A PRESCRIPTION FOR CHANGE
5. Delivering on Rights for Disabled People
Fairer, safer and more efficient healthcare
HEALTH PLAN HOMEPAGE
UNIVERSAL HEALTH AND SOCIAL CARE
LOCAL HEALTH AND SOCIAL CARE SERVICES
HOSPITAL REFORM
MENTAL HEALTH
DELIVERING ON RIGHTS FOR DISABLED PEOPLE
STRATEGIC IMPROVEMENT PROGRAMMES
AGING AND OLDER PERSONS CARE
TACKLING ADDICTION, EMPOWERING RECOVERY
SAFE STAFFING FOR SAFER HEALTHCARE
ACCOUNTABILITY AND REFORM
OTHER KEY INFORMATION
Delivering on Rights for Disabled People
Current Expenditure: €829 million
Sinn Féin are determined to strengthen rights for disabled people. Upholding the rights of disabled people means ensuring that human rights to independent living and good health and social care supports, as well as adequate housing and other public services. A Sinn Féin Government would work to ensure that the State is fully compliant with the UNCRPD.
By significantly raising the effective qualifying threshold for a medical card to the median income, Sinn Féin would ensure that part-time employment does not pose a threat to medical cover for people on Disability Allowance. We would also cut the maximum monthly cost of prescription medicines from €80 to zero through a phased reduction in the Drug Payment Scheme threshold every year, and abolish prescription charges for medical card holders.
Certain rights of disabled people were set out in the Disability Act 2005. This Act has provided some legal entitlements, such as the right to an assessment of need, but these rights are not being vindicated due to underinvestment in services. Sinn Féin would review the Disability Act with a view to modernising it and strengthening legal rights for disabled people in the State are compliant with the UNCRPD. We would implement a disability workforce plan to underpin service improvements.
The services needed and accessed by the vast majority of disabled people are provided by mainstream, rather than specialist, community services. This includes therapies, psychology, public health nursing, social work, and other primary care services. This section details proposals on independent living supports, empowering people to live in the community, early intervention children’s services, home care, residential care and de-congregation, day services, and respite services.
To improve access to services and deliver on our commitment to strengthen rights for disabled people, Sinn Féin would, over a five-year government term, commit €829 million in additional current expenditure and €659 million in additional capital expenditure to improve disability services.
Sinn Féin Will:
Work systematically towards full compliance with the UN Convention on the Rights of Persons with Disabilities
Review the Disability Act 2005 and ensure the State is complaint with existing disability and equality legislation
Develop mainstream services which are accessible to all, and implement a workforce plan to reduce waiting lists
Deliver free prescription medicines for all households, abolish prescription charges for medical card holders, and deliver median income medical cards
Provide for a senior policy official with responsibility for disability in the Department of Health to improve access in mainstream services and improve coordination with the Department of Disability
Inclusion and Participation
Personal Assistance Services (PAS) provide people with the opportunity to exercise control and choice in their lives. In so doing, it enables people to be active participants within their families, communities, employment and society and therefore results in an overall improved quality of life.
According to the 2021 Disability Capacity Review, there is a ‘substantial’ unmet need for PAS. The review informed us that about 2,500 people get a PAS, averaging around 12 hours a week. Many people do not have any access to a PAS while many more who do have access have it only on a very limited basis.
The Disability Capacity Review recommended that by 2032, an additional investment of €5 million would be needed to accommodate demographic changes and a further €8 million to begin tackling unmet need for PA services – currently equivalent to over 400,000 hours.
However, as with Home Support services, the Review acknowledged due to the lack of data on the exact level of unmet need, the investment needed to accommodate is likely to be a multiple of existing provision.
In 2023, there were 1.77 million PA hours provided. This represents an increase of just 70,000 hours from 2020, much lower than the modest targets under the Capacity Review and a far cry from the real levels of unmet need.
The Disability Action Plan provided a much more substantial target for additional PA hours after years of underinvestment in services by government. The Action Plan estimated that an additional 800,000 PA hours would be required from 2024 to 2026 – an average of 267,000 PA hours a year.
In government, Sinn Féin would double the number of PAS hours to better address the substantial unmet need for these services while accommodating demographic changes. This would see an additional 354,000 hours delivered per annum.
