Joint Committee on Health and Children díospóireacht -
Thursday, 19 Nov 2015

Disability Issues Update: Minister of State at the Department of Health

Vice Chairman

I ask members and delegates to ensure their mobile phones are switched off as otherwise they cause serious problems for broadcasting, editorial and sound-recording staff.

I welcome the Minister of State, Deputy Kathleen Lynch, and her officials, Ms Frances Spillane, Mr. Kieran Smyth and Ms Grainne Duffy. I also welcome Mr. Pat Healy, national director for social care at the Health Service Executive.

The main focus of the meeting is on providing the joint committee with an update on disability issues. It is important that we have an opportunity to engage with the Minister of State specifically on the theme of disability. In recent months the committee has done a lot of work on a range of issues in this area, including on proposals for a national vision strategy to incorporate deafblindness and community funding for people with intellectual disabilities. We are interested in receiving an update on the move away from congregated settings to more person-centred care. In our second session later today we will be meeting an umbrella group which represents different organisations that work with assistance dogs.

By virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by it to cease giving evidence on a particular matter and continue to so do, they are entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or an entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable.

I invite the Minister of State to make her opening statement, after which I will take questions from members.

Minister of State at the Department of Health (Deputy Kathleen Lynch)

I thank the joint committee for the invitation to attend to discuss disability issues. I appreciate its interest in this important matter. As the Vice Chairman indicated, I am joined by Ms Frances Spillane, Mr. Kieran Smyth and Ms Grainne Duffy from the Department of Health, with Mr. Pat Healy, national director of social care at the HSE.

The Government, statutory and non-statutory agencies which provide services for people with disabilities have been working towards the goal of enabling disabled citizens to live as independently as possible, with appropriate social, housing, employment and all other mainstream supports from the State. Our aim is to transform services to provide a model of personally chosen supports designed to enable the individual to live a normal life in society.

During 2015 funding of almost €1.5 billion is being provided for health and personal social services. It is important to illustrate the range and complexity of the services and supports this significant figure encompasses. Residential services are being provided for some 9,000 people with disabilities at more than 1,200 locations. These facilities range from large congregated settings to community group homes to supported independent living. Day services are being provided for approximately 22,000 people at 850 locations. Some 1,400 young people who left school and rehabilitative training programmes this year have received new services and supports. Respite residential support, amounting to 190,000 overnight stays, is being provided. The target for the provision of personal assistance or home supports in 2015 is 3.9 million hours. A variety of other services are also provided under the disability services programme, including non-centre-based respite care, early childhood and family support, community-based medical, nursing and therapy services, rehabilitative training, and aids and appliances.

I will outline briefly how disability services are supporting people with disabilities from childhood onwards and the major reforms taking place in children's disability services. Implementation of the HSE's national programme for progressing disability services for children and young people, covering birth to 18 years of age, involves a reorganisation of existing therapy services into geographically based, multidisciplinary, early intervention and school-aged teams. The key objective of the programme is to bring about equity of access to disability services and consistency in service delivery. There should be a clear pathway for children with disabilities and their families to services, regardless of where they live, what school they go to or the nature of the individual child's difficulties. Some €8 million in additional funding has been invested in 2014 and 2015 to fund 200 additional posts to support the implementation of the new model.

Improving access to children’s therapy services is a particular priority for the Government, not only in disability services but also in primary care. An additional €20 million was allocated in 2013 to strengthen primary care services and to support the recruitment of prioritised front-line posts, including more than 260 additional posts for primary care teams. Further funding is being provided in 2016 to expand the provision of speech and language therapy in primary care and to support the reorganisation and expansion of speech and language and other therapies under the progressing disability services programme. Full implementation of the progressing disability services programme is expected before the end of 2016.

This brings me to the matter of health-funded supports for young people after they leave school. Government policy is to enable young people with disabilities to develop the skills they will need to live independent lives to the greatest extent possible and to receive the supports they need in order to achieve this. Every year, young people finish their second level education and progress to the next stage in their lives. For most, the hope is that they will progress directly to further education, vocational training or employment. However, young people who have more complex support needs will initially rely on life-skills training or day supports provided by the HSE. Additional funding of €12 million was allocated by the HSE to meet the needs of around 1,400 young people who require continuing health-funded supports on leaving school or rehabilitative training this year. Some €6 million of this has been made available to provide services from September. The provision of services to these numbers of young people has, in recent years, posed a challenge to the HSE. When this year’s support requirements were identified, the cost of meeting those needs in full exceeded the amount available. I am pleased to say that an additional €1.5 million was added by the HSE to the overall allocation, making a total of €13.5 million full-year costs available to meet those needs. A further €1.5 million once-off capital funding was also allocated by the HSE for the provision of suitable buildings, premises and accommodation. There is an onus on us all to use the substantial resources committed to disability services throughout the public sector more effectively and efficiently and, most importantly, we must ensure that we are achieving real and significant improvements in the lives of people with disabilities.

