Select Committee on Children, Equality, Disability, Integration and Youth díospóireacht -
Wednesday, 26 Apr 2023

Vote 40 - Children, Equality, Disability, Integration and Youth (Further Revised)

An Cathaoirleach

I welcome everyone to the meeting.

I remind members of the constitutional requirement that they must be physically present within the confines of the place that Parliament has chosen to sit, namely, Leinster House, to participate in public meetings, so I cannot permit a member to participate where they are not adhering to that constitutional requirement. Any member who attempts to participate at the meeting from outside the precincts will be refused. Today's agenda is the Further Revised Estimates for public services - Vote 40, per the Dáil order on 29 March 2023 for the further Revised Estimates to be referred to this committee for consideration

At today's meeting, the select committee will consider these Further Revised Estimates and report back to the Dail. I remind members that only matters relevant to the Estimates for 2023 can be discussed. On behalf of the select committee, I welcome the Minister for Children, Equality, Disability, Integration and Youth, Deputy Roderic O'Gorman, and the Minister of State at the Department of Children, Equality, Integration and Youth, Deputy Anne Rabbitte, and their officials here today.

Thank you both for being here and for the briefing material that was furnished in advance. We are particularly delighted that we are dealing with the disability section. It has been a long time in the making so this engagement is very welcome. The Minister of State is particularly welcome in this regard.

I will go through the format. We will ask each Minister to give an opening statement and these will be followed by questions and answers from the members who will have ten minutes each for questions. I will outline the rules on parliamentary privilege. I wish to advise that witnesses are protected by absolute privilege in respect to the presentation you make to the committee. This means that they have an absolute defence against any defamation action for anything they say at the meeting. However, they are expected not to abuse this privilege and it is my duty as Cathaoirleach to ensure this privilege is not abused. Therefore, if their statements are potentially defamatory in relation to any identifiable person or entity, they will be directed to discontinue your remarks and it is imperative that they comply with any such direction.

I call the Minister to deliver his opening statement.

Minister for Children, Equality, Disability, Integration and Youth (Deputy Roderic O'Gorman)

I am very pleased to be here to discuss my Department’s Further Revised Estimates for 2023. I attended the committee on 8 February and presented the Department’s Estimate for 2023. In the intervening period we have seen the transfer of responsibility for specialised community-based disability services. This took longer than we would have liked but, like the committee, I am delighted it is fully completed. I am also delighted that the Minister of State, Deputy Rabbitte, is now fully within our Department and we have an enhanced team; many of whom have moved over from the Department of Health. This expansion and the increased budget of the Department requires that I revert with the Further Revised Estimate for debate and approval.

The expansion of the Department arose from the discussions at the time of the formation of the new Government where it was decided to relocate a number of functions across Departments. Certain functions were moved from the Department of Justice, with effect from 14 October 2020. A certain number of functions also moved from my Department to the Departments of Justice, Education and Enterprise, Trade and Employment, respectively. It was also agreed at that stage that responsibility for community-based disability services would transfer from the Department of Health to the Department of Children, Equality, Disability, Integration and Youth, and this transfer was finalised on 1 March 2023. This means that my Department now has oversight and responsibility for a budgetary increase of €2.6bn.

Overall, the areas now transferring bring with them funding amounting to an additional €2.6 billion in 2023, so the overall budget for our Department is now €5.9 billion. This is an increase of €2.6 billion from the Estimate approved by the committee in February. As a result, the Department is spending €5.8 billion on current expenditure and €124 million in capital expenditure during 2023.

Looking at the Vote in detail, we discussed with the select committee the details of the funding allocations for the different programme areas, along with a summary of the 2023 allocation by subhead area. We also discussed the changes from the 2022 figures.

In terms of the overall Vote allocation in 2023, including the new allocation, 94% of the Department’s funding is concentrated in five areas of the Vote. These are: specialist community-based disability services, which is 44% of our Vote; early learning and childcare, 17%; Tusla, 15%; Ukraine-related spending, 11%; and international protection accommodation services, IPAS, 7%. The next largest one is youth affairs, representing 1% of the overall allocation. The administrative budget for the Department is also 1%. The remaining balance of 4% of the allocation is spread across the remaining subheads and programmes of the Vote.

At our meeting in February we dealt with the existing parts of the Vote and I gave an expanded overview of the larger areas of the Vote. This Further Revised Estimate now incorporates the transferred functions in respect of the specialist community-based disability services. I will focus on that element, as we have discussed most of the other elements.

The transfer of specialist community-based disability services provides a unique stimulus towards achieving a more equal society and fulfilling our obligations to persons with disabilities. The Minister of State and I strongly believe that the location of disability equality policy and oversight of specialist disability services in a single Department presents a significant opportunity to strengthen strategic disability policy development. Critically, we are determined that it will facilitate the transition from a medical model of support towards a more holistic, human rights-based approach, in line with Ireland’s commitments under the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. Ultimately, it will move us closer to achieving a more equal society, closer to fulfilling Ireland’s commitment under the UNCRPD and to fulfilling our obligations to persons with disabilities across Ireland.

This is of course very much in line with the wider view our Department takes for a fair, equal and inclusive society where rights are respected, and where everyone can reach their potential. It also speaks to the Department’s wider mission to enhance the lives of children, young people, adults, families and communities, recognising diversity and promoting equality of opportunity.

We have been preparing for the transfer for some time. There has been the amalgamation of the existing resources in our Department with the incoming colleagues from the Department of Health in the new disability division. This will build our capacity for strategic leadership and policy-making in the disability sector and also for our ability to engage with the HSE and partners in the sector.

Regarding specialist disability services, the disability capacity review, which was published in 2021, has set out the scale of current unmet need and future demand up to 2032. I recognise the level of increase in resources and investment that will be necessary to meet the service need and to implement the disability capacity review action plan.

We will work with all stakeholders to meet the demands and challenges of an increasing, more complex and ageing demographic, as we seek to ensure that all persons with disabilities can live ordinary lives in ordinary places. In advancing the disability capacity review action plan, my Department will look anew at key policies such as the Transforming Lives programme and the progressing disability services, PDS, model and critically review how specialist disability services can be reformed over time and delivered more sustainably, with more early intervention, and greater control on the part of the individual. We are acutely aware of the continuing pressures within disability services, some of which are long-standing and systemic, and the impact these challenges have on persons with a disability and their families.

We are determined to place a sustained focus on budgetary management and performance oversight and to target further investment where it can have the most positive impact. Staffing is a particular challenge and I welcome the HSE’s commitment to prioritise the recruitment of an additional 521 whole-time equivalents, WTE, to disability services in 2023.

Mainstream-first is at the heart of fair, sustainable and person-centred disability policy. More than 90% of people with disabilities have their needs met through the range of community health and social services available to all citizens. I look forward to continuing collaboration with the Department of Health to ensure a mainstream-first approach is maintained with seamless integration between services.