Disabled Persons Representative Organisations are led, run, directed, staffed, and mostly membered by disabled people and are distinct bodies separate from Disability Service Providers. The UNCRPD states that DPROs are the bodies which should be consulted with regarding matters relating to disability. However, these groups are mostly small with little or no resources. Sinn Féin would support DPROs and ensure that public bodies, such as the HSE, meet their obligations to engage with disabled people on matters which affect them.
Sinn Féin Will:
Double the number of Personal Assistance hours over a term of Government by increasing the number of PA hours by 354,000 every year
Provide funding to DPROs for training and development
Implement the Autism Innovation Strategy and develop further policies that support neurodiversity
Children’s Disability Services
Children deserve timely assessment and intervention to give them the best chance at success. Early and ongoing assessment and intervention is key.
In August 2023 there were nearly 15,000 children on Children’s Disability Network Team waiting lists. More than 10,000 of these children are waiting over a year for their first contact with their team. At the end of Q1 2024, there were 9,924 children whose assessment of need was overdue, of whom 8,141 were overdue by more than 3 months, and possibly more than 12,000 overall outstanding assessments due to previous illegal assessments. Staff vacancy levels for CDNTs are extremely high, with over 700 vacancies reported in the December 2022 CDNT staffing census report.
Sinn Féin would develop a comprehensive workforce plan to fully staff CDNTs. We would streamline the recruitment process, double the number of undergraduate training places, and provide a job guarantee to health and social care graduates. In the absence of accessible public services, we would temporarily fund access to trusted community and private psychology and therapy services until CDNTs are staffed appropriately to be able to carry these out.
CDNTs have been rolled out under the Progressing Disability Services model, which has been heavily criticised by professional organisations including the Irish Association of Speech and Language Therapists, the Irish Society of Chartered Physiotherapists, the Irish Association of Social Workers, the Association of Occupational Therapists of Ireland, the Psychological Society, and the Irish Nutrition and Dietetic Institute. These organisations have backed parents and disability rights campaigners in walking away from the Government’s policy steering group. The Government has since reversed its policy to withdraw therapies from special schools, but neither decision was evidence-based.
Sinn Féin is committed to pursuing an evidence-based independent review of the service-delivery model, and to implementing a fit-for-purpose approach that works best for the children in need of services. It is essential that, under whichever model, services are properly staffed and that there are workforce plans in place to deliver safe services.
Sinn Féin Will:
Develop a common, compliant, and efficient process for assessment of need under the Disability Act
Conduct an evidence-based and independent review of the service delivery model for children’s disability services
Develop and resource a comprehensive workforce plan to fully staff Children’s Disability Network Teams linked with community care and schools as appropriate
Temporarily fund access to trusted community and private psychology and therapy services, particularly for those waiting longest for assessments and intervention, with a view to phasing out reliance on private providers as we build public capacity
End pay disparities between core service provider Section 39 organisations and the HSE
Care in the Home and Living in the Community
Sinn Féin recognise the importance of home care for disabled people. We have set out significant policy commitments to overhaul home care in the Local Health and Social Care section, including a statutory scheme, a Home First approach to care, and recognition of levels of care.
Sinn Féin is fully committed to fully acting on the Ombudsman’s Wasted Lives (2021) report. In the latest update, the Ombudsman noted:
“[I]t is clear that progress has been slow for those affected and for their family and friends who often contact my Office. I am delighted that 81 people have been able to access the support they need to transition out of a nursing home but there are many more, over 1,200 in July 2024, who currently have not had that opportunity.”
Home care and support provide essential personal care services for disabled people to support independent living in the community. It is an essential component, along with other services and supports, of facilitating younger people who are inappropriately placed in nursing homes to be moved into a home of their own. We are committed to ending the practice of inappropriately admitting younger disabled people to nursing homes.
The 2021 Disability Capacity Review noted that around 8,000 people were in receipt of home support hours averaging around 7 hours a week. The Review noted that the level of home support provision catered for just a fraction of the disabled people who experience difficulties with activities of everyday living. In addition, those who are provided with services often receive fewer hours than they need.
