DAY SERVICES

13.3.1 Introduction and Description

The Day Service Programme provides a number of services including training in personal social skills, pre-vocational training, employment support (to be transferred to Department of Social Protection), occupational therapy, and support for the activities of daily living. The Day Services programme is delivered directly by the HSE and through Section 38 and Section 39 specialist non profit disability agencies. Day services and supports for people with intellectual, physical and sensory disabilities are provided on the basis of Service Level Arrangements at over 800 locations by around 70 agencies. The HSE itself provides day services at over 200 locations. A number of agencies have Grant Aid agreements with the HSE and receive funding of €250,000 and under towards the cost of providing a range of support and advocacy services. Approximately 90% of day services are provided by non-statutory services and the remaining 10% by the HSE. Virtually all personal assistant services to persons with physical disabilities are provided through the non-statutory sector. Disability day services interact with a number of other programmes aimed at the same type of beneficiary such as (i) integrated health and education support services for children with special needs (Department of Education and Skills and the HSE); (ii) appropriate health related and employment supports for people with disabilities and people with mental health concerns (Departments of Health, Social Protection and Enterprise, Trade and Innovation, the HSE and FÁS); and (iii) the provision of income supports (HSE and Department of Social Protection).

13.3.2 Rationale, Objective and Continuing Relevance

The purpose of the Day Service Programme is to enable adults with disabilities to live normal lives as part of their local community in a supportive day care setting.

While high level objectives for the Day Services programme have not been specifically articulated, they may be expressed as:

(i) To provide the individual with a disability, to the greatest extent possible, the opportunity to live a full and independent life with their family and as part of their local community;

(ii) To support the individual with a disability as far as possible to participate in work and in society and to maximise their potential.

(iii) To ensure that the individual with a disability would, consistent with their needs and abilities, have access to appropriate health and personal social services.

(iv) To support and acknowledge the role of carers in their caring role.

The Day Services Programme is consistent with, and contributes to the achievement of the following aims in the Programme for Government:

• We will ensure that the quality of life of people with disabilities is enhanced and that resources allocated reach the people who need them.

• We will also facilitate people with disabilities in achieving a greater level of participation in employment, training and education.

• We will seek to get best value for money for investment in services and to ensure that services meet the needs of users. A Comprehensive Spending Review will examine all provision for people with disabilities with a view to determining how users can get the best services. We will also ensure that money spent on disability services under the National Disability Strategy is clearly laid out and audited.

• As part of this Review we will move a proportion of public spending to a personal budget model so that people with disabilities or their families have the flexibility to make choices that suit their needs best. Personal budgets also introduce greater transparency and efficiency in funding services.

13.3.3 Programme Effectiveness

The effectiveness of the day services programme was examined under the VFM & Policy Review on a similar basis to that of Residential Services as set out in Section 13.2.3. The HSE established a Working Group on Adult Day Services to reconfigure and modernise HSE-funded day services to embrace the principles of person-centeredness, access, accountability and quality. The Working Group commissioned an extensive independent national public consultation, a programme of research and a census of current day service provision. The work programme also included a demonstration phase, where day service innovations being applied by providers were documented.

Based on its findings, the Working Group proposes that day services in the future take the form of a menu of individualised, outcome-focused supports which will allow adults in day services to live a life of their choosing in accordance with their own wishes, aspirations and needs. The range of supports to which individuals will have access should equip them to make choices and plans to support personal goals; have influence over the decisions which affect their lives; achieve personal goals and aspirations; and be active, independent members of their community and society. The nature of the supports offered to an individual will depend on the particular needs and abilities of that individual. It will be the responsibility of the service provider to work with each individual to tailor the programme of supports to their individual needs, according to their person-centred plan. The Report of the Working Group on Adult Day Services is due to be discussed by the Board of the HSE shortly.

13.3.4 Programme Efficiency

The output trend in recent years has been to maintain the existing core levels of service and to meet the needs of emergency placements and school-leavers.

Table 13.4: Trend in Outputs – Disability Day Services 2008-2011

2008 2009 2010 2011  20,000 day places  3.2 million hours of Personal Assistant supports  20,000 day places  3.2 million hours of Personal Assistant supports  20,000 day places 3.2 million hours of Personal Assistant supports  20,000 day places;  3.34 million hours of Personal Assistant/Home Support Hours.

The current suite of performance indicators in the HSE National Service Plan 2011 measure the number of persons with (i) intellectual disability and/or autism and (ii) physical or sensory disabilities, who engage in a work/work-like activity service, and the number of places provided; the numbers who attend rehabilitative training and the number of places provided; the numbers who attend other day services, and the number of places provided;

the number of personal assistant/home support hours provided and the number of persons who benefited. A range of PIs also measure the implementation of Part 2 of the Disability Act. Performance measurement will be reviewed as part of the VFM & Policy Review, and in particular the development of metrics to measure outcomes as distinct from outputs. Options to achieve greater efficiency and effectiveness are currently being examined. Some efficiencies apply to residential services to a greater extent than day services and have been described above. Other proposed efficiencies apply equally to day and residential services and are described in the conclusion to this chapter.

One area which may be considered in the context of levying charges is the provision of transport to and from disability service providers. An examination of the feasibility of charging a contribution for transport services is warranted in the light of the significant cost involved (over €18m for transportation and vehicle maintenance), although this is not a core function of the HSE. On the other hand, virtually all service users have medical cards and are in receipt of Disability Allowance so any charges levied could not be significant, and might be offset by the administrative cost of collecting the charges.

It is not possible at this stage to quantify any reduction in WTEs arising from the introduction of efficiencies but is not anticipated at this stage that there will be significant WTE reductions overall. Neither is it possible to quantify the impact in terms of outputs arising from the introduction of efficiencies. However, the aim is to maintain outputs at their current levels by improving the efficiency and the effectiveness with which services are delivered.

