As the first two items are being taken together, the Deputies will have five minutes each to speak and the Minister of State will have ten minutes to reply.
Adjournment Debate.
Hospital Services.
I thank the Leas-Cheann Comhairle for allowing me to raise the resignation of the consultant doctor, Dr. Oscar Breathnach from his position at Cork University Hospital. His resignation was greeted with disbelief by the people of Cork and Kerry, especially those dependent on the vital oncology services in the region. Dr. Breathnach resigned because of the failure of the Tánaiste and Minister for Health and Children, Deputy Harney, and her Department to provide the resources for a dedicated oncology ward in the area and the lack of a back-up service due to the shortage of consultant colleagues. For four years, Dr. Breathnach informed the health board and the management of Cork University Hospital that such a dedicated ward was vital for an efficient and effective oncology service to be available to the people of the region. He resigned out of disillusionment and frustration at the indecisiveness of the former Minister for Health and Children, Deputy Martin, and his successor, Deputy Harney.
It is ironic that Dr. Breathnach has been offered a job in the Dublin area where he will be one of 12 medical oncologists providing treatment. At the same time, the Cork-Kerry region will have just one. Cork University Hospital is hoping to get a locum consultant for the post in the coming weeks. Realistically, it will be at least 2006 before this post will be filled, if the hospital can manage to recruit anybody given the shortfalls of the service. In the meantime, in Dublin, two additional positions have been advertised and interviews will take place shortly. A further two positions are at the planning stage. These posts are attractive as they offer, at most, two hospital site locations. This is in contrast to Cork, where any position is based on three hospital sites. In Dublin, all units have dedicated oncology wards, while Cork has none.
Dr. Oscar Breathnach's resignation raises two issues. First, there is a need for a dedicated cancer ward for the region. Second, additional consultant posts must be provided. Several efforts to develop an oncology ward at Cork University Hospital have not been fruitful. When the new radiotherapy unit was being built, it was suggested that an oncology ward be built over it. However, this was rejected by the then Minister for Health and Children. That the day procedures unit lies idle is another scandal. If this were opened, it would free up space that could be quickly converted into an oncology ward. The situation at Cork University Hospital is disorganised as cancer patients are situated in nearly every ward, doubling the time required to see them, fragmenting their care and making it sub-optimal.
The chronic climate of under-resourcing in the region is impacting on other consultant posts. A recent consultant radiotherapy post, the first in Cork in ten years, attracted only one candidate for interview. A recent post in one of the other Cork hospitals attracted two candidates. However, a similar post at St. James's in Dublin attracted 22 applicants. Dr. Breathnach's resignation is symptomatic of several key issues in the Cork area that are not just cancer related. I hope the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, will give us positive information and this crisis in Cork can be reversed before Dr. Breathnach finally leaves his position. I blame the Minister for Health and Children, and her predecessor, for an appalling lack of proper planning in the delivery of hospital services in the Cork-Kerry area. I hope it is not too late to rectify the problem.
I thank the Ceann Comhairle for allowing me to raise this matter. I hope the Minister of State at the Department of Health and Children, Deputy Tim O'Malley, will show ministerial qualities in making a decision on this important matter instead of reading what has been handed to him by the civil servants in the Department. We are elected to represent the people in our areas. Deputy Allen has outlined the situation at Cork University Hospital. It is now a matter of life and death for our constituents. Cancer is a serious illness that is frightening and potentially fatal. Thankfully, over several decades procedures and services have been developed meaning that most early detected cancers can be treated effectively. As this is a matter of life and death, it is important the best service possible is provided to ensure the medical professionals involved have the best chance to save lives.
A dedicated cancer ward is badly needed in Cork University hospital. However, the people in the Cork area are not getting the best possible care because several Ministers have not made decisions to open such a ward. To make a large difference, it would only cost approximately €1.6 million per quarter to run such a ward.
The medical consultants and professionals involved are frustrated by the Government's indecision and lack of commitment on this matter. I challenge the Minister of State, Deputy Tim O'Malley, to make a decision giving a commitment for the provision of a dedicated seven day cancer ward. This is the only cancer centre in the State with no dedicated ward. Cancer patients are scattered across seven different wards in the hospital, resulting in the specialist doctors involved not operating at the best level. Instead, they spend most of their time going from one ward to another, meaning other specialist services are fragmented. It is difficult for families, teaching purposes and, most of all, the patients. We appeal to the Minister of State to put his foot down, to say "enough is enough". If he does not, there is no point in him continuing as a Minister and he should resign.