Transforming Lives is the programme to implement the recommendations of the Value for Money and Policy Review of Disability Services in Ireland. This transformation of our disability services will mean that person-centred and individually chosen community-based supports will increasingly become the norm, which is a distinct move away from the group-based, often segregated approach of the past. People with disabilities will be supported to make the types of choices about their lives which are available to everyone else in society. This new approach will be underpinned by a more efficient method of assessing need, allocating resources and monitoring resource use.

We can see this person-centred approach being progressed by the HSE in the provision of day services, as outlined in the New Directions report on HSE-funded adult day services. Service providers are actively engaging in delivering services which have a person-centred focus, with person-centred planning now widely implemented, along with an increase in the delivery of community-based day services. Service providers are taking practical steps to support and actively engage with people with disabilities in community settings and are exploring new and innovative ways of doing this, including through a range of demonstration projects. An example of this is the Next Steps Project, a network of shared learning and support, set up by the National Federation of Voluntary Bodies, involving people with disabilities, their families and their key workers. A measure of its success is the fact that the project received an International Zero Project Innovative Practices award earlier this year at the United Nations headquarters in Vienna.

Person-centred planning also underpins the movement of people with disabilities from congregated settings into the community. In July 2012, the national implementation framework was launched to support the Government’s National Housing Strategy for People with a Disability 2011–2016. This continues the successful collaborative approach between the Department of Health and the Department of the Environment, Community and Local Government. The implementation framework reflects the recommendations of the mental health policy, A Vision for Change, and in respect of disability, Time to Move on from Congregated Settings - A Strategy for Community Inclusion.

The congregated settings report identified that in 2008, around 4,000 people with disabilities were living in congregated settings, which the report defined as residential settings where ten or more people with disabilities live together. I am aware that implementation of the report will introduce a huge change for people, including people with disabilities, their families, service providers, the HSE, various Departments, statutory bodies and representative organisations. To ensure that the needs of people transitioning from congregated settings are fully taken into account during the process, the model of care will be based on a person-centred plan.

The HSE has established a working group under the Transforming Lives steering group, which is developing an implementation plan for the process which will be rolled out at regional and local levels, in full consultation with the stakeholders. At the end of August 2015, there were around 2,800 people with a disability living in congregated settings. In 2015, the HSE prioritised the transition of people from congregated settings under its social care operational plan and the target was for 150 people to move. So far this year, 84 people have moved and the HSE will accelerate implementation of this policy next year.

The Government is very committed to the protection and safety of our most vulnerable citizens. We placed regulation and inspection of residential and respite care disability centres on a statutory footing in November 2013. The purpose of the regulations is to safeguard and support the delivery of person-centred care to vulnerable people of any age who are receiving residential care services and to ensure that their health, well-being and quality of life is promoted and protected.

Compliance with national standards for disability residential centres is now a requirement under the service level arrangements between the HSE and voluntary service providers. More than 1,000 inspections have taken place to date and the lessons learned from those inspections are continuing to improve the quality of services. People with disabilities and their families can be assured that this regulatory regime is being rolled out across all residential facilities.

I am aware that while the Health Information Quality Authority, HIQA, has reported evidence of good practice in the delivery of many residential services, where the support and care needs of residents have been prioritised, it is also sadly true that some of HIQA’s findings can make for difficult reading. However, those findings serve as evidence that the regulatory process works effectively and in the interests of protecting vulnerable people in the care of the State. They serve to increase our determination to ensure that the regulatory regime is used to shine a light on poor, out of date practice and make real and tangible changes in people’s lives.

The HSE is implementing a comprehensive change programme of measures to improve the quality of residential services for people with disabilities. The HSE has also appointed an independent person as a confidential recipient. This role supports the implementation of the policy launched in December 2014, Safeguarding Vulnerable Persons at Risk of Abuse.

I asked the National Disability Authority, NDA, to undertake an independent review of the impact of one year’s implementation of the registration and inspection system, focusing on the actual experience of those who have been involved in the inspection process. This has included service users and their families, the HSE, HIQA, service providers and organisations representing people with a disability. The NDA’s report is being finalised at present. It will be supported by an advice paper which will guide us in determining next steps in implementing the learning from their analysis.

