Dáil Éireann díospóireacht -
Thursday, 10 Sep 2020

Vol. 997 No. 2

Services for People with Disabilities: Statements

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I am honoured to serve as Minister of State with responsibility for disabilities in the new Government. I take very seriously the responsibility and opportunity to have a positive effect on the lives of thousands of people with a disability in Ireland. I want to be the Minister of State who reimagines how disability is viewed in this country. Disabilities are not merely a health issue. People with disabilities have a human right to be considered in every Government portfolio, be it health, transport, employment, sports or arts. We must ensure that every person in society, regardless of his or her abilities, is valued and supported in being able to fully participate in society.

In this debate, I want to focus on the most pressing issues that have been raised with me in recent weeks. I will listen with great interest to the views of the speakers who will follow me this afternoon. Disability services are provided in various settings by many organisations throughout the country. In the age of Covid-19, these organisations have had to adapt to do their best to ensure that services can continue to be provided. I acknowledge the commitment of these services over the past six months in supporting and protecting those with a disability who attend the health and social care services. However, I am sure Deputies will agree that realistically the provision of these services will not be as it was prior to Covid for some time to come. It would be misleading of me to say otherwise.

The New Directions policy has guided change in the day service sector. It has helped to reconfigure day services, in a person-centred way, prioritising community inclusion, active citizenship, and high-quality service provision. However, as the House will be aware, in line with the public health advice, disability day service locations closed in March. The Department of Health, the HSE and day service providers know how vital disability supports are for people and their families and want services to resume as soon as possible. Service providers have been working tirelessly since the recent publication of guidance to get day services ready to reopen safely and in line with public health guidance. A total of 90% of day services have now reopened but they are not open at the same level as prior to Covid. The remaining services will re-open this month.

Children's disability services were also stepped down last March. Through the pandemic, services continued to be provided on the phone and online, with face-to-face services for some children and families with high prioritised needs. At the end of July, the HSE issued two guidance documents to support the resumption of children's disability services to its nine community healthcare organisations, CHOs, throughout the country. The guidance maps the pathway of access to services and supports, commencing with phone and online supports, and where these do not meet the needs of the child or the family, moving to face-to-face interventions and what is required to do so safely. I hope this will lead to a gradual return to services as they were provided before but, as I mentioned, it will not be possible in the near future.

An issue I specifically want to address is the long waiting periods for some families to get an assessment of need, AON, appointment for their child. This is a priority for me. I am very aware of the challenges to families with the waiting times for a child requiring an assessment of need. The HSE has made a number of changes to the process, such as a revised standard operating procedure and the appointment of network disability managers, but there are still many waiting too long. I do not want to allow waiting lists to continue to grow so I am pleased to announce to the House today that I have secured an additional, once-off €7.8 million in 2020, which will allow the HSE to address the current backlog of overdue assessments of need around the country. This work will begin immediately in accordance with individual plans set out in each CHO area.

Processes are under way to plan for the reintroduction of respite services for people with a disability and their families. The HSE has developed a roadmap for the reopening of disability respite services, which is now available on the HSE website. The HSE supports approximately 8,300 residential places for people with a disability under the national service plan. The plan also provides for an additional 64 emergency residential placements for allocation during the year.

Residential placements are provided on the basis of need and within available resources. The HSE engages with families to ensure those with the greatest need are prioritised. This has been a particular focus of the HSE during the Covid-19 emergency. In recognition of the additional pressures faced by many families, the HSE is providing 144 intensive in-home respite support packages for emergency cases this year. We will continue with the decongregation programme and move more people with disabilities from congregated settings to homes in the community with the necessary supports. Although there have been particular challenges this year, I am pleased that so far 52 people have moved to their new homes in the community.

The voluntary sector in the provision of health and personal social services to people with a disability is remarkable and we owe it a debt of gratitude. Its flexibility and collaborative approach in working with the HSE to respond to the challenges presented by the Covid-19 pandemic is brilliant. I am aware that a number of section 38 and section 39 disability organisations have reported they are facing financial challenges and have incurred deficits during this time. In recognition of this, the Minister, Deputy Donnelly, and I have asked the HSE to relieve section 38 and section 39 disability service providers of the obligation to achieve the 1% efficiency target set out in the 2020 national service plan. I look forward to listening to the contributions of my colleagues this afternoon and I thank them for their time.

Deputy Pauline Tully

Has a budget to be provided to facilitate the reopening of day services for people with disabilities? I was led to believe a budget for this was meant to come to Cabinet last week. If so, how much has been allocated to ensure the full reopening of services? If not, will it come before Cabinet and what does the Minister of State envisage the amount will be?

A stand-alone budget needs to be provided for this very important service and it should not be part of the winter action programme, for example. A budget was provided to schools for their preparations to reopen in their entirety. This was done to accommodate the vast majority of students on a full-time basis.

I welcome the reopening of the services. Most of them have reopened or will do so in the next two weeks. I commend all the staff involved on getting the centres open at very short notice and in exceptionally difficult and unprecedented circumstances.

This partial reopening is welcome, but is it not the case that people with disabilities are being discriminated against? Day services for adults are reopening at much reduced capacity. I have been told that people who were receiving, say, five full days' services before Covid are now getting one, two or, if they are lucky, three days' services. Should they not be treated on a par with beneficiaries of equivalent services that have reopened? Day services are education and training services for adults and school leavers with disabilities. Schools have now fully reopened, so why not the day services? To end the discrimination and allow day services to open safely, financial assistance is required from the Government. A ring-fenced budget for this is very important but there are additional staff costs because I think the HSE is advising staff in these centres to divide into teams, which sometimes means additional staff to cover staff absences, rental of extra space if needed for cleaning requirements, additional work premises or extra PPE or sanitiser costs. All these costs are very difficult to cover, especially for section 39 organisations. They do not know whether they will receive funding from Government towards the costs. They cannot be expected to fundraise, especially in the current climate. Many section 39 organisations feel quite aggrieved at being told to prepare to reopen in August because they were not given any support from the HSE to do so. They would have welcomed even just advice but they felt that was not forthcoming in a lot of instances.

Having talked to many service providers, I understand that transport to the day services seems to be the biggest challenge at the moment. Capacity on buses has been drastically reduced as a result of the 2 m rule and the fact that many of the service users cannot wear masks. Therefore, some service providers are not providing any transport at all. Others are offering transport perhaps on only one day. Users are therefore dependent on family to get them to the services, and if their family is not available they cannot use the services. One service in my constituency owns a 15-seater bus but it can only take three people due to the 2 m rule. It is doing several runs, but that is incurring extra costs because of the extra diesel, the extra wear and tear of the bus, increased wages for the bus driver and additional PPE. Will the Government cover these costs? If they are not covered, I feel the service providers will be unable to reopen fully and discrimination against people with disabilities will continue.

People living in residential settings and those availing of the limited respite currently being allocated are being denied access to day services, according to HSE guidelines. That is totally unfair and must be addressed. The practice of using nursing homes to house people with physical and intellectual disabilities is still being applied and it is totally unsuitable. It is soul-destroying for the person forced to live there, not to mention very costly. Therapies such as occupational therapy, speech and language therapy and physiotherapy have not resumed either. They are vital services for people with disabilities. For example, stroke survivors need rehabilitation and community care. That will enable them to improve disability outcomes and their quality of life, reduce the likelihood of long-term residential care, even reduce their time in hospital and reduce their risk of another stroke. Without this care, however, the opposite is true. I am told that therapists are not available to carry out this work because they have been redeployed to contact tracing and testing. That has to stop because these are vital services and we need those highly-qualified staff back doing the job they should be doing.

I think we all know how devastating the past six months have been on service users. These people were suddenly cut off from friends and their daily routines. It has been extremely harsh on many, who have said they feel lonely, frustrated or bored, sometimes not even comprehending why these services have been stopped. It has had a very serious impact on people's mental health. Services are not fully reopened, with many service providers indicating that they cannot see that happening for the foreseeable future. This needs to be addressed urgently to ensure the full resumption of services for people with disabilities.