People with cancer related illnesses are now being admitted through the accident and emergency department. Cork, the second largest city in the State, must have a dedicated cancer unit as a priority. I admit much good work has been done at Cork University Hospital. However, one of the top medical doctors in the hospital still resigned out of frustration. From talking to patients I have heard praise for the unit at St. James's Hospital. A similar unit should be opened in Cork. The staff of the hospital does its best but it is now time for the Government to make a decision. Instead of bland remarks on what has been done, we want to know the Government's intentions for the ward.
I am pleased to have the opportunity to set out the position in regard to the delivery of oncology services for the southern area. The Health Service Executive, southern area, has confirmed that the consultant medical oncologist referred to by the Deputies has resigned to take up a position in Beaumont Hospital after the summer of 2005. He is based at Cork University Hospital and holds a clinic once a fortnight at Kerry General Hospital, KGH, where a registrar in oncology, based at Kerry General Hospital, oversees patient chemotherapy treatment. There is currently one consultant medical oncologist employed by Beaumont Hospital. The consultant referred to by the Deputy will be the second consultant medical oncologist at that hospital.
Cork University Hospital, CUH, is committed to patient care and all steps are being taken to ensure continuity of patient care. The HSE, southern area, has advertised for a locum appointee and the recruitment process for the replacement permanent consultant medical oncologist post has commenced. The HSE, southern area, is working on a proposal for a dedicated oncology ward, which it will submit to the HSE within the next fortnight.
The hospital strategy is to achieve a dedicated oncology ward of 20 beds, that is, the current oncology bed complement, and to open the day procedures unit. The transfer of existing day services to the day procedures unit will allow the vacated space to be utilised for other priority purposes, including a dedicated oncology ward. The hospital is at the relatively early planning stages of a major cardiac-renal facility to include a 30-bed dedicated oncology ward.
The acute hospital planning forum in Cork previously identified the need to additional manpower in this area and, as a consequence, the hospitals have been working on a submission to progress the appointment of two additional consultants.
Since 1997 there has been a cumulative additional investment of approximately €720 million nationally for the development of appropriate treatment and care services for people with cancer. The HSE, southern area, has received an investment of approximately €80 million for oncology services, including this year's allocation of an additional €3.5 million from national cancer strategy funding to address increased regional pressures in oncology services. This funding has provided for the approval of an additional 11 consultants in key areas of cancer care as follows: two consultant medical oncologists, three consultant histopathologists, one consultant radiologist, one consultant haematologist, two consultant radiation oncologists and two consultant surgeons with a special interest in breast care. The funding has also provided for the appointment of 27 cancer care nurse specialists across the southern area.
In regard to radiation oncology services, the supra-regional centre at CUH will provide services for patients in the southern, south-eastern and mid-western areas. Approval has issued for the purchase of two additional linear accelerators for this centre and the necessary capital investment amounting to over €4 million to commission this service as rapidly as possible. These linear accelerators have been ordered and the first one has been installed. The second linear accelerator is scheduled for delivery in April 2005. It is expected that this linear accelerator will be installed and commissioned by the autumn. The expanded unit is expected to provide an extra 5,000 OPD treatment visits a year.
Last year approval issued for the appointment of 29 staff for this unit and additional ongoing revenue funding of €3 million to cater for this expansion. Two additional consultant radiation oncologists will be appointed at Cork University Hospital, with sessional commitments to the south-eastern and the mid-western areas. CUH is also in the process of recruiting other key posts required for the commissioning of the new linear accelerators. In regard to phase two of the development, the design brief for the expansion to eight linear accelerators has been submitted by the HSE, southern area, to the Department and is being examined.
The developments I have outlined describe an overall framework through which cancer services are being developed and provided in the southern area. We are extremely fortunate in this country that those involved in cancer care provide a professional and high standard of care that is broadly appreciated by patients with cancer and their families. I recognise this dedication and commitment. I am glad of the opportunity to place on record the substantial developments that continue to take place in cancer services nationally and in the southern area in particular.
Pupil-Teacher Ratio.
I am thankful for the opportunity to discuss this matter and I thank the Minister of State, Deputy Tim O'Malley, for coming in to reply.
Cahergal national school, County Galway, has over the years been treated shabbily by the Department and the Minister's predecessors. Accommodation in the school is totally inadequate and the Department and previous Ministers have ignored the pleas of staff and parents to have proper accommodation provided. All requests have fallen on deaf ears and I request the Minister and the Department to review the situation as a matter of urgency. I specifically request the Minister to bring to finality the purchase of a site. If the option being pursued at present is not successful, another option, which is known locally, should be moved on. I ask the Minister of State to bring that to the Minister's attention.
