Dáil Éireann debate -
Thursday, 31 Jan 2008

Vol. 645 No. 2

Adjournment Debate.

Services for People with Disabilities.

Deputy Seán Barrett

I raise this matter because of the appalling treatment received by a little five-year-old boy in my constituency, who is in urgent need of speech and language therapy. Speech and language therapy is like life blood to persons who are speech or language impaired since verbal communication is the essence of modern life. This therapy is as essential to a speech or language-impaired person as a wheelchair is to someone who is mobility-impaired. Effective verbal communication will enable a person to make a positive contribution to society and live a normal life. This child was placed on a waiting list for assessment, which transpired to be over a period of 12 months. After waiting for 12 months, the child was assessed and was rated as being in "critical" need of services. From this assessment, one would imagine that the child would be placed at or near the top of a priority list for treatment. The parents have been informed that the child faces a minimum further 12 months on a waiting list before he can have access to speech and language therapy.

What a sad and shameful commentary on the level of speech and language therapy services available in this country eight years into the 21st century. This matter got some national coverage and, since I raised it, a number of parents around the country have been in touch with me. Nothing has changed since I first raised this issue in the Dáil a quarter of a century ago in a similar case when I described speech and language therapy services then as "dire" and "in the Dark Ages".

Back then, just 25 speech and language therapists were graduating annually from the College of Speech and Language Therapy — barely enough to cover retirements. The number of speech and language therapists in the country then was around 85, less than a quarter of the minimum optimum figure recommended by the Quirk report 10 years earlier in 1975, 33 years ago.

Let us fast-forward to 2002, when the Bacon report recommended that the annual output of 25 be increased fourfold to 100 in an attempt to make some impact on the waiting lists. To his credit, the then Minister for Health and Children, Deputy Micheál Martin, committed to increasing the annual number of graduates to 100, as Bacon had recommended. One would think this was signalling a new era for all those persons who had spent years in some cases on waiting lists for this vital service. Unfortunately, when the first graduates came on stream and were available for appointment, they were turned down due to lack of experience. How were they expected to gain the necessary experience except by being initially appointed to posts which had not been created? The problem was that we trained people but did not create the posts. The policy was so pig-headed and illogical that one wonders how people can seriously cook up such facile impediments to the provision of an essential service to persons in grave need of treatment.

The earliest possible intervention for children with speech and language disorders is crucial, since it can preclude the need for infinitely more costly intervention at a later stage, perhaps when the persons are in their teens or older.

Deputy Bernard J. Durkan

Hear, hear.

Deputy Seán Barrett

I have had practical experience of children who failed to receive this essential service. Between the Departments of Education and Science and Health and Children, it is a scandal that we have gone through the so-called Celtic tiger while young, unfortunate children are left impaired because of the lack of commitment by the State to co-ordinate a service essential to young people whether in schools or outside.

I will continue to raise this matter for as long as God gives me the health to remain in this House. I first raised the issue 25 years ago about a particular individual whose parents were told that their child was mentally handicapped and that they should put him in an institution and have another baby. Today that young man is a qualified architect. When I think back I wonder how many unfortunate young people were cast into mental institutions, as they were then known, and are still there today who only needed psychological and speech therapy to lead normal lives. I shudder to think how many people were left in that situation.

I have given a practical example from 25 years ago and if the Minister of State, Deputy Devins, wishes to accompany me, I will be only too happy to introduce him to the parents of that man who is now a fully qualified architect, contributing to this society and to the health services through his taxes. Something must be done immediately. The Minister of State should examine what is currently being done in Northern Ireland and Scotland. We should be ashamed of ourselves.

Minister of State at the Department of Health and Children (Deputy Jimmy Devins)

I am dealing with this issue on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

Deputy Seán Barrett

The Minister was here less than five minutes ago but could not wait to deal with this matter. It is a disgrace.

Deputy Jimmy Devins

I am pleased to take this opportunity to address the important issues raised by the Deputy. I wish to emphasise the Government's commitment to providing a high quality service to all people with a disability. This commitment is illustrated by the substantial investment we have been making in disability services over the last number of years.