An issue with some school transport to special schools has also been brought to my attention. I do not know if that is within the Minister of State's remit or whether I should talk to the Minister of State, Deputy Madigan, about it. School buses going to special schools are treated as school buses to primary schools so they are operating at full capacity even though there are teenagers using those services. This is causing a lot of concern to some parents.

Deputy David Cullinane

I thank the Minister of State for taking these statements on this issue. I have consulted with many disability groups over recent weeks and months, as I am sure the Minister of State has. We all know that Covid has had a dramatic impact on people's lives. Children and adults with a disability have had a harrowing time, and their parents and those who care for, support and love them have been doing their best. I wish to deal with the high-level issues first, before I get to issues that existed even before Covid, and then the Covid measures which need to be put in place.

It is time we implemented in full, for once and for all, the United Nations Convention on the Rights of Persons with Disabilities. I have been hearing that for years and years from Ministers and politicians in government and in opposition, yet disability groups are still waiting for action on the matter. We need to get the rights-based approach to it right first, and what flows from that is the implementation of all the rights of people with disabilities, which has not been the case up to now. We need the safe, full resumption of adult day services for all people with disabilities insofar as possible. Yesterday, in the Dáil Chamber, in response to questions on health, the Minister of State mentioned that services are available and recommencing. We need to ratchet them up as much as we can to ensure that as many adults as possible get access to them. There are also a whole range of issues for children, and they need to be addressed as well, in schools and outside of schools.

My colleague mentioned the issue of deficits in section 39 organisations. We proposed that these deficits be wiped out by the State in alternative budgets in the past. That is what needs to happen to ensure they are on a sustainable footing to be able to provide the services people need. A lot of these organisations and the services they provide should be brought into public ownership, and the people who work in these areas should be State employees because there are contractual employment issues, workers' rights issues and pay issues. They are described as analogous workers, doing the same job as people who work in the public health system but not getting the same pay because they work for section 39 organisations. There is a lot to be done there.

In addition, there needs to be a real focus on speech and language therapists, occupational therapists, physiotherapists and psychologists. There is a lack of child psychologists, for example, which plays a real part in children not getting diagnoses as quickly as they should. In my part of the country we do not have enough specialists on the diagnostic assessment teams to ensure that children get early diagnoses. With those early diagnoses come all the supports that should be there, that is, the therapies. If we are not getting that right, if we are not getting the diagnoses right and if there is then no pathway to all the services that should be there, that is a real issue.

We should make sure that all people with disabilities have proper income supports when they go to work. We need to look at issues such as medical cards and all the other issues we in Sinn Féin have pointed out before. We need to clear the home support service waiting list through additional investment in services.

I will finish on this because it is very important. We want to see a statutory right to a personal assistance service. The proposed cut to the service was one of the mean-spirited, very regressive measures the previous Government took, and the Minister of State was very vocal against that when she was in opposition. We all know how important it is for adults with a disability to have a personal assistant. Reduced hours mean they do not get the supports or the help they need. We have to make sure that that is where the investments are. It all comes back to rights. If we establish the rights in principle and there is an obligation on the State then to deliver those rights, we will be able to give people with disabilities the merit they deserve and their place in society, which should be the same as ours. They should be treated as equals.

Deputy Sean Sherlock

I welcome the Minister of State to the Chamber and welcome her statement. The announced €7.8 million is a significant sum of money but it will only become so if the follow-on services are provided. Last night in the House I raised the issue of professionals such as occupational therapists being deployed to contact tracing and even testing.

That makes a mockery of any attempts to ensure people who rely on the follow-on services arising from an assessment of need would get those services. I ask the Minister of State to take a closer look at that to see if those people can be brought back into a core front-line service. If the announcement of the €7.8 million is to mean anything for families, it should mean a follow-on service becoming available arising from the retrenchment of those who are otherwise engaged at present.

I accept the Minister of State's point in respect of 90% of day services having reopened but forgive me if I am sceptical. Some 90% of the services might be open but that does not mean people have access to 90% of services. People are back on a part-time basis and it is still very piecemeal. Until we get to the stage where people have full access to the services they have always enjoyed and have a right to, there is a long way to go. To be fair to the Minister of State, she would acknowledge that.

I also want to speak for organisations like St. Joseph's Foundation in my neck of the woods. One of its facilities, Cooleens House, has been reassigned as an isolation centre. It was a respite house and respite is key to all of these services for families. I am sure the Minister of State will respond to this case. If Cooleens House could revert to a respite house and some other such facility could be found to provide for isolation, that would send a clear and positive signal to those who use the services of St. Joseph's Foundation.

Will the Minister of State examine the relationship between the HSE and the section 38 and 39 organisations? The voluntary organisations are very much price takers. They have to accept the budget they are given. They must then raise funds, which has been challenging in the current climate. I ask that the HSE, on ministerial direction, give some ground and financial leeway to these organisations in the current climate in order that they can get on with restoring the services to which people are entitled. In my experience, the relationship with the HSE has sometimes been lopsided. The HSE has come in waving a stick or beating the drum against some section 38 and 39 bodies. In the current climate, these organisations need a little financial headroom and leeway to allow them to deliver services. There needs to be a rebalancing of their relationship with the HSE. I am sure the Minister of State is conscious that without these organisations, these services would not be provided.

I make the case for respite services. I ask the Minister of State to reply, if not today then at some stage, regarding the metrics for every single person or group who should have access but do not have access at full capacity at this time. If that issue were addressed and a full service restored, it would bring relief to many families.

Deputy Jennifer Murnane O'Connor

While I welcome the return of many day services for those living with disabilities, many families have contacted me because they are finding it difficult to access transport to services. I know of many families who had places on buses but now do not. They have no other means of accessing services because some of them do not have a car. They are informing me that they are even paying for taxis. In some cases, disability services are only available for a few hours per day. The schools have reopened and we need to try to get disability services fully reopened to ensure everyone has full access to services every day.

We did not have a fit-for-purpose school transport service for schools that cater for children with special needs before Covid. Are the concerns in that area being considered? Are there plans to improve that transport service for those living in rural Ireland? My understanding is that these families should not have to pay for the service but there is confusion in that regard. The mobility allowance, a payment made to people with severe disability to allow them to hire public transport such as taxis and enable them to get around for social and health reasons, was never replaced when it was removed by the previous Dáil. A memorandum setting out proposals for a new transport support payment scheme was brought to Cabinet but later withdrawn in favour of revised proposals. Does the Minister of State know if such a scheme is being put in place to support families with children in special education schools who do not have transport? What do families need to do to access this kind of support? Many families cannot afford transport, which I know has been a big issue for the Minister of State.

The Minister of State spoke about section 38 and 39 organisations with which she is working through the HSE. Has a special budget been provided for additional buses, hiring more escorts and cleaning and sanitising buses?

I welcome the Minister of State's announcement today of €7.8 million for the assessment of needs for children aged up to 18. In my area of Carlow and Kilkenny, CHO 5, €693,000 has been allocated for the assessment of needs. I welcome that allocation because this has been an issue on which I have spoken to the Minister of State. We need to provide as much funding as possible for assessments of needs to ensure no child has to wait to access disability and other services. We need to make sure children have access to services as soon as possible. As the Minister of State knows, the quicker assessments are done, the better one can work on whatever area of need is involved.

We have a fabulous respite house in Tullow. What is the roadmap for overnight respite stays? Perhaps the Minister of State will come back to me with a written answer. When Tullow respite house opened, we were told it would provide overnight respite care as well as day respite care. I ask the Minister of State to come back to me on that.

I thank the Minister of State for visiting Carlow recently. The Holy Angels day care centre is a love of mine. I have constantly been looking for a new school building for this centre which is accommodated in prefabs. As I have said on several occasions, it is unacceptable in 2020 to have children with special needs in prefabs. I was delighted the Minister of State met members of the committee. She will soon meet CHO 5 to look at plans for a school for the Holy Angels centre. We cannot have children in prefabs. I will also seek an update on those plans, on which I look forward to meeting the Minister of State.

Covid-19 has been challenging for people, particularly families with disabilities. When there were protests outside the convention centre, the Minister of State and the Taoiseach - in fairness to them - went out and met the families and parents. That line of communication that everybody has is very important. The only way forward is to have all of us working together.

