I listened in silence for 40 minutes to contributions from the opposite side of the House. I am as concerned as Deputy Owen about these issues which I want to deal with properly. If interest payments of £40 million a week could be reduced, there would be more money available to deal with them.
The Opposition made no attempt to defend its record in government or compare it with that of the Government over the past 18 months. It does people with disabilities a disservice in suggesting there is a golden opportunity to address these issues. It is a facile argument. The objective is not professional accountancy, as the Green Party suggests, but to ensure the Minister for Health and Children will have much more money at his or her disposal to provide the required services.
I am pleased to have the opportunity to speak on issues related to the provision of services for people with physical and sensory disabilities and to outline the Government's plan to meet the needs of this group. The Government fully supports the principle that people with disabilities are entitled to all the rights and privileges which go with citizenship and that any and every barrier to the enjoyment of these rights and privileges should be removed. These barriers have been identified by the Commission on the Status of People with Disabilities in its report, A Strategy for Equality. In drawing up its recommendations the commission adopted three guiding principles — equality, maximising participation and enabling independence and choice. The overall thrust of health policy for people with disabilities is to provide the supports necessary to enable each individual to live in the community with the maximum possible degree of independence.
Ensuring equality, participation and independence for people with disabilities involves much more than health services appropriate to their needs. People with disabilities are tired of what they call "the health model of disability". They wish to be treated the same as their fellow citizens by having services delivered to them by the mainstream agencies, that is, the agency that provides the service for the rest of the community. This is one of the objectives set out by the commission in its report. The pursuit of this objective is a fundamental element of the Government's policy on people with disabilities. As it involves a wide range of services crossing numerous boundaries of Government Departments, the Government decided on day one to appoint one person to co-ordinate efforts to achieve this objective. That person is the Minister for State at the Department of Justice, Equality and Law Reform, Deputy Mary Wallace, who has responsibility for all matters related to disability. The appointment of a Minister of State with special responsibility for disability issues is a clear indication of the Government's determination to tackle not just health issues but all issues affecting people with disabilities.
A specific commitment is given in the programme for Government to the implementation of the commission's report. The practical steps needed to develop services within my area of responsibility are outlined in the report of the review group on health and personal social services for people with physical and sensory disabilities, Towards an Independent Future. A commitment to implement the recommendations of this report is given in Partnership 2000 which states that "resources will be allocated, within overall expenditure parameters, for the development of services for people with disabilities in line with the Report of the Review Group". A commitment was also given in the Department's strategy statement, 1998-2001, which undertakes to pursue the development of services for people with disabilities in line with the report's recommendations.
There are no definitive statistics for the number of people with physical and sensory disabilities. Based on population trends in other countries it has been variously estimated that the number here could be anywhere between 100,000 and 200,000. Not every person with a physical or sensory disability is in need of a health service. The report, Towards an Independent Future, highlighted the lack of reliable information on the numbers and service needs of people with physical and sensory disabilities and recommended the establishment by the Department, health boards and voluntary bodies of a database on the health service needs of people with physical and sensory disabilities. As a first step the review group recommended the establishment by the Department of a database development committee to prepare detailed proposals for the development of the database. Nominations for membership have now been made and the committee will begin its work next month. A joint database pilot project has been undertaken in three health boards and this will provide a valuable impetus to the work of the committee.
Once established the database will provide reliable and up-to-date information for a number of separate but related purposes. It will provide epidemiological information at national level to describe the prevalence and, where possible, annual incidence of the various types of disability and to provide a baseline from which trends can be monitored over time; provide the factual information necessary for the orderly planning of service developments at national, regional and sub-regional level, including prioritising service needs and assisting in decisions on the allocation of resources; enable individual health boards and other service providers to maintain, at their discretion, data for their own purposes such as the development of group or individual care plans; and it will provide a valuable resource for the purposes of research.
One of the basic recommendations of the Commission on the Status of People with Disabilities is the establishment of a national disability authority. Progress is continuing on the implementation of the report of the establishment group on the new national disability authority. As the House is aware, the establishment group is currently analysing and discussing the practical implementation of the report, Building a Future Together, which was approved by the Government earlier this year. All relevant Government Departments and agencies are fully engaged in this process.
The final stages in the preparation of the national disability authority Bill have been reached. I give credit to my colleague, the Minister of State, Deputy Mary Wallace, for her contribution to achieving this progress. Her determination to see matters through has meant that the impetus for change will not be lost. Credit is also due to the staff of the NRB. Without their valuable input and co-operation over the past three decades or so, we would not have reached the stage we are at now — improving, advancing and reshaping the State's apparatus for the delivery of services for people with disabilities.