Plans for 2016 will be set out in detail in the HSE’s service and operational plans. While we intend to move on implementation of our policy objectives, 2016 will involve consolidation of the existing significant resources invested in disability services. The actions for next year will include a major focus on ensuring we are getting the best value for that investment. This will include use of a service reform fund, recently established by way of agreement between Atlantic Philanthropies, the Department of Health, the HSE and the Genio Trust.

I welcome this opportunity to discuss the Government’s position on services for people with disabilities. Central to that position is the recognition that people with disabilities have the same goals, aspirations and abilities as every other citizen and the same right to participate in society and to make a contribution.

While we are making good progress in achieving a fully inclusive and equal society with appropriate services and supports for people with disabilities, we still have work to do. I assure the committee that I am firmly committed to that task.

Deputy Caoimhghín Ó Caoláin

I welcome the Minister of State, Deputy Kathleen Lynch, and her colleagues. In the area of disabilities, in particular, children with disabilities, there are so many issues we could address. I would like to highlight a number of them, some of which the Minister of State referenced in her opening remarks, including the 190,000 overnight stays in respite residential support centres.

In the course of her presentation, the Minister of State made reference to what was being provided, understandably so, but I am sure she will agree that much more must be done not only for the person with a disability but also for his or her immediate carer, loved one and so on. Respite care is hugely important. It is not that the extent of the need is unfathomable, but the number of overnight stays needs to be significantly increased to make a critical difference not only for the person with a disability but also for his or her carer. Without carers, many people with disabilities could not continue to live at home or in community settings. It is important in my opening remarks on people with disabilities that I make reference to those who provide such stoic, heroic support for them on a daily basis, year in and year out.

On the targets for the provision of personal assistants and home supports, again, there is, undoubtedly, a need for a significant increase in the hours provided across the country. Personal assistants and home supports are crucial. It is right that I reference this issue in following on the earlier reference to carers and the need for respite care. Some 3.9 million personal assistant and home supports hours were provided in 2015. I accept that the service plan has not yet been published for 2016, but is the Minister of State in a position to tell the committee what improvements, as a result of promised measures, we can expect to see in 2016 on the performance in 2015? I note that Mr. Healy who has responsibility for the social care area is accompanying the Minister of State. Perhaps he might like to comment on that issue also.

There are a number of congregated settings around the country in which there has been little, if any, capital investment for many years. I am speaking not only about facilities for persons with physical disabilities but also for people with intellectual disabilities. I recently visited a facility I had occasion to visit on a more frequent basis many years ago and was concerned to note that it had not been upgraded or updated in any way since I had last visited it. I am also concerned about the registered nurse intellectual disabilities, RNID, cohort employed not only in congregated settings but also across the community sector. RNIDs perform important work, but there is real concern that the training, professional knowledge and experience they bring to their respective positions are somehow being diminished by the idea that they are replaceable by care assistants who do not have the training or experience or potential to make a critical difference to an individual. I would, therefore, welcome a comment from the Minister of State on RNIDs. It is essential that their full range of skills be employed as an integral part of the care supports provided for people with intellectual disabilities, many of whom are in care settings.

At this stage I would like to make reference to an individual case that I believe is reflective of a serious problem across the country. I speak about the group home which has been promised for ten years in my constituency, in the main for young women with physical and sensory disabilities. Ten years on construction of this essential facility in Carrickmacross, County Monaghan has not commenced. There is concern across the political spectrum about this matter. I recently tabled a parliamentary question about it, in respect of which I have spoken to staff in the Department of Health in preparation for its response. The Department, the HSE, the Department of the Environment, Community and Local Government, Monaghan County Council and the housing association Respond have acted as five silos during the years in this matter, with one demanding a response from another on this, that and the other. The absence of joined-up thinking resulted in the mother of a daughter with special needs who has since passed on never having certainty in her later years that her daughter would be properly catered for post her time on Earth. Another young woman, whose parents are now in their 70s, is awaiting construction of this facility, yet in the past ten years not one brick has been placed on another. This project has been approved in principle. All of the entities to which I have referred are willing to give it their full support, but no one seems to be willing to take the lead to ensure commencement of construction of this facility is given the green light.

I am sorry to use the opportunity of today's meeting to refer to a specific matter, but it is an example of the problems we encounter with governance in general. I am not referring to particular Government parties but to governance in the permanent government and the need to have joined-up thinking and action in the interest of special citizens, and all citizens.

