Disability Capacity Review 2021-2032

The Disability Act 2005 placed a statutory duty on the HSE to provide an Assessment of Need (AON) for any person with a disability and to deliver a Service Statement based on that assessment. The Act has run for two decades alongside chronic non-compliance: the AON backlog has been the single most-litigated thread in Irish disability rights, including a 2025 High Court ruling (Pauline Tully / David Cullinane statement, milestone-2025-aon-ruling) that the HSE's assessment methodology was unlawful. The Act is the principal domestic statute against which the Capacity Review's gap figures must be read.

Ireland deposited its instrument of ratification of the UN Convention on the Rights of Persons with Disabilities (CRPD) on 20 March 2018 — among the last EU Member States to do so, and without ratifying the Optional Protocol that would allow individual complaints to be heard in Geneva. The CRPD is the principal international-law obligation that the Capacity Review explicitly seeks to make deliverable; Articles 19 (independent living), 24 (education), 27 (work), 28 (adequate standard of living) are the most-cited provisions in subsequent advocacy.

The 33rd Government re-organised disability policy responsibility into the renamed Department of Children, Equality, Disability, Integration and Youth (DCEDIY), with Roderic O'Gorman as senior Minister and Anne Rabbitte as Minister of State for Disability. Operational responsibility for HSE-funded specialist disability services (the bulk of the Capacity Review's scope) was held by the Department of Health at this point and only fully transferred to DCEDIY on 1 March 2023.

On 15 July 2021 the Department of Health, with Ministers Stephen Donnelly (Health), Anne Rabbitte (MoS Disability) and Roderic O'Gorman (DCEDIY), published the Disability Capacity Review to 2032: 'A Review of Social Care Demand and Capacity Requirements to 2032'. The Review found that, against a 2021 specialist-disability spend of €2.2 billion, additional annual investment of roughly €550 million to €1 billion (a quarter-to-a-half uplift) would be required by 2032 to meet unmet need and demographic change. Headline shortfalls quantified: ~4,000+ additional residential places needed; 2,500-10,200 additional day-service places; ~8,000 people then on an average of ~7 home-support hours/week needing significant uplift; an indicative €30m/year package for the un-served. Capital cost of housing and final decongregation estimated at €500m-€800m over the period to 2032. The 11-year horizon is the spine of every subsequent disability-services planning document.

The Department of Social Protection published Indecon's 'Cost of Disability in Ireland' research, based on a survey of 4,734 recipients of disability-related social welfare payments — one of the largest such surveys ever undertaken in Ireland. Indecon estimated the average annual additional cost of disability at €9,482-€11,734, rising to ~€9,600-€12,300 for households experiencing severe disability. The report sits alongside the Capacity Review as the principal evidentiary base for subsequent budget submissions: it quantifies what the Capacity Review's service-side gaps cost individual disabled households in cash terms.

Hours before indefinite strike action was due to commence across ~17 Section 39 employments, an agreement was reached at the Workplace Relations Commission between the Government and SIPTU, Fórsa and INMO covering ~5,000 community-and-voluntary sector workers. The deal provided phased increases totalling 8% (3% from April 2023, 2% from November 2023, 3% from March 2024) and committed Government to address the underlying pay-parity gap with HSE Section 38 staff. Section 39 organisations deliver a very substantial share of HSE-funded specialist disability services on charity contracts; pay erosion drives a documented recruitment-and-retention crisis that the Capacity Review's targets ultimately depend on resolving. Unions later said Government reneged on the parity element, triggering the 2024 and 2025 disputes.

Ministers Roderic O'Gorman (DCEDIY) and Anne Rabbitte (MoS Disability) launched the Action Plan for Disability Services 2024-2026 — the first formal three-year implementation framework for the Capacity Review, two and a half years after the Review itself. The Plan was structured around three areas (better access, maximising service-delivery impact, improved planning/management) and carried a Budget 2024 first-year allocation of €64.1 million in new measures against a record €2.9 billion specialist-disability envelope. DFI and Inclusion Ireland both welcomed publication while flagging that €64 million in new development funding was below the ~€80-90 million/year run-rate implied by the Capacity Review.

Budget 2025 provided ~€42 million in additional development funding for new measures under the Action Plan for Disability Services. DFI's official response was titled 'Budget 2025 a missed opportunity to make a real difference in disabled people's lives'; Sinn Féin disability spokesperson Pauline Tully TD said the additional €42m 'comes nowhere near the level of funding required to address the issues found in the Disability Capacity Review'. The 2025 allocation was less than two-thirds of the Capacity Review's implied ~€80-90 million/year new-money requirement.