The National Disability Strategy, which was launched in September 2004, reinforces equal participation in society of people with disabilities and provides for a framework of new supports for people with disabilities. This programme, together with the enhancement of other key support services, are key factors in building the additional capacity required to ensure that services best meet identified needs.

The strategy builds on a strong equality framework, which is reflected in equality legislation. It puts the policy of mainstreaming of public services for people with disabilities on a clear legal footing. The main elements of the strategy are the Disability Act 2005, the Education for Persons with Special Educational Needs Act 2004, sectoral plans published in 2006 by six Departments, the Citizens Information Act 2007 and the multi-annual investment programme for disability support services for the period 2006-2009.

In launching the national disability strategy, the Taoiseach also announced the Government's commitment to a multi-annual investment for disability-specific services over a five year period. To the end of 2007, €420 million, in revenue and capital, has been allocated to services for people with disabilities since the launch of the strategy in 2004.

Additional revenue funding of €50 million was provided in the 2008 budget in respect of the multi-annual investment package. This funding is to meet the costs associated with a range of elements in the multi-annual investment programme. The additional funding will continue to provide a base line to considerably enhance the multi-disciplinary support services for people with disabilities, in line with the Government's commitment to build capacity within the health services and to deliver on the various legislative provisions contained in the national disability strategy.

Deputy Seán Barrett

I ask the Minister of State to give way momentarily. I raised the issue of speech and language therapy. I do not want to hear about a general programme or strategy.

Deputy Jimmy Devins

The Health Service Executive, which has statutory responsibility for the provision of services to individuals, states that it recognises that waiting lists exist for many services. It is a reality that these lists are managed in different ways by different services. Therapies divide their waiting lists into priority categories so that immediate need is first dealt with, followed by urgent need, and finally all other needs. Some therapies further divide their waiting lists into assessment and treatment.

The management of waiting lists is an issue for the HSE to address. Nevertheless, my Department is concerned about the lack of consistency in how waiting lists are managed as, in addition, each voluntary agency holds their own waiting list so it is very difficult to get a clear picture of waiting lists for services. However, I understand that in relation to therapy services, clinicians manage and review these lists regularly.

In the period 2005 to 2007, the Department provided funding to the HSE for the employment of multi-disciplinary supports and other staff in the context of the implementation of the Disability and Education for Persons with Special Educational Needs Acts. A total of 446 posts were approved in the areas of speech and language therapy, occupational therapy, psychology, physiotherapy and social work between the HSE and voluntary service providers. The HSE states that the majority of these posts were identified as required to provide the assessments and ongoing service interventions arising from the commencement of the Disability Act.

It continues to be a challenge to fill these important posts, which inevitably contributes to the development of waiting lists. The HSE has advised the Department that it is currently finalising plans for a co-ordinated recruitment process in each region, in addition to recruitment abroad for senior therapists over the next number of months, to fill the remaining posts. The filling of these key posts will help to address the waiting lists of the kind raised by the Deputy.

I understand the HSE has explained the situation in relation to the individual case raised by the Deputy and that it will continue to do all it can to provide services to those assessed as in need of them.

Health Services.

Deputy Jan O’Sullivan

The courage shown by a number of young adults with cystic fibrosis, people like Orla Tinsley and Jennifer Tormey who told their stories on the national airwaves, must be rewarded with firm commitment and action by the Minister for Health and Children and the HSE. That is why I am raising this matter in the Dáil today.

Their harrowing stories expose a system that is not responding to their most basic need, namely, to be able to get to hospital and receive treatment without being exposed to the kind of infections that could so easily shorten, or even end, their lives. It is vital for cystic fibrosis patients to be able to access treatment in a dedicated unit with individual rooms, each with en suite bathrooms. This does not seem too much to ask in a country as rich as ours. I must point out that we did not only find out about this issue on the airwaves over the past few weeks. In fact, Doctor Ron Pollock, who conducted a survey and independent review relating to cystic fibrosis, published his report on Monday, 7 February 2005. At that time, he said that the majority of adults with cystic fibrosis are being treated in facilities that are dangerous. That was in February 2005. Tomorrow is the first day of February 2008.