Deputy Seamus Healy

I welcome the Minister and the officials from the Department and the HSE and I thank the Minister for her presentation. The final paragraph of that presentation is key to the disability area. Part of it is worth quoting: "[P]eople with disabilities have the same goals, aspirations and abilities as every other citizen, and the same right to participate in society, and to make a contribution". That is what we all wish to see happen in a reasonably short period of time.

We have been contacted by the Disability Federation of Ireland and we are very concerned about this area. The 600,000 people with disabilities do not consider that they were protected during the recession or that they were the priority social justice issue, as was promised by the current Taoiseach in the last week of the 2011 general election campaign. There is also serious concern in the disability community that not only was it not protected during the recession, but that it will be sidelined to some extent in the current situation where the economy appears to be recovering. That view is held by a significant number of people with disabilities and I hope the Minister and the Government take it on board. We have received correspondence about this from the Disability Federation of Ireland.

A series of issues is dealt with in the presentation. I wish to highlight and seek further information on three of them. On the issue of the transfer of persons with disability from congregated settings, I note that the HSE target for 2015 was to move approximately 150 but only 84 have taken place. Currently, there are 2,800 people in those settings. Perhaps the HSE representative could tell us what the plan is for moving people from these settings. What period of time is involved? If it continues to operate on the basis of 150 per year, it would be a considerable length of time before it would be addressed and finalised.

Regarding acquired brain injury, a significant number of people, approximately 10,000, acquire a brain injury every year. What services are available for people with acquired brain injury?

Finally, there is the issue of work. The entitlement of persons with disabilities to work and avail of training is a key concern of the disability community. It appears, and I am subject to correction on this, that the programmes under the Youth Guarantee scheme are not open to persons with disabilities or, indeed, those on illness payments. Similarly, the Momentum programme does not appear to be open to people with disabilities. Can the witnesses comment on that?

Deputy Sandra McLellan

I welcome the Minister of State and her officials, and thank her for her presentation. It covers a vast range of services across the sector so I will concentrate on a few points.

The Minister of State mentioned enabling our disabled citizens to live as independently as possible with appropriate social housing. We have raised this matter on a couple of occasions in the committee. Many people with disabilities who are living in social housing have difficulty accessing grants to adapt their housing. There is concern that some people are waiting on lists for years and cannot get their houses adapted through the local authorities. There is some type of breakdown between the Department of Health and the Department of the Environment, Community and Local Government or local authority housing departments on this. Is the Minister of State or her Department doing anything to try to improve that situation?

Regarding some of the figures the Minister of State gave in her report, have they improved since 2011 and by how much? The 190,000 overnight stays are being provided to people with both physical and mental disabilities. There are approximately 600,000 people in the country living with disabilities but those figures only provide two weeks of respite for approximately 13,500 people. When one breaks it down like that, it does not appear to be much. In addition, there does not appear to be a huge facility for people who are caring for people with mental health issues to access respite care. I have been dealing with carers of people suffering from mental health issues and they found it very difficult to access respite services. How is the 190,000 figure broken down with regard to mental health and disabilities?

Another issue is children with mental health problems accessing services. It has been brought to my attention that counselling services are very limited. It depends on where one lives in the country and how one accesses them. It has also been brought to my attention that they are not very consistent. It is hard to get consistency even if one manages to get counselling appointments. When one returns one often meets a different person, so the young person is constantly repeating themselves. How is the Minister addressing the gaps in that service regionally?

With regard to the €1.5 million once-off capital funding, what is that allocated for? As regards accessing services, the Minister of State said there should be a clear pathway to services for children with disabilities and their families, regardless of where they live. It has been brought to our attention that when people with disabilities who live in a rural area leave mainstream school at 18 years of age and require follow-on services, they often cannot get transport to and from these facilities. What is the Minister's opinion on that?

Deputy Dan Neville

I, too, thank the Minister of State for her presentation. My colleagues have raised some of the issues I wished to raise so I will not dwell on them at length. Prior to the economic crash there was much concentration on the employment of people with disability. My recent checks on this area show that the public service is still at its target.

Given that the target was set approximately 15 years ago, has consideration been given to increasing it for the public service? There was a strong media campaign and a discussion within the body politic regarding private and non-State companies employing people with disabilities. We were all very interested in the area of employment and disability until the crash when the entire employment situation changed. Now that, according to yesterday's figures, we are moving back towards 2008 levels, let us engage again with the employment of people with disabilities. I have spoken to individuals who have taken on those with disabilities I have never heard any of them say that the disability interfered with a particular person's performance. In fact, the opposite was the case. The employers with whom I spoke found that people with disabilities were extremely conscientious workers and contributed greatly to the business. There is an opportunity to promote that area and to look at the public service in the context of employing such people.

