowding must be caused for a different reason that is not primarily related to staffing levels.
If the Minister had listened carefully, he would have noted that is what I said. Connolly Hospital is one such example, of which I have good knowledge from talking to the managers of that hospital. They told me they could not recruit agency staff at key times such as Christmas and other times as the staff did not want to work. I do not know what the numbers are. My question relates to the fact that the health service has to pay out in this respect. For example, the hospital in Galway, as has been well publicised, had to spend €10 million last year on agency staff, which represents a five-fold increase in one hospital. Imagine the resources that is sucking from our health service. The Minister's ban on recruitment is leading to higher costs throughout the health service. Connolly Hospital has had the highest number of people on trolleys in the State on several occasions and that must be a bit embarrassing for the Minister as that hospital is in his constituency. On 10 April there were 30 people on trolleys in that hospital-----
This is Question Time, Deputy. Would you put your question please?
-----and on 8 April there were 32 people on trolleys, which was the second highest number in the State. The Minister is certainly not looking after the health service in that area. We need a huge investment in public health-----
Thank you, Deputy.
-----which involves taking resources from elsewhere, taxing the wealthy in society and introducing a financial transitions tax. We cannot continue to keep gutting the health service and making people pay.
I am a little confused about the point the Deputy is making. She is saying that Connolly Hospital could not recruit agency staff over Christmas because staff were not willing to work over Christmas, so it was not that there was some type of Government edict that they could not do it or that the resources were not there. They just were not able to find agency staff willing to work over Christmas, and if that was the case, that was the case.
We have the hospital recruitment embargo.
I am not entirely sure what we were supposed to do about that at the time.
The Minister will not create permanent jobs.
As I pointed out in the numbers I gave the Deputy, we are creating proper jobs. We will hire at least 500 additional nurses to proper jobs with proper contracts across the country this year, but that will not get people off trolleys. People are not on trolleys because of the number of nurses. It is to do with admission rates, bed capacity and many other different issues. It is not the number of staff that causes people to be on trolleys; it is the fact that they are admitted and, for whatever reason, there is not a bed on a ward for them to go into.
The major problem I believe Connolly Hospital has faced, and this is what I have heard from the managers and consultants to whom I have been talking, is that there has been a very significant increase in the delayed discharges in that hospital. More than 40 people in that hospital, who would account for more than a whole ward, are now awaiting long-term care, and that is why we took the action we did a few weeks ago. I am hoping and expecting that this will alleviate the situation over the coming weeks. It is the case that on a couple of occasions in the past few months Connolly Hospital had more people on trolleys than other hospitals. There are 50 hospitals and it is not unusual for any given large hospital to top the table on a particular day.
10. Deputy Mick Wallace asked the Minister for Health his plans to restore the cuts to funding for drugs and alcohol treatment, particularly in relation to County Wexford; and if he will make a statement on the matter. [14631/15]
I heard the Minister's earlier reply to Deputy Ó Caoláin. I accept the Minister is starting to make some progress in this area but we would accept there is much catch-up to do. The Minister is well aware that there is a strong link between substance abuse and mental illness. Without it sounding too much as if I am engaging in parish pump politics about this, Wexford has suffered more than most areas and things are particularly difficult there. Successive budgets have slashed up to 25% of provision in this area. We have no 24-hour acute mental health facility in the county. The Cornmarket project in Wexford, which provides a drug rehabilitation programme, has noted a yearly increase of 20% in the number of clients accessing its drug rehabilitation programme. There are particular problems and challenges there which the Minister might consider attending to.
As the Deputy will be aware, the economic crisis necessitated significant reductions in health service expenditure in recent years. Notwithstanding the difficult economic climate, a range of new services have been introduced in the south east in the past five years, which have been of benefit to those in County Wexford who are affected by substance misuse issues. The additional services provided in Wexford include a new methadone maintenance treatment service and the expansion of needle exchange, with 12 pharmacies now offering this facility in the county. The HSE has also commissioned 12 new detox beds, including a four-bed adolescent detox service in Kilkenny, which can be accessed by people resident in the south east, including Wexford.