It is entirely wrong that sick people have to resort to appealing for help on a radio programme to get the health care to which they are entitled. However, by taking that action, despite its toll on their health, they have succeeded in getting certain commitments which I wish to ensure are clearly stated on the record of this Parliament. My understanding is that a temporary unit will be provided at St. Vincent's Hospital in Dublin, catering for 14 patients at a time. I understand from the Minister that it will cater for six initially, and then a further eight patients, totalling 14, by the end of the summer of 2008. I ask the Minister of State, Deputy Devins, to confirm that this is the intention and that agreement has been reached with the hospital and the HSE to make this happen. Further, I ask the Minister of State to clarify whether the rooms will have en suite facilities that will ensure there is no cross-infection.

I also understand there is a commitment to providing a 34 bed dedicated cystic fibrosis unit at St. Vincent's Hospital, as part of a larger development. Again, I ask the Minister of State to confirm this on the record and to indicate the anticipated time frame. The Minister said earlier it would be late 2010 when this would be finished. I would like that to be placed on the record and the process speeded up, if at all possible. Late 2010 is quite a long time to wait for this facility to be up and running fully.

These are the most pressing issues on which clear commitments are needed. However, a comprehensive service must address the requirements of patients all over the country. Dr. Gerard Canny, of the cystic fibrosis unit in Our Lady's Hospital for Sick Children in Crumlin, wrote a letter which was published in today's newspapers, in which he stresses the need for a continuum of care from babyhood to adulthood, with multi-disciplinary teams, as well as dedicated inpatient wards with single, en suite rooms to prevent cross-infection.

He argues for the introduction of a screening programme for newborns to ensure early diagnosis. Such a programme has been in place in Northern Ireland since 1983. It produces much better outcomes because early detection means early treatment and provision of care.

I commend the bravery of Orla Tinsley, Jennifer Tormey and the many young people and families — in some cases, members of those families have died of cystic fibrosis at an early age — who took the initiative, went on the airwaves and continue to campaign for facilities. That they have done something they should not have needed to do is a shame on us. They deserve clarity and urgency concerning what will occur. In particular, they do not deserve to subject themselves to the danger of infection by attending accident and emergency departments and wards comprising people with a variety of illnesses, including hospital-transmitted illnesses such as MRSA and C. difficile. We must respond to these young people and I want to ensure a commitment to them on the record of the House. We who have been elected by the people must ensure that their needs are met as quickly and comprehensively as possible. I look forward to the Minister of State putting those commitments on the record.

Deputy Jimmy Devins

I will be taking the Adjournment on behalf of my colleague, the Minister for Health and Children, Deputy Harney. The Minister acknowledges the need to improve services to persons with cystic fibrosis. The negative experience recounted recently by a number of young patients is a matter of much concern. I join Deputy O'Sullivan and others in acknowledging their courage.

The Minister identified the development of cystic fibrosis services as a policy priority in the Estimates process. In 2006 and 2007, additional revenue funding of €6.78 million was provided to the Health Service Executive to develop services. The HSE was asked to place a particular focus on the development of services at the national tertiary referral centre at St. Vincent's Hospital. Some 44 additional staff dealing with cystic fibrosis have been appointed to date throughout the country, ten of these posts at St. Vincent's Hospital. The necessary funding is available to facilitate the recruitment of a further 37 staff nationally, including a further nine posts at St. Vincent's Hospital in Dublin.

The Minister accepts the need to improve the infrastructural facilities for persons with cystic fibrosis attending St. Vincent's Hospital. A number of capital projects have recently been completed at the hospital and have helped to improve facilities. These include a new ambulatory care centre with dedicated accommodation — eight suites in total — incorporating single room facilities on an outpatient appointment basis for cystic fibrosis patients in an environment that allows for improved infection control, the refurbishment of St. Camillus's ward, which provides 15 additional respiratory-cystic fibrosis beds, bringing the bed complement to 44, and a new accident and emergency department, including single room accommodation that may be used for the care of cystic fibrosis patients.