Deputy Pádraig O'Sullivan

I recognise the announcement this morning of the €7.8 million for assessment of needs. It is an issue on which the Minister of State, Deputy Rabbitte, has worked. Even when she was in opposition, she spoke of her desire to achieve that and clear the backlog in this area. The announcement is fundamentally important and needs to be acknowledged.

The previous speaker acknowledged the Minister of State's visit to Carlow. I would like to acknowledge her recent visit to the Cope Foundation and St. Gabriel's special school in Cork. She also met consultants in Cork University Hospital to discuss rehabilitation.

I thank her for making that trip. I hope that, following on from those meetings, some of the issues that were highlighted on those days might be resolved.

I want to touch on school transport as well, which is the hot topic in mainstream and special schools alike. I have corresponded with the Department in recent weeks, specifically on Cope Foundation in Cork. As the Minister of State knows, when she met the CEO, Sean Abbott recently, he highlighted that there are four schools in or around that campus. Unfortunately, given the demand for the bus services in Cope Foundation, those students from different schools are sharing the same buses. The response we have received heretofore from the principal officer in the transport section has been unacceptable. The correspondence we have indicates that this situation will not change and I urge the Minister of State to revisit that. It is not acceptable that people with underlying health conditions and some of the difficulties they have would be expected to share the same bus and possibly risk cross-contamination if there was to be a breakout. School transport is a fundamental issue and it needs to be tackled.

I refer to school transport in the wider respect. We all meet different people every day of the week coming into our clinics and offices talking about making round trips of maybe two or three hours per day. That needs to be overhauled. Somebody needs to sit down with those students, take a map and streamline those bus services in a better way. Money is wasted on buses in a facility such as Cope Foundation, where it could provide the care it gives students in the community setting. I do not mean to say the money is wasted on buses as it is a fundamental part of getting the children to school but it would be far better spent in the community so that the service is situated among the people who need it most. I take the Minister of State's point that the vast majority of services have resumed but I want to echo what previous speakers have said. We are dealing with difficult situations with people who might have acute epilepsy and suffer from seizures, for example. With respect, one day per week of a service is welcome to get services back but when people with severe needs are being dealt with and the pressure their parents are under is considered, we need to up the ante and get services back to normal as much as we can.

I mention St. Gabriel's special school, which I already mentioned at the outset of my contribution. The Minister of State, Deputy Rabbitte, was kind enough to visit there with me a number of weeks ago. With the conditions in that school and the circumstances it is in, with the most vulnerable students we have in that area, that school needs to be looked at, either by the Department of Health or the Department of Education and Skills. A case needs to be made for St. Gabriel's special school to get a permanent home. The previous speaker, Deputy Murnane O'Connor, mentioned that the day of prefabs is gone, especially for our most vulnerable children because they do not have rooms with adequate facilities or adequate toilet facilities. That is an acute setting that needs to be looked at.

Deputy Rose Conway-Walsh

Most of my contribution is confined to transport. Coming from a rural area, the Minister of State will really understand the situation with transport. I refer to the issue of multiple schools using the same transport. Parents are asking me why there are different rules for other people who are being transported than for really vulnerable children. I am really in fear of one of those children catching Covid-19 and it having a detrimental impact on those children. This needs to be sorted out as a matter of urgency. I know all of the other issues are urgent but that is particularly urgent.

Transport and access to adult day services are terrible because it is almost worse to have those services and yet to tell people they cannot go to them because there is no transport. Transport has fallen between the stools and nobody will take responsibility for it. There are solutions to it because great work is being done by Rural Link and so on. If the HSE would instruct or enable Rural Link to be able to do this job, that would solve the issue. It needs to be fixed because people in Achill trying to access services in Castlebar are being told they cannot access them. These parents and the people themselves have been fighting for years just to get into the limited services that were already available.

I want to ask the Minister of State about the mechanical physical restraints that are being used, particularly for autistic adults. I am talking about the buckle body system. I understand that everybody, including the workers, needs to feel safe but I am concerned about situations where there are workers in the front of a vehicle holding a key and the service user is in the back of that vehicle. What would happen in the event of an accident if someone did not have time to get back with the key?

A lot of the workers in these services are being asked to use their own vehicles. Two issues arise there. First, they have to pay the insurance and they will not get the job unless they have the vehicles. Second, with Covid-19, when workers are using their own cars, surely it cannot then be safe for vulnerable adults to use the same vehicles during the day and then go home and have those vehicles be used for the family or whoever? Surely there must be real dangers there of the spread of Covid-19? Will the Minister of State look at the issue of workers using their own vehicles?

There are many other issues I wanted to raise but I am running out of time. Could the Minister of State confirm the situation with respite care for me? What are the rules across the board with that? Nobody stood out and clapped for carers and there are carers who desperately need some day-time and night-time respite care to be able to continue caring for the people they love and have cared for over years. They just need a break so I ask the Minister of State to sort that out.

Deputy Holly Cairns

I congratulate the Minister of State on her appointment. I welcome change in this Department because it is much needed. I wish the Minister of State lots of luck and I look forward to working with her.

The past few months have been an incredibly challenging time for people with disabilities and their families. I refer to the issues of underlying health concerns, the absence of day and respite services for months, a lack of therapeutic services and uncertainty about work and the list goes on. The pandemic has highlighted the absence of a rights-based approach for people with disabilities, as well as years of underinvestment in social and healthcare services by the State. As too often happens in Ireland, family members and voluntary organisations have had to step in to fill the gap of the State’s shortcomings. If there is a single lesson we can take from the pandemic, it is the absolute need for a massive investment in disability support services, which are grounded with a rights-based approach.

At a meeting of the Special Committee on Covid-19 Response in July, representatives for the sector all highlighted how many people with disabilities are living in congregated settings. There are an estimated 2,900 people with disabilities residing in larger settings of ten or more people, along with the 1,500 in nursing homes, although they are under-65. All of these people have been put at unnecessary risk by the State during the pandemic due to their living arrangements. Article 19 of the Convention on the Rights of Persons with Disabilities guarantees the right to live independently in the community rather than in institutions. Successive Governments have failed to ensure the provision of this right. Mark O’Connor from Inclusion Ireland explained that:

A policy has been in place for almost nine years to move people out. It saddens me to say that up to this point people in these settings have had as good a chance of passing away in a congregated setting as being moved out to a community setting.

That is an incredible statement indicating the continuing and disgraceful treatment of people with disabilities. Dr. Frank Conaty, of the Irish Human Rights and Equality Commission, pointed out that throughout the restrictions residential settings had been essentially shut down, which confined these people without access to family. This has knock-on effects as many of these people need access to family as their immediate advocates. HIQA’s recent annual overview report on disability services in 2019 highlights both progress and issues in this sector. It identifies inappropriate living conditions, residents being at risk of abuse due to non-compliance with the basic requirements of safeguarding and practices which restrict basic dignity of people, such as not being able to access their own money independently.

It seems that people in need of independent supported living, in west Cork, for example, can only get it if they are elderly and even then it is after considerable struggle. This leaves so many people without options. One of my constituents is stuck in a psychiatric ward, despite being ready to leave, because there is nowhere else for him to go.

The pandemic did not create these conditions, it has merely highlighted their impact. I ask the Minister to prioritise the right of people with disabilities to live independently in the community. This will involve the provision of suitable housing and supports to enable people to live with dignity and appropriate autonomy, including considerable investment in homes, healthcare services and advocacy.

A horrific, ongoing case in Cork has shown what happens when this basic infrastructure is not put in place. A father and son have been living in an abandoned bus since being evicted from their one-bedroom apartment. Patrick Walsh is caring for his son Adrian, who suffered a brain injury after an accident. Patrick has to stay with Adrian, as he suffers from blackouts. They have fitted the bus out with a small kitchen and beds. They have been living there for four years without running water, electricity or a toilet. State authorities and the council are aware of the situation. I know this session is about statements, but I would love if the Minister of State could intervene immediately in that situation because it is so heartbreaking. It is in the newspapers today and on the radio.