Across the wider canvas of Government action, the Disability Act 2006 sets out the responsibility on all public bodies to deliver their mainstream services to people with disabilities and to plan and deliver services that are accessible to people with disabilities, in accessible premises, and through provision of accessible information and communications.

More broadly, the development of a new national disability strategy during 2023, a process that will be facilitated and steered by our Department, provides an opportunity to develop a framework for transformative change and a whole-of-government shift to accelerating UNCRPD delivery. We will lead this process and in doing so prioritise the participation of people with disabilities and their representative organisations.

Underpinning this reform will be the development of legislation. Today the Assisted Decision-Making (Capacity) Act 2022 has been commenced.

It is an important step. I am happy to provide further information on these and other areas relevant to the Vote, which are detailed in the brief, as we go through the subheads in our discussion. I and my departmental officials and the Minister of State, Deputy Rabbitte, will work closely with all sectors and stakeholders to maximise outcomes for the resources being considered.

Minister of State at the Department of Children, Equality, Disability, Integration and Youth (Deputy Anne Rabbitte)

I am delighted that the transfer of functions of specialist community-based disability services to the Department of Children, Equality, Disability, Integration and Youth from the Department of Health took place on 1 March. I thank the Chair and the committee for their forbearance in working with me and interviewing two Ministers of State, at times, about the same topic. I thank the committee team. For the first time, responsibility for co-ordinating and steering an all-of-government policy to promote the equal participation in society of people with disabilities has been brought together with policy responsibility and funding for specialist disability services in one Department. There is now a significant opportunity to pursue strategic policy development, investment and reform of disability services. I look forward to progressing this agenda with the Minister, HSE colleagues and all of our partners in the disability sectors across government. I am committed to ensuring that the transfer of functions to the Department of Children, Equality, Disability, Integration and Youth is as seamless as possible, maintaining the provision of services during the time of transition. Specialist disability services continue to be provided by the HSE and a range of other providers to children and adults in residential, day and respite settings, as well as children's therapy services, personal assistance, home support and other community services and supports. Consistent with a mainstream-first approach in the provision of integrated service delivery, all other health and social care services ordinarily available to people with disabilities will continue to be supported and provided as before. I aim to strengthen and improve oversight and performance management structures with the HSE. This will involve building relationships between officials in the new department and with key personnel in the HSE and other partner organisations to better understand opportunities, constraints and plans for improving performance delivery and oversight arrangements. The Department is putting in place an oversight agreement with the HSE which will reflect the Department of Children, Equality, Disability, Integration and Youth's responsibility for funding, policy and performance oversight. It will provide a supporting framework for the implementation of relevant legislative provisions and governance arrangements, including robust financial governance and service performance arrangements.

One challenge of the transfer was accessing accurate and consistent information and data related to disability services. Much of this was down to current constraints in the HSE's system and the nature of health service delivery. We will work and support the HSE to improve data and build the strong evidence base critical for future reform and investment in the sector. Building on the work undertaken in the Department of Health, the transfer will facilitate the transition from a medical model of support to a holistic, person-centred approach that supports people with disabilities to live autonomously. A review of disability social care demand and capacity requirement up to 2032 was published in July 2021, which sets out additional capacity required in specialist disability services in light of anticipated demographic changes and addresses the gaps between available services and the level of unmet need. The action plan for disability services was developed by an interdepartmental working group to progress action on the findings of the disability capacity review. Now that the transfer is complete, I intend to accelerate progress in this area. Developments planned for 2023 within the available funding will improve services for some but the scale of need identified in the capacity review report will require agreement on the implementation of the action plan for disability services.

In 2023, we will continue to drive the reform of disability services through the implementation of the Transforming Lives programme, including New Directions, progressing children's disability services, personalised budgets and the neuro-rehabilitation policies. Advancing the PDS roadmap related to children's services will see a critical priority focus on access to services, staff recruitment and retention, communications and engagement with families and address assessment of need backlogs. The number of children still awaiting assessment of need is unacceptably high. Reducing the assessment of need waiting list is a key priority of mine. Funding has been provided in the budget to significantly reduce the waiting times for children seeking an assessment of need. I recognise the recruitment and retention of staff in disability services is a significant challenge for the HSE, which has a large bearing on the achievement of service delivery targets. We will encourage and support the HSE to implement a series of actions to improve staff retention and recruitment performance to increase base staff levels in line with funding received.

I will outline the areas I am committed to progressing in 2023. I will continue to prioritise the delivery of therapy services to children with disabilities and their families. In day services, additional funding in 2023 will support approximately 1,250 people with disabilities leaving school to transition to adult day services. I will provide for residential placements in line with policy to respond to increasing need through the programme of decongregation and the provision of emergency placements and care. I continue to provide supports to keep people in their homes for as long as possible and out of residential care. The funding provided will deliver an additional 70,370 personal assistant hours to expand and enhance supports for people to live self-directed lives in the community. Respite care is a key priority as it provides important supports for families in maintaining their caring role. The funding provided will establish five additional respite services and increase one service from part time to full time, providing 27 additional in-home respite packages to children and young adults in a full year and to provide 265 day-only respite packages to 180 people in a full year. We aim to increase the number of those under the age of 65 moving from nursing homes to community settings. The HSE will continue to work with community support teams to provide safeguarding supports to vulnerable adults with disabilities. Mindful of this, the Government's priority is to deliver comprehensive on-site health and social supports to all special schools. I am pleased to that the HSE has commenced the process of prioritising the allocation of approximately 136 additional staff such as speech and language therapists, occupational therapists and physiotherapists to these schools. I am delighted to work with the Minister and the team in his Department to progress on these commitments in 2023 for persons with disabilities and their families. It is also important to state that it will be my ambition to leave no money unspent in any of my budgetary lines in 2023, whether it be in revenue or capital.

An Cathaoirleach

That is a good note to finish on because I think we all agree that we do not want to see any money unspent. I should have said at the start that we had apologies from Deputies Sherlock and Cairns, and that Deputy Tully is substituting for Deputy Ward. I call Deputy Costello.

Deputy Patrick Costello

I thank the Minister and Minister of State for their statements. The fact that youth affairs only covers 1% of the overall allocation speaks volumes about the position of youth work and the need for better funding of youth work. Without further information and, given that the committee is examining that issue, I will interrogate the Minister about that another day.

I wish to pick up on two issues, one of which is the recruitment and retention of staff. The other is unmet needs, which the committee has dealt with regularly and the Minister of State also mentioned because she knows this full well. She has visited my constituency and met parents who should be receiving services but are not. I have to stand here and represent them.

It seems that we will have a vote shortly.

An Cathaoirleach

The Deputy can ask the question and we can get the reply when we return from the vote.

Deputy Patrick Costello

The families I meet and talk to and who are in touch with my office are crying out for services. They have fought to get the assessment and now they have to fight again. They do not have fight left. They are broken with grief for their children and for the lack of services their children are getting. They feel that they and their children are invisible and are just not getting the services they need. They have no faith in the children's disability network teams, CDNTs. There is no point in me mincing my words. I know that the Minister of State, Deputy Rabbitte, is aware of this, and that she has been spoken to directly on it, but I have to represent them and ask what it is we are doing. Is there enough money in this? Are the structures right? I am aware that the Minister of State has a plan here but it is not being felt yet on the ground.