It is accepted that these developments do not address the immediate needs of patients. The HSE has been working intensively with the hospital and representatives of the Cystic Fibrosis Association of Ireland to progress options for further interim improvements. The Department is advised that the option of developing a modular unit is being examined in this context and the position will be clarified shortly. The HSE advises that it is fast-tracking the redevelopment of a ward adjacent to the main cystic fibrosis treatment area. The project is to commence within the next few weeks and will provide six single rooms. On completion, additional work will begin to provide a further eight single rooms, which will result in a total of 14 single rooms for cystic fibrosis patients by the end of the summer.

In the longer term, a new ward block is to be built and will include 120 replacement beds in single en suite accommodation. The new facility will accommodate cystic fibrosis patients and include appropriate isolation facilities. Planning permission has been obtained, financial provision has been included in the HSE capital plan and the contract is to be awarded by the end of this year. It will be a condition of the contract that the design-build period is to be not more than 24 months from the date of contract award. The developments I have outlined will significantly enhance the level of service provided for persons with cystic fibrosis.

Grant Payments.

Deputy Bernard J. Durkan

I am glad to inform the House that I am not attempting to extend my remit into other constituencies. This issue was dealt with in the first instance by my colleague and party leader, Deputy Kenny. He adroitly and correctly referred to the appeals system, a hearing was held and the original decision upheld. However, it has come to my attention that the refusal to award a respite care grant was in respect of two people, not one. When I challenged the refusal, I was informed that it was the decision of the deciding officer that neither person qualified. I pursued the matter further to discover that one of the people was elderly, the mother of the carer. Given the decision, I assumed that she was in her 70s and did not require ongoing care and attention. However, I discovered that she was aged 82 years. It was concluded that she was ambulant and did not require care and attention as envisaged under the scope of the grant. I reject that opinion in its entirety. There is no 82 year old who does not require ongoing care and attention.

To make matters more complicated, I discovered when pursuing the case further that the person concerned was also caring for a brother. I assumed that the brother was in receipt of a disability allowance, was not severely affected and could get by on his own, but I was appalled to discover that he was a cancer patient who required ongoing care and attention. It transpires that he qualified on medical grounds, but the Department overlooked this fact for some unknown reason.

Where two people were receiving care and attention of the nature provided by the carer, thereby ensuring that the State need not incur an expenditure by way of providing institutional care at a time when hospitals and other institutions across the country are overcrowded, would it not be in everyone's interests, including the Exchequer's, to make a decision in favour of the claimant? For the life of me, I cannot understand how a decision could be made on medical or economic grounds to refuse a grant to someone claiming it on behalf of two persons. As the grant is envisaged, the legislation provides that a person is regarded as requiring full-time care and attention where they require continual supervision and frequent assistance throughout the day. That criterion applies in both cases.

The Minister of State opposite me will probably read a history lesson. With all due respect to Members — I listened to the plight of Deputy Barrett's case — we are wasting our time if we go down this road. An appalling decision was made in respect of someone caring for two people, a cancer patient and a person aged 82 years. I rest my case and I hope that the Minister of State will use his care and compassion as a medical practitioner to ensure the decision in question is overturned. I hope he will contact the office of the Minister for Social and Family Affairs and tell it that there are no economic or other grounds for a decision of this nature to be repeated.

Deputy Jimmy Devins

The main conditions for receipt of the respite care grant are that the person or persons in respect of whom the application is made must require full-time care and attention and that the applicant must be providing that care. The legislation provides that a person is regarded as requiring full-time care and attention where they require continual supervision and frequent assistance throughout the day in connection with normal bodily functions or to avoid danger to themselves.

The person to whom the Deputy refers submitted an application for a respite care grant in respect of his mother and his brother. In respect of the applicant's brother, the deciding officer refused the application on the grounds that the care given is in the nature of help around the house and farm which does not constitute the care and attention envisaged by the legislation. In respect of the applicant's mother, the application was refused on the grounds that her condition is not such that she requires the level of care envisaged by the legislation. The deciding officer based this decision on the advice of a medical assessor who reviewed the medical evidence submitted by her general practitioner. Also, in respect of the applicant's mother, the deciding officer was not satisfied that the level of care being provided was consistent with that envisaged in the respite care grant legislation.