SIPTU's ~5,000 Section 39 members returned a 96% ballot in favour of industrial action over Government's perceived failure to honour the October 2023 commitment to restore pay parity with HSE Section 38 staff. The ballot was followed by WRC talks in March 2025 and an agreement reached on 10 March 2025 providing a further 9.25% over two years (October 2024 to October 2026) and a commitment to include Section 39 workers in future public-sector pay agreements. The dispute remains the principal workforce risk to the Capacity Review's delivery profile: pay erosion drives recruitment and retention shortfalls in the charity-sector workforce that delivers the bulk of HSE-funded disability services.

Following the formation of the 34th Government in January 2025, the department was renamed from 'Children, Equality, Disability, Integration and Youth' (DCEDIY) to 'Children, Disability and Equality' (DCDE), elevating disability into the title for the first time. Norma Foley TD (Fianna Fáil) was appointed Minister; Hildegarde Naughton TD initially served as Minister of State, succeeded by Emer Higgins TD on 19 November 2025. A standalone Department of Disability has not been established despite advocacy from sector organisations; the disability brief remains within a multi-portfolio ministry.

Government launched the National Human Rights Strategy for Disabled People 2025-2030 at the Mansion House in Dublin — the first overarching disability rights strategy published since Ireland's 2018 ratification of the UN CRPD. The Strategy is structured around five pillars and three Programme Plans of Action, the first of which (2025-2026) is to carry KPIs against the commitments. IHREC welcomed the publication as 'a significant step forward' while saying 'further detail on implementation is urgently needed'. The Strategy is intended to provide the policy/rights overlay against which the Capacity Review's service-side delivery is measured.

Budget 2026 allocated a headline €619 million increase to HSE-funded disability services (HSE 2026 disability envelope ~€3.88 billion, +20% on 2025), with new funding for residential and day supports, respite, Assessment of Need capacity for children, and additional home-support and PA hours. DFI CEO Elaine Teague called the package 'a devastating setback for disabled people unable to work', because the once-off cost-of-disability lump-sum payments that had run in each of the previous three Budgets were withdrawn with no permanent replacement. Disability allowance rose €10/week to €254 from January 2026. The Irish Wheelchair Association said disabled people would be ~€1,614 worse off when one-offs were removed.

Following a 2025 High Court ruling that the HSE's existing Assessment of Need (AON) methodology under the Disability Act 2005 was unlawful, the Minister announced reforms to the AON process. Sinn Féin's Pauline Tully TD and David Cullinane TD called for the HSE to accept the ruling and end appeals. The AON backlog is the single most-litigated thread in Irish disability rights and is the upstream gate that determines how many children and adults appear in the Capacity Review's demand projections in the first place — meaning any AON methodology change directly affects the Review's measured 'gap'.

The HSE National Service Plan 2026 was the first NSP to operationalise the Budget 2026 disability uplift. DFI's summary and review (February 2026) noted that while the headline 2026 disability envelope of ~€3.88bn represented a 20% year-on-year increase, the proportion of new development funding earmarked specifically for the Capacity Review's residential / day-services / PA hours shortfall was lower than the Capacity Review's own implied trajectory for the period 2024-2026. Confidence is medium pending the formal mid-term review of the Capacity Review (expected 2026-2027).

1. CHO 1 — Donegal / Sligo-Leitrim / Cavan-Monaghan· waypoint— Northwest region. The Capacity Review explicitly identifies regional inequities in residential, day-service and PA provision; CHO 1 covers the most rural, longest-distance-to-service population in the country.
2. CHO 2 — Galway / Mayo / Roscommon· waypoint— West region. Major Section 39 disability-service provider density (Brothers of Charity, Ability West).
3. CHO 3 — Mid-West (Clare / Limerick / North Tipperary)· waypoint— Mid-West region. Significant adult-services-cliff pressure as Brothers of Charity, Daughters of Charity and similar legacy providers transition from congregated settings.
4. CHO 4 — Cork / Kerry· waypoint— South. Cope Foundation, Enable Ireland and other Section 39 providers; capacity pressure on day services and Personal Assistance hours documented in DFI submissions.
5. CHO 5 — South-East (Tipperary South / Waterford / Wexford / Kilkenny / Carlow)· waypoint— South-East. Regional inequities in adult day-service provision flagged by Inclusion Ireland.
6. CHO 6 — Dublin South-East / Wicklow· waypoint— Greater Dublin. High service-provider density but also highest absolute waiting lists for residential places.
7. CHO 7 — Dublin South-West / Kildare / West Wicklow· waypoint— Greater Dublin and Kildare. Major adult-services backlog driven by population growth in Kildare commuter belt.
8. CHO 8 — Midlands / North-East (Laois / Offaly / Longford / Westmeath / Louth / Meath)· waypoint— Midlands and North-East. Lowest population density of CHO areas with disability-services pressure; significant PA-hours postcode-lottery pattern flagged by ILMI.
9. CHO 9 — Dublin North / North-West / North-East· waypoint— North Dublin. St Michael's House, Daughters of Charity and other Section 39 providers; significant adult-services-cliff pressure.

