Summary of Disability Measures in HSE National Service Plan 2025

Issued on January 17 2025

Summary of Disability Measures in HSE National Service Plan 2025
Summary

 

A total of €3.2bn has been provided in day-to-day funding for specialist disability services in 2025 by DCEDIY. This is a €330m / 11.5% increase on the 2024 Budget with a further €18m once-off (non-core) funding provided for 2025 also. €290.4m of the €330m additional funding will support existing levels of service, while €39.4m will support new service developments.

 

Specialist community-based disability services

The Chair of the HSE Board’s foreword notes that “our vision for disability services is to be able to support people with disabilities to live full and autonomous lives in their communities. This will be achieved by developing and providing access to person-centred, integrated, responsive supports that are flexible and achieve greater choice and for all people who need specialist disability services.” The HSE CEO’s introduction includes the following priorities in relation to disability:

  • Critique and revise our approaches to providing services to adults and children with a disability.
  • Target disability services towards supporting people living with their families and in their own communities.
  • Review approaches to assessment of need and time to access all disability support services.
  • Review all models and approaches to service delivery for people with a disability to maximise access and outcome.
  • Design further tailored approaches to attract and retain professionals in disability services.

The Service Plan further notes that the HSE will develop and expand services in line with the Action Plan for Disability Services 2024-2026, and that a progress report will be published at the half-way point of the Action Plan’s implementation to determine further measures or changes required or its successor for the period post 2026. The following measures will be carried out in 2025:

  • Additional 95,000 personal assistant, PA, hours. Cost: €3.5m.
  • Additional 40,000 home support hours. Cost: €7.1m.
  • Progressive alignment of home support and PA rates with those paid in other sectors, in line with the part year 2025 funding allocation.
  • Provide between 1,250 and 1,400 new day service placements for school leavers and rehabilitative training graduates and progress an outcomes-focused monitoring system. Cost: €0.6m.
  • An additional 70 residential placements for people assessed as priority 1 and 40 additional places for children and young people under the Joint Protocol with TUSLA (to be updated following 2024 implementation review). Cost: €16m.
  • Making better use of existing respite and alternative respite provision through increasing occupancy, including in-home respite support hours, home sharing short breaks and group-based targeted services such as summer camps and evening sessions
  • Support 15 younger adults to move from nursing homes to appropriate community placements and support individuals who, through need or in line with their will and preference, will continue in their nursing home placement. A model of service, developed in collaboration with people with lived experience, will be finalised in 2025.
  • Support 21 people to move from institutional settings to community-based services in line with the Time to Move On from Congregated Settings
  • Develop community teams in line with the Neuro-Rehabilitation Implementation Framework, and enhance capacity for its implementation nationally. Cost: €0.6m. `
  • Work with the National Disability Authority to conclude the evaluation phase of the Personalised Budget Demonstrator Pilot. While evaluation is ongoing, continue to support individuals in Stage 4 ‘Living Life Stage’ of the Pilot to avail of their personalised budget.
  • Building on the proposed interdisciplinary approach in day services, commence development of the model of provision for adult multidisciplinary therapy based on a mapping exercise in 2025.
  • Provide additional resources for the six Regions and nationally to enhance data coverage and quality through the National Ability Supports System and National Children’s Disability Network Team Management System, to enable greater focus on performance and inform policy development. Cost: €0.6m.
  • Progress projects for specialist disability services including the development of a disability multiannual capital strategy.
  • Provide for a housing coordinator in each Health Region to work with local authorities to enhance access to housing.
  • Work with DCEDIY, the Department of Transport and a wide range of stakeholders to develop initiatives through the forthcoming National Disability Strategy to improve access to transport to support people with disabilities to access other services and their communities.
  • Review the recommendation of the World Health Organisation (WHO) findings of the Assistive Technology Capacity Assessment and prepare guidance for implementation. Work with DCEDIY to implement actions set out in the Global Agreement between Ireland and the WHO, including in the area of workforce optimisation.
  • Enhanced pathway to health and social care supports for thalidomide survivors.
  • Targeted services to benefit children and adults, including equine therapy, occupational therapy for dyspraxia, specialist phone line supports for Parkinson’s Disease, the Cumas Ability Programme, Ability West Best Buddies Programme, expansion of services in the Central Remedial Clinic, hydrotherapy pools and provision of frequency modulation systems through Chime.

 

Children’s Services (total cost: €9.7m)

The Chair of the HSE Board’s foreword states that “A key priority in 2025 is to significantly improve access for children and families to disability services. The availability of integrated services for children and families is a cornerstone of supporting each child to have the best chance to realise their potential.” The following measures in relation to children’s services are outlined in the Service Plan:

  • Establish a single point of access for all children, with child and adolescent mental health services and primary care services.
  • Recruit 40 therapy staff, 20 therapy assistants and 15 clinical psychology placements.
  • Reduce the waiting list for access to Children’s Disability Network Team (CDNT) supports by 10%, by increasing staffing levels in line with the agreed Disability Pay and Numbers Strategy.
  • Fully implement a minimum of 50% of the actions from the Roadmap for Service Improvement 2023-2026 Disability Services for Children and Young People by the end of 2025.
  • Fully implement the Special Schools Pilot Programme across 16 schools between Cork, Dublin and Galway while continuing a focus on reinstating health and social care supports that were provided to some special schools prior to reconfiguration
  • Recruit additional assessment officers and liaison officers to bolster the assessment teams in regions with the highest waiting lists.
  • Provide a dedicated fund for health and social care practice education resources.
  • Address the deficit in delivery of assessments of need in line with legislative obligations and the Roadmap for Service Improvement 2023-2026 using all available mechanisms including procurement, updating the Standard Operating Procedure, further development of assessment hubs and continuation of the AoN waitlist initiative.