We have all received countless messages about the full reopening of day services. Research carried out by Inclusion Ireland shows that the closure and restriction of these services is having a significant impact on mental well-being. Some 38% of respondents indicated an increase in behaviours of concern, while 36% indicated an increase in loneliness and 33% indicated that their family members had increased anxiety. It is essential that the Government's living with Covid-19 strategy includes clear provisions for the full reopening and provision of day services.

Those in the sector have also raised concerns about the redeployment of senior HSE therapists to work as Covid-19 testers and contact tracers. Therapists, such as speech and language therapists, physiotherapists and occupational therapists, do vital work in supporting people who are born with or acquire disabilities. Additional staff should be recruited, instead of reallocating essential staff.

Finally, I urge the Minister of State and the Government to ratify immediately the optional protocol in the United Nations Convention on the Rights of Persons with Disabilities, which will provide formal mechanisms for persons with disabilities and advocacy groups to challenge the Government and the State and to hold those in authority to account to ensure the rights of people with disabilities are respected.

Deputy Michael Moynihan

I am glad to have the opportunity to speak in this debate. I welcome the Minister of State and I thank her for making one of her first visits to service users in St. Joseph's Foundation in Charleville, where she met the parents of service users at the end of July. I think she got a broad sense of the challenges facing not only St. Joseph's in Charleville or the parents in Duhallow in north Cork, but those throughout the country.

There are several issues in the disability sector. In recent years, the sector has been underfunded and forgotten. In many of the contributions I made in the last Dáil, I sought further respite for families, as well as assessments of need etc. I therefore welcome this morning's announcement. Regarding assessments of need, we must look at the highly trained and highly qualified people in the HSE and try to ensure that they are not taken away from their fundamental duties in assessing children for special attention and special services. We should try to ensure that the assessment of need takes place at an appropriate time and as quickly as possible because many people are struggling with extreme difficulty, especially in the early stages, and they are meeting a brick wall.

This brings me to the HSE. St. Joseph's Foundation in Charleville - the Minister of State met the people there - spans Limerick, Cork and Kerry. Of the two sections in the HSE, it is easy to deal with one, but extremely difficult to deal with the other. It is one HSE and one national health service. When funding for the provision of services to people with intellectual disabilities is being sought, people go to one section, where it is possible to meet with people. Alas, people find the other section covering Cork and Kerry extremely challenging to deal with. I am at a loss as to why that is the case. It is fundamental to how we treat section 38 and section 39 organisations. We have a briefing in the morning with the HSE South and I will be raising this issue then, because service providers such as St. Joseph's Foundation, in my area, the COPE Foundation and others are doing extraordinary work.

I do not know how this was arrived at, but there was a 1% efficiency cut in the last budget. Where were these efficiencies supposed to come from? There is penny-pinching here and penny-pinching there and we must ask if the HSE is trying to get rid of these voluntary organisations and bring all these services under the umbrella of the HSE. Is that what the HSE is at? I would urge caution on that approach, because the voluntary organisations have the voluntary ethos, commitment and brand that allows them to fundraise within their communities. It is important that the integrity and identity of those organisations is maintained and that we support these section 38 and section 39 organisations.

Regarding the section 39 organisations and the matter of insurance, they are providing services to users and their families on behalf of the State. I believe funding regarding those organisations should be included within the remit of the State Claims Agency. Some of the service providers have had astronomical insurance costs of more than €500,000 and that is draining their resources.

Where are we today regarding disability services? Families and service users are faced with major challenges and have not been able to avail of services since the first week in March. The service users have found it very difficult and challenging and many have regressed. Many people in this situation thrive on routine and have built up friendships and a community within their organisations. It has not been possible, however, for the organisations to facilitate the service users recently. The services are now, slowly, reopening for one and two days a week.

The Minister of State spoke passionately about this subject when she was in north Cork. There should be a commitment that these services will be open five days a week. Transport must be provided in the way that it used to be. We must dig deep to give the service users and their families the best possible experience. Transport is hugely important and is also a huge cost, but it has not been provided for the last six months because the buses have been off the road. Transport must now be provided for the morning and the evening. Regarding day services, many people are looking at community day services having portals or hubs in different locations, but the services provided must be the same in each location. These services have been built up and the users have been happy and content with them. We must ensure that the same services are provided now.

We must take onboard several of the points made today, such as the issue of the UN Convention and all of that but I think we should look to the service users and their families in our State who are under enormous pressure and have been under enormous pressure in the past couple of months. It is 10 September and we must ask how we can get the best services for those people in the days and weeks to come.

I am referring to the provision of a full five-day service and a full transport service. A full service might not be possible now, because we know the challenges faced in every sector because of the Covid-19 pandemic and related restrictions. I compliment the Minister for Education and Skills, Deputy Foley, and the Department of Education and Skills for getting the schools reopened. The same urgency must be applied in the approach to the provision of services to people with intellectual disabilities and their families. They have suffered enormously in the last six or seven months.

It is high time that we agreed to grasp this issue. There is no doubt that this is a challenge and there is huge pressure involved. It will be a challenge to get all the service providers up and running across the country. There had been a funding shortfall heretofore.

I am glad that the Minister of State reversed the 1% efficiency cut. I do not know how anybody in his or her right mind could have classified that as an efficiency cut because these organisations were on the breadline. I compliment the Minister of State on the meeting she had just after we met in Charleville at which she got that 1% cut reversed because it was a lifeline to the service providers, families and service users. We must get full day care services back and provide transport for these families because many people are getting elderly and rely on public transport to access services.

An Leas-Cheann Comhairle

Go raibh maith agat, a Theachta.

Deputy Michael Moynihan

I apologise for going over my allotted time but these are important issues.

Deputy Darren O'Rourke

I will continue in the same vein as the previous speaker by talking about the need to ensure that transport services are in place. St. Ultan's special school, Navan is served by 22 buses, all of which are close to capacity. Twenty of those buses carry students for St. Ultan's and other schools, including St. Mary's special school. Issues in that regard need to be acknowledged and addressed as quickly as possible. I have been contacted by numerous parents who have expressed their genuine and earnestly-felt concerns. They need to be addressed.

The issues extend beyond that and I encourage the Minister for State to contact her colleagues in education and transport about the constraints on school bus transport. Some 120,000 children were carried on buses last year, including 14,000 with special educational needs. Only 97,000 places have been allocated this year, a reduction of 23,000. That urgently needs to be tackled. My colleague, Deputy Ó Laoghaire, in conjunction with me and Deputy Conway-Walsh, has submitted proposals for tackling that matter. This obviously has clear implications for mainstream and special schools, children with additional needs, and people who are attending day services. It also has implications for the broader transport network. I have been contacted by numerous people who are delighted that services are beginning to open up again albeit that service is patchy and partial. The lack of transport services is a significant block. We must get back to a place where those services are provided again.

I thank the Minister of State for meeting a constituent of mine, Ms Laura Campion, who has been advocating on behalf of her sister. As we have heard from other Deputies, the Minister of State is engaging with groups but we want to see as much progress as possible. Particular concerns have been raised about contingency planning. Nobody wants to go back to lockdown so let us see the plan to continue opening up services and providing respite for families. It is not an issue about day services but it has been reported that some people have experienced significant difficulty in accessing respite, which is of concern.

I will speak about access to day services for adults who live in a residential setting with my remaining few seconds. Service providers have stated that service users in residential respite will be unable to attend their day service under current HSE advice. That is of considerable concern and the gap needs to be addressed.

I wish the Minister of State well in her efforts to tackle those problems.

Deputy Richard Boyd Barrett

Even before Covid-19, supports and services for people with disabilities and their carers were woefully inadequate. The equality that is demanded by the UN Convention on the Rights of Persons with Disabilities, UNCRPD, is not, and was not, a reality. For the past six months, the hardships that all of society has gone through have disproportionately fallen on those with disabilities and carers, with the closure of day care services, schools and so on. While it is welcome that day care services are now reopening, as they will not reopen at full capacity a hell of a lot more must be done.

