Dáil Éireann Debate, Tuesday - 28 April 2026
961. Deputy Paula Butterly asked the Minister for Children, Disability and Equality to respond to matters raised in correspondence (details supplied); and if she will make a statement on the matter. [30575/26]
Amharc ar fhreagraI want to acknowledge the tireless work of all parents/carers involved with the ‘Before We Die’ group, to advocate for increases in the provision of residential services for people with disabilities and to bring awareness to the issues many parents are facing.
I also wish to recognise the vital work carried out by family carers, while acknowledging the impact on carers' physical and mental health. Most importantly, I wish to recognise the voices of those with disabilities and the importance of listening to their wishes for their own futures.
To support families and carers, the HSE and contracted service providers endeavour to provide the correct supports for individuals when needed including day services, respite services, residential services, home support and personal assistance.
As of December 2025, approximately 90 service providers are delivering 8,911 specialist disability places. From 2020 to 2025, the additional funding provided to the HSE, has supported an additional 955 newly created residential places for people with disabilities. These placements largely support people moving from their family home to a residential service and are in addition to supporting transitions of people from congregated settings to the community and people under the age of 65 out of nursing homes and into more appropriate community-based homes.
To meet the specific needs of each individual, the HSE works in partnership with both not-for profit and for-profit organisations to ensure the best level of service possible is provided to people with a disability and their families, within the available resources.
Demand for disability services, particularly residential services is very high due to a number of impacting factors including a change in need and the availability of appropriate housing. This has led to a situation where the HSE must respond to emerging urgent cases and in some circumstances, the most appropriate placement with immediate availability is with a private-for-profit provider.
The Department of Children, Disability and Equality is working closely with the HSE to achieve a more balanced response to the demand for residential placements and a move towards planned provision and away from unplanned responses where possible. This will include the development of housing to ensure all sectors will be able to respond to need including the HSE and Section 38 and 39 organisations. It is important to note that all designated centres for people with a disability, including private for-profit services, are regulated by the Health Information and Quality Authority (HIQA).
This Government is committed to providing services which promote a good quality of life for all, and I must acknowledge the role of service providers, which comprises the HSE, Section 38, Section 39 along with private providers, in delivering good quality, person-centred care in line with the UNCRPD, Government and HSE policies.
This year, this Government has provided €3.9billion in funding to the HSE for the provision of Specialist Community-Based Disability Services, representing a 20% increase on last year. Residential services make up the largest part of the Disability funding disbursed by the HSE, almost 60% of the total budget.
In respect of disability residential services, €65 million has been allocated in 2026 for new developments. €40 million of this funding will provide 199 new residential responses. This includes 152 new residential placements, comprising of 80 new placements to meet urgent need and the development of 72 new planned residential placements, as well as provision for the requirements for new residents entering into existing funded placements that have become vacant and in limited circumstances, placements in nursing homes.
Additionally, within the funding allocated for 2026, the HSE has begun work to establish Residential Placement Planning & Review Teams in each Regional Health Area. The aim of these teams will be to improve forward planning of residential placements, and to ensure that individuals are appropriately assessed in relation to support needs prior to placement in residential services and reviewed in a timely manner for duration of the placement in respect of quality of care and support needs.
The Budgetary investment in existing level of service issues in S38 and S39 providers and wider sustainability issues such as pay awards for S39s, has increased the capacity of the not-for-profit sector to deliver more residential placements in 2026.
The HSE is working with the voluntary sector to build capacity to provide more residential services and a proportion of the planned places being provided this year are expected to be provided by not-for-profit organisations. HSE regions are working collaboratively with voluntary service providers in each Integrated Healthcare Area to identify individuals with urgent need to ensure plans are in place before a crisis arises.
The HSE's Framework for the Management of Residential Supports provides guidance to HSE regions in their oversight and decision-making process governing the allocations and use of resources for the provision of residential care and supports. The purpose of this framework is to ensure that:
• An equitable, transparent and consistent practice regarding the prioritisation of need of applicants for residential supports is implemented across and within each of the 9 CHO areas.
• Measures are put in place to ensure residential placements and supports are only considered when all other options such as respite and in home supports have been exhausted.
• A robust review and regular monitoring of the current configuration or delivery of services takes place.
• Assist in the strategic planning of residential resources.
The Disability Supports Application Management Tool (DSMAT) is designed to deliver a consistent listing process for each HSE area by presenting a detailed profile individuals who require both residential and non-residential supports. This supports the decision-making process within each area for the placement of people with a disability requiring a residential placement by ensuring that a standardised consistent profile is available for each applicant for services.