More than €3.8 million has been provided for addiction services in the south east this year, in line with the Government's policy of focusing resources on services. This includes €1.06 million for the south-east regional drugs task force, the same level of funding as 2014. Reflecting the Government’s commitment to the national drugs strategy, we have also provided an additional €2.1 million in the HSE budget nationally for this year for measures to benefit vulnerable problem drug users.
The resources available to address substance misuse will be kept under review in the context of the overall resources available to the health services and the most effective utilisation of those resources.
I was approached by a doctor two weeks ago at home and he pointed out that the lack of a 24-hour acute mental health service in the county is a dramatic problem in Wexford. He pointed out that since the merger of acute services for Waterford and Wexford in Waterford in 2011 many of those in need of help in Wexford have been left with no access to these vital services. He claimed that a person going through a mental health episode needs a referral letter from a GP in order to get an appointment with a psychiatrist. If the person is at risk of self-harm, he or she would be referred to the accident and emergency department at Wexford General Hospital, which is not equipped to deal with psychiatric patients, where they could wait up to 24 hours before seeing a liaison nurse who would then speak to a psychiatrist. From there they could be referred to the accident and emergency department in Waterford where they could again have to spend hours in a queue. Apart from the obvious fact that people are not getting the care they need, and that the need for a person with a mental illness to be seen is often time-sensitive, the person often cannot even get a lift to Waterford. Many family members have contacted me and said that having this unit in Waterford is not quite good enough for the many people in Wexford who are in dire need.
The question the Deputy asked related to cuts to funding to drugs and alcohol treatment in County Wexford. Had I been aware that he wanted to raise mental health services more broadly in the south east, I would have prepared for the question a bit better. I am informed that the 24-hour service for the south east operates from Waterford and that Wexford is catered for from there but also by its own community services across the county. Increasingly in the mental health area we are moving towards much stronger community services and centralised acute 24-hour services. That would have happened also, for example, in my part of Dublin where we had the old St. Brendan's Hospital but that has now changed very much to a community-based service with some acute services in Blanchardstown.
It would be less challenging to merge units in Dublin or whatever. If a person is in dire need of help and is living in Wexford town, it can be a massive problem for them to have to go to Waterford. I understand the Government does not have a limitless supply of money but Wexford hospital has the infrastructure to house a 24-hour acute unit. The facility to provide for it is there. I understand it will cost money to put such a unit in place. The problem in this area will continue and it will increase. It is hard to credit that Wexford has the second highest suicide rate in country. It has one of the highest illiteracy rates and one of the highest teenage pregnancy rates in the country. We have an unemployment rate of just under 24%. It is an abandoned county. There are some serious challenges in the county. There are more challenges in the mental health and drug abuse areas than there are in most areas. The Minister should examine the prospect of putting a 24-hour acute unit in place in Wexford General Hospital. I do not know what it would cost but it is something he should consider.
As far as I understand, people can be seen in the community and from there be referred to the specialist centre in Waterford if that is what is best for them.
It is worth pointing out, and I hope this will not be taken up wrong, that there are such things as psychiatric emergencies. Provision can be made, using either emergency ambulances or intermediate care vehicles to transfer patients to the right units in emergencies. That is done for all other types of illness and it can be, and is, done in mental health cases as well.
11. Deputy Finian McGrath asked the Minister for Health if he will pursue the implementation of agreed measures, targets and timelines for disability; and if he will make a statement on the matter. [14659/15]
I ask if the Minister of State will pursue the implementation of agreed measures, targets and time lines for disability services. I ask this question in the context of the crisis that exists in many disability services. There is a lack of planning and targets with regard to the provision of services for people with disabilities. One example of this is that adult services for 30 young adults on the north side of Dublin will be under major pressure from next September. What is happening with regard to these services? The Minister of State has said that €12 million will be made available for school leavers nationally, yet I have had 30 families tell me that they will not be able to get an adult service in September.
