Disability - Health and Social Care Services

Issued on February 20 2024

Within the frame of Health, what human rights does the UN CRPD (Convention on the Rights of Persons with Disabilities) adopt?

Article 25 of the UN CRPD recognises that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability¹.
Article 26 of the UN CRPD recognises the right of persons with disabilities to maintain maximum independence and full inclusion and participation in all aspects of life. To that end, States must provide comprehensive habilitation and rehabilitation services, particularly in the areas of health, employment, education, and social services².

Government Department Responsibility

In March 2023, responsibility for community disability specific services transferred from the Department of Health to the Department of Children, Equality, Disability, Integration, and Youth.
Over 90% of those with a disability are supported through general/mainstream community health and social services, under the responsibility of the Department of Health.
Mainstream health services are complemented by specialist community-based disability services under the responsibility of the Department of Children, Equality, Disability, Integration and Youth and delivered to approximately 7% of those with a disability (up to 80,000 people) for people with physical, sensory, intellectual disabilities or autism³.
Almost 70% of specialist disability services are provided by voluntary sector, over 27% are provided directly by the HSE and 4% are provided by private sector bodies⁴.

Health Status and Inequalities

Globally, people with disabilities face significant health inequalities:

Some persons with disabilities die up to 20 years earlier than those without disabilities⁵.
Persons with disabilities have twice the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity, or poor oral health⁶.

In Ireland, Census 20227 found that:

22% of the population report at least one long-lasting condition or difficulty to any extent. Of these, 407,342 (8% of the population) report experiencing at least one long-lasting condition or difficulty to a great extent or a lot.
Of the total 1.1 million people in Ireland who experience at least one long-lasting condition or difficulty to any extent, just under 350,000 had difficulty participating in other activities, almost half of whom (46%) experience this difficulty to a great extent.
23% of people who experienced at least one long-lasting condition or difficulty to any extent reported very good health; with 12% of people who experienced at least one long-lasting condition or difficulty to a great extent, compared to 53% of the general population who reported very good health.⁸

Just under one in five people who experienced a long-lasting condition or difficulty to a great extent reported bad or very bad health compared with just 1.7% of the general population.

Data from the CSO (Central Statistics Office) Irish Health Survey, reported in 2020 found that:⁹

43% of disabled people aged 15 and over had some form of depression (compared to the State average of 14%).
Around a quarter of disabled people aged 15 and over had unmet health care needs due to waiting times.
37% of disabled people aged 55 years and over have difficulties with personal care activities (compared to the State average of 9%).

Data from the CSO on mortality differentials found that:

From 2016-17, the standardised mortality rate for disabled people was 4.1 times higher than non-disabled people. For disabled women, the rate was 4.5 times higher, and for disabled men it was 3.9 times higher¹⁰.

Health and Social Care Service Utilisation

There are a range of community-based services available in Ireland, which include, public health nursing (PHN), home supports, personal assistants (PA), psychological services, speech and language therapy, occupational therapy, social work services, physiotherapy, day services, and respite.

A Health Research Board (HRB) report from 2022, with data extrapolated from the National Ability Support System shows that 73,927 people were registered as engaging with disability services in 2022¹¹.

Of these, 45,068 were children:
70% were male, and the
average age was 9 years old.
The remaining 28,859 were adults, comprising:
15,521 (54%) males and
13,338 (46%) females.

The Department of Health’s Disability Capacity Review – A review of Social Care Demand and Capacity requirements to 2032 (2021)¹² examines current and future need for specialist disability services:

The number of adults requiring these services is expected to be around 10% higher in 2027, and 17% higher in 2032 compared to their 2018 level. Similar rates of growth are predicted for those with intellectual disabilities and those with physical or sensory disabilities.
The fastest growth will be among the young adult population (up a third by 2032) and over 55s (up a quarter by 2032).
The combined impact of addressing unmet need and of demographic change will raise overall demand for therapy services (psychological services, speech and language therapy, occupational therapy, physiotherapy etc.) by about two thirds by 2032

Spotlight on Specific Service Areas

Children’s Disability Services

In 2021, nearly 4,000 children with disabilities were waiting for an Assessment of Need¹³.
Inclusion Ireland’s report ‘Progressing Disability Services for Children and Young People’ (February 2022) states that over 50% of the children of families surveyed (1,013 families) were not in receipt of any service¹⁴.
Many parents reported their child spent a significant amount of time on a waiting list for services.
85% of respondents had waited or continue to wait for more than a year¹⁵.
With some respondents waiting more than four years¹⁶.

Personal Assistant, PA Services

The ESRI (Economic and Social Research Institute) report ‘Personal Assistance Services in Ireland: A Capability Approach to Understanding the Lived Experience of Disabled People’ highlights¹⁷ shows that:

Personal assistance services are provided primarily to persons aged 18-65 years with physical and sensory disabilities.
38% of respondents said that PA was meeting their needs.
71% used the PA services for support for personal care.
79% used PA services for activities of daily living.
The median number of PA hours received is 10 per week, with higher allocations among those with lower levels of “natural support”¹⁸. This equates to less than two hours per day.

Under 65s in Nursing Homes

At the beginning of 2023, 1,250 people with disabilities under the age of 65 were in nursing homes in Ireland¹⁹:

706 were men.
544 were women.
The average stay is 4.5 years, with the longest stay standing at 19.5 years.
The youngest person in a nursing home is aged in their 20’s.

ENDS

References:

United Nations Article 25 – Health | United Nations Enable
United Nations Article 26 - Habilitation and rehabilitation | Division for Inclusive Social Development (DISD) (un.org)
Department of Children, Equality, Disability, Integration and Youth (2023) Action Plan for Disability Services 2024 – 2026.
Department of Health (2021) Disability Capacity Review to 2032 – A review of Social Care Demand and Capacity requirements to 2032
World Health Organisation (2023) Disability
World Health Organisation (2022) Global report on health equity for persons with disabilities (pg.64)
A total of 1,109,557 people reported experiencing at least one long-lasting condition or difficulty to any extent, accounting for 22% of the population. Census 2022 (2023).
Census 2022 (2023) Profile 4- Disability, Health and Carers.
CSO (2020) Irish Health Survey 2019 – Persons with Disabilities
National Disability Authority (2021) Overview of UNCRPD Article 25 in Ireland (pg.6)
HRB – NASS (2023) Overview of people engaging with disability services, 2022
Department of Health (2021) Disability Capacity Review to 2032 – A review of Social Care Demand and Capacity requirements to 2032
Ombudsman for Children (2021) ‘4,000 children with disabilities in waiting list limbo’
Inclusion Ireland (2022) Progressing Disability Services for Children and Young People (pg.4)
ibid (pg.5)
ibid (pg.14)
ESRI (2022) Personal Assistance Services in Ireland: A Capability Approach to Understanding the Lived Experience of Disabled People
Note: natural supports = unpaid assistance from family and friends.
RTÉ News via Freedom Information Act (2023) Nearly 1,300 under 65s in nursing homes due to lack of services