Speech by Mr Tim O’Malley TD, Minister of State at the Department of Health and Children At the conference “From Survival to Success” organized by the Not for Profit Business Association.
I would first of all like to thank the Not for Profit Business Association for inviting me to speak to you today. The title of this conference “From Survival to Success” is very appropriate given the particular point in time which we find ourselves at today.
I believe that we are standing at a crossroads where a number of roads meet.
The first is the road travelled by people with disabilities, their families and those who worked to assist them from the earlier part of the last century through to the 1970s. Along this road we see following the first purpose built service in Stewarts Hospital, the involvement of the psychiatric hospitals in the provision of care, the development of a somewhat limited range of support services by various religious orders and the growing involvement of organizations founded by parents, families and others involved with people with physical, sensory and intellectual disabilities. In the main these supports consisted of residential and day supports, with increased provision in the area of special education services mainly through the special school system.
The second road leading into this crossroads is the road travelled by people with disabilities through the 1970s to date. We now see a growing emphasis on the development of more community based services and a very significant enhancement of the range of support services being provided, with the emphasis on increasingly enabling people with disabilities to remain within their local communities and to live as independently as possible.
In particular the 1990s and early years of this century have seen very rapid and significant changes which have impacted very positively on the lives of people with disabilities.
The growing recognition by society in general of the right of people with disabilities to participate in and contribute to the social and economic life in Ireland and on an international basis has underpinned much of what has happened in more recent years.
Some of the significant milestones along this road have included;
•The recognition of the need for the development of a more person centred approach in providing support services
•An awareness of and emphasis on the abilities of people with disabilities. The Special Olympics World Summer Games in 2003 in particular highlighted this point and brought home very clearly to people all over the country what can be achieved if people are given opportunities to develop their talents
• The move from institutional settings to community based services and a recognition of the need for a greater range of support services delivered in a flexible manner which meets individual needs
•The very significant investment by the Government in supports for people with disabilities, including personal allowances, employment schemes and revenue and capital funding for education, health and personal social and other services.
•Finally, the various legislative and policy measures, including mainstreaming, which have been put in place by the Government in the areas of equality, education and access to facilities, services and information.
We are now facing down the third road leading from this crossroads. This is the road which we will travel over the coming years. I would like to outline for you some of the key elements of the vision which the Government sees as being part of this journey which we are now commencing.
Principles underpinning future service provision;
The philosophy which has underpinned the planning and delivery of services to people with disabilities is that people with disabilities should be given the opportunity to live as full a life as possible and to live with their families, and as part of their communities, for as long as possible. Factors which have influenced current policy include the Health Strategy -–”Quality and Fairness” which was published in November 2001 and Government policy in relation to mainstreaming of services for people with disabilities.
One of the principles which is included in the Health Strategy is to ensure that health services are people centred. It is also the approach which is increasingly being taken by service providers. Mission statements throughout the health system contain phrases such as person focused, people centred etc.
These principles should continue to guide us. However we need to take a close look at how we are giving practical expression to their implementation and to use the opportunities which we now have to build a better foundation on which to move forward.
However if we are to translate this philosophy of inclusion into practice – and I believe we should –
we need to look at every aspect of how the disability specific support services interact with those seeking support. The majority of people turn to the health services at a time of crisis in their lives or the life of a family member. This is particularly true in the area of disability when the first point of contact generally relates to seeking answers to worries concerning the development of a child or when a disability is diagnosed. Whatever the circumstances, the primary need is generally for practical support and information. We are all aware from experience that the response which some individuals get when they seek assistance in these circumstances not only may not help them, but may actually add to their anxiety and distress.
While accepting that issues such as the availability of resources can affect to a greater or lesser degree the response which can be given in particular circumstances, there are other factors which also need to be taken into account.
If we are to pay more than lip service to the principle of “person centred services”, we need to look very hard at the way in which we plan and deliver services. It is no longer acceptable that individuals are expected to fit into the “system”. The “system” therefore must change if it is to truly respond and meet the needs of those who require its support.
I am not underestimating the difficulties which responding to this challenge would place on all of us. However I do believe that if we are willing to take an honest and critical look at how the services, as currently structured, could be made more responsive to individual needs, we will find many situations where implementation is not dependent on resources, but on changes in attitudes and practices.
In addition, it is crucial that, as a first step, we clearly identify resources from existing funding, given the level of current expenditure on these services and personnel, with which to underpin this process. Our first reaction should not be that we cannot do anything until we get additional funding or personnel. It should be to demonstrate clearly what we can do and how, with some additional assistance, we could build on that.
Establishment of Health Service Executive
The establishment of the HSE is a significant milestone in the development of the Irish health services. The purpose of the very significant restructuring which this represents is to enable the health services to develop to provide more effectively and efficiently for the needs of those who require access to and support from them.
The new structure will assist in providing for a more co-ordinated approach to the delivery of all services, including those for people with disabilities. It will also greatly assist in putting in place the structures necessary to deliver the provisions contained in the new legislative measures which the Government has put in place.