Previous speakers referred to disability. I raise the matter of acquired disability, which we appear not to include in our discussions. There is a big change in a family when one of its members suffers a stroke, for example. Sometimes stroke is not seen as being on the disability spectrum but, of course, it is on that spectrum. Concerns arise in respect of the adaptation of houses, change in lifestyle and so on. If one has a medical card, one will be eligible for certain services. There is a whole range of issues we do not include when discussing disability. We see something as a disability but we do not include those with such a disability in the overall discussion relating to disability services.

Aging can also give rise to disability. The issue with which we, as public representatives, are all confronted is that of grants for the adaptation of houses by means of the installation of shower facilities, handrails, lifts and so on. Sometimes there is an immediacy about these things because people may become disabled. at a certain age. We all know of families who try to bath an elderly person and who may have to wait six or 12 months to convert to a shower.

Deputy Caoimhghín Ó Caoláin

I apologise for interrupting but Second Stage of the Health Insurance (Amendment) Bill 2015 is commencing in the Dáil.

Deputy Kathleen Lynch

I understand that.

Deputy Caoimhghín Ó Caoláin

I am sorry that I cannot remain to hear the Minister of State's responses. I thank for them in advance. My colleague will note and advise me of them afterwards.

Vice Chairman

Shall we take Deputy Catherine Byrne now and then the Minister of State can respond?

Deputy Catherine Byrne

I am sorry I was not present but I was listening to what the Minister of State on the monitor in my office. I support Deputy Dan Neville in respect of adaptation grants for showers and so on. If, for whatever reason, one wants one's bathroom renovated, it is great if one has a person with a disability - old or young - in the house and if one owns that house. If, however, one is a tenant of Dublin City Council or South Dublin County Council, then it is impossible. I give full marks to Dublin City Council and South Dublin County Council because when they are contacted regarding a private resident who wants a walk-in shower, a new bathroom or a new toilet installed, the job is done and the grant is paid within a couple of weeks. If one is a Dublin City Council tenant, if one lives on the second floor of, for example, Oliver Bond Flats and if one has a disability, one will find it almost impossible to get Dublin City Council to carry out adaptation works to one's dwelling. One cannot be given a flat downstairs because it will not be suitable. There are people waiting for extensions.

I have a constituent who is severely handicapped and in a wheelchair. His mother struggles to take him up and down the stairs, to bath or shower him, etc. She has an old seat in which she puts him when she is bathing him. I have been trying to get an extension built on to their house for the past five years. Every time I go back to the council I am told my constituent is on the list. It is not acceptable for someone with a disability, regardless of whether he or she is a private tenant or a tenant of Dublin City Council or some other local authority, to be on a waiting list. People such as the man to whom I refer should all be treated the same. However, those with disabilities are not being treated the same. Somebody needs to make a definite decision about Dublin City Council tenants. These people have been completed neglected because and are being asked to continue to live in their current conditions.

I have another constituent who lives in a three-bedroom house which Dublin City Council would love to take back tomorrow. She lives downstairs in her kitchen. She cannot go upstairs because she cannot use the bathroom. I have been trying to get her into a local senior citizens complex. She got an offer of a place but it was not suitable. The woman has lived in close proximity to other people for so long that the place she was offered would not have been suitable as a result. If at all possible, somebody from the Minister of State's Department should speak to the local authorities about how they treat their tenants in terms of installing basic facilities - such as, for example, shower units - and the length of time people are obliged to wait.

Another constituent, whose name I will not mention, is a beautiful young man of 20 years of age who has autism and intellectual difficulties. I am embarrassed about this case. He can speak. His family has reared him to be a lovely young man. He lives in a different world. I see him every day because he lives not far from my home. His parents have been struggling since the day he was born to get him into various services. They made telephone calls, wrote letters, lobbied the authorities and did all in all in their power. Recently, after he finished in mainstream school, he was in a day care centre where he could do little work projects. He was excluded from the school because he had an altercation with one of the students and became violent. He has been out of sorts for the past couple of weeks because his medication has been changed. Somebody else is now looking after him. His family has requested that he be considered for long-term rehabilitation because there is no more they can do. They are at their wit's end. He has home help coming to the house. However, the home help runs out of the house and on to the street to get away from him. I have been in contact with the Minister of State's office, with the office of the Minister, Deputy Varadkar, and with the HSE. I have gone around the world in respect of this case.