There needs to be serious acknowledgment of carers. Carers are paid €230 for doing a huge State service. That amount is derisory in the first place, but the double burden that carers have carried over the most recent period means that a bonus payment should be made to those carers to acknowledge the extra service they have given in recent times. I make that direct call to the Minister for State and the Government. We rightly praise our healthcare workers for what they have done but we often forget about carers and the heroic efforts they have made over the recent period.

The Government has acknowledged that the pandemic unemployment payment, originally proposed to be €203 per week, was not enough for people and had to be raised to €350. That has implications for the disability allowance payment because if we rightly recognised that €203 was not enough for people who lost employment as a result of the pandemic, by the same token it is not enough for people with disabilities, particularly when they have significant additional costs such as paying taxi fares and all sorts of other things. We must look at increasing that disability payment for carers.

I would also like to mention the campaign that Access for All Ireland has waged and pay tribute to Sean O'Kelly and Bernard Mulvany for highlighting the unacceptable failure to properly maintain lifts and ensure access to the public transport system. It was a victory for the campaign that a welcome additional €3.3 million was announced to fix 12 stations in Dublin. That is welcome but still leaves many DART stations with serious problems. That money will not be translated into changes until 2024. Six lifts were out of service on the DART line yesterday. The day before, five lifts were out of service. The day before that, six lifts were out of service. A similar pattern was repeated in the weeks before that. It is not enough that the work will be completed in 2024. We need all of those lifts to be properly maintained in order to ensure that we get real access, and equality of access, to public transport for wheelchair users, people with mobility problems and so on.

I will speak briefly on the school transport issue. I have said the following to others in the past and I will say it to the Minister of State now. It would be a win-win situation if the Minister of State engaged with some taxi drivers whose employment opportunities have significantly diminished. A number of taxi drivers are already involved in school transport and many others are crying out for work. As we have said, there is a significant deficit in school transport, in particular serving children with disabilities and special needs where there may be concerns about Covid-19 and so on. I suggest that the Minister of State engages with the representative organisations of taxi drivers to discuss how they could assist to address the school transport issue, particularly for those with disabilities. It would also be beneficial for a cohort of workers who are in real trouble and need additional support.

The Minister of State's remit is partly within the Department of Health but she also is covering a whole range of other issues. It seems to me that given our commitments under the UNCRPD, the issue of disability should be taken into the Department of the Taoiseach. That could allow a cross-departmental approach that is needed for the disability sector.

Deputy Joe Flaherty

I am sharing time with Deputy Christopher O'Sullivan. I wish the Minister of State well in her new role and commend her on the significant body of work that she his achieved to date and, specifically, today's announcement on funding to clear the backlog of young people waiting for an AON. It is much needed and I hope, in respect of my parish and county, that it will enable the Phoenix Centre in Longford, which operates a special needs unit, to return to optimum capacity. A number of staff are swabbing in Covid centres and it is important that this funding will facilitate their return to mainstream duties.

I will hone in on a couple of local points specific to St. Christopher's Services in Longford. It employs 220 people with a range of residential and day care facilities. When lockdown kicked in, unfortunately, 12 of the day care staff had to be redeployed to cover residential settings. As a consequence, the service is now catering for, at best, 55% of its day service users and those users are only getting a limited service. I have exchanged correspondence with the Minister of State about this. To expand day service provision to other families, the centre will need to repatriate 12 staff, but that will come at a cost in the region of €580,000. The reality is that without that additional funding the centre will not be able to provide a full day care service. My colleague, Deputy Moynihan, spoke very passionately about how we need to get back to a full resumption of day care services, and that means activating transport services, getting everybody back and providing the services that people need. The reality is that service users are suffering in isolation. We need to get them back into services. As I have outlined, that will come at a cost. We have to realise that this cost can, and will be, discounted in the context of the well-being of those people when they get back into a familiar setting.

The backbone of the St. Christopher's organisation is its 220 staff. The Minister of State will be aware that it is a section 39 organisation. We have had a number of conversations about this, but she will know that a festering issue for this and many similar organisations has been the fact that since 2013, St. Christopher's has been unable to pay or award its staff their much deserved increments. This issue has to be addressed because this wonderful facility is struggling to retain and recruit staff. Over the past year, it has lost 20 of its most experienced and capable staff. Sadly, many have gone directly to HSE facilities, which is cruelly demoralising for management but also colleagues who have remained in St. Christopher's.

The Minister of State has visited many facilities. On behalf of the staff and management in St. Christopher's, I extend an invitation to her to come and visit the facility, as well as the Phoenix Centre in Longford. When she visits them, she will realise their important place in the hearts of the people of Longford. I look forward to welcoming her in the coming weeks.

I am also very anxious to get clarity on the transition of a young service user in St. Christopher's to adult day services who has been with the service from a very young age. He started in the Holly Green crèche and is delighted to have progressed through the service. He has a great affinity with St. Christopher's and the staff, and it has been a huge part of not only his life, but that of his entire family. The Minister of State has ring-fenced funding for the transition of this young service user and a number of his peers around the country to adult services, but it is important that she impresses upon the HSE that this transition needs to happen in the short term, if not immediately. The reality is that this young man has seen his siblings return to school and is, unfortunately, simply unable to comprehend why he has not been able to return to his beloved St. Christopher's.

I refer to a second service user about whom I have conversed on a number of occasions with the Minister of State in recent weeks. A 48-year old service user is currently in a facility in Mullingar. His parents are in their 80s and he is undergoing dialysis. It was always the family's expectation and desire that their son be transferred back to St. Christopher's in Ballymahon as it is much more convenient for them. They live approximately eight miles away and want to be close to their son, particularly as the winter months set in.

An Leas-Cheann Comhairle

Deputy, you are colleagues so I am not sure how you are sharing time.

Deputy Joe Flaherty

The family and I understood that a bed is available in Ballymahon. I urge the Minister of State to try to expedite that transfer.

An Leas-Cheann Comhairle

I am sorry to interrupt. You did not indicate the breakdown of time.

Deputy Christopher O'Sullivan

I understood we had four minutes each. I will have words with Deputy Flaherty later. I thank the Minister of State. I commend the Minister of State on the passion she has brought to this role. It is clearly an area she is incredibly passionate about and she has started off in the right vein. The reversal of the €20 million cut was widely welcomed by service users and voluntary groups. Today's announcement of funding of €7.8 million for early assessments has been welcomed by everyone I have spoken to.

Every sector has its issues. Like Deputy Flaherty, I wish to discuss voluntary groups and services for people of all abilities. There is an issue with the recruitment and retention of staff. CoAction West Cork is an incredible facility that provides services for 200 adults and 800 children of a variety of abilities throughout west Cork. It is a phenomenal service. I have visited the centre in my home town of Clonakilty on numerous occasions, including once as mayor of County Cork. It was an uplifting experience. I received a warm welcome and interacted with service users. To see the interaction between staff and service users, the supports they got and the relationships developed was incredible. It was phenomenal to see at first hand the importance of the service. Like other Deputies, I would love to extend an invite to the Minister of State to visit the Clonakilty service, and other CoAction centres dotted throughout west Cork to see the incredible service they provide.

CoAction, like many other organisations that have been mentioned, is under pressure in respect of the recruitment and retention of staff, which comes down to the old chestnut of section 39 workers who have not had their pay restored in line with their counterparts in section 38 organisations. A perfect example of what is happening at the moment is the fact that, due to Covid, CoAction is slightly realigning its service. It is moving towards a hub model and has 16 or 17 hubs dotted throughout west Cork. It will have to recruit approximately 30 staff to provide that service. The bottom line is that they cannot because staff are going to the HSE and private nursing homes, and are not attracted to the terms available in CoAction.

That needs to change because at the end of the day it is service users who suffer. That is who we are looking out for here and if we can recruit and bolster staff and increase the number of health professionals and other staff in CoAction, we will see phenomenal results. I ask the Minister of State to please come to west Cork and see for herself what is happening.

Deputy Ruairí Ó Murchú

Is it possible to have an exchange with the Minister of State?

An Leas-Cheann Comhairle

No. It is a session for statements.

Deputy Ruairí Ó Murchú

I realise that. If I do not ask-----

An Leas-Cheann Comhairle

The Minister of State can reply at the end of the debate. She has ten minutes to reply.