The Disability Capacity Review identified a need for more than 4,000 additional residential places by 2032 to clear the existing backlog and respond to demographic change, plus completion of the long-running programme to close remaining congregated (institutional) residential settings. The capital cost of meeting the residential and decongregation requirement alone was estimated at €500-800 million over the period to 2032. The shortfall is most acute for adults living with ageing parents who are themselves entering frailty — the so-called 'invisible' demand cohort. Inclusion Ireland CEO Derval McDonagh characterised Budget 2024's allocation of just 90 additional residential places as a 'sticking plaster' against thousands of people requiring independent living arrangements.

The Capacity Review identified that at the time of publication ~600 adults were without any day service and many more were receiving only partial provision, with an estimated need for an additional 2,500-10,200 day-service places over 2020-2032. Approximately 8,000 people were in receipt of home-support hours averaging just ~7 hours per week. Independent Living Movement Ireland (ILMI) characterises current Personal Assistance provision as a 'postcode lottery' dependent on the goodwill of individual HSE staff, with no standardised assessment — a structural pattern the Capacity Review documents but does not, by itself, resolve. The 'adult services cliff' (loss of supports at age 18) is an annual recurring pressure repeatedly flagged by Down Syndrome Ireland's National Advisory Council.

The Capacity Review's central finding is that current annual spend on specialist disability services would need to grow by between approximately a quarter and a half over 2018-2032 — an additional ~€550 million to ~€1 billion per annum by 2032 in 2021 prices — plus €500-800 million of one-off capital. Successive Budgets have allocated new development funding well below the implied annual run-rate of roughly €80-90 million per year: Budget 2024 €64.1m, Budget 2025 ~€42m, Budget 2026's headline €619m increase larger but with the cost-of-disability lump-sum withdrawn. The cumulative gap means that even on optimistic delivery the Capacity Review's 2032 endpoint will be reached materially later than 2032 unless run-rate funding rises.

The majority of HSE-funded specialist disability services are delivered by Section 39 charity-sector organisations under State contracts (Brothers of Charity, Daughters of Charity, St Michael's House, Enable Ireland, Cope Foundation and ~2,500 smaller bodies). Section 39 workers are paid less than HSE Section 38 statutory colleagues for equivalent work — a documented parity gap that drives recruitment-and-retention crisis across the sector. The 2023 SIPTU/Fórsa/INMO deal (October 2023) and the 2025 follow-on agreement (March 2025) provided phased uplifts (8% + 9.25% over the cycle) and an in-principle commitment to align with future public-sector pay agreements, but unions have repeatedly accused Government of delaying implementation. The Capacity Review's service-side targets cannot be delivered if the workforce that staffs the buildings is not retained.

Where Capacity Review services are not in place, disabled adults are disproportionately supported by ageing parents and other unpaid family carers. The Family Carers Ireland 'State of Caring' research and the Indecon Cost of Disability report (2021) jointly establish that the average household carrying a severe disability faces additional annual costs of ~€9,600-€12,300, the bulk of which is absorbed by an unpaid family carer. Inclusion Ireland and DFI have repeatedly flagged the cohort of disabled adults living with parents over 70 as the population most exposed to a sudden, unplanned residential placement when the parental carer dies or enters frailty.

States Parties must take effective and appropriate measures to ensure equal recognition before the law (Art 12), liberty and security (Art 14), independent living and community inclusion (Art 19), inclusive education (Art 24), work and employment (Art 27) and an adequate standard of living and social protection (Art 28). Article 19 specifically requires the State to ensure disabled people have access to community support services (including Personal Assistance) necessary to live in the community, and that they are not obliged to live in particular living arrangements. Ireland has not ratified the Optional Protocol, which would permit individual complaints to the Committee.