On the recruitment of staff, I wish to pick up on the Office of the Disability Appeals Officer, which I have asked about recently via a parliamentary question. The person who was in post recently retired. I am glad that, according to the Minister of State's reply, a replacement is under way. Will this person be working more than the two days that the recently retired person was working? I am particularly conscious of the build-up of appeals while we are waiting for a person for this post. Is one person doing two days really enough for such an important job? If the Department is looking to recruit staff, can it recruit more people for this very important national role?

An Cathaoirleach

We will return for the response after the vote in the Dáil Chamber.

Sitting suspended at 6.02 p.m. and resumed at 6.26 p.m.

An Cathaoirleach

We will resume with the Minister of State's response to Deputy Costello's question.

Deputy Anne Rabbitte

The Deputy is correct that we are in a recruitment process for the appeals office. It is an independent office but we are in a recruitment process. We will keep the committee updated on it, if that is okay.

The Deputy also asked whether I have enough money for staff and recruitment. One never has enough money but at the moment I have a lot of money for the recruitment of staff. What I need are the measures to ensure that I am actually able to attract staff. Part of the PDS roadmap is putting in the various steps along the way. Looking at supporting quite a number of clinical psychology placements per annum from 2023 will be one of the pieces I am looking to put in. I also hope that the HSE will consider occupational therapists, physiotherapists, and speech and language therapists posts for the third and fourth year placement students. Their fees could be paid for and maybe they might work for us for 18 months thereafter to build up supply. I believe this will address a lot of the shortfalls. We also have international recruitment going on. We have the critical skills list piece of it, which is part of a suite of measures so we can come at it from all angles. We are also working on it with the areas of further and higher education.

I will also acknowledge the groups mentioned by the Deputy. I was talking to the Minister about Involve Autism and the phenomenal work that they do. The Deputy has a special school in his area that has not had the uplift in relation to the therapists that are part of the 136 that should be going in. We have made a commitment and the HSE will honour on that commitment. It is unfortunate that it has taken so long to get there, but it is our plan. It is our ambition. We have funding secured to put those therapists in. This includes an occupational therapist, a physiotherapist, and a speech-language therapist. This will be under constant review to meet the needs of the families.

Deputy Pauline Tully

I welcome the that the disability remit has finally, after this length of time, transferred over to the Department of Children, Equality, Disability, Integration and Youth.

I echo what Deputy Costello has said regarding the PDS plan. Parents have lost faith. They feel it is a failed system and they are very discouraged. I am hearing that parents are getting service statements but with no date on them as to when the services will be provided. Others are being told that it will be years but they have no date at all. They are at the end of their tether. I welcome the response given by the Minister of State but I do not believe that money is real problem here. It is about getting the staff and something has to be looked at in this regard.

I have been told that one parent was offered the use of the National Treatment Purchase Fund, NTPF, to obtain an assessment. The parent was informed by a regional manager in the HSE that this is being used by a number of people to gain assessments for the children in Belfast or in Poland, yet I have been told in replies to parliamentary questions that this is not happening. Perhaps the Minister of State could give some clarification on that.

A very big budget has transferred over for disability. Does this include transport schemes? I am aware that the Minister of State is heading up a committee that is looking at replacing the mobility allowance and motorised transport grant. Are the transport schemes covered under that? Hopefully, something will be introduced to replace the schemes that were suspended more than ten years ago.

In a broader sense, does the Minister of State intend to review the Disability Act 2005 to update it to a more rights-based approach?

Many, including this committee, the disability committee and the autism committee, will argue that it should be reviewed, especially the aspects of it that apply to the Education for Persons with Special Educational Needs, EPSEN, Act. The two Acts were supposed to work in tandem. The EPSEN Act is being reviewed but the Disability Act is not. Is the plan to review the latter?

As regards funding for services for adults in the community, it is indicated that consideration may be given to reforms as to how they are delivered. Again, I come across many adults who are not receiving any services. Yesterday I spoke to a person whose husband had a stroke a year ago at the age of 37. He is not receiving any sort of support. He has got two sessions of physiotherapy since he vacated the National Rehabilitation Hospital, where he was getting intensive support. He is a young man and needs stimulation, physiotherapy and occupational therapy. He has had no support other than the two sessions of physiotherapy. MS Ireland has a proposal, a business case, on physiotherapy. Has MS Ireland met with the Ministers, and are they looking at that proposal? It comes in at a cost of €880,000 per annum to provide physiotherapy services to people with MS and other neurological diseases such as stroke and Parkinson's. It is much needed because of the waiting lists in primary care. MS Ireland reckons that a saving of something like €19 million could be made on people not having to go to hospital because of falls and so on. It has made a good case.

I know I am asking a good many questions. If there is not time for people to provide answers now, I would welcome written replies.

As regards respite, Annaly House in Cavan was providing respite for people in Cavan and Monaghan but, because it is only one house, was operating on alternating weekends for children and adults. When it was closed due to necessary renovations, another house at Killygowan was opened. Why would Annaly House reopen? Could the two houses not have been operational, one for children and one for adults? I put the question to the HSE at an Oireachtas and health board meeting in January and was told that there was no reason, that the house was still available to them but that the funding was not provided by the Government. The reply I got to a parliamentary question on this issue stated that it was the case that new services are opening, which is very welcome, but the reply did not make reference to that, so I am wondering what the situation is in that regard.

Many services receive funding year on year based on what they received the year before. Services need multi-annual funding in order that they plan ahead because the funding is often delayed until February or March of the year before they know exactly what funding they received. At the same time, however, funding is given without any oversight as to what service was provided in the year before, so there seems to be little accountability. I would love to see multi-annual funding for services but a lot more accountability on the service provision and assurance that it is meeting the needs of those who require that service.

I am sorry, Chair. I know that is a lot of questions.

An Cathaoirleach

There is a lot in that. Does the Minister of State wish to touch on some of that?

Deputy Anne Rabbitte

Right, and the Minister, Deputy O'Gorman, will take the questions about disability.

An Cathaoirleach

You can decide among yourselves as to whatever you think is best.

Deputy Roderic O'Gorman

I might take some of the higher level policy stuff. The Minister of State is very much across the detail of the local issues.

Deputy Tully is absolutely right, and it is similar to what Deputy Costello spoke to us about in terms of the lack of faith parents have in the PDS programme at the moment. That is entirely understandable and something I know the Minister of State has experienced on a national level as she has gone around the country visiting and meeting parents and groups. It is something I see in my constituency as well. Deputy Tully is right that the issue right now is not money. There are two issues. She identified the most important one, the lack of staff, but there is a need to reset the relationship between parents, the HSE and the individual service providers. Some of that will come when there are more staff because those staff who are there are under immense pressure, and we have to recognise that. There are, however, issues even with how parents are written to. We get the letters as well when we advocate in our constituencies as Deputies. When someone is not getting a therapy, we could probably call out what the letter would state because we have all seen those letters so many times. There has to be a recognition that this is not pro forma stuff and that these are parents dealing with some of the most traumatic experiences, in their concern about their children, that they will ever deal with. We have to change attitudes there. The Minister of State probably spoke earlier about our welcome for Bernard Gloster taking over the helm in the HSE. We know he has dealt with issues in Tusla incredibly sensitively and we hope to see that culture continue to grow and develop.