Deputy Ruairí Ó Murchú

Okay. I congratulate the Minister of State on her appointment and wish her well in her endeavours. Like many other issues in the State, we would like to start from a different place. We all know the difficulties that faced family carers prior to Covid, such as the requirement for respite and, in some cases, residential services, which were not always necessarily available. The history of the State in recent years has involved the outsourcing of some of those services.

I would like to bring to the attention of the Minister of State an issue that came up about residential services in County Louth. They have been told that some of the people who stayed with them had tried to access new dental care services and discovered that the dental treatment services scheme, DTSS, they had used is no longer being operated by their dental providers. We had heard about this happening to medical card holders, but this affects a specific cohort of people with intellectual disabilities living in residential settings.

They had been told that Louth community care services would be able to deal with them. I received an answer from Louth community care services, which came directly from the HSE, in which they indicated that owing to a backlog, resource issues and additional difficulties they are experiencing, they would not be able to deal with anything other than medical emergencies. This needs to be addressed across the board as regards dental services because it is deeply worrying. This cohort of people and their families have enough difficulties and do not need the added burden of having to pay for dental services or being unable to access such services.

I have spoken to a number of family members who are delighted that services have opened up. These are people who use day services such as those provided by the Venegas Centre in Dundalk, which is operated by the St. John of God Foundation. The families greatly welcome the opening of services and are now getting home based services. Many of those who previously had 30 hours of service per week are now getting between ten and 12 hours of service each week. While the situation is much better than it was a couple of months ago, the issue needs to be addressed. I hope the Government, when it sets out its nine-month plan, in which the Minister of State will obviously play a part, will take this into account and provide a roadmap that will include a service for these people that will be able to operate in the Covid-19 world in which we now live. These people require services. They are providing a great service not only for their families and family members but also the State by saving it a large amount of money and resources. We need to play our part. If there is a requirement for further resources, whether for buildings or staffing, they need to be provided as soon as possible. If the Minister of State answers those two questions, I would be very grateful.

Deputy Verona Murphy

I wish the Minister of State all the best in her new portfolio. I have no doubt that, like any woman, she will make an impact.

Some 13% of Irish people live with disability. When we talk about disability we must include all of those who are suffering from a disability, be it mental or physical, profound or otherwise. Disabled citizens have constitutional rights just like the rest of us. For them to adequately or at all benefit from these rights, they need supports. They have a right to equality but equal treatment does not give true equality to disabled citizens. We need to move towards Aristotle’s version of equality, which does not mean treating all citizens the same, as that only gives uniformity. We must give our disabled citizens, as best we can, the supports that puts them on the same level or playing field as those who are not suffering from a disability. While it is accepted that this comes with a financial cost to the State, what about the cost borne by these disabled citizens and their families who, without fail, go above and beyond to give their disabled children and siblings the best possible chance of coping with their disability in their day-to-day living? They need State support and they have a right to it. Regardless of what it costs, these citizens have a right to the supports which, it appears, are being systemically removed, sometimes with the Covid-19 emergency being cited as the reason. This is not acceptable. The State has obligations towards its disabled citizens, not least flowing from the Constitution although they also flow from European and international human rights treaties.

In April 2018, Ireland ratified the UN Convention on the Rights of Persons with Disabilities. Under that treaty, Ireland has a duty. It is our duty and that of the Government to advance and implement the convention’s provisions, which include empowering persons with disability to live self-directed lives of their own choosing. Basic civil and political rights for all are guaranteed under the Constitution. During the current Covid-19 emergency, disabled citizens require more supports, not less.

I will tell a little story about someone who called me in floods of tears at 11 o’clock last night. I supplied the details of the story to the Department this morning and with respect to the lady’s family, I will leave out the names of the individuals involved. I was contacted as I said by a woman who was in floods of tears. Her sister attends a special needs facility in Dublin. She has severe cerebral palsy, is wheelchair bound and requires 24-hour care. She is non-verbal and requires assistance with all aspects of life, including feeding and eating, and all needs. Her parents, who are in their 70s, are her full-time carers. Before Covid-19, she attended a facility, a large adapted house in Dublin with seven other residents with similar needs, five days a week from 9 a.m. until 3 p.m., with respite until 7 p.m. on Wednesday and Thursday. Every so often, she was offered weekend respite. The service was completely shut down in March and did not resume until six months later, some two weeks ago. She is now attending two days a week and moving to three days from 15 September. Following a recent meeting with the chief executive of the facility, which took place last Tuesday, her parents were told that their daughter's full-time service would not resume and she would only be offered three days a week for the foreseeable future. In addition, there would be transport for one day a week only and no respite would be offered, whether at weekends or late evenings. This is extremely difficult for the family to accept. Their aim is to give the best quality of life, which they have achieved over the years, but the parents are in their 70s. As the Minister of State is aware, this family are saving the State a great deal of money and are not being given any credit for doing so. They have been informed that the reason for the cut in services is primarily the need for social distancing. What makes no sense is that the facility had seven day residents and this has been reduced to four, all of whom are wheelchair bound and unable to leave their wheelchairs unassisted. While the facility has reduced the number of day residents to four, it has doubled staff numbers. I do not understand this. Surely a different approach should be taken to the most vulnerable in society. Their care should be a priority for the HSE and Government.

Schools have reopened, matches are being played, shopping centres are open and draft guidelines for the pubs are ready to go but the most vulnerable people in our society are being left behind. The Government may well be accused of being in breach of an international treaty, namely, the UN Convention on the Rights of Persons with Disabilities. It will affect the most vulnerable in society if we allow this situation to remain unchanged. I hope the Minister of State will respond to me on this matter as soon as possible.

Equally relevant is a case in New Ross, County Wexford, about which I have also been in touch with the Minister of State. A service provider, Cumas New Ross, has informed all of its 104 service users that no transport will be provided for them in future. Everybody who spoke today has raised the same issue. I ask the Department to at least consider the possibility of using the Irish Rural Link service. It should produce a roadmap for addressing this problem because it appears to be an issue all over the country.

I invite the Minister of State to visit New Ross at the earliest opportunity to see the facilities and meet service users and providers.

Deputy Brian Leddin

I will speak about mobility impairment. We do not treat disabled members of society fairly. There is much evidence to support this claim but I want to focus on how we have failed to create towns and cities that all of our citizens can get around and enjoy. We park vehicles on footpaths. We allow dogs to foul our streets and do not clean up after them. We install gates that people with disabilities cannot get through.

We tolerate these things individually and collectively and that makes life more difficult for those who have mobility impairments. When it comes to our commitment to providing quality, universal access infrastructure our track record has been lacklustre at best. In doing so, we are showing a systemic disregard for our fellow citizens.

The United Nations Convention on the Rights of Persons with Disabilities was ratified by the Irish Government in 2018. The National Disability Authority states:

The purpose of the Convention is to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. It applies established human rights principles from the UN Declaration on Human Rights to the situation of people with disabilities. It covers civil and political rights to equal treatment and freedom from discrimination, and social and economic rights in areas like education, health care, employment and transport. States which ratify the UN Convention commit themselves to delivering civil and political rights to people with disabilities, and to progressive realisation of social and economic rights.

It is time we embraced the United Nations Convention on the Rights of Persons with Disabilities. We must ensure that people with disabilities have the right to access their own community. We must give a clear signal of intent as to where our priorities lie and that we intend to design our public spaces so that they are fully inclusive for all members of society. We need to stop constantly having to retrofit our public realm to be accessible as an afterthought.

People with disabilities walk and cycle too. People without power in their lower limbs can use hand cycles. People with conditions such as multiple sclerosis or Parkinson's disease can often find it easier to cycle rather than walk. Every person has abilities, and every person has limits to their abilities. If we make sure that our streets are designed so that they are open and accessible to people with disabilities, they will be open and accessible to us all at all stages of our lives. Designing our streets to allow people using wheelchairs to move safely and comfortably around would allow parents pushing buggies to move safely and comfortably around also. It will allow a footballer who has broken her leg and is on crutches for months to get about safely and comfortably. If we design for people with disabilities we will have villages, towns and cities that benefit us all at all stages of our lives.