I understand the Deputy's question specifically relates to the reconfiguration of residential services as recommended in the HSE's report, Time to Move from Congregated Settings - A Strategy for Community Inclusion. I will come back to the Deputy's supplementary oral question presently. The aforementioned report proposes a new model of support in the community by moving people from institutional settings to the community over a seven year time frame.
The report identified that around 4,000 people with disabilities in Ireland live in congregated settings, defined as residential settings where people live with ten or more others. It found that notwithstanding the commitment and initiative of dedicated staff and management, there were a significant number of people still experiencing institutional living conditions where they lacked basic privacy and dignity and lived their lives apart from any community and family.
I would like to acknowledge the work and progress made by the HSE and disability service providers in transitioning people from congregated settings since 2008. At the end of 2014 there were approximately 2,900 people with a disability living in institutional care and many of the original group of 4,000 surveyed had transitioned to alternative community living arrangements. I am anxious to ensure that this momentum is maintained. The reconfiguration of disability residential services has been prioritised by the HSE social care directorate in its operational plan for 2015, with an additional 150 people targeted to move this year. The HSE is currently developing an implementation plan for de-institutionalisation that will be rolled out at a regional and local level in full consultation with the stakeholders.
I am anxious to answer the Deputy's supplementary question. The 30 families to whom the Deputy referred need have no fears. As long as I have been in politics there was a crisis-driven approach, with people with disabilities coming out of training or school having nowhere to go in September. We did not have such a situation last year and will not have it this year either. People will have to outline to the HSE directorate the particular needs of the individuals in question and a place will be found for them. We do not want a crisis-driven approach to re-emerge. I assure the Deputy that it will not happen this year and the €12 million that we have set aside will ensure that it does not. A lot of planning is going into ensuring that people do not have the type of anxiety the Deputy has described.
I hope the Minister of State is right in that regard. I am putting down a marker now with regard to the provision of services next September. The Minister of State should note that parents have been told by St. Michael's House services that there is no guarantee that the required buildings will be available for use in September. Furthermore, the HSE has said that it will not fund transport services. There is an issue in that area.
On the broader issue of planning for people with disabilities, does the Minister of State accept that there have been major cuts to the supports that enabled people with disabilities to live independently? Many parents, particularly those who are more elderly, are suspicious when they hear the big fuss being made about congregated settings because they are afraid that their children will end up in a community setting without the necessary supports and services. We have seen cuts to the mobility allowance, respite care grant, motorised transport grant, benefit allowance, medical cards and home help services. There was also an attempt to cut the personal assistant service in the past which was reversed because of the reaction of people with disabilities. Is the Minister of State aware that such cuts are in breach of Article 19 of the UN Convention on the Rights of Persons with Disabilities? We need to up our game and plan proper services for all people with physical and intellectual disabilities.
I am determined that the crisis-driven service that we had in the past, which was more costly and was very unsatisfactory for those with disabilities and their families will no longer pertain. I do not accept that something is a crisis when it happens every year. This is something for which we should be able to plan and that is what we are doing.
If we are serious about mainstreaming people with disabilities and ensuring that they live the type of lives that we would expect to be able to live then a combination of efforts is required. It should not be necessary, for example, for people to be driven to every single venue. St. Michael's House, for instance, presented a project which involved service users being trained to use their free bus pass, which was a freeing experience for them, although I accept fully that not everyone is in that position.
We must be very careful to ensure that people with disabilities who are coming out of institutions into the community do not find themselves more isolated than they were previously. I am very conscious of that danger and will be very careful about how we manage the transition to ensure that people do not find themselves isolated within communities.
I hope that will be the case and that they will not be left without back up and support. Finally, on the broader question of people with intellectual disabilities, the Minister of State will be aware that there are 27,256 people with disabilities here, of whom 2,271 are looking for residential places or places in a community setting. There are only 197 people who need day care services now and surely that is something that we can deal with immediately, as a priority.
I do not have the information on that to hand and would not like to comment lest I lead the Deputy astray. That said, I do know that we will be dealing with 1,400 people this year, between school leavers and those leaving training schemes. We dealt with a similar number of people last year and we should be able to plan in respect of these people.
