Policy development and implementation
3.1 To change the lives of people with disabilities for the better requires a concerted and organised response from the whole administrative machinery of state. The deep anger already noted amongst people with disabilities is based not solely on the inadequacy of particular services: it is based primarily on a sense of helplessness and frustration in the face of a system which they experience as complex, passive, incommunicative, bureaucratic, reactive, fragmented and not focused on their needs.
3.2 This is a theme which is not exclusive to people with disabilities but is being heard throughout Irish life as an educated society articulates its wishes more forcibly. These wishes are for a user-friendly system and also one in which relations between those providing services and those using them are conducted on a more equal and participative basis rather than on one of subservience between clients and professionals.
3.3 The Commission has come to the conclusion that the State needs to make proper provision for people with disabilities in order to give them a realistic hope of equality of access to the benefits of society. To do so will require major changes in the structures and approach of state services as well as the legislative changes outlined in the last chapter.
3.4 There are already signs of a new sensitivity in the public service, an example of which is the Department of Health's strategy document Planning for a Healthier Future which includes many of these themes. Such a development is necessary across the whole spectrum of administrative bodies. These measures need institutional, political and legal expression and a change in the system and the culture which drives it, in order to provide a pro-active service.
3.5 To achieve this and to eliminate the administrative dysfunction which impacts unfavourably on people with disabilities, the Commission proposes a number of radical and far reaching measures at both central and local government level. These will address the absence of co-ordination and the lack of focus in the present arrangements: there is, for example, no single agency at present which attempts to develop an overview of the needs of people with disabilities and how they fare across the whole spectrum of services. These measures will provide a positive ethos and culture in the administration of public services for people with disabilities and provide the necessary statutory basis from which this renewal will arise. Finally, there is a need to establish a practical mechanism to enable people with disabilities at crucial times in their lives to obtain the best result possible from the available services.
3.6 In order to achieve this, the Commission recommends that the Department of Equality and Law Reform be given the prime responsibility for the development, monitoring and implementation of policy for people with disabilities. The decision to establish a Department responsible for equality is fully vindicated in the light of the situation revealed in this report: it should be maintained in existence and its influence strengthened in relation to social, economic, cultural and political policy for people with disabilities.
3.7 The Department of Equality and Law Reform should be given any necessary resources for its task as national co-ordinator of disability policy. It is further recommended that a Disability Equality Unit be established within the Department headed by an official at Assistant Secretary level. The function of this unit should be:
- To provide a focal point for disability equality policy and legislation development
- To operate an inter-departmental co-ordinating mechanism
- To monitor the implementation of government decisions in relation to disability policy
- To monitor the achievement of the quota for the employment of people with disabilities in the public sector
3.8 The Department of Health and its agencies currently provide a range of services such as respite care, home helps, personal assistants, technical aids and appliances. These services are not primarily health services at all. However, the Department of Health and the health boards have built up a wealth of experience in the provision of these services and there is little justification for changing departmental responsibilities in these areas. The Commission believes, however, that it is important to make it clear that these services are social rather than health services. This is not just a change of terminology but underlines the need to change from a medical and caring model of services towards one based on meeting the social needs of people with disabilities. For these reasons, the Commission recommends that the Department of Health should be renamed the Department of Health and Social Services; the section of the Department which currently deals with a range of non-health services (including child care services and services for the elderly) should be renamed the Social Service Section. The health boards (which are, in any case, to be restructured under the Health Strategy) should be described as Health and Social Service Authorities with appropriate changes in their internal structures.
3.9 An interdepartmental committee should be established at a senior level, under the aegis of the Department of Equality and Law Reform, to co-ordinate government strategy for people with disabilities. All major government departments should be asked, as an integral part of the Government's Strategic Management Initiative, to identify their strategic objectives in relation to providing public services to people with disabilities, and to develop and publish a five year plan for achieving those objectives.
3.10 Each government department should also carry out a physical access review and plan to ensure that, within five years, all their buildings are made accessible to citizens with disabilities. Many offices throughout the public service are still not accessible: many health centres, for example, have no wheelchair access.
3.11 Government departments and state agencies should provide disability awareness training for all staff. Specific staff members should be assigned responsibility as 'key workers'. These 'key workers' would act as points of contact within their agencies for people with disabilities, their families, carers and Support Co-ordinators.
The National Disability Authority
3.12 In order to achieve the primary aim of ensuring equality for all citizens, the Commission believes it is necessary to create an executive body which will monitor the impact of public policy and services on people with disability. This body should not only be in a position to monitor the system at local level but should have the power to intervene in particular cases in order to ensure equity. The Commission therefore recommends the establishment of a National Disability Authority which would report to the Department of Equality and Law Reform.
3.13 It is important, when setting up a new body, to be able to offer a cogent logic for its creation and to be sure that there is no overlap or duplication of functions. The Commission understands that the devolution of executive functions from departments of State to executive agencies is part of the Strategic Management Initiative. It supports this devolution but considers that a new body is required in order to redress the imbalances which work against people with disabilities. The Commission sees the National Disability Authority as having a clearly separate and independent role, one focused on audit, co-ordination of best practice, and in a position to intervene and evaluate. It will be important to ensure that other roles and functions which would blunt its effectiveness are not loaded on to the National Disability Authority.