High quality, inclusive, active-travel infrastructure is infrastructure that improves people's opportunities to access employment, public transport, education, green spaces, health services and social amenities. Walking and cycling provide opportunities for social interaction for people to meet and greet each other. We have seen during this pandemic the importance of social interaction. It helps combat social isolation. It helps build communities. Now, more than ever, in the face of a pandemic, a global recession and a climate and biodiversity crisis, we need to ensure that we have strong, cohesive communities. Allowing more people of different abilities access and engage with our public space enriches our society through diversity.

In the middle of a public health crisis we need to consider the impact of our streets on our public health. I urge local authorities around the country to filter through-traffic from town centres and build quality walking and cycling networks to allow people to be physically distanced while remaining physically active. We all know the importance of physical activity to maintain and improve our physical and mental heath. We cannot continue to put barriers in front of people with disabilities so that they are excluded from doing the same. With sedentary lifestyles and lack of access to physical activity, people with disabilities can often start with one impairment and develop others. Disabled people have shorter life expectancies. We need to do more to protect their health.

The Design Manual for Urban Roads and Streets was published jointly by the Department of Transport, Tourism and Sport and the Department of Housing, Planning and Local Government in 2013. It is a very good document which contains within it many of the important design principles and fundamentals which will greatly improve mobility for all our citizens. DMURS, as it is known, is mandatory guidance, that is to say that all local authorities must follow it when designing a new public realm or making any interventions to an existing public realm. Regrettably, it is widely ignored.

It is not enough to have good guidelines. We must have adherence and implementation. It is time we created the role of disability officer in our councils, qualified personnel who can access projects for their alignment with the guidance and with the needs of those who are mobility impaired.

This Government has committed to funding walking, cycling and mobility infrastructure to ensure that many more people can choose to walk or cycle in their communities and to improve dramatically modal shifts to sustainable modes of transport. Active travel has been under-funded for far too long. All across the country, local authorities are implementing active-travel infrastructure. We must ensure that this active-travel infrastructure is fully inclusive. We need more continuous footpaths with level surfaces. We need extended pedestrian crossing times. We need mobility lanes wide enough to accommodate different types of bikes and the provision of disabled bike parking. We need to be ambitious about the design of our streets.

To ensure that active travel in Ireland is fully inclusive, we have to look beyond infrastructure. Financial supports are available for adapted cars for people with disabilities but adapted cycles can be prohibitively expensive. I would welcome an expansion of the current successful bike to work scheme that the Green Party introduced to ensure that all members of our community - disabled people, the unemployed, students and our elderly - can avail of the scheme. The July stimulus included an expansion of the scheme to include ebikes. I would welcome its further expansion to include adapted cycles also for people with disabilities.

We must bring about a sea change in our attitudes to people with disabilities and everyone must play their part. A zero-tolerance approach to parking on footpaths and in cycling lanes, which disproportionately affects people with disabilities, is required. We need traffic wardens and An Garda Síochána to enforce that. We need local authorities, planners and engineers to ensure that our public realm is inclusive to everyone and that our active travel infrastructure allows everyone to get around their community safely and comfortably.

An Ceann Comhairle

I thank Deputy Leddin. We move now to Deputy Carol Nolan, who is sharing with Deputy Mattie McGrath.

Deputy Carol Nolan

I begin by wishing the Minister of State, Deputy Rabbitte, the very best of luck and every success in her new role. I begin on a positive point by noting the funding for the assessment of need has been put in place. We have the worst waiting list in Laois-Offaly so I am hoping that progress can be made in that regard.

The backlogs in terms of children on speech and language therapy and occupational therapy waiting lists is a very serious problem. Currently, 1,118 children have been waiting in excess of 12 months for occupational therapy while 159 children have been waiting in excess of 12 months for speech therapy. I am very concerned about that as a former teacher who spent some time teaching children with special needs. This problem needs to be tackled. I have met parents of children with special needs such as Laois Offaly Families for Autism, and they have done fantastic work in highlighting the issue. I hope that we can get to grips with this ongoing problem once and for all because it is having an effect on children's well-being and also their education.

I want to raise the issue of people with disabilities and the fact that the effective closure of day care services is ongoing. The Minister of State, Deputy Rabbitte, replied to a parliamentary question of mine on this very issue in July but I stress that it is important that we get these adults with intellectual disabilities back into the day services as soon as possible. I have been contacted by many families worried about their loved ones who are regressing. It is a very serious issue and one we need to get to grips with quickly.

The Minister of State referred to the guidance to support the framework for the resumption of adult disability services that was published by the HSE on 8 July 2020. I ask the Minister for an update on the implementation of the framework for the resumption of adult disability services. Have any significant obstacles been identified and, if so, what steps are being taken to address those obstacles? I know the Minister of State will appreciate that these are vital links for families and for the service users themselves and the loss of them has had a very negative impact on many of the people affected. I also understand that the day services were meant to resume gradually during August and that the service providers are working to get all those services ready to reopen safely and in line with public health guidance.

I would like an update on that. I would be grateful if the speech and language therapy waiting lists could be tackled in Laois-Offaly.

Deputy Mattie McGrath

I too congratulate the Minister of State and wish her all the best in her very challenging and important role, which concerns disabilities of all kinds. We pay lip service to the disability sector and breach UN conventions regularly but we do not seem to care.

Covid has had a shocking impact on the capacity of those with profound disabilities, from young children right up to the elderly, to avail of services. I wish to refer to two cases in this regard, one concerning a young person, a constituent's daughter. She received a letter on 30 July 2020 stating she had been accepted by the Brothers of Charity. Her mother was delighted. The daughter finished in Scoil Chormaic, a great institution in Cashel, last March because of Covid and did a trial in Dún Aoibhinn in Clonmel, a wonderful house where she understood she would be getting a place in September. She did not get it however. She is 18 years of age, waiting at home, wilting away and regressing.

The other case concerns a man I know very well. He is 62 years of age. He attends Cluain Árann, as well as Cuan Croí in Tipperary town. This is a wonderful service but such services are all closed. The man cannot avail of a respite service in Cluain Árann every eight weeks. Cuan Croí is a wonderful place that I often visit but the doors are closed. All these places are locked up. We find that skilled people from the HSE who are needed in these services are out doing contact tracing although thousands of people signed up to Ireland’s cause and offered help. The HSE is utterly dysfunctional. The Minister of State knows that and was in opposition long enough to know it.

The disability service is so sensitive. It is so important for the young people affected. I know them. Can one imagine being incarcerated? Can one imagine not being able to go off in the bus with the carers and driver, who are part of a wonderful community, to and from a day services centre? Their being able to do so would allow for interaction with others. For the service to be closed up since March, thus locking out those in need of it, is criminal. While we must listen to the advice of NPHET, we must also be cognisant of the impact on people's lives, including their mental health. Consider the mental health of the families of those in need of services. They see their loved ones suffering and cannot do anything about it. I appeal to the Minister of State, the Minister and the Taoiseach to say to NPHET that they heed its advice, that its advice is important and that it is qualified to give it but that they have to strike a balance overall, accounting for the impact on mental and physical health and on those with special needs. The latter cannot just be sidelined and marginalised.

Deputy Marian Harkin

I formally congratulate the Minister of State on her new and most important role. I know she will bring intelligence, empathy and real commitment to her work because she is a woman who likes to get things done.

First, I ask for the Minister of State's strong support so the forthcoming budget will provide adequate resources to support people with disabilities. Consider some of the headline issues, including the implementation of the UNCRPD. For many, that is just a document. The reality of it is that we have to have rights-based entitlement to services. Housing is an issue for many people, no less so for people with disabilities. The latter have to be part of any housing plan to speed up deinstitutionalisation and independent living. Access to employment is important for all people, including those with disabilities. We should examine the mainstreaming of the Ability programme. I am glad to see the Minister of State is nodding her head about it. We also need to ensure there is accessible travel. These are not entirely the responsibility of the Minister of State because it is also a question of co-ordinating with other Ministers. The ratification of the UNCRPD involves a whole-of-government approach, and the upcoming budget can start the process.