We are spending huge sums of money, more money is coming in and all that could be offered to this family in stress was a week's respite in Monaghan. I do not usually talk about intimate, personal matters because I do not like naming people. As a public representative I have come to the end of the line, like that family because unless this lad is dealt with he will either hurt himself, the people caring for him or, worse, a member of the family. I listen to other public representatives describe individual cases at every meeting here. My job, like theirs, is to deal with individual cases. I have come to a brick wall on this one and I beg the Minister of State to intervene because I am afraid of what will happen. If anything serious does happen we will all be dragged over the coals and I do not think it is worth that. The Minister of State knows the case.

Vice Chairman

Deputy Mitchell O’Connor is not here but we would appreciate an update on deaf-blindness because Carol Brill addressed the committee on this issue.

It is very significant that in the lifetime of this Government disability residential centres are being inspected on a statutory basis by the Health Information and Quality Authority, HIQA, because the services are so varied. The Minister of State is familiar with this from the nursing home sector. Now that HIQA is inspecting disability services there is a cost for them to bring their facilities up to the standard. Is there a plan for them, similar to the one the Minister of State approved for nursing homes in the past few weeks?

It would be useful to have breakdown of where the additional posts in primary care are and how they are used.

Deputy Kathleen Lynch

I will consider Deputy Catherine Byrne’s request this afternoon and see how we can progress it because the Deputy has been talking about it for a considerable time. I would have thought it would have been sorted out by now.

To respond to Deputy Ó Caoláin’s question about respite and Deputy McLellan’s comment about the 600,000 people and the breakdown of respite hours, I would not like the message to go out that everyone who is registered as having a disability wants respite because they do not.

Deputy Sandra McLellan

I was trying to make that point.

Deputy Kathleen Lynch

Most people with a disability want their own space rather than respite. There are people, however, who will never be in a position to live as independently as they would like and will need supports, whether in separate accommodation or not. Some have such profound difficulties that they will always need the type of wraparound service being provided at the moment in this case.

We will continue this year to maintain the amount of hours, 3.9 million, of respite. That service is being delivered to 2,300 adults. Reconfiguring service will be very important as more people come out of congregated settings. In answer to Deputy Healy, that will increase but the 84 places we are talking about are for this year. That is not the sum total of what is being done. We were hoping for 150 but as everyone is aware the resources were not available. We have the resources for next year and the transformation fund with Atlantic Philanthropies will help us to do an enormous amount. I should have included that in my opening remarks because it has allowed us to do things we probably could never have dreamed of doing.

The transformation fund of €45 million will comprise €15 million from Atlantic Philanthropies and €30 million from the Department of Health. There will be four key priorities - a transition to a person-centred model of service and supports, which is decongregation and independent or community living; developing capacity, there is no point saying we will bring people into the community unless the capacity is there to support them; and research and evaluation. I saw Last Tuesday an interesting publication from inclusion networks, which evaluated the experience of 50 people who have moved to community-based settings. The majority, not all, were very happy. It is amazing that we expect people to be full of the joys of life but they are exactly the same as us and people expect different things. The fourth priority will be to develop an advocacy framework for people with disabilities, which we have already developed for older people and which is working extremely well. Inclusion Ireland, under Paddy Connolly, is working with various groups around the country to help us develop that and that is going well.

There will be 160 registered nurses intellectual disability, RNID, qualifying this year. We are very lucky that as part of the reform in the Department, Siobhan O’Halloran is one of the directors. She looks after nursing and mental health. She has a particular interest in nursing and started her career as a disability nurse. She is very aware of the value of what a disability nurse does in the congregated settings but also in the community where we will need far more, to co-ordinate and allow people the freedom to ensure they reach their potential. Sometimes I think that we almost expect it to be our potential but that is our expectation rather than theirs.

In respect of social housing, grants and so on, I spoke on a Private Members' Bill in the Seanad last week on older people and all the same issues come up, how to maintain people in the community; reconfigure the house, the community, the outside space and so on. I do not have responsibility for any of that. I say that not to pass the buck but because I believe it should be under one umbrella. Someone who owns a home is treated differently from someone in social housing, as public representatives we all know exactly what the difficulty is. Was it Julius Caesar who said as soon as everything goes wrong, we put a different name over the door or organisation? I do not believe in doing that but I think that in the next Government and I am not certain it will happen because I do not think I have that much influence, we should have a Department of social and primary care which would take responsibility for all of that, the social needs of the person and the primary care as well.

