Thursday, 18 April 2002
Dáil Eireann Debate
There is no need for me to emphasise the importance of the scale and quality of the services provided by the Hospitaller Order of St. John of God at St. Raphael's, Celbridge, County Kildare, and those provided at a number of similar institutions, such as Islandbridge, throughout the country. There is no need to enumerate the various efforts invested in the provision of those services. I refer here to the efforts made on a voluntary basis by the parents and friends of St. Raphael's, the local community and the management and staff of St. Raphael's to put in place a service that is more urgently required with the passage of time. Everyone recognises that and, in fact, Her Excellency, the President of Ireland, and the Taoiseach both visited St. Raphael's in the past year in recognition of the efforts made there. Imagine, therefore, the disappointment, surprise and hurt on the part of those involved at St. Raphael's when it recently transpired that its budget for the current year has been reduced, in effective terms, to the extent of approximately €2.9 million.
We have lived with the Celtic tiger economy for the past number of years. We are informed that we have one of the most successful economies in the western hemisphere and that Ireland is one of the 20 wealthiest nations in the world. In my opinion the management, staff, parents and the children and adults involved at St. Raphael's would not be surprised if its allocation for the current year was made commensurate with the economic factors to which I refer. However, that is not the case. It is sad and disappointing that St. Raphael's budget has been reduced at this point.
It is also sad that it appears that a great deal of effort has been put into providing services in various areas to meet the demands of various competing interests. What demand is greater than that of those who are not in a position to fight their own cause? What demand is greater than that of those who are assisting that cause on a voluntary basis? What need is greater than that of the children at St. Raphael's, Islandbridge and the other institutions which are obliged to depend on outside resources and the goodwill of fundraisers who operate on a voluntary basis? These people ultimately rely on the health services – the Department of Health and Children, the Minister and the relevant health board – to provide them with the necessary resources to carry out their work.
Essentially, the authorities at St. Raphael's will be obliged to consider curtailing existing services and not proceeding with proposed new services. The combination of these two will reduce the value and quality of the necessary services, either those in existence or those that are proposed. A letter was sent to the chief executive of the Eastern Regional Health Authority pointing out that  there was a shortfall of approximately €2.9 million in the 2002 budget which, effectively, is a reduction of 5.6%. There are four factors involved. There is a shortfall in the amounts provided for some approved pay awards. In other words, a pay award was approved but no provision was made for it. No amounts have been provided for some pay awards, particularly those for psychologists, despite all we have heard in the House about the urgent need for psychologists in schools and institutions. Certain costs incurred in 2001 on an ongoing basis have been treated as once-off costs only and no provision has been made in the 2002 allocation for these costs. Specific pressures on the non-pay budget, for example, insurance, energy and VAT increases, have not been recognised. There is no need for me to outline that the matters of insurance, energy and VAT are fundamental when taken into account in terms of the operation of the services at St. Raphael's. Insurance costs have become an increased burden in recent times. Notwithstanding the reply that has been prepared for the Minister of State, I ask him to implore the Minister for Health and Children to put in place the necessary resources to enable St. Raphael's to continue to provide existing services and to enhance, as was originally envisaged for the current year, what it has to offer by providing new services.
Mr. Davern: On behalf of my colleague, the Minister for Health and Children, Deputy Martin, I thank the Deputy for raising this matter and giving me the opportunity to outline the position concerning this issue.
This Government has made a significant level of additional funding available for services for persons with an intellectual disability and those with autism in recent years. By the end of this year, we will have provided additional revenue and capital funding amounting to nearly €312 million. Within the overall revenue funding which has been provided, specific amounts have been allocated to meet identified needs in existing services and for new service developments.
On foot of the changing profile of those who have been in services for many years, there is a need to review issues such as staffing levels and skill mix. For example, an increased need for additional night cover has arisen in many agencies because of the more dependent profile of the residents due to old age, illness or behavioural issues. An ongoing review process has been under way for a number of years with the health boards and voluntary agencies, with funding allocated annually in recent years to meet these identified needs.
Significant additional funding has also been allocated for the development of new services. Between 1997 and the end of this year approximately 1,700 new residential, 470 respite and 3,000 day places will have been provided. There has also been a significant enhancement of the health related support services for children with an intellectual disability or autism and the  specialist support services. Any funding for either new services or existing needs which may be made available to the health boards or the Eastern Regional Health Authority in any given year is specifically identified in the letter of determination. This funding is agreed by the Government and must be used for the purpose set out in the letter of determination. I assure the Deputy that the question of developments in respect of which funding has been provided and which have been agreed with the Department as part of a board or the authority's service plans being frozen or seriously curtailed will not arise.
Responsibility for the provision of funding for organisations providing services for people with an intellectual disability or autism in the eastern region is a matter, in the first instance, for the Eastern Regional Health Authority. The Minister understands the authority is in ongoing discussions with the St. John of God Order and other voluntary agencies in regard to its 2002 budget and he has asked the authority to keep him informed in relation to the outcome of those discussions.
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