1. The Policy Context

1.1 Quality and Fairness: A Health System for You

The national health strategy Quality and Fairness: A Health System for You is guided by the principles of Equity, People-centredness, Quality and Accountability in the delivery of health services including services for people with disabilities. The strategy commits the Government, the Minister for Health and Children, and the Department of Health and Children to:

  • Engaging with everyone in the wider community to improve health;
  • Working with those in the health system who have a role to play in improving health;
  • Evaluating services so that resources are used to best effect;
  • Reforming the way we plan and deliver services within the system;
  • Modernising and expanding health and personal social services through focussed investment;
  • Supporting the development and contribution of people who work in the health system.

Building on that strategy, the mission of the Department of Health and Children, as outlined in its strategy statement 2005-2007, is to help enhance the health and well being of all by:

  • Supporting the delivery of high quality, equitable and efficient health and personal social services;
  • Leading change in the health system;
  • Putting health at the centre of public policy; and
  • Promoting a 'whole of Government' approach to health and social gain.

1.2 Government Policy in Relation to Disability

The overall Government objective in relation to people with disabilities, as stated by An Taoiseach at the launch of the National Disability Strategy, 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. The new framework will include provision for health services for disabilities and special educational needs arising from those disabilities. The policy framework includes:

  • The National Disability Strategy;
  • New structures and organisations;
  • New legislation;
  • Policy reviews in relation to disability and mental health services;
  • Resources to implement the policy and strategy.

1.2.1 The National Disability Strategy

The National Disability Strategy was launched in September 2004. It provides for a framework of new supports for people with disabilities. The Strategy builds on a strong equality framework, which is reflected in several pieces of equality legislation. It puts the policy of mainstreaming of public services for people with disability, which was adopted by Government in 2000, on a legal footing. The main elements of the Strategy were:

  • The Disability Act 2005;
  • The Education for Persons with Special Educational Needs Act 2004;
  • Six Outline Sectoral Plans published by Government Departments;
  • The Comhairle Amendment Bill 2004.

The Strategy also made provision for an Investment Programme, which was subsequently announced in the 2005 Budget, for the period 2006 to 2009 to build capacity in priority areas of support services for people with disabilities. These included new residential, respite and day services and new community-based mental health facilities.

1.2.2 New Structures and Organisations

The environment and structures within which health services to people with disabilities are delivered have changed over the past two years, with the establishment of the Health Service Executive and the National Council for Special Education.

Until recently, statutory responsibility for the provision of a range of health services was vested in the regional health boards, under the Health Act, 1970, and the Eastern Regional Health Authority under the Health (ERHA ) Act 1999. These services are now the responsibility of the Health Service Executive (HSE) under the Health Act 2004. Under the Act, the Executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for all health related educational supports. A key objective for the HSE is to ensure that health services, including services for people with a disability, are delivered in the most effective, efficient and appropriate manner, while also taking account of equity of access.

Part 7 of the Health Act 2004 sets out the accountability obligations of the HSE. It requires the Executive to prepare and submit both a Corporate Plan and a Service Plan to the Minister for Health and Children.

The Corporate Plan will specify the key objectives of the Executive for a 3 year period and identify the strategies for achieving these objectives. Under the provisions of the Act, the Executive is required to prepare a Service Plan for the financial year or other period as may be determined by the Minister, and adopt the plan and submit it to the Minister for approval.

The Service Plan is the annual agreement between the Minister for Health & Children and the Executive. It sets out in a comprehensive, integrated statement the type and volume of health and personal social services to be provided by the Executive for the population of Ireland, within the voted allocation (Vote) of the Oireachtas for that year and the approved employment levels set out in Government policy. The plan must also reflect Government and Ministerial priorities. The Service Plan should be framed in the context of the Corporate Plan of the Executive.

Once a service plan is approved by the Minister, the HSE is required by Section 33 of the Act to manage the services so as to ensure that they are delivered in accordance with the plan. As is the case with all legislation, arrangements for the implementation of the Disability Act must be made within this statutory accountability framework.

The National Council for Special Education was established in October 2005. The functions of the Council are set out in the EPSEN Act 2004 as follows:

  • Planning and co-ordinating provision of education and support services to children with special needs;
  • Disseminating information on best practice concerning the education of children with special educational needs;
  • Providing information to parents in relation to the entitlements of children with special educational needs;
  • Assessing and reviewing resources required by children with special educational needs;
  • Ensuring that progress of students with special educational needs is monitored and reviewed;
  • Reviewing educational provision for adults with disabilities;
  • Advising educational institutions on best practice;
  • Consulting with voluntary bodies;
  • Advising the Minister for Education and Science on matters relating to special education;
  • Conducting research and publishing findings.

The Council also has specific functions under the Disability Act 2005.