If breached: UN CRPD Committee may issue critical Concluding Observations on Ireland's State Report; without Optional Protocol ratification there is no individual-complaint mechanism. Domestic litigation can use the CRPD as an interpretive aid under the Equal Status Acts and the Constitution.

Article 26 of the EU Charter recognises and respects the right of persons with disabilities to benefit from measures designed to ensure their independence, social and occupational integration and participation in the life of the community. The Charter applies to Ireland when implementing EU law (Art 51 Charter).

If breached: CJEU enforcement where the breach arises in EU-law implementation; domestic courts may refuse to apply national measures incompatible with the Charter when EU law is engaged.

Directive (EU) 2019/882 requires Member States to ensure that certain products and services (e.g. ATMs, ticketing terminals, e-commerce services, banking services, e-books, audiovisual media access) comply with accessibility requirements. Ireland transposed the Directive via the European Union (Accessibility Requirements of Products and Services) Regulations 2023 (S.I. No. 636/2023), with most obligations applying from 28 June 2025.

If breached: CJEU infringement proceedings; domestic enforcement and administrative sanctions under the 2023 Regulations.

Sections 7-13 confer a right to an Assessment of Need (AON) for any person with a disability, a duty on the HSE to deliver the AON, a duty to issue a Service Statement based on the AON, and a complaints and appeals mechanism. The Act is the statutory pipeline by which the Capacity Review's quantified demand is registered against the State.

If breached: Judicial review (the 2025 High Court ruling that the HSE's AON methodology was unlawful is the principal recent example); Ombudsman complaints; Disability Appeals Officer findings.

The Equal Status Acts prohibit discrimination in the provision of goods, services, accommodation and education on grounds including disability, and impose a duty on service providers to provide reasonable accommodation (Section 4) to enable disabled people to access goods and services.

If breached: Complaints to the Workplace Relations Commission and IHREC; compensation orders.

Inclusion Ireland CEO Derval McDonagh characterised Budget 2024's €12/week increase in disability allowance as 'a disturbing blow to human rights' and criticised the allocation of just 90 additional residential places against a Capacity Review-identified need of 4,000+ as a 'sticking plaster'. She argued that 'tokenistic once-off payments ignore the plight of exclusion and inequality' currently experienced by disabled citizens, and noted the gap between the pandemic Pandemic Unemployment Payment rate (€350) and the then disability allowance (€232) as evidence of unequal treatment. Inclusion Ireland advocates from the perspective of people with intellectual disabilities and their families and uses person-first language.

DFI CEO Elaine Teague called Budget 2026 'a devastating setback for disabled people' despite the €619 million headline increase in disability services funding. Her core criticism: the once-off cost-of-disability payments that had run in each of the previous three Budgets were withdrawn with no permanent replacement, and 'one in five people unable to work due to disability live in consistent poverty — for them, this Budget means less support and less security'. Teague also said 'the Government has chosen to highlight big numbers on services while quietly removing the once-off payments that made last year's Budget bearable for disabled people'. DFI is the sector-wide representative body for ~120 member organisations.

ILMI, the national Disabled Persons' Organisation working from an independent-living, identity-first ('disabled people') framework, published a detailed overview of the Capacity Review in January 2022. Their core objection: the Capacity Review accurately quantifies the gap in Personal Assistance hours but does not, by itself, replace the 'ad-hoc system, dependent on goodwill of HSE staff, with no standardised assessment and a postcode lottery that determines whether you get any PA hours, let alone the hours many of us need to live our lives'. ILMI's substantive ask, repeated since 2019, is legislation for a statutory right to a Personal Assistance Service — a measure the Capacity Review does not propose and successive Action Plans have not enacted.

Sinn Féin's Disability and Carers spokesperson Pauline Tully TD said the €42m additional development funding in Budget 2025 'comes nowhere near the level of funding required to address the issues found in the Disability Capacity Review'. Sinn Féin's alternative submission proposed €155 million to progress decongregation, additional respite, day-service places, intensive home-support packages, further Personal Assistance hours, and a development fund for Disabled Persons' Organisations. Tully framed the gap as a deliberate choice by Government, not a fiscal constraint.

Social Democrats leader Holly Cairns TD has used Dáil time and committee work repeatedly to argue that the Capacity Review's slow implementation is a rights breach rather than a delivery shortfall, citing UN CRPD Articles 19 and 28. Her March 2024 Private Members' Motion on Supporting People with Disabilities and Carers sought a binding commitment to fully fund the Capacity Review's annual run-rate. Cairns is one of the parliamentarians who has consistently used identity-first language in this context.