In terms of right now, inasmuch as we have been in negotiations with the Department of the Environment, Community and Local Government and the officials have met Bairbre Nic Aongusa who has a very deep and clear understanding of the disability sector. We have talked to the Department about the whole area of environment and disability. However, it is something that we have to negotiate rather than being able to make that decision ourselves, something I hope that people will understand. It is not that we are disagreeing because we agree fully with what has been said.

I will allow Mr. Pat Healy to deal with the question on transport to day services. We have made significant progress in regard to people leaving second level education. Every year it was a crisis which those of us who have been here for a while will know. Every June and July parents stood outside the gates demanding to know where their children would go to secondary school. We have managed to ensure there is funding. Advanced planning needed to be put in place. The situation where suddenly, at the end of May, some 4,000 people would look for a place needs to be addressed. Therefore, advanced planning is crucial and that has been happening.

Deputy Neville spoke about jobs and asked whether we could increase the percentage of jobs in the public sector. Under the jobs strategy the percentage has been increased to 6%. I always viewed the 3% figure to be the floor rather than a ceiling. The public sector accepted that stance as well because it always breached its target. The new target is 6% and in some cases the public sector has already reached the target.

The excellent jobs strategy was launched by the Taoiseach recently. The collapse of the economy took us to a different space and meant we took our eye off the ball for a long time. The Department of Justice and Equality is responsible for jobs because it is an equality issue. I shall return to my point about an umbrella. Maybe we should be in that space under that umbrella. Jobs cannot just be the responsibility of the Department of Justice and Equality and the Department of Jobs, Enterprise and Innovation should play a central role.

I believe one cannot have a jobs strategy without including people with disabilities. I do not think that every one that is registered with a disability will sign on as being unemployed. The numbers will be fairly small but they could grow if we are serious about the matter. The Department of Jobs, Enterprise and Innovation and the Department of Social Protection have a major part to play in this initiative. Again, its about that umbrella and figuring out how to join up all of the pieces. In saying that, I sometimes get frustrated when I am asked questions about matters for which I have no responsibility.

Yesterday afternoon, the Minister for Children and Youth Affairs, the Minister for Education and Skills and I launched the new child care pre-school package for children with disabilities. Joining up the three Departments is an incredible piece of work. The initiative will work well but it took the three Departments to come together at official level in order to bring it together. The same outlook is needed in other areas as well but we often do not see it.

I will ask Mr. Pat Healy to deal with the questions on the capital programme. I can confirm that the capital programme is for both nursing homes and disability units. More than anything else, we are determined that the 20% of the beds supplied within the public space which is State-run will continue because we all know, despite the fact that it is sometimes delivered in workhouse style buildings, the care provided is exceptional. People are very anxious to be cared for in those settings and it is important we continue to ensure that happens. I now ask Mr. Pat Healy to deal with the capital programme and transport but he can ask someone else to reply if he thinks it is more appropriate.

Mr. Pat Healy

No, that is fine. The whole issue of graduating, school places and rehabilitation, etc., is tied in with the transport issue. On the positive side, as the Minister of State has said, 1,340 people have been supported and of those we were able to address as many as 508 from the existing capacity within the system, with an additional requirement for 832, including transport, for some of them. We try to prioritise and make sure that people link into the existing network of transport because there is quite a bit of it. Some of it is provided directly by the disability sector but also in local areas there are local arrangements and transport schemes. We try to link into such systems so that we do not duplicate a service. Where that is not possible then the provision allows for the transport cost to be part of this programme.

On the positive side, in regard to all of the placements in terms of 2015, the majority of people have been accommodated. Only 35 out of the 1,340 have not had their issues resolved at this stage. Principally, the issues are not around transport. Most of them have to do with trying to find additional capacity, which has been a challenge, particularly on the northside of Dublin. Securing appropriate capacity has also been a challenge in some locations. There was a particular issue with one provider that we are still working through. Transport has worked out well for that initiative this year.

When Members meet constituents they have heard about the broader issue of transport and not just transport for school leavers. We have prioritised transport within social care with our chief officers and it is something that we will prioritise for in 2016. We have already started work on the initiative. It is clear to us from the work that we have done with our service improvement teams, etc., on models of care that there is such a variety of transport provision that we are not necessarily getting best value. To get best value will require a more co-ordinated approach than currently happens across disability services whether it is physical, sensory or intellectual disability. Also, with the HSE's service provision, we have taxis, direct provision and local transport being provided in different locations. We are looking at how we can make that a priority in order to maximise the result for local people, make the system simpler for them and, from a value for money point of view, use the resource to best advantage, which will be a priority for us in 2016.