The VFM Review has not made any interim or final conclusions. Consequently, no decisions have been made regarding the applicability, or otherwise, of the Croke Park Agreement to any of the options above.

Similarly to the Residential Services Programme, the implementation of new technology would benefit both the administration of services as well as clients on the ground.

13.3.5 Conclusions

• The current range of day services has tended to reinforce social exclusion and does not enable individuals to exercise choice and control over their lives. Individualised supports would be a preferable approach as this would provide a personal social service which includes a range of assistance and interventions required to enable the individual to live a fully included life in the community.

• While the requirement for day services will be equally essential in the future, the nature of the services provided will change from a model which focuses on the provision of day places to a model where day supports are provided. Although there is a multiplicity of day services currently being provided, generally these services involve people with a disability coming together with other people who have similar disabilities, in a segregated location to partake in set activities. Day supports on the other hand, would focus on the individual with a disability being supported to do normal things in normal places, including participation in training and work. The focus of the support provided is likely to change, following the outcome of the VFM & Policy Review, into a model where the range of supports and services provided are individualised, and are primarily determined by the individual and tailored to their needs.

• While statutory charges are not levied for Day Services, most persons in receipt of day services are also in receipt of Disability Allowance (plus in some cases an allowance or top up in work or “like-work” settings,) so the scope to introduce charges is limited. 13.4 VARIOUS ALLOWANCES

13.4.1 Introduction and Description

The purpose of the Mobility Allowance, Blind Welfare Allowance and Motorised Transport Grant is to provide financial support to people with a disability in respect of (i) the additional costs associated with mobility/transport and (ii) the supplementary costs associated with being blind.

The Mobility Allowance provides financial support to people with a disability, who are unable to walk, or use public transport. The allowance is intended to enable individuals to benefit from a change in surroundings. An example might be providing financing for the occasional taxi journey. The Blind Welfare Allowance is a supplementary payment to persons who are blind. This is provided in addition to an existing State payment such as the Blind Pension or Disability Allowance. The Motorised Transport Grant is a grant to support people with a disability to purchase and adapt a car to travel to and from work. 13.4.2 Rationale, Objective and Continuing Relevance

The objective of the allowances is to provide financial supports for specific purposes for people with specific disabilities. This sub programme tackles poverty and protects the most vulnerable and, as such, is consistent with Government policy and the Programme for Government. The allowances are linked to the Department of Social Protection allowances such as Blind Pension and Disability Allowance and the Department of Finance’s Tax Concession Scheme for Disabled Drivers. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx. 13.4.3 Programme Effectiveness

The objective of the sub programme has been met in that financial support has been provided to people with disabilities as reported above. However, equity and equality for people with disabilities is not being achieved as the eligibility criteria for these allowances are focussed on the nature of the disability and not on the needs of individuals with disabilities. For example supplementary payments are made to blind people only and not to others who also incur additional living costs associated with their disability. The Motorised Transport Grant is only available for people with a disability to go to work whereas there is no provision for other people with a disability who require a car for transport purposes because other alternatives are not available. The Mobility Allowance is only provided to people who cannot walk but not to people with other types of disability (intellectual, mental health) that have transport/mobility issues.

Eligible people with a disability have received financial support each year as follows:  Mobility Allowance – 5,000 (estimated).

 Blind Welfare Allowance – 3,500 (estimated).  Motorised Transport Grant – 500 (estimated). 13.4.4 Programme Efficiency

Table 13.5 below sets out estimates of the expenditure trends in relation to the disability allowances. While the HSE National Service Plan 2011 indicates a 2010 outturn for the Mobility Allowance of €18m, the budget provision for 2011 is €13m. The payment rate for the Mobility Allowance has remained the same in 2011 and the numbers in receipt of the Mobility Allowance are unlikely to decrease, therefore, it is anticipated that expenditure in 2011 will be at least €18m. The Motorised Transport Grant expenditure is estimated to have 500 recipients each year. The expenditure figures in respect of Mobility Allowance and Blind Welfare Allowance were obtained from the HSE National Service Plans (2009, 2010 and 2011) and include forecast/expected outturns and proposed budgets. Trends in expenditure would seem to indicate:

 A small increase in expenditure and recipients for Mobility Allowance  Little change in expenditure and recipients of the Blind Welfare Allowance

Table 13.5: Trend in Expenditure Associated with Disability Allowances 2008-2011 2008 (€m) 2009 (€m) 2010 (€m) 2011(€m)-budget allocated Non-Pay MA MTG BWA 16 2.5 10 17 2.5 9 18 2.5 11 13 2.5 9

Trends in WTEs cannot be calculated because the schemes would form only an element of the work of individuals rather than being engaged in the schemes on a full time basis. The trend in the level of total administration costs for each sub-programme is unknown. By way of indicating the possible numbers involved, fewer than 50 WTE transferred to the Department of Social Protection in 2009 upon transfer of the Domiciliary Care Allowance for 25,000 clients.

13.4.5 Conclusions

The Department understands that there are proposals to centralise applications for these allowances in the HSE. This sub programme is delivered through the administrative staff, community welfare staff and medical staff in the HSE. Centralisation and standardisation of the assessments associated with the application of these schemes should lead to improvements in efficiencies. The introduction of new technology, as part of the proposal to centralise these schemes, should also assist in achieving more efficiencies. The Department understands that a small WTE reduction should be possible as part of centralisation. The numbers involved in terms of administrative, community welfare and medical staff involvement in processing applications and payments would probably be possible through natural staff turnover.

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx.

13.5 THALIDOMIDE PAYMENT