I fully recognise the importance of their contribution. I take this opportunity to thank all the staff at the NRB. The imminent dissolution of the NRB signals not the end of its influence but a milestone in the beginning of a whole new emphasis for the delivery of services for people with disabilities. The proposed reconfiguration of institutional responsibilities for these services will ensure a more targeted and inclusive approach.
The planned changes should be effected early next year. The knock-on effect of the transfer and the mainstreaming of vocational training and employment opportunities for people with disabilities within the Department of Enterprise, Trade and Employment will free up my Department to concentrate fully on its primary role which is to provide rehabilitative training and care services, and appropriate work opportunities for people with disabilities. The aim will be to equip and enable them where possible to advance through the training continuum to other mainstream activities.
Currently some £18 million is provided through the Operational Programme for Human Resources, from the European Social Fund, on an annual basis towards the cost of vocational training for people with disabilities. This funding supports vocational training services and the very important work of many service providers. A sum of £33 million pounds has been provided through the same operational programme from the European Regional Development fund over the five year period 1994-95. This funding has been made available towards the purchase of new centres, the upgrading of existing centres and for equipment.
One of the difficulties in developing services for people with physical and sensory disabilities is the very wide range and variety of disabilities included in that category. This makes the development of the services rather complex. From time to time a certain group will mount a campaign for the development of a particular service. Respite care and personal assistance services are examples. While these and other services are of vital importance and are among the priority areas for development, they cannot be treated in isolation. What is involved is a wide range of interlocking and complementary services, designed to provide the person with a disability with a flexible range of services. Many individuals with disabilities may require a combination of several services to meet their needs.
To clarify the complex issues involved and to provide a blueprint for the development of the services my predecessor, Dr. John O'Connell established on 30 June 1992 the Review Group on Health and Personal Social Services for People with Physical and Sensory Disabilities. The terms of reference of the group were :
To examine the current provision of health care services to people with physical and sensory disabilities and to consider how they should be developed to meet more effectively their needs and specifically to make recommendations for service developments in accordance with the commitment contained in Section IV, Paragraph 33 of the Programme for Economic and Social Progress.
The Minister requested the group to prepare an interim report on the most urgent service needs so that these could be considered in the context of developments under the Programme for Economic and Social Progress in 1993. The interim report was submitted to the Minister in December 1992. On foot of the interim report, additional revenue funding of £1.5 million was made available in 1993 for the development of the services and a pattern established whereby additional development funding is provided every year.
The final report of the review group, Towards an Independent Future, was published in December 1996. It set out the requirements for the development of the services over a five year period. I am committed to the implementation of the report.
We are very fortunate to have a culture of concern for the welfare of our fellow citizens. This is manifested by the considerable number of people who work tirelessly both in a voluntary capacity and on a professional basis with voluntary agencies in providing a wide range of supports and services to their fellow citizens. The effect of this is most evident in the health sector where many voluntary agencies provide services which have, over time, become a vital part of our overall scheme of health care delivery. This was fully recognised by the review group in looking at the organisation of services. The group recommended the structured involvement of the voluntary agencies in planning and co-ordinating the services and in fixing priorities for the allocation of funding for the development of the services.
The review group's recommendation was that the chief executive officer of each health board should establish a regional co-ordinating committee for services for people with physical and sensory disabilities. Membership of the committee would comprise officers of the health board, major voluntary sector services providers, representatives of service users, that is, people with disabilities and the National Rehabilitation Board.
These committees have now been established in every health board. My Department is currently pursuing a review of the operation of the committees in consultation with the health boards and the voluntary organisations concerned. The purpose of the review is to identify best practice, to encourage a cross-fertilisation of ideas across the regions, to come up with solutions to any teething problems which may have arisen and to contribute to the development of overall national policy.
Voluntary service cannot be mentioned without referring to the invaluable contribution made by carers. It is estimated that there are about 100,000 carers in lreland, 25,000 of whom provide care on a full-time basis. Although the majority of these care for an elderly person, a sizeable proportion provide care for people with disabilities.
People with disabilities living at home require assistance with the tasks of daily living and often the responsibility for the care rests with one person principally. The review group report acknowledges the need to expand and develop different levels of home support services for people with disabilities and their carers. The crucial role of the carer is taken into account in the planning of services with, for instance, the strong emphasis placed on the development of respite care services, which benefit both the person with a disability and the carer. The provision of this and other support services with the object of enabling the person with a disability to remain in the home serve the dual purpose of promoting independent living for the person with a disability and of taking as much pressure as possible off the carer.