Members have also asked about congregated settings which, as the Minister of State has said, has transformed lives. It is the model that will transform the disability sector, particularly the old large institutional settings and principally around the intellectual disability side. We want to transform such places into a new model of service that works better for the people that we serve. We held a national summit yesterday, which is the fourth one this year and this topic was discussed in some detail. We gave a commitment we would make sure, as we start to roll out this programme in 2016, that there would be a strong communication programme. We also gave a commitment that we would fully consult with families, service users and their representatives and local communities as we progress this programme.

The Minister has announced that there will be capital funding to support the programme. It is an important contribution that will free us up and enable us to progress in a way that we have been unable to do so before. This year we had a target of 150 people to be transferred but we only achieved a transfer in respect of 84. The principle reason for not reaching our target was capital resources. I wish to emphasise that the Minister has secured additional resources but we are still working with the Department of the Environment, Community and Local Government to access that important resource, referred to by Deputy Ó Caoláin, in regard to Monaghan and the Respond housing association. We want to access the fund. We need to compile an appropriate set of guidelines between ourselves and the HSE and the Department of the Environment, Community and Local Government to access that fund because putting the two funds together will secure a much better result.

An important point to make is that there are different strands across the sector. There is no one size that fits all. As the Minister of State said, there are significant challenges in some of the large old institutional settings, many of which are run by the Health Service Executive, while others are run through voluntary providers, as we have seen in Health Information and Quality Authority, HIQA, inspection reports and so on. There is a necessity, as we progress with the transformation programme, to target the dozen or so centres where significant compliance issues arise. Moving people into the community will assist in dealing with that issue.

There is, however, a second strand - the 150 centres which do not need revenue resources but more access to capital. It is not generally about building new houses but about leasing or securing existing houses in the community and tailoring them through refurbishment and adaptation to make them fit for purpose for the people who wish to live in them. Consultation and engagement are required in undertaking this work. In the past two years much of the planning and consultation has taken place, meaning that we are not starting from a greenfield site. In these two strands much of the work has already been done.

There is a third strand - levels of complexity. Deputy Catherine Byrne spoke about a case in a community where there was challenging behaviour, as well as complex needs. There is a cohort who require additional focused supports to enable them to live the lives they choose in local communities. It is important this be done properly and it will require the capital fund to assist it. It will also require some initial preparatory work. For example, we have converted two of the bungalows at Áras Attracta to be used for eight people in preparing to move into the community next year. That approach is being replicated at other locations.

As the Minister of State announced, the capital plan has to be finalised as part of the service plan process. Our understanding is that we will be looking at a figure of €20 million next year, a significant additional contribution which will be well received in the sector, given the challenges encountered. We will be working closely with the sector in implementing the plan.

Deputy Kathleen Lynch

In the primary care sector there will be 260 additional posts, 52 of which will be in speech and language services because this is the area where there have been the greatest difficulties. It is to build up primary care teams, a process which will continue with the €20 million allocated.

We took a particular view of the waiting list for CAMHS, child and adolescent mental health services, at the start of the year. We discovered that there were over 200 who should not have been on the list and should have been dealt with in primary care services. Accordingly, we are developing a programme in child and adolescent psychological services to be delivered in the primary care sector. I admit it took a little time to get the two groups together. Now that they are together, it is incredible the amount of work they are doing. We will be delivering much of the programme in the primary care sector rather than having people move into acute units which, in some instances, are not suitable for them. This will be included in the service plan.

We have looked at the issue of deafblindness, a matter in which Deputy Mary Mitchell O’Connor is very interested. We are not inclined to have a specific definition because, if we did, there would have to be specific definitions for other conditions. It would also raise issues about the questions included in the census and the database. While there are particular difficulties around it, we are not inclined to go down that road. I realise that for people who are deaf and blind and may have additional difficulties also, there will have to be extra and specific specialised supports put in place for them.

The launch yesterday of the preschool programme took place with Child Vision and the Learning Tree, organisations which do an incredible job in this area, not just with those who are visually impaired but also with a range of children with disabilities.

Vice Chairman

I thank the Minister of State and her officials for attending. It has been a useful exchange, one we have been trying to facilitate for some time.

Sitting suspended at 11.25 a.m. and resumed at 11.35 a.m.