To address the issues of staff, the Minister of State and I identified, even before the transfer, the need for the HSE to set out a clear set of actions that would be taken in the short to medium term to show parents and elected representatives that we are moving back on track in respect of the delivery of PDS. That is what the roadmap is. We are looking to see that published soon. It contains those proposals as to how we get in more staff. Some of them are medium-term in terms of more college places for speech and language, occupational therapy, physiotherapy and psychiatry, but some of them will deliver in the shorter term in terms of conversion courses and master's courses and how we fund them, recognising that they are expensive. If we can get someone in to take them up, let us see if we can fund them. It is a range of issues to try to deal with those staffing issues so we can move away from the 34% vacancy rate nationally, which is such a barrier to the delivery of services.

As regards Deputy Tully's point about a revision or a review of the 2005 Act, we are working at the moment on our work plan. We have about 20 months left, probably, from the outset of this Government, and there are a range of very important issues, many of which we have discussed at this committee or the disability committee. We have the PDS roadmap, which needs to be delivered; the action plan on the capacity review, which is all about setting out how we get the investment across the entire sector, not just in PDS; the European accessibility act; the discussion as to whether we look to progressing the ratification of the optional protocol; the autism innovation strategy; and the new disability inclusion strategy. There is a lot of work there, and we have a job of prioritising. I like to be as up front as I can, and the Minister of State does too. We will not get all those things done in the next 20 months so we have to prioritise what are the most important elements to deliver. We are committed to service delivery. That is what has to be so important because we have fallen so far behind. We are happy to listen to both this committee and the Committee on Disability Matters for input on that, but there will have to be a prioritisation. Everything we all want to do we will have to prioritise because we will not get everything done. The move to this Department is the start of a new process but it is only the start. Whoever succeeds us as Ministers will have to take up that baton, but we want to get some of the basic work done in our time here.

Deputy Anne Rabbitte

I thank Deputy Tully for the wide breadth of her questions. I will start with the good stories. The good story is about the neuro teams announced in the budget. That speaks a lot to MS and Parkinson's. The community neuro teams are really about putting services into the communities. Two things happened in this year's budget. One was the clinical neuro nurses going directly into the acute settings. There were 28 of them and there were the community neuro teams. That is about that multidisciplinary, interdisciplinary approach within the community and working across, regardless of whether it is MS, Parkinson's or Huntington's disease. Having that really good, proper team in operation is what is needed. I am ambitious. We do not need just two or three of them; we need one in each of the regional health areas, RHAs, as this unfolds. We need also to have teams that we can expand and that can work on the various specialties. We are working very closely with Brian Higgins in the HSE. He is leading out on the reform piece. The neuro mapping was done last year, which we funded. The neuro mapping is being done with Mags Rogers in the Neurological Alliance of Ireland, NAI, along with the Disability Federation of Ireland and the HSE. There is now a clear understanding as to what the need is. It is being funded. Two teams have been funded this year.

There is also the conversation about community health organisations, CHOs, 6 and 7, which were funded in 2018. Those teams have not been properly stood up. We are getting under the bonnet as to why that did not happen and we are working with Mr. Higgins on getting that funding spent and getting them operationalised. The ambition is by the end of this year that we would be talking about having four teams in position around the country and then finishing off what needs to be done.

That speaks to all the various disability groups, from the very small ones to the larger ones.

We finished the work on transport. Any funding that is within my budget has come across with me. I refer to the €2.5 billion, of which €44 million – believe it or not - is spent on transport. That has come across with me. Transport that is being provided will continue to be provided, but we are also talking to the Department of Finance – the report has been sent across – about how we can have a more targeted support to ensure we address a lot of the needs that we are all acutely aware of when it comes to disability.

Regarding service statements, what Deputy Tully is describing is no different to what Deputy Costello or Deputy O'Sullivan would describe. It is a bit hit and miss. Some CHOs give very detailed service statements. Others are not as detailed. Some do not have dates on it at all or do not do them. To be quite honest, it is very important to know what is to be achieved, but the intervention is what I am really focused on. That intervention and the continuation of interventions is the most important. I am not a big fan of filling out forms and repeating that. What I want to see is therapists delivering on interventions. That is what we need to focus on. Children need the interventions in a timely fashion, but there is a variance as to how service statements are being done.

Deputy Tully has hit on a very important point relating to respite. She refers to Cavan and Monaghan. I was down there. It is one week for children and one week for adults. It is not good enough. Both counties are big, and it is not correct that the two have to be interchangeable. Neither is it right to have buildings not in use. If there is a need for funding, that can be stepped up. We do take into consideration that there is an issue with the recruitment of staff. Many children and adults need access to respite. In fact, it is a priority for me and the Minister to ensure that families can have access to services. I appeal to any Oireachtas Member who knows of any building that is a designated respite house, that is not in use and is standing idle, to please come and tell me and I will work with the local CHO as part of our business cases to make sure that all of our respite houses are operationalised and we do not have any in vacant use. That cannot be allowed to happen.

I would also say to the local HSEs that where we have time-related savings, that would be one way I would encourage them to spend some of those savings.

Deputy Jennifer Murnane O'Connor

I thank the Minister and the Minister of State. It is great to see that the two Departments have merged since 1 March. I believe the merger was vitally important. All of us have seen the great challenges within the system. I see families who come into my clinics on a daily basis who are so upset, as do all of us here. I can honestly say that. It has got to a stage now that although we are constantly trying to work with everybody, we are not getting any answers. My theme today for both Ministers is communication and lack of information. For me, that is the biggest issue. I will explain that in a moment.

I went through both of the ministerial statements. I welcome them. I am delighted with them. I can truthfully say that from working with both Ministers, they are very committed and they are doing their best. A lot of challenges have come with their Ministry, going back a good few years.

One question for the Minister relates to the national disability strategy. He stated:

More broadly, the development of a new national disability strategy during 2023, a process that will be facilitated and steered by my Department, provides an opportunity to develop a framework for transformative change and a whole-of-government shift to accelerating UNCRPD delivery. We will lead this process and in doing so we will prioritise the participation of people with disabilities and their representative organisations.

The Minister might provide more information on that. Some of the organisations I have been speaking to had no issues, but others felt there was not enough communication with all the different agencies. I am not saying that is the case, but what is the timescale for the strategy and what can we do in regard to it?

I will now turn to the Minister of State. I want to get more information on a point she made. She stated:

I am continuing to provide supports to keep people in their homes for as long as possible and out of residential care. The funding I have provided will deliver an additional 70,370 personal assistant hours.