I set out the case of the specific issue before us, the urgent need for the appointment of an extra teacher to Cahergal national school. At present the school has four class teachers for 105 pupils. This means the average class size in the school is 26.25 pupils. These figures are particularly intolerable as all these students are in split classes. For example, there is one teacher for 11 junior infants and 13 senior infants, a class size of 24 four and five year olds. In addition, the school has the services of a shared learning support teacher three mornings per week to provide extra support to 13 pupils and the services of one shared and one part-time resource teacher with a combined time of 21.5 per week to provide support for nine children with special educational needs. These additional supports for the school must be maintained for the benefit of the most vulnerable children.
Class sizes in the school and resources for children with special needs are issues of urgent concern for this community. It is unfair that children in Cahergal national school should be taught in classes of these sizes which belong to a bygone age. This is happening at a time when our country is experiencing unprecedented economic prosperity. The demands for increased staff in Cahergal national school are set out in the context of a commitment in the 2002 programme for Government which states:
We will continue to reduce the pupil:teacher ratio in our schools. Over the next five years we will progressively introduce maximum class guidelines which will ensure that the average size of classes for children under 9 will be below the international best-practice guideline of 20:1.
What has happened in respect of that commitment in the programme for Government? I do not have to wait for the answer because, unfortunately, absolutely nothing has happened. The Minister of State might tell us when something will happen. The reality is that three years later not one single step has been taken towards achieving the Government's target, notwithstanding the fact that for the first time in many years, there are qualified primary teachers available for work and a further 1,600 teachers set to graduate in 2005.
The most immediate need for Cahergal national school in regard to staffing is the appointment of one extra class teacher to the school from next September. It would bring Cahergal national school closer to achieving the class sizes of other developed countries. I look forward to hearing the Minister of State's reply and urge him to take the issues concerning Cahergal national school seriously.
I am glad to have the opportunity to outline to the House the position of the Department of Education and Science concerning staffing in primary schools, including in Cahergal national school. The mainstream staffing of a primary school is determined by reference to the enrolment of the school on 30 September of the previous year, with schools staffed on the basis of having a maximum average class size of 29 in the school. As the Deputy pointed out, the average class size in Cahergal national school is 26 pupils. Based on its enrolment on 30 September 2003 of 103 pupils, the school was allocated staffing for the 2004-05 school year of a principal and three mainstream teachers.
The school also has the service of a resource teacher and a shared learning support teacher. According to data submitted to the Department by the board of management, the enrolment of the school on 30 September 2004 was 105 pupils. The staffing for the 2005-06 school year will be determined on the basis of this figure in accordance with the agreed staffing schedule for the next school year which is expected to be notified to boards of management shortly.
If a school believes its staffing allocation is wrong, it can make an appeal to the independent appeal board on mainstream staffing which was established in August 2002 and commenced operation at the beginning of the 2002-03 school year. The purpose of the appeal board is to allow for the independent consideration of appeals, under certain criteria, against the mainstream staffing schedule as issued to schools. The appeal board allows for equitable and transparent treatment of all primary schools and its decision is final. It is not open to the Minister for Education and Science or her Department to interfere in this process.
I take this opportunity to outline the significant improvements made in the area of class sizes in our primary schools in recent years. The average class size at primary level nationally is now 23.9, down from 26.6 in 1996-97. The pupil teacher ratio, which includes all the teachers in the school including resource teachers, has fallen from 22.2:1 in the 1996-97 school year to 17.44:1 in 2003-04. These benefits are the result of the employment of more than 4,000 additional teachers in our primary schools since 1997.
In line with the Government's determination to tackle social exclusion, significantly smaller class sizes have been introduced in disadvantaged schools, with approximately 47,700 pupils in 243 disadvantaged schools availing of reduced class sizes of 15 to 20 pupils per class. In line with Government policy, the Department of Education and Science will continue to provide further reductions in the pupil teacher ratio within available resources and subject to spending priorities within the education sector. Priority will be given to pupils with special needs, those from disadvantaged areas and those in junior classes.
I thank the Deputy once again for raising this matter in the House.
I thank the Chair for allowing me to raise on the Adjournment the important issue of class size. Let me first declare an interest. I was a teacher for more than 20 years and am still a member of the INTO. I am always honoured and privileged to represent the INTO view in the Dáil and I will continue to push the case for Irish education and the importance of teachers in Irish society and their valuable role in the community.