The DSMAT captures detailed information on home and family circumstances and a detailed presentation profile of each individual, including specialised profiles of behavioural intensity, key diagnoses, and complex support needs due to the extent and intensity of intellectual and/or physical & sensory disability.
It is important to note that residential placements are based on greatest presenting need and potential associated risk/safeguarding.
The HSE’s Capital Plan 2026 (Building and Infrastructure) has been published and is available on the HSE website at https://about.hse.ie/news/hse-capital-plan-2026-building-and-infrastructure/.
Funded from the National Development Plan, it provides significant public investment in health infrastructure to meet current needs, to cater for anticipated population growth and to respond to the changing demographic profile in Ireland.
In respect of Disability Services, the HSE announced €43 million in capital investment in 2026. This represents a substantial increase of €16 million compared with 2025 and demonstrates the Government’s firm commitment to support and expand disability services. 2026 is the first of a five-year investment plan supported by €278 million in funding secured by the Department of Children, Disability and Equality through the National Development Plan.
The Capital Plan supports the vision of high quality, safe, accessible and sustainable healthcare, enabled by capital funding. It aligns with the strategic priorities of the Government and the Minister for Health, the Department of Health, the Department of Children, Disability and Equality and the HSE.
In the context of the increased investment in Disability Services in 2026, the HSE is examining a number of other disability projects which may be added to the Capital Plan during the year. In doing so, the HSE will take into account the need for regional balance and to ensure an appropriate blend across service areas. This is in addition to housing provision by the Local Authorities.
The implementation structures established under the National Housing Strategy for Disabled People (NHSDP) 2022-2027 are central to ensuring independent living housing outcomes for disabled people. The provision of the housing for disabled people in conjunction with the care (health and social care) supports is the cornerstone of supporting independent living for disabled people. The Health Service Executive (HSE), under the auspices of the Department of Children, Disability, and Equality (in the case of physical, intellectual and sensory disability), and the Department of Health (in the case of mental health disability), is responsible for funding the provision of care support services by disability service providers.
At national level, implementation and monitoring of the Strategy is driven by the National Implementation Steering Group (NISG) (chaired by the Housing Agency) with membership from key Departments and Agencies and both Disabled Persons Organisations and umbrella disability groups.
At the regional level, a new regional structure operating between the national and local structures was established under the National Housing Strategy for Disabled People 2022-2027. Significantly, these new Regional Interagency Groups (RIGs) are based on the HSE Health Regions to ensure cooperation and collaboration at an operational local level bringing together both the local authority and HSE dedicated housing representatives for both disability and mental health services. These Groups also aim to bring consistency across their organisations and evaluate any pilot structures or process progress in their area.
At local level, all local authorities have established Housing and Disability Steering Groups (HDSGs) whose role is to put in place strategic plans for housing for disabled people and to monitor activity under these plans and are therefore a key driver of the provision of housing for disabled people at local level. HDSGs facilitate integrated, aligned and timely responses to the housing needs of disabled people through an interagency collaboration framework to drive progress at the local level. Membership of the HDSGs includes local authority Director of Housing Services, HSE, Disabled Persons Organisations, organisations for disabled people including service providers, and Approved Housing Body sector.
In addition, a number of HSE regions have appointed dedicated Housing Coordinators to assist with residential placement planning and identifying various housing options for people with all levels of disability.
The annual publication of unmet housing need is under the remit of the Department of Housing, Local Government and Heritage.
The Department is undertaking research and progressing policy development throughout 2026, with a view to developing a new policy framework for specialist residential services. The policy development process will consider a range of matters relevant to specialist residential services including models of service.
The Assisted Decision-Making (Capacity) Act 2015, which commenced in 2023, marked a landmark reform of Ireland’s capacity laws, bringing the state into much closer alignment with the United Nations Convention on the Rights of Persons with Disabilities. The 2015 Act represents an important shift away from a ‘best interests’ approach to a rights-based approach to capacity, privileging a person’s will, preferences and autonomy.
The 2015 Act provides for a review of its operation and effectiveness within 5 years of commencement. This is also a commitment in the current Programme for Government. The Department intends to commence this review in 2026.
I appreciate the role of many parents as strong advocates for adults with diminished capacity. In that regard robust engagement and consultation with a wide range of stakeholders, including those with a lived experience of the Act, parents and families, will be central to the review. A written report of the findings of the review and the conclusions drawn from those findings will be laid before each House of the Oireachtas, as required under the 2015 Act.