There are huge challenges in the system in that regard. I welcome the Minister of State's statement, but I wonder if she would provide more information on that and how she intends to do it.

What is being done to bolster the staff members on CDNTs? That is a major issue for me. What recruitment initiatives are being pursued? What is the Minister of State's plan to address the backlog for assessments of need? I spoke about this today. As the Minister of State knows, Carlow-Kilkenny is my area. My understanding at the moment is that there is no occupational therapist for children in Carlow at the moment. The waiting list for the public service is incredibly long. The speech and language CDNT assessments are working from referrals given in 2019. These children and families are under major pressure. This is what we face every day. I know from speaking to families that their children are going into mainstream school in September, but they are waiting for assessment. They cannot get the assessment to get their child assessed to see if they will be going into mainstream school or if they will not. That has become a huge issue. Lots of people have come to me with cases in recent weeks. To be honest, I am very worried about this. This is the reason I spoke about communication and information. My understanding, which is open to correction, is that because there is funding, if a family with a child is waiting so long to get a child assessed, they can look at going privately and the Department will refund them. This came up recently at a meeting I attended. I am not sure, but that is my understanding of it. I need to get that clarified. I spoke to another Member who said they know of a case where this was done. What are we doing to alleviate the situation while there is great pressure on waiting lists in Carlow?

There is another issue I am concerned about. I welcome the budget of €5.9 billion. It is also welcome that when we come in here, much of the time we are told there is funding, but a lot of recruitment is required. I am beginning to wonder about the different Departments. When I go to a service in my area, I say the funding is available and the Minister is working on it and the service will get it. However, when I go to the HSE, I am told that it did not get the funding. I explain that I got a commitment, and the funding is there. I am absolutely fuming about this. It is getting to a stage where I do not want to hear any more that: "We have the funding and it is a case of recruitment", when I speak to all the different Ministers. By the way, this is across the board, but I am very focused on children because that is my remit. I have been waiting for the funding for six months, which I am told is there, but when I go to the HSE that is not the case. I am going back to the various services and saying I am told the funding is there, but the HSE has not got it. The Department is telling me it is there. The Ministers must work on this. It is a huge issue for me now. If it is an issue for me, it is an issue for all Oireachtas Members. It is unacceptable. I do not know whether it is due to a lack of communication or a lack of information within the different sectors. I know everybody is doing a good job. I am not here to be disrespectful to anyone, because that is certainly not the case, but I have services that are telling me that if they do not start getting the proper funding from the HSE they are going to close. I cannot go to meetings like that where I am told there is loads of funding, it is coming, and it does not come. I am asking what is the first port of call.

It is great to see all the officials to here today. I am delighted to see them here. It is great that everyone is working together, but services are struggling, in particular children's services, given the cost of living, the cost of heating, the general cost of running the service itself, and the ESB. Services across the board are struggling. Children are not the only ones who are suffering; families are suffering. The only thing I ask is that when the funding is there that it would be given as quickly as possible and that we make sure we are never in a position where a service will close.

I thank the Minister of State. One service in Carlow was under pressure - thank God it was not going to close – but the money was delivered. It was only delivered because in fairness to the Minister of State, I had her heart broken. I rang her constantly.

An Cathaoirleach

The Deputy has to conclude.

Deputy Jennifer Murnane O'Connor

I know. We need to work on this. Everyone is doing his or her best, but I call for more communication and information.

An Cathaoirleach

A vote has been called.

Deputy Jennifer Murnane O'Connor

Has one? I am sorry. I am finished.

Deputy Roderic O'Gorman

Should we suspend now?

An Cathaoirleach

We have two minutes if the Minister or Minister of State wishes to respond. We will revert to the matter afterwards.

Deputy Anne Rabbitte

I know what the Deputy is saying about communication. We have a budget, which was announced. We also have the €100 million in energy funding that the Deputy mentioned and that service providers are waiting to get their hands on. It is their only mechanism. With the support of the Minister, the team with us and the Minister for Health, Deputy Stephen Donnelly, I was fortunate to get the lion's share of that €100 million - we got €67 million. The Deputy is right and I understand the providers' frustration. The funding was agreed in September, but it was only released five weeks ago and has still not reached some of them. That is not my fault or that of the Minister. We are pushing it as hard as we can, but the money has not dropped. With the Department, we are working within constraints to get the money out. The money has got out, but if it is not dropping, that is a HSE operational matter and I would call on the HSE to ensure that all providers get funding. We have secured 3.5% of an uplift for all to meet their needs, so it is unfortunate that it has not reached some of the providers. Some of them are at the pin of their collar just to keep their doors open and are waiting on that money.

An Cathaoirleach

We will suspend until after the vote.

Sitting suspended at 6.52 p.m. and resumed at 7.17 p.m.

An Cathaoirleach

We are resuming in public session. Hopefully, we will get through it this time. We were on the answers to Deputy Murnane O'Connor. I ask the Minister of State to please continue.

Deputy Anne Rabbitte

I had just addressed the €67 million, the communication involved and acknowledging what the Deputy had said. The Deputy also referred to the backlog relating to the assessments of need. I was fortunate to secure funding of €13.5 million in the budget to address that backlog. Mr. Ó Conaill from the Department and I had a really good meeting recently with Mr. Gloster. The Minister has also met with Mr. Gloster. We did not meet him together. We give him two opportunities to familiarise us in relation to the wide range of needs within the portfolio. However, we did discuss the assessment of needs in depth. As part of the PDS roadmap and as part of the plan relating to it, he is an agreement that it needs to be radical, dramatic and very timely. A great deal of work has been done by the Minister with the help of his officials in preparing the PDS roadmap. As part of the discussion of the assessment of need, we decided that we should create regional hubs or what I would call centres, to ensure that families can be supported, either through a centre in their CHO in that sort of a breakdown, or each RHA. The decision rests with Mr Gloster and his team at the HSE. We need to have a targeted piece, while at the same time ensuring that interventions continue. We need to work with the private sector to address the backlog in order that there is a targeted approach to assessment. When assessment has taken place in these regional areas, there should be a decanting within the teams so that we would have somebody from the CDNTs present to liaise from an educational perspective. In that way, the children can go back into their proper CDNT team and be supported there. That is the plan. It is a long time in the making but now we need to see delivery on it. The Minister, Mr. Gloster and I are in agreement on this. To be fair to Mr. Gloster, I feel he has been very positive about addressing the issue.

Regarding the national treatment purchase fund, Mr. Gloster is working very closely with us to ensure that funding will be used, be it time-related savings or be it from the pot of funding that was gathered. This will enable us to provide assessments of need for all children who require them as soon as possible and it will allow them to go back to their teams.

Deputy Ruairí Ó Murchú

Where does one start with questions when we are talking about disability and disability services? A considerable number of people have spoken about the difficulties of accessing services and how distressing those difficulties are for families. I will go through a couple of questions and follow up on some of what was said earlier. The Minister of State is proposing to have one neurorehabilitation team per RHA. What sort of capacity are we talking about, and on what sort of timeline will that be introduced?