There has been a long running campaign by the Centre for Independent Living for a personal assistance service funded by an independent living fund. A personal assistant provides assistance at the discretion and direction of a person with a disability with everyday tasks, such as personal care, household tasks etc., which the person is unable to do for him or herself. A full PA service is defined by the Centre for Independent Living as a need for at least 20 hours service per week. One person can require up to 105 hours, necessitating the employment of three PA's and can cost in excess of £20,000 per annum. The independent living fund is no more than a model for funding a PA service. The important thing is that the service itself be provided to those needing it — the precise manner of funding it is a detail. The PA service is one of a range of support services designed to enable people with disabilities to live in the community with the maximum degree of independence. The range includes home helps, home care attendants, respite care, day care etc. and the objective of policy is to develop the range of services as a whole. The amount of funding to be devoted to the development of this service will be decided in each health board area in accordance with locally perceived priorities. Out of £3 million provided for development of services in 1998, £113,000 was allocated by the boards to personal assistance services.
On the question of funding, the review group report set out the requirements for the development of the services over a five year period. It specified numbers of additional places in services such as long-term residential and respite care and day care and numbers of additional staff, such as therapists and nurses. The review group estimated the cost of implementing its recommendations at £50 million over the five year period.
A major proportion of the services for people with disabilities are provided by agencies in the voluntary sector. Very often the provision of services was in response to demands for services from their own members. Some of these could be funded out of fundraising income but not all. A situation developed over a period of years where services were not fully funded by the State. In recent years with falling income from fundraising most agencies have been running services at a loss and thereby building up debts. One of the basic recommendations of the review group is that existing services be put on a firm financial footing to provide a sound basis for future development. In 1998, £2.4 million has been provided in my Department's Estimates towards the elimination of this underfunding by the State. In addition, in 1997, a Supplementary Estimate of £5 million was provided to eliminate the accumulated deficits of these agencies.
One of the areas singled out by people with disabilities and their advocates is aids and appliances for people with physical and sensory disabilities. Shortly after taking office this Government took an early opportunity to alleviate this problem when, on 27 October 1997, decided, with the agreement of my colleague, the Minister for Social, Community and Family Affairs, Deputy Ahern, to make £4.325 million available out of savings on his Department's Vote for aids, appliances and equipment for people with physical and sensory disabilities. It is estimated that more than 10,000 people with disabilities benefited. A further £1 million in capital funding was made available to health boards in 1998 for aids and appliances. Notwithstanding this funding, it was brought to my attention recently that there are still substantial waiting lists in health boards for aids and appliances and, as I announced earlier, I have decided to allocate a further £4 million to help eliminate these waiting lists. This will be distributed on a regional basis through health boards to specific organisations. The Irish Wheelchair Association will receive £1.5 million; Cerebral Palsy Ireland will receive £500,000; the Rehab group will receive £500,000; the Central Remedial Clinic will receive £500,000; the National Rehabilitation Hospital will receive £100,000; £500,000 will be allocated for sensory disabilities; and £400,000 will be allocated for other organisations.
I expect the agencies will work closely with the health boards to ensure primacy is given to those already identified as waiting for aids and appliances. It is important that there continues to be a high level of co-operation between statutory and voluntary bodies to ensure services are provided in an orderly and planned way.
This year a total of £8.4 million was allocated to the maintenance and development of services for people with physical and sensory disabilities. Of this, £2.4 million was devoted to eliminating core underfunding of existing services and nine of the main voluntary agencies in the sector received grants for this purpose. A further £3 million was for capital projects, £1 million of which was invested in aids and appliances. The balance of £3 million was allocated to health boards for further development of the services. Almost half of this funding was used to create 50 new posts in health boards such as speech and language therapists, physiotherapists, occupational therapists, social workers and public health nurses.
In terms of new structures put in place to facilitate the co-ordination of existing services and to make the development of services more effective and the allocation of substantial additional funding, this Government's commitment to improving the quality of life of people with physical and sensory disabilities is clearly demonstrated. Following the publication of the report, Towards an Independent Future, in December 1996, the previous Government provided a total of £3.688 million in 1997. Since taking office my Government has to date provided a total of £22.4 million for these services. No matter how you parse and analyse those figures, the performance of the present Government in pursuing the development of services for people with physical and sensory disabilities cannot be faulted in comparison with the previous Administration.