The decisions were appealed to the social welfare appeals office. The appeals officer examined all the evidence submitted, including that adduced at an oral hearing, and upheld the decision of the deciding officer. A decision by an appeals officer is final but can be revised if new evidence or facts or any relevant change of circumstances come to light after a decision is made. It is open to the person concerned to make an application for the 2008 respite care grant if he feels that he may qualify. The earliest date for receipt of any such application is 10 April 2008.

Deputy Bernard J. Durkan

Things have changed in the Department of Social and Family Affairs. It should be called the Department of social indifference.

Schools Building Projects.

Deputy David Stanton

I thank the Ceann Comhairle for giving me the opportunity to raise this issue on the Adjournment and the Minister of State for coming to the House to debate the need to construct a new building for the gaelscoil in Midleton in County Cork. As the Minister of State may be aware, Midleton is one of the fastest growing areas in the country. In 1999, 159 students were enrolled in primary schools in Midleton, including Saleen outside the town. Last year, the numbers rose by 226. The total number of primary school students in the town is 1,661 and it is envisaged that this number will increase.

The gaelscoil is operating in premises that are unsuited to its needs. It has an enrolment of 268 children. We are told that this will increase to 310 next September and 346 in September 2009. It operates out of an inadequate building with insufficient space, leaking roofs and insufficient toilet facilities which staff share with children. There is no storage space and the school building opens on to the open road. There is a huge demand for places due to the excellent staff and a desire by parents to have their children taught through Irish. This year, the school will have to turn away children.

A site is available and planning permission has been granted. Midleton is a growing town and I understand that it has been described by the Department as being in crisis where primary school places are concerned. A construction company agreed to build a school and make a site available. Everyone was happy with that and it was all systems go. However, that company has recently written to say that it is not in a position to give a date for the completion of the school owing to the slowdown in the housing market. On a positive note, however, it can and will make available immediately and free of charge to the Department of Education and Science a site with full planning permission for a school to the value of €6 million. I know that until recently, the Department and the Office of Public Works were actively seeking a site for the school. There is a great need for it and I urge the Minister of State to go back to the Department of Education and Science and impress on it the urgency of this matter.

It appears that there will be another increase in numbers in the school next September. Portakabins are being used and the situation is unsafe, yet it is a very successful school. It needs a new building. The site, plans and everything else are in place. Unfortunately, the school wanted to and thought it could build a new school independently of the Department with no cost to the State. That will not happen because of the downturn in the construction industry so we go back to the Department to see whether it will fund the building of the school on the site as planned as soon as possible.

I would like the Minister of State to say it will happen and will proceed. I will not hold my breath but I ask him and the Minister for Education and Science to use their good offices in the Department to ensure this happens. There is great need. All the schools in the area are full. Building this school would serve to alleviate the problem of overcrowding in the schools in Midleton in the short term. It is a growing town and will grow even more. The projections are frightening. I await the Minister of State's reply and hope it will be positive.

Deputy Jimmy Devins

I thank the Deputy for raising the matter as it affords me the opportunity to outline to the House the Government's strategy for capital investment in education projects and also to outline the position regarding Gaelscoil Mainistir na Corann.

Modernising facilities in our 3,200 primary and 750 post-primary schools is not an easy task, given the legacy of decades of underinvestment in this area, as well as the need to respond to emerging needs in areas of rapid population growth. Nevertheless, since taking office, this Government has shown a focused determination to improve the condition of school buildings and to ensure the appropriate facilities are in place to enable the implementation of a broad and balanced curriculum. As evidence of our commitment, national development plan funding of €4.5 billion will be invested in schools over the coming years. I am sure the Deputy will agree this record level of investment is a positive testament to the high priority the Government attaches to ensuring school accommodation is of the highest standard possible.

Gaelscoil Mainistir na Corann is a co-educational primary gaelscoil with a current enrolment of 268 pupils. The Department of