A key objective for the HSE is to ensure that the health services are delivered in the most effective, efficient and appropriate manner, while also taking account of equity of access.
As I have already stated, I believe that we must take a very hard look at the manner in which services for people with disabilities are planned and delivered.
Over €2 billion is being spent by the health services alone on services and allowances which provide support for people with disabilities, including those with mental illness.
Having committed to significantly further enhancing the level of funding available to these services over the coming years, the Government is also adamant that there is a very urgent need to ensure that the funding already available is being targeted in an effective and appropriate way and in a manner which facilitates equitable access to services.
Issues such as duplication of services and the sharing of resources and facilities by various agencies need to be examined. It is very probable that situations will arise as a result of this exercise where decisions will have to be made regarding the manner in which service providers, both statutory and non statutory, deliver services. This links back to my earlier comments regarding person centred planning and the need to rationalize service delivery and planning in a way that clearly places people with disabilities at the centre of any decision making process.
Non-statutory agencies developed in the disability sector to meet specific areas of identified need which were not being met by the statutory services. These agencies have played a vital role in the overall development of services in this area over the years. However because of the manner in which both statutory and non-statutory services have developed, there are serious inequities in relation to access to services and the levels of support available around the country.
The Department of Health and Children will be assisting the HSE as it works with all relevant stakeholders over the coming months in relation to these issues.
In more recent years, structures which are inclusive of people with disabilities, their families and carers and statutory and non statutory service providers, have been put in place which underpin the partnership approach to provision of support services.
The Government is committed to continuing to work in partnership with all key stake holders in this area to build on this framework. We hope that we will continue to have your support over the coming months and years as we move forward.
National Disability Strategy
The Government has a clear and effective strategy in relation to the planning and delivery of health funded services to people with disabilities, including those with mental illness. As I have already stated, the principle underpinning the planning and delivery of these services to persons with disabilities is that individuals should be given the opportunity to live as full and independent a life as possible, to live with their families and, as part of their communities, for as long as possible. There has been a particular emphasis since the 1970s on support at community level in the development of these services, including community based day, residential and respite and other support services. It is recognised and acknowledged that the health funded services in this sector have advanced greatly in particular since the late 1990s. It is also acknowledged however that further work is required in the coming years.
The provision of health funded services to meet the identified needs of people with disabilities is a key element of the National Disability Strategy, which was announced on September 21st 2004..
The Disability Act, 2005 and the Education for Persons with Special Educational Needs Act 2004 place very specific statutory responsibilities on the health services.
The commitment to provide a multi-annual Investment Programme for Disability Support Services gives recognition to the need to build capacity in the health services to deliver on these obligations.
Significantly the Government has decided on a fundamentally different approach to that which normally applies in relation to current revenue funding for high priority disability support services. A multi-annual funding package for current expenditure on these services, with a total cumulative value of almost €600m, has been agreed with the Minister for Finance. This is the first time that Government has adopted this approach in the case of spending on services.
In all a special disability multi-annual funding package with a total cumulative revenue and capital value close to €900m has been put in place by the Government for the period 2006 to 2009.
As you are aware, the bulk of this new funding will go to the health sector where it will be invested in services for persons with intellectual, physical or sensory disability, those with autism and mental illness. It will focus, in particular, on the provision of extra residential, respite and day places, extra home support and personal assistance, and extra places in community based mental health facilities.
In relation to funding for other aspects of the health funded support services required by people with disabilities, this will be a matter for discussion between the HSE, the Department of Health and Children and the Department of Finance as part of the annual ongoing Estimates and Budgetary process.
This new approach shows the Government’s commitment to funding disability support services and to implementing the overall National Disability Strategy.
Implementing the National Disability Strategy;
While I am aware that the provisions contained in the Disability Act 2005 do not meet the expectations of the disability sector as a whole, the Act provides, for the first time, a very specific framework which will support the planning and delivery of disability specific support services.
Together with the Education for Persons with Special Educational Needs Act 2004, it changes not just the manner in which services are delivered, but also places very specific obligations on the health and education services.
I would ask all relevant stakeholders to work with the Department of Health and Children, the Department of Education and Science and other relevant Government Departments and agencies and the HSE to ensure that the legislative measures now in place can be implemented in a manner which brings optimum benefit to people with disabilities, their families and carers.
The Government’s overall objective is to put in place the most effective combination of legislation, policies, institutional arrangements and services to support and reinforce equal participation for people with disabilities. Public policy for the future is to be based on an understanding of disability that is described as the move from the medical model of disability to a social model.
We will, over the coming months, be making decisions which will guide the way the health funded services support people with disabilities over the coming years. The outcome of many of those decisions will also influence the perception of other sectors of society concerning the abilities of people with disabilities and the role which they can and do have within our communities. I look forward to working with all of you as we move along this third road towards the future.