The Council employs Special Education Needs Organisers (SENOs) throughout the country, whose job it is to make decisions about the specific resource needs of children with special educational needs within the policy parameters set by the Department of Education and Science. They also liaise with parents, schools and the HSE in relation to the needs of children and young people with special educational needs.

1.2.3 New Legislation

The Disability Act 2005 is a central element of the National Disability Strategy. The Act is a positive measure designed to advance and underpin participation by people with disabilities in everyday life and provides for:

  • an independent assessment of individual needs, a related service statement and independent redress and enforcement;
  • access to public buildings, services and information;
  • Sectoral Plans for six key Departments which will ensure that access for people with disabilities will become an integral part of service planning and provision;
  • an obligation on public bodies to be pro-active in employing people with disabilities;
  • restricting the use of information from genetic testing for employment, mortgage and insurance purposes;
  • a Centre for Excellence in Universal Design.

Mainstreaming places obligations on public service providers to support access to services and facilities for people with disabilities as well as other citizens, to the greatest practicable extent. The focus on mainstreaming and social inclusion is given particular emphasis through the Sectoral Plans provided for in Part 3 of the Act. Furthermore the Act provides for, inter alia, the identification and delivery of individual health, education and personal social services for people with disabilities who meet the relevant eligibility criteria set out in Part 2 of the Act. In particular it provides people with disabilities with an entitlement to:

  • An independent assessment of health and education needs;
  • A statement of the services (Service Statement) which it is proposed to provide;
  • Pursue a complaint through an independent redress mechanism if there is a failure to provide these entitlements.

Further details in relation to Part 2 are provided in Chapter 5.

The Education for Persons with Special Educational Needs Act 2004 (EPSEN Act) makes provision for children from 0 to 18 years. Under the EPSEN Act, a child is entitled to an assessment to determine if a special educational need exists. The EPSEN Act states that an assessment under the Act "shall include an evaluation and statement of the nature of the child's disability (including in respect of matters that affect the child overall as an individual) and an evaluation and statement of the services which the child needs so as to be able to participate and benefit from education and generally, to develop his or her potential".

The EPSEN Act describes how assessments will be carried out, how standards are set, the grounds on which an assessment is required or provided, the educational resources available on foot of an assessment, and the provisions for appeals.

The National Council for Special Education is required to prepare an implementation plan by October 2006, setting out the Council's estimate of the resources needed for the implementation of the EPSEN Act, a proposed time table for the implementation of the Act and suggestions as to how special educational needs can be met pending full implementation.

The two Acts (EPSEN and Disability Act), described above, together provide the new framework within which specialist support services to children and adults with disabilities will be planned and delivered.

The provisions of the EPSEN Act 2004 and the Disability Act 2005 are complementary and designed to cover the spectrum of needs for both adults and children. This includes transition planning at various stages such as pre-school to primary, primary to second level and into adult services. The NCSE and the HSE are the two key delivery organisations in both Acts and the same standards will apply in both Acts in relation to assessment.

A child with a disability may be assessed under either Act. Where special educational need is identified, the child must be referred to the NCSE or a school principal. Health needs identified under the EPSEN assessment will be dealt with in the Service Statement under the Disability Act 2005.

Further details on the arrangements for the implementation of Part 2 of the Disability Act and their co-ordination with the implementation of the EPSEN Act are provided in Chapter 5.

1.3 Consultation Process

An extensive consultation process was undertaken by the Department of Health and Children in the preparation of this Sectoral plan. The Department participated in a comprehensive regional consultative process, which was organised by the National Disability Authority in 2005. In addition, advertisements were placed in national newspapers in September 2005 requesting submissions in respect of the Sectoral Plan, of which twelve were received.

A major conference was held in Mullingar in February 2006, focussing specifically on assessment of need. Representatives of all the major stakeholders in the area of disability were in attendance, including people with disabilities, the National Disability Authority, representatives of key professionals involved in the area of assessment and the statutory and non-statutory service providers. Representatives from the education sector, including the Department of Education and Science, the National Council for Special Education and the National Education Psychological Services (NEPS) also attended. Following the conference a discussion document was prepared on the main themes and issues which had emerged.

Further consultation events took place during May 2006 in Dublin, Carrick-on-Shannon and Cork. Building on the themes which had emerged from the Mullingar conference, these events provided an opportunity for a broader range of people with disabilities to have an input into the process.

The views expressed during the consultation fed into the development of the Department's and the HSE's thinking in relation to the assessment of need process and were particularly helpful in the preparation of Chapter 5, the arrangements for the implementation of Part 2 of the Disability Act 2005.

The National Disability Authority and the Disability Legislation Consultative Group was consulted on the draft Sectoral Plan during June 2006.

A list of organisations which took part in the consultation process is at Appendix 4.