Deputy Anne Rabbitte

The funding was secured in this year's budget. The mapping has been done and it was launched earlier this week. Brian Higgins, as part of the HSE, is working closely on the roll-out of that in the two CHOs, but also on addressing the two other CHOs that were not stepped up in 2018-19. The HSE is engaging with the various organisations, whether it is AIMS Ireland, the Parkinson's Association of Ireland or the Huntington's Disease Association of Ireland, to start advertising and finding a correct location so we can have community neurorehabilitation teams. It is a part of an expansion of the strategy. We have a neurorehabilitation strategy, but there are other pieces within it. One of the main pieces has to be what happens when a person is discharged, be it from acute or the National Rehabilitation Hospital, so he or she can supported in his or her community.

Deputy Ruairí Ó Murchú

I imagine in some of these cases, and know from people who have come to me, that if people had these supports we might not necessarily get some of the hospitalisations that occur.

Deputy Anne Rabbitte

Absolutely. With the likes of Parkinson's it is about preventing readmissions, because it has a lot to do with falls. Having that OT or physiotherapist in the community means we will not have readmissions. We know the cost of readmissions into hospital.

Deputy Ruairí Ó Murchú

We are all familiar with issues with not having enough OTs and speech and language therapists, SLTs. Taking only the OTs in these neurorehabilitation teams, some will need very specific skill sets. How do we ensure we get these people with the acute skills and get them trained up, as is necessary? I am aware of times when people have been able to access occupational therapy but it has not been the bespoke OT solution they require if we are talking about, say, multiple sclerosis.

Deputy Anne Rabbitte

That goes down to the proper clinical governance and oversight. Part and parcel of having a multidisciplinary and interdisciplinary team is the ability to provide clinical governance and proper training for trainees coming through, such as third-year and fourth-year OTs and physiotherapists. That means they will have a breadth of experience. It also allows people in those teams to specialise. It is, therefore, also creating a pathway in specialist areas at the same time as growing our pool of people who are able to work within the community.

Deputy Ruairí Ó Murchú

Okay. Talking in general about disability services, at times someone makes a determination about how severe a person's disability is, for want of a better term. With children, that might mean they fall into the CDNT system or primary care. How does that work with the changeover into this particular Department?

Deputy Anne Rabbitte

I have been Minister of State for the last two and a half years. I have shared my experience with the Minister, Deputy O'Gorman, and my frustration with the Minister, Deputy Stephen Donnelly, that we have the national policy on access, which is a HSE document that sets out how the integrated services work. We all believe in people having their own front door they can walk through, but when they get in there how are they signposted through? If I can be honest and share something again-----

Deputy Ruairí Ó Murchú

I imagine the Minister of State is going to say something about the silos.

Deputy Anne Rabbitte

It does not really work in all the CHOs. Some are very good, but not all. By and large, the national policy on access is not working. The policy is not just primary care; it is disability, primary care and mental health. It is about how we can integrate these. When people enter a service they might be in specialised disability services for OT and physiotherapy, but might need access to eye treatment in primary care. A person should still be recorded on the database within the HSE as needing that service. That is one of the pieces that is not working which we are going to address. We brought it up with Bernard Gloster and Yvonne O'Neill very recently. It is a priority for me, because there is no point in having a policy if it does not work.

Deputy Ruairí Ó Murchú

Exactly. An example I was going to use, and we have discussed this before, was a lady who was older than me and therefore fell into primary care. The family basically said they could not take her back into the family home, that her dad was in his 80s and not fit to look after her and that she required some type of assisted-living scenario. However, the only options that seemed available to her were staying in the Louth County Hospital in Dundalk and blocking a bed, for want of a better term - obviously, that was not suitable - or going into a nursing home, but she was too old. Thus, it was literally the service she needed or the requirements were not there. She needed a certain amount of supports put around her to provide a decent framework so she could live her best life and play her part in society, rather than having us just locking her away, which is a sin this State has committed over many years and not something anybody in this room wants to do. How does the Minister of State anticipate dealing with that?

I will mention two other issues I dealt with before. Families whose children's needs are not being met come to us. In one case the child is a teenager and the other involves a woman in her 40s. The teenage kid has a number of siblings, I think there are three of them, and they all have special needs, so the mother is under severe pressure. I will not get into the ins and outs of it, but she has not been able to avail of respite services. In the other family, the parents of the lady in her 40s are in their 70s. The parents have only been able to get two hours once a week, which does not provide any real element of respite. I think Praxis Care assessed her and found she was not suitable for some of what it provides. There is nowhere, therefore, for these people to go.

Deputy Anne Rabbitte

On the person in the hospital bed and the family with the ageing parents, it is very frustrating to say we know there are proper pathways that could be delivered on. Respite is the answer for the parent of the teenager. We need more respite and to build more capacity into it. Earlier today, the Minister, Deputy O'Gorman, the Minister of State, Deputy Joe O'Brien, and I met the Taoiseach to discuss the need for planned funding for more respite. Putting in respite is the most important means of preventing more expensive cases that end up in emergency residential spaces.

Deputy Ruairí Ó Murchú

Families are doing the heavy lifting here and saving the State a huge amount of money. We cannot break them by failing to provide them with any element of respite.

Deputy Anne Rabbitte

That is something that I, along with the Minister, Deputy O'Gorman, and the team here, have as a priority. We have three priorities. One of them is personal assistance, PA. If the person in the hospital could come out and have PA hours, they could be in supported living. It is the same with the parents of the woman in her 40s. It is not home help. There is a difference between PA support-----

Deputy Ruairí Ó Murchú

I was going to say that there is a difficulty even when we try to get home help at the moment. It is not happening.

Deputy Anne Rabbitte

This is not that. It is people living their independent lives.

Deputy Pádraig O'Sullivan

I am sorry to say I also have a big long list. I will try to run through it. I have met with the Minister of State a number of times about the Rainbow Club in Cork. Obviously, I am here this evening to speak to her about that. It is a charity that does amazing work. At the last count, some 1,300 children were availing of its services every week. It does all of this for the grand sum of €50,000 and with just one employee. There are equivalents across the country, which I will not list here, that receive multiples of that figure. In some cases, these charities receive six- and seven-figure sums while dealing with a far smaller population. I need to highlight the work of the Rainbow Club and the positive impact it has in Cork. The Minister of State was on site with me. It was over a year ago at this stage. We thought we had a new home for the Rainbow Club. At least eight or nine months on from that visit, there is still no resolution. In the last couple of months, the Rainbow Club has tried to negotiate with the HSE with a view to offering some kind of respite arrangement. A couple of months of work went into that but, unfortunately, it yielded nothing. I would appreciate any update the Minister of State can give on those two issues. More to the point, what is her Department's vision for working with the likes of the Rainbow Club in delivering much-needed services for children? That is my first question.

An Cathaoirleach

I thought the Deputy was going to say that is it.

Deputy Pádraig O'Sullivan

No.