The Disability Capacity Review recommended that by 2032, an additional investment of €10 million would be needed to accommodate demographic changes and a further €23 million to begin tackling unmet need for Home Support services – equivalent to over 1 million hours. It was estimated that this investment in unmet need would expand recipients by 20% and increase the hours of existing recipients by 10%. Although the Review acknowledged that, due to the insufficient data on the exact level of unmet need, the investment needed to accommodate it is likely substantially higher than outlined in the Review.
Yet, the Disability Action Plan 2024-2026 only commits to delivering an additional 110,000 hours for home support from 2024 to 2026, an average of just 37,000 additional hours per year. This is insufficient. Just 400,000 additional disability home support hours were provided for in the HSE Service Plan between 2019 and 2024.
Sinn Féin would address the substantial levels of unmet need by delivering an additional 296,000 home care hours per annum. Over a government term, we would expand disability home care hours by 40% on 2023 levels to adequately address the substantial levels of unmet need for these services. We would further support care in the home by expanding the provision of intensive home support packages on the basis of need, which provide vital assistance for disabled people with complex and high support needs.
Sinn Féin Will:
Provide an additional 1.5 million disability home care hours including needs-based access to intensive home care packages
Residential places and de-congregation
Disabled people should have the right to live in accommodation that is appropriate to their needs. Sinn Féin would deliver an expansion of needs-appropriate residential places for people whose care needs cannot be adequately met at home or in a nursing home.
The Disability Capacity Review – published in 2021 – forecasted that 4,000 or more additional residential places would be needed by 2032 to both clear the backlog of need and respond to demographic change. This translated into approximately 330-500 additional places required per year.
Yet, the current government have delivered only 700 additional places over 4 years, leaving a substantial shortfall. Sinn Féin would reverse the underfunding of residential places and fund the development of services in line with need.
As stated in the previous section, we are committed to acting on the Ombudsman’s Wasted Lives report. Sinn Féin is fully committed to fully implement the Time to Move on from Congregating Settings (2011) policy.
Sinn Féin would increase the availability of appropriate residential care places, progress de-congregation to support independent living, and prioritise the transfer of younger disabled people who have been inappropriately placed in nursing homes.
Sinn Féin Will:
Provide over 3,000 additional residential places
Deliver on de-congregation commitments
Adult Day Services
Day Services offer support to disabled people on weekdays. The vast majority of service users have intellectual disabilities. These services are vital to them and to their families.
The 2021 Disability Capacity review had noted that 600 people were without a day service and likewise many more were in receipt of just a partial service. In addition, to meet rising demographic demand it was estimated that an additional 2,500 to 10,200 additional day service places may be needed over the period 2020 to 2032. This would require 200 to 775 additional places per annum over the period 2025 to 2029 depending on the rate of exits.
Children with special needs should not reach the age of 18 and have nowhere to go. Sinn Féin would provide the necessary investment to meet the existing unmet need for adult day service places and future demographic need for these vital services.
Sinn Féin Will:
Expand the number of day services places by 4,000
Respite Services
Respite plays a key role in supporting family carers and improving quality of life for a disabled person. It can help prevent or delay full-time residential placements, preserving the family unit and supporting family stability.
However, many families get no respite at all. There is a significant level of unmet need. The Disability Capacity Review noted that in 2017, fewer than one in four people with a so-called intellectual disability that live in the family home got access to any form of respite.
The Action plan for Disability Services 2024-2026 forecasts that overall respite provision would need to increase by about one third including through daytime and overnight services by 2026. In 2023, €106 million was allocated for respite services.
Sinn Féin would double investment in respite services and capacity to address the substantial levels of unmet need and to meet rising need over a government term.
Sinn Féin Will:
Double investment in respite services over the term of government to deliver a range of additional in-home, afterschool, day and overnight respite services
A Prescription for Change - Sinn Féin's Healthcare Plan
Sinn Féin has the plan, vision, and determination to deal with the big challenges in healthcare. Our plan sets out in detail how we will deliver better access to healthcare when you need it, improve access to a GP when you need one, and end the crisis in our Emergency Departments.
Our plan will transform your experience of our health service and to deliver fairer, safer and more efficient healthcare.