It is essential that this House should note that Irish primary schools have the second highest class sizes in the EU, that no improvements in mainstream class size have been made in the past three years, that additional teachers are also urgently required to meet the needs of pupils with special educational needs and the needs of pupils from disadvantaged communities. I call on all Deputies to support the campaign led by the INTO with the support of local communities to secure improved staffing levels in primary schools so that primary classes are reduced to European norms in accordance with best practice as promised in An Agreed Programme for Government 2002-2007. I also demand increased resources for primary education, including specifically a reduction in primary class size as a matter of national importance that warrants immediate action.
I am sick to the teeth of all the teacher bashing that has gone on in the media in recent days, especially on radio programmes such as the Pat Kenny Show. My experience of teachers, as a teacher for 20 years, is as follows: teachers assisting pupils outside school hours; teachers training and bringing pupils to matches after hours; teachers putting their lives at risk on child abuse cases; teachers bringing children abroad or around the country at weekends; teachers assisting children with disability beyond the call of duty — I know many teachers who have done this on numerous occasions and I commend them in this debate; teachers taking on racism head on while some of our politicians stoke the fires of fear; and teachers doing extra voluntary work in their local communities. These teachers are not looking for gold medals for their work. They enjoy their job and derive great satisfaction from it. However, they deserve balanced reporting and fair play. I urge all Deputies in this House to defend teachers.
On the issue of staffing in schools, it is essential that we understand that class size is a major issue for parents and teachers throughout the State. Parents are concerned that their children are in large classes. We want action from the Government and we want it now. Teachers want to get on with their work in the classroom. They can do their job more effectively if there are smaller classes. This has been proved educationally and internationally. There can be a number of groups in a small class comprising children with different reading ages and different reading ability. I have seen this work in projects that have been very successful. I refer to the Breaking the Cycle programme in the 34 poorest schools in the country where extra educational resources were put in to help the most needy. I commend the people involved in these projects and the teachers working on the ground. They have proved that such examples of good practice work.
I urge the Minister to listen to the voice of the INTO, to the voice of teachers and to the voice of parents.
I thank the Deputy for raising this matter. I am glad to have this opportunity to outline to the House the improvements that have been made in primary class sizes by the Government. Since 1997, the Government has dramatically increased the number of teachers in our primary schools. In that time more then 4,000 additional teachers, including nearly 2,500 resource teachers, have been employed. These additional teaching posts have been used to reduce class sizes, to tackle educational disadvantage and to provide additional resources for children with special needs. Average class size has been reduced from 26.6 in 1996-97 to 23.9 in 2003-04. The pupil-teacher ratio, which includes all the teachers in the school including resource and learning support teachers, has fallen from 22.2:1 in the 1996-97 school year to 17.4:1 in 2003-04. Significantly smaller class sizes have been introduced in disadvantaged schools involved in the Giving Children an Even Break — Breaking the Cycle programme, with approximately 47,700 pupils in 243 participating schools availing of reduced class sizes of either 15 or 20 pupils per class.
The mainstream staffing of a primary school is determined by reference to the enrolment of the school on 30 September of the previous year. The staffing allocation system is based on ensuring an overall maximum class of 29 in each school. Where some classes in a school have class sizes of more than 29, it is generally because a decision has been taken at local level to use their teaching resources to have smaller numbers in other classes in the school. As a result of the decrease in the overall maximum class size by reference to the staffing schedule from 35 in the 1995-96 school year to 29 at present, the number of children in classes of 30 or more has decreased substantially. In that regard, the average class size in the 30 to 39 category in 2003-04 was 31.7.
Other improvements in staffing for primary schools in recent years include a reduction in the appointment and retention figure for the first mainstream class teacher to 12 pupils, the appointment of administrative principals to ordinary schools with nine or more teachers including ex-quota posts, a reduction in the enrolment figures required for the appointment of administrative principals to ordinary schools and Gaelscoileanna, the allocation of teaching posts to schools where 14 or more pupils with significant English language deficits are identified and the allocation of additional learning support teachers. In line with Government policy, the Department of Education and Science will continue to provide further reductions in the pupil-teacher ratio within available resources and subject to spending priorities within the education sector. Priority will be given to pupils with special needs, those from disadvantaged areas and those in junior classes. I again thank the Deputy for raising this matter.
The Dáil adjourned at 8.50 p.m. until 10.30 a.m. on Wednesday, 9 March 2005.