Deputy Anne Rabbitte

In a nutshell, I acknowledge the work the Rainbow Club does and the universal interventions it provides every week to 1,134 families. I cannot applaud it enough. I understand what the Deputy is saying about the grant of €55,000 it receives to deliver the Saturday club. I know it has capacity to support. To be honest, when a service is good, we should support it. We need good models and the Rainbow Club is a good model. There is no one on this side of the room who has never heard of the Rainbow Club. Every one of the officials here understands the Rainbow Club and knows the value of what it does. Bernard Gloster and Fergus Finlay are aware of it and its value and importance of the Rainbow Club and other clubs around the country were discussed at a board meeting very recently. We need to look at different models. The needs within the area of disability have changed. We need the HSE to support that changing delivery need in its funding model. The issue of the outstanding bill for the first quarter of this year that has not been paid has been raised with the HSE. The Rainbow Club has not been paid for January, February and March of this year and that is not acceptable.

Deputy Pádraig O'Sullivan

I will go on to the next question. The issue of residential care has been raised previously by a number of Deputies. We have our own issues in Cork. To my knowledge, four children have been left in school with a note in their bag over the last couple of months. People are at breaking point. One family I am aware of were offered residential care in Dublin for their 13-year-old daughter. It is a big enough decision for any family from Cork to ask for their child to be put into a residential setting but asking them to accept a place three hours from their home is a very big ask, no matter how desperate the family is. Where are we with regard to residential care in Cork? Are there any plans to expand provision?

Deputy Anne Rabbitte

As I said earlier on, there absolutely are plans to expand residential care nationally. Unfortunately, last year, emergency residential care entirely ate up the budget for planned residential care. That is what happened. I am not talking about small money. As part of the action plan that I and the Minister, Deputy O'Gorman, are to launch, we need respite and residential care to be prioritised. Every county has to have sufficient respite and residential places. If respite services were there to support families, perhaps we would prevent such young children entering residential care. I do not know if it is ethically correct that supportive families are forced and given no other choice but to abandon their child at school. We have to look at every mechanism and lever to support families. Respite happens to be the main one and it does work.

Deputy Pádraig O'Sullivan

I welcome the Minister of State's earlier comment that anybody who is aware of any sites or buildings should bring them to her attention. I am aware of a few in Cork but I will pass the details on later.

I have one more question. I was not going to raise this matter but I will because it has come up. I refer to paediatric services for people who require neurological rehabilitation. The Minister of State has met one particular family in Cork. I will give people an idea of their lives. The child suffered an acquired brain injury and lost the ability to speak and walk. The child has had to relearn and retrain all of those faculties. The family send me videos via WhatsApp when they are lucky enough to be sent to Dún Laoghaire for rehabilitation and you can see the child walk, talk and smile again. The Minister of State has worked on delivering paediatric neurological services for Cork over the last few months. I understand an announcement was made in last year's budget but nothing has happened on the ground yet as far as I am aware. Where are we with that? People from the south are coming all the way to Dublin. They are having to present at accident and emergency departments to get referrals to go to Dublin in the first place. I just do not understand it. I cannot fathom it and do not understand why there is not an outreach clinic of some description further south. I understand that is part of the plan. Will the Minister of State explain where we are in that regard?

Deputy Anne Rabbitte

Absolutely. It is an expansion of the community neurological teams. While I was in the Department of Health, I had the support of the Minister, Deputy O'Gorman, and the team to ensure there was a funding line in place for neurological services. We also need specialist teams. Over the years, I have managed to create specialist progressing disability services, PDS, teams for the deaf and for the blind. We have worked with Chime and with ChildVision. The next specialist team we plan to work on is a team for paediatric neurological services. There will be an expansion of the community neurological teams but also work with the specialist team. The Deputy is right; there will be an outreach model. Data will be gathered to support families. Rather than always meeting with a crisis, there will be a reaching back into the National Rehabilitation Hospital, NRH, or the local team so that when a child hits a milestone, there can be a proper clinical follow-up to ensure he or she is not left behind. That is equally as important for a child who gets a concussion on a rugby pitch. Nobody might follow up with such a child after his or her visit to the accident and emergency department. It is about that piece. This will be a specialist team and quite bespoke. It will work with the likes of Dr. Irwin Gill and the NRH. That piece will be a game-changer not only for children in Cork, but for children all over the country who need to access services in Dublin for care. That is a priority for the team and for me.

Deputy Pádraig O'Sullivan

I have one last question and a comment about PDS. Deputies Ó Murchú and Tully and I are on the Joint Committee on Autism. We were given a presentation a number of months ago by a family or group from Mayo, where PDS are not experiencing the same levels of staffing vacancy as other parts of the country, although I will not say they are adequately resourced. There is a reasonably decent level of staffing there. It surprised us to hear this group say that, in Mayo, PDS are working much better than the previous model. It is better resourced, better staffed and backed up. It was eye opening for me to hear that PDS can work. We can make it work and need to do so. There is no magic wand but it needs to be said. That group changed my mind despite my experiences in CHO 4, where we unfortunately have a great number of vacancies. That is a point rather than a question.

My last question is on something I raised with the Minister of State in the Dáil last week in the context of Carrigaline Community Special School. There is a new special school coming to Carrigtwohill in east Cork and it is hoped another will be coming to Glanmire in my own area soon. There is an issue there. The education and training board was appointed the patron but community disability network teams are not being aligned to that new patronage. Typically, such a school would be under the Cope Foundation, the Brothers of Charity or whatever. What is the story with that? Can we clarify it for once and for all? I know the Minister of State gave me an answer last week but will she again put on the record whether that is going to change? I believe she said it would change in May.

Deputy Anne Rabbitte

Therapists should land in Carrigtwohill for the first time ever on 1 May.

They will be accompanied by an OT, a physiotherapist and a speech and language therapist. Myself and the team here have met with Mr. Gloster with regard to whatever cannot be found or filled at that stage. We must have therapists in there. The plan is that on 1 May, therapists will be reinstated in the school. Going forward with the new school in Carrigtwohill, and all new special schools coming on board, it will be in the remit of the local CDNT under whoever the team lead is to support that school. We will always start out with an understanding that time will be allocated for an OT, a physiotherapist, and a speech and language therapist. That is the position right across the country.

Deputy Pádraig O'Sullivan

I thank the Minister of State and the Chair.

An Cathaoirleach

I call Deputy Michael Moynihan.

Deputy Michael Moynihan

I thank the Chair for allowing me to contribute. I welcome the Minister and the Minister of State. It is great to see them in their new Department. It has been talked about for a long time over the past two and half years. It is there now and we need to move forward on it.