 

Workforce and Sustainability (total cost: €1.4m)

The Service Plan acknowledges substantial challenges in recruitment and retention across disability services, with unfilled roles impacting service provision. It states that the focus in 2025 is to retain the existing workforce and grow it in support of planned developments, with tailored approaches to attract and retain professionals now and in the future. The following measures are outlined to address workforce and sustainability:

  • Finalise the Disabilities Pay and Numbers Strategy in Q1 2025. It will be underpinned by a series of measures including pay savings (agency conversion / reduction), strong management of performance at regional level, carrying forward recruitment initiatives commenced in 2024, a Whole Time Equivalent (WTE) limit for existing levels of service demonstrable productivity, and regional control of pay bill and workforce utilisation.
  • Develop a disability specific workforce strategy and workforce plan to support the delivery of disability services in the HSE, Section 38s and Section 39s, with a clear priority focus on CDNTs.
  • Continued focus on funded workforce increases to meet service expansion related to demographic growth and for new service developments.
  • Progress delivery of disability specific workforce reporting, in particular specific reporting on CDNTs in the Health Service Personnel Census.
  • Identify cross-sectoral opportunities to drive through resourcing initiatives and solutions to create sustainable capacity.
  • Implement an interim guidance to support practice educators, pre-registration students and higher education institutes, with a focus on CDNTs to build sustainable practice education infrastructure with adequate supports.
  • Implement the recommendations of the Review of National Interim Guidance on Clinical and Professional Supervision and develop guidance on the respective roles of CDNT managers and heads of discipline. Provide an evidence-informed governance framework implementation plan to reflect the ethos of the Progressing Disability Services for Children and Young People programme and the UNCRPD (to be completed Q1 / Q2 2025).
  • Explore the development of specific roles to support employing people with disabilities.
  • Maintain the focus on service, finance, human resources and governance challenges for specific organisations and develop proposals for more sustainable models of service with particular emphasis placed on maximising the use of available resources.

The Service Plan notes that despite welcome investment, the cost of running existing services at current levels over the next twelve months will be a significant challenge and that disability services will likely require additional funding support for excess 2024 costs. As it is not intended to cut services in 2025, the HSE will seek to minimise the level of financial deficit by focusing on:

  • Improving financial controls, particularly around staffing levels, including substantially reducing agency staff and overtime hours.
  • Maintaining current service levels while growing service levels in areas where this has been specifically funded particularly in support of key priorities around residential, respite, day services and children’s services.
  • Avoid cost growth or reduce costs where practical of bought in goods and services.
  • Work with DCEDIY to agree €47m savings measures in 2025 and monitoring and reporting of same, in line with the 2024 Disabilities Non-Pay Strategy.
  • Improving the efficiency and effectiveness of care and other process to safely provide more care via the same or less staffing hours. This must be done without reducing quality for patients or over-burdening staff.
  • Continue work commenced in 2024 to review the disability service delivery landscape from an organisational, governance and financial perspective.
  • Progressing a cost management programme in residential services, including an updated procurement framework, seeking to ensure consistency in the approach to sourcing and funding residential placements. Provide for a housing coordinator in each Health Region to work with local authorities to enhance access to housing.
  • Audit capacity and provision of respite services across all Health Regions.
  • Commission an evaluation of intensive support packages and supported living packages, reviewing the scale of deployment and cost-effectiveness of the current approach to inform future policy.

 

Disability Inclusion in Mainstream Health Services

There were also a number of measures outlined to improve access to mainstream health services for people with disabilities:

  • Improve opportunities for people with a disability to participate in all aspects of Healthy Ireland.
  • Develop needs and evidence-based clinical designs and innovations in areas such as acute/episodic care, older persons, children and young people, chronic disease, mental health and people with disabilities through the design and planning for the implementation of models of care and pathways, guidelines, clinical strategies and clinical design scoping exercise.
  • National Stroke Strategy 2022-2027: Improve access to specialist staffing in acute stroke units and expand the number of Early Supported Discharge teams
  • Neurology Model of Care: Establish services such as hub and spoke model, chronic neurological management, functional neurological disorders and deep brain stimulation to enable timely access to neurology services.
  • Specialised mental health services: Provide support across all age groups for targeted specialities, such as eating disorders, early intervention in psychosis, dual diagnosis, ADHD for adults, and mental health for people with intellectual disability.
  • Rare Disease Strategy: Increase the capacity of National Rare Disease Office and invest in improving the co-ordination and transition of care, in preparation for the implementation of the forthcoming National Rare Disease Strategy.
  • National Strategy for Accelerating Genetic and Genomic Medicine in Ireland: Introduce a National Genomic Test Directory for rare and inherited disease, a National Genomic Processing Service, and deliver enhanced communication and education on genetics and genomics.
  • Support staff and services to implement the Assisted Decision-Making (Capacity) Act 2015 (including by way of promoting the provisions of the Act, ongoing training, practical guidance and resources) and ensure compliance with key policies and legislation, including the public sector duty under the Irish Human Rights and Equality Commission Act 2014 and the Disability Act 2005 by updating the HSE National Guidelines on Accessible Health and Social Care Services. Support implementation of the HSE National Consent Policy 2022 and develop a revised standalone HSE Do Not Attempt Resuscitation policy with an education, training and implementation plan.
  • Implement the recommendations of the Report of the Review of the Irish Health Services for Individuals with Autism Spectrum Disorders 2018 and deliver actions under the Autism Innovation Strategy 2024 for which the HSE has responsibility.