I have two questions for the Minister of State. The first relates to the resumption of adult disability services. We are all aware of the situation and of the Enough is Enough campaign, which brought its case to the street outside the Convention Centre Dublin last July. At the time of the publication of the HSE guidance on the resumption of services, I was very critical of some of the top-down, bureaucratic proposals and the language used. I am pleased, however, that genuine efforts are being made at local level to get services back up and running. That is a testament to the local staff and organisations. I am not saying that because it sounds good but because some parents have said it to me. There is, however, only a partial resumption. Many still do not have adequate services and transport is a major issue. Does the Minister of State have an indicative timeline as to when more of the services will be resumed? The parents of adults with disabilities are so grateful to get anything. Once a service starts again, they are grateful but we really need to consider the educational needs of all of our children, not just the ones who have gone back to school recently.

My second question relates to the huge waiting lists for various therapies for children, including those with disabilities. These therapies include speech and language therapy and occupational therapy. I believe there may be a move to use the National Treatment Purchase Fund for obtaining psychological services. That is good news if true, and perhaps the Minister of State can speak to it, but it would be great if the initiative could be enlarged to include speech and language therapy and occupational therapy. If the Minister of State cannot respond today, she might respond in writing.

I have two final points. Deputy Boyd Barrett spoke earlier about a payment for family carers who took full responsibility for adults with disabilities during the Covid crisis. It is my understanding that they did not get anything extra. I know it is hard to ring-fence this kind of thing but maybe a once-off payment through the budget or some extra respite or recognition would assist. Could the Minister of State put her mind to it? It is not easy but worth thinking about.

The Minister of State mentioned section 39 organisations. In this regard, I have spoken to many in my constituency, including representatives of North-West Parents & Friends Association and Acquired Brain Injury Ireland. I heard the Minister of State say there is a need to relieve all section 39 organisations of their obligation to achieve the required 1% efficiency target. I am pleased to hear that.

The lower pay scale for section 39 staff since 2012 is just not acceptable. The staff are expected to provide the same services as their colleagues in the HSE on a much lower pay scale. That means attracting and retaining staff comprise a huge issue. The most important point is that of fairness and equity. I am sorry to bombard the Minister of State. It is my first time speaking on this. I have raised many points but, as I stated, I know the Minister of State is a woman who likes to get things done.

An Ceann Comhairle

Would the Minister of State care to respond to the debate?

Minister of State at the Department of Health (Deputy Anne Rabbitte)

I will respond to the debate and to the one Member who has managed to stay in the convention centre to hear my response. Correct me if I am wrong, a Cheann Comhairle, but is there anybody else other than Deputy Harkin here to hear me respond?

An Ceann Comhairle

The Minister of State at the Department of Health, Deputy Feighan, is present.

Deputy Anne Rabbitte

I am sorry.

Normally when I am taking notes, I believe it is important to respond to everybody who has taken the time to come in to raise their issues. I have made many notes on the valuable contributions made. It is regrettable that the contributors have not stayed here to listen to my answer.

I will begin with Deputy Harkin, who just raised issues with me. I will respond directly to her before delivering my speech. She raised two issues, the first being the resumption of the adult day services. I could not agree more with her on this. I have met many of the families concerned and noted they were absolutely delighted that there has been a resumption of the services. The Deputy is quite right in saying this is down to the staff and providers of all the services. They are putting their shoulders completely to the wheel. I must also acknowledge the collaborative work done since the outbreak of Covid by the Department, the HSE, the providers, the families and service users.

One of the earlier contributors spoke about a breakdown along the way. However, if Covid-19 did anything within the disability sector, it was to create an opportunity for services to work together more closely with one focus in mind, namely, protecting service users. Since becoming a Minister of State, I have met the Department and the HSE and they want that collaboration to continue. That is why I have support in relation to the 1% efficiency target and the €7.8 million allocation. There is a wide recognition in both the Department and the HSE on the need to support the frustrated families now. When we talk about the resumption of adult services, Deputy Harkin is right that it is not perfect. Services are not by any manner or means back at 100% or operating at their normal level of five days a week.

The most important point to remember is that Covid-19 has not gone away. Every provider is unique. All the service users who attend them are unique individuals with different underlying conditions who need particular care plans. The challenge the providers are tasked with meeting is to protect our most vulnerable as they return to the service. The objective is to ensure we have a comprehensive resumption of services. The whole costing behind that resumption of services is being discussed. It is part of the winter plan which has been extended on both sides, its start and finish. Part of that plan involves providing an additional 813 staff and the extra accommodation required to ensure facilities are in place to allow as many people as possible to return to the adult services.

Transport, which was raised by almost every speaker, is also being addressed. We might not hit the desired requirement of funding but the issue is being addressed.

Deputy Harkin also raised waiting lists for therapeutic interventions and the National Treatment Purchase Fund. Budgetary conversations are taking place at this time. The first step we took this morning was to address the backlog in assessments of need. I would like to start by carving into the backlog of people waiting for speech and language therapy, occupational therapy and physiotherapy.

I am also aware that a high-level conversation is taking place to ensure people who deliver part of the network disability teams are recalled from contact tracing. I was aghast to hear a directive was sent on this. I have requested that these people are returned to their posts because there are children in need and we cannot have our most critical staff who are needed for interventions doing contact tracing. We should deploy staff from other sectors to do contact tracing. I have no problem in saying that.

The Deputy opposite, whose name I have forgotten, raised two issues. I will look into the dental treatment issue he raised. I do not have an answer offhand but I will investigate the matter for the Deputy. Will he prompt me on the other issue he raised?

Deputy Ruairí Ó Murchú

It was the reopening of services and I raised a specific service in Dundalk.

Deputy Anne Rabbitte

The other Deputies also raised vital points. I touched on transport. On funding for school leavers and those transitioning to adult services, the sum available is €12.5 million. That issue is being addressed by the different providers and through the school leaver programme.

One contributor stated there was no funding available for the reopening of adult services. A sum of €40 million was provided as part of the Covid-19 reopening which was in addition to the €484 million allocated for budget 2020.

There is a programme for Government commitment to ratify the optional protocol after reporting first cycle which I believe is due in December 2020. Additional funding is being sought for day services through the winter plan, which I explained to Deputy Harkin.

Transport is a huge issue all round. What I will do, having taken notes today, is discuss this matter with the Department and HSE. Where a service provided before Covid-19 is not being provided on the resumption of services during Covid-19, I will need to get a better understanding of that because I do not understand why a service has fallen. If a person is returning to a reduced service for two days a week, it is hard to comprehend that we are not able to provide him or her with the transport we provided pre-Covid. I will look into that. I have addressed assessments of need.

The carer's allowance is a matter for the Minister with responsibility for social protection, Deputy Humphreys. The Minister and I will certainly have a conversation on that.

A Deputy stated that this portfolio should have been placed in the Department of the Taoiseach. Decisions on appointments and where functions reside are far above my pay grade. At the same time, in my function as Minister of State with responsibility for disability, I am not afraid to talk to the Minister of State with responsibility for special education, Deputy Madigan, or the Minister with responsibility for transport, Deputy Eamon Ryan, or anyone else to ensure we join the dots. If anything, we have learned that cross-departmental work is often vital where disability is concerned because it cuts through Government. I would like to think I am a communicator and I will be able to deal with people.

One of the best speeches this evening was made by Deputy Leddin from Limerick. He articulated very well the challenges faced by people with disabilities in their active lives and in their day as they try to get around. When developing county development plans and doing remedial work in our local towns and villages, we should keep in mind how people with disabilities can access their route around their locality. That is important.

I thank Deputies for their constructive contributions to this afternoon's debate. I have listened and noted all points and I assure them, as I did earlier, that I will do everything within my capacity as Minister of State to improve the lives of those with disabilities. Across Government, a programme of reconfiguration of services has been under way to support people with disabilities to make the types of choices available to other adults in an environment that is as accessible to them as it is to everyone else in society and to support them to live the lives they want to lead. The recently published Programme for Government: Our Shared Future continues this theme of reconfiguration by making a number of crucial commitments and we believe it will deliver supports in a manner that promotes empowerment and improves quality of life.