There are a number of issues which I want to raise. I took a phone call this afternoon from a mother whose autistic child had been seeing a consultant paediatrician, but the language or attitude that was used by medical personnel greatly disturbed me. We had the launch this morning of the autism awareness programme in the Leinster House complex of the Oireachtas. There is a wider issue out there in respect of attitudes right through society, including among very educated and learned people. This mother forwarded to me some documentation which I will be raising at a further level. There is an attitude there. I believe that all of us, including Ministers, must make the case that people need to have a sea change in respect of attitudes towards people with disabilities. We are trying to ensure our society is all-inclusive but there is a challenge right through all the services. Indeed, there is a challenge in terms of some of the attitudes in the services. I am reluctant to say that. One would think that the people providing the services were paying for them out of their own pockets when they are charged with the responsibility of giving services to people with disabilities. There is a challenge here. They have an attitude, even towards public representatives who contact them on behalf of families, which we all do on a daily basis. I would like the word "attitude" to receive a significant mention.

A previous speaker spoke about respite. When some people talk to families about respite, they say they might be able to get it three or four hours away. It is frightening for families to hear that there is no respite, or that they might receive it in Dublin, Louth or Donegal. People in Cork have been told that there may be respite in Donegal. In all fairness, what is an official trying to do when he or she says that to a family that is in dire need? Is he or she trying to demean or belittle the family further, or drive them from what is a very challenging position for them? We need to be conscious that these attitudes are there, that we understand them, and that we need to drive them out of the system to ensure people are working together on this.

Throughout this debate, the Minister and the Minister of State have mentioned their own budgets. First of all, the attitude of both of them in how they are going about their business is very welcome. I ask them to continue with that because it is refreshing, to be honest. In respect of the capital budget, where are the Ministers with shovel-ready projects? As I understand it, there is unspent capital even for the first quarter of 2023, and when we move to the end of 2023 there will still be money which has been allocated from the Department for capital projects within the HSE which will be unspent. We all know of the absolute need for those projects and facilities to be put on the ground. Perhaps the Minister and the Minister of State might tease out the position with regard to the unspent money. Will they explain to the committee how serious the Department and the HSE are about ensuring that the envelope of money they have for capital projects is spent, and that the badly needed services or structures are in place for people with disabilities, their families and their communities?

I want reassurance in respect of an ambitious children's respite project in Kanturk. Could I be given similar reassurance in regard to the equestrian centre we are also trying to construct in Kanturk, which is at the planning and tender stage at the moment? Where are those projects in respect of the capital funding for 2023?

I will leave my contribution to those questions. I might come back in at the end, very briefly. I thank the Chair.

Deputy Roderic O'Gorman

I thank the Deputy. I will take the first part of his question. I thank him for his comments. We look forward to working with the Deputy’s own committee with regard to advancing these issues.

The point the Deputy made on attitude is very important. I spoke briefly earlier about the PDS roadmap and trying to reset the engagement between the HSE, service providers and parents. A number of Deputies have raised some of the written correspondence. When bad news is being delivered, it can be delivered in a certain way. We need to recognise that, rather than just having an approach of ”the computer says no". We recognise that not every communication will be a positive one, but how it is delivered is important. That goes all the way from PDS to the overall approach to disability issues.

We considered the most extreme element of this spectrum earlier in the Dáil when we voted on the hate crime legislation. We know that persons with disabilities suffer and are victims of crimes on the basis of their disability. This is on the far end of the spectrum the Deputy is talking about, but it is a spectrum. It is about how we as a society talk about and treat persons with a disability. We said earlier that one of the central elements of the Department's role is to ensure that disability is not seen as a medical issue, which it has been for too long. It should be seen as a societal issue where all elements of disability are understood.

My final point of that attitudinal piece is that there has to be a change across Government and the State. Even though this Department has specific responsibility for disability, responsibility for meeting the diverse needs of persons with disability remains with every single Department. The Department of Transport has a responsibility with respect to disability, as do the Departments of Education and Social Protection. The Minister of State, Deputy Rabbitte, and I will be very clear in looking for the support of Deputy Moynihan's committee on this because we have a responsibility now. Other Departments retain their responsibility for what they are doing. Our Department cannot deliver transport services or EmployAbility services. Other Departments and other parts of the State must step up to recognise all of the obligations, commitments and rights under the UNCRPD to which we, as a country, have signed up.

Deputy Anne Rabbitte

I thank the Minister. I completely understand the issue of respite. I am fully supportive of everything the Minister, Deputy O'Gorman, has just said.

The issue of capital is one of my biggest bugbears. The gathering of data within the Department of Health, as part of the transfer of functions, was very difficult. One of my officials might disagree with that. One of the hardest pieces was to understand how and where the money was spent, and the grey areas within that. Capital was one of those pieces.

I will explain one thing which frustrates me greatly. When one has a fantastic capital budget, such as €22 million, which is a serious uplift on what the previous budget was in the Department of Health, not one penny of that budget should be left behind unless one is underperforming in any quarter on one’s key performance indicators. Unfortunately, the way the HSE has worked to date is that it nearly directs its funding to the back end of the year rather than the front end. It does not front-load its capital piece but leaves all of this money at the back end. By the time one reaches the end of the year and the shovel-ready projects, where one has been missing one’s target beyond the three months or the six months, that money cannot be turned around quickly enough. One loses it and it goes back into the overall piece again to be restarted. People do not understand that well enough. That is how capital has worked in the past.

My senior officials agree with me. We need to change that piece. From talking with my assistant secretary, Mr. Ó Conaill, it is one of the pieces we wish to change in how we approach capital spending within this Department. We are not spending the money we are being allocated. I am not talking about this Department, which will spend every last penny of it. In the past, however, we have not. It is our ambition to spend it all, but it cannot all be projects that are earmarked as projects for design or those at appraisal stages. What we need are shovel-ready projects.

Every one of the members has spoken about children who need intervention and about respite houses and residential homes. We need to ensure that there are enough centres of excellence used around the country and that we can access that funding to support the likes of Rainbows Ireland, which can support 1,100 kids on a weekly basis, or the neurodiversity groups in Dublin. It is no different from what I have seen in Liskennett on the Limerick-Cork border. We have really good projects that need to be stepped up. There is an exciting one under commission in Deputy Moynihan's own area in Kanturk at the moment. Those projects are being done but at the same time, they need to be funded so that children under the school summer programme have access to these services. We need to have deliverables and not just be aspirational. I am very happy with the support the Minister and I have received for our collaboration. My plan is that when the HSE runs under on its capital spend on a monthly basis, that money will go to a shovel-ready project that is ready to turn around and make operational before the end of the year.

Deputy Michael Moynihan

I thank the Minister of State.

An Cathaoirleach

That concludes all our questions, the vast majority of which were outside of the remit of the Revised Estimates. I am aware of that in case anyone thought otherwise. I felt it was appropriate given that this was our first opportunity to discuss disability, which has been something the committee has sought for so long. The Minister has always been really good when we have brought up issues outside of the Estimates and I knew the Minister of State would not mind either. We took a bit of advantage there; I thank her very much.

That completes the select committee's consideration of the further Revised Estimates for Public Services in respect of Vote 40 - Children, Equality, Disability, Integration and Youth. A message to this effect will now be sent to the Clerk of the Dáil in accordance with the Standing Orders. Is that agreed? Agreed. It is proposed to publish the opening statements to the website. Is that agreed? Agreed.