Disabled school leavers can’t be abandoned

Speaking in the Dail today, Fine Gael TD for Dublin South Olivia Mitchell said that for the first time ever, there was no provision in the health budget to provide services to 18-year old disabled children.

“If there are no health funded day services provided this summer when the Department of Education’s statutory obligation to 18 year olds is finished, then many of these children are so disabled they may never leave home again. We cannot abandon them or their families in this way.

“If we abolished all third level education for able bodied school leavers there would be a revolution. How can we allow it for those most in need of supports? Many of these children are in local schools such as Setanta Special School in Stillorgan, St Augustine’s in Blackrock and Cheeverstown in Templeogue. In fact there are up to 650 children leaving such schools across the country.

“I’m calling on the Minister to find, somewhere in the vast €14,000,000,000 budget, sufficient funding to ensure even a basic day service for this cohort of children.

“I recognise the need for savings and efficiencies right through the health service but it is indefensible to use disabled children to drive these efficiencies. None of us can happily live with a decision whereby the one health service that is completely abolished is the one to 18 year old disabled children.”

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DÁIL ÉIREANN

Topical Issue Debate  23 February 2012

Services for People with Disabilities  

Deputy Olivia Mitchell: I thank the Minister of the State for taking this debate. I wish to raise two issues regarding disability services. I acknowledge the Government wants to protect them but the overall reduction in the budget allocation for these services is 3.7%, 2% of which is supposed to be achieved through efficiencies. I am in favour of efficiencies and I accept that the headline salaries paid to the chief executive officers of so-called not-for-profit organisations are indefensible. However, only a few service providers offer such salaries. Most of the providers have pared back their costs as far as they can in the past four years of cutbacks. It is inevitable that front-line services will be impacted on, if not devastated.
One such organisation with which I am familiar is Cheeverstown. Its budget for 2012 has been reduced by €1.5 million while last year it was reduced by €700,000. The administrators are working within the confines of the recruitment ban, increments payable to all staff under the Croke Park agreement and an exceptional pensions bill. The organisation will lose three of their four social workers to early retirement. One of them at least will have to be replaced even though there is no budget for that position and Cheeverstown has to use the probation service to paint buildings. They have no flexibility to achieve efficiencies. The only way the new budget can be implemented is by cutting back on services. Due to the cutbacks, for example, respite services have been reduced by 40% and they probably will be terminated altogether this year. The Minister of State can imagine the impact this will have not only the disabled clients themselves but on their families who depend on respite care. All disabled people and service providers cannot be penalised because of high salaries paid to a few chief executive officers. For instance, hospitals are not penalised because consultants have high salaries, even though there is room for inefficiencies in this sector more than in the disability sector.
The most urgent issue is the plight of disabled school leavers this year. Normally, special provision is made for them but the service is being abolished. No provision will be made for the 650 school leavers this year. A number of the high performing clients will enter the education sector but those who are most handicapped depend on the health service and they will have no access to services. If they are forgotten by the health service, they will be forgotten by all of society, which is unacceptable.
There was a misunderstanding about what was agreed between the HSE and service providers, which was regrettable, but no matter where the blame for this lies, it does not lie with 18 year old severely disabled children. I cannot stand by while they and their families pay the price for this mistake. If the Government decided to cut all third level education, there would be a revolution and we would not even consider it and, therefore, I do not know why we consider it for people who need our help most. I can understand and accept cutbacks in the provision of transport, meals and so on. Everybody understands we are in difficulty but condemning a cohort of children to lifelong incarceration without services from next summer is indefensible and unacceptable. Many of these children are so disabled that they will not leave home again if they are abandoned now by the State.
I plead with the Minister of State in conjunction with her senior ministerial colleague to examine the overall health budget and to find relief within it for this cohort of children. Savings must be achievable in the overall health budget. The Minister does not have to single out this most disadvantaged group.

Minister of State at the Department of Health (Deputy Róisín Shortall): I thank the Deputy for raising this matter, which I am taking on behalf of my colleague, the Minister of State at the Department of Health, Deputy Kathleen Lynch.
Under the Health Act 2004, the Health Service Executive, HSE, is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services, including disability services. The HSE, through its occupational guidance service, works with schools, service providers, service users and families to identify the needs of young people with disabilities who are due to complete their second level education. This process requires flexibility from disability service providers and the maximisation of additional capacity from within existing resources. Some referrals are appropriate for rehabilitative training programmes and others are suitable for other disability and mainstream services.
Where appropriate, the occupational guidance officer will refer and support the individual to access FÁS services in line with the operational protocols agreed between the HSE and FÁS at national level. Referrals are also made to other services appropriate to the individual. The aim is to address the needs of individuals in one or more of the following ways: health funded rehabilitative training; health funded day services; FÁS funded rehabilitative training; FÁS funded vocational training; and approval to extend education placement for a specified time. The plan for each individual is dependent on final decisions by service users where more than one service model may be considered; approval, if requested, to extend current educational placements; and capacity of providers to make best use of available resources.
The HSE monitors the outcome of this process to ensure that, in as far as possible, the needs of each individual young person with a disability leaving school are addressed. The demand for services for school leavers continues to grow. The planning process is under way to ensure all school leavers requiring services are considered and prioritised. The HSE expects that approximately 600 school leavers will require services in 2012. Other health funded day services are provided from the range of general day services provision for adults with disability. While the executive makes every effort to provide day services to people over 18 on leaving school, this always has been dependent on the availability and location of appropriate places coupled with the needs of the individual school leaver.
In the current year, the disability services will be required to cater for demographic pressures such as new services for school leavers and emergency residential placements, from within their existing budgets. Meeting the needs of all school leavers with disabilities will be challenging. However, both the voluntary sector and the HSE are committed to the best use of available resources in a creative and flexible manner to be as responsive as possible to the needs that present. There is evidence that an accelerated move towards a new model of individualised, person-centred service provision in the community can help to achieve efficiencies, particularly relating to services for those with mild or moderate intellectual disability.
The emerging departmental policy direction – the value for money and policy review, coupled with recommendations from HSE national working groups on key service areas, including the forthcoming review of HSE funded adult day services, emphasise the need for a new model of service provision that, if agreed by Government, will further the independence of people with disabilities in an efficient and cost effective manner. The adult day services review will be published in the coming weeks and will contain recommendations that will guide the reconfiguration and modernisation of services in this area.

I regret to say that it is not an option to seek additional funding. There are huge pressures on all our public services and for that reason a much higher level of flexibility and creativity is required. I thank the Deputy for raising the matter.

Deputy Olivia Mitchell: I am a little surprised to hear that the planning process is under way to ensure that the needs of school leavers will be considered and prioritised when one cannot prioritise something if no funding is being provided for it. This is the first time ever there is no provision for such school leavers. I understand the need for efficiencies and savings and I have no problems with the 2% savings, but to use disabled people to drive efficiencies in organisations is not fair. It is not the job of the disabled to drive efficiencies; it is the job of the Minister and the HSE to ensure there are efficiencies.
The service providers are now being asked to provide services for additional people out of funding that is now 14% less than it was a few years ago. It is not possible to implement the kind of efficiencies that will ensure there is no reduction in front line services. I am talking specifically about the school leavers. If there is no provision, there is no service. I am not seeking the allocation of additional funding into the health service but that there must be a reallocation of funding within the overall €14 billion. In that €14,000 million surely it is possible to find even half of the meagre sum of €10 million which was allocated last year. If they even got €5 million, at least it would ensure that those children who are leaving school would get out of the house sometime over the rest of their lives.

Deputy Róisín Shortall: It is not a case of using disabled people to drive efficiencies. In the case of disability services, the plan provides for a 3.7% reduction in budgets but it makes it clear that there is scope for achieving a 2% saving on efficiencies, which brings it down to a 1.7% reduction. In the current climate where everybody is under pressure in terms of budgets and is required to reduce their budgets, cut down on overheads and achieve efficiencies, I think that is a reasonable figure. We want to ensure that people with disabilities do not take the hit in this regard. We want to achieve savings through reducing overheads, adopting a better approach to the provision of services and a more realistic view in regard to salaries in this area and the Minister of State, Deputy Lynch, is determined to achieve those efficiencies but not at a cost to the individuals concerned who are dependent on the services. That is why this report is being brought forward and why there will shortly be recommendations on new models of care, which are more efficient and more responsive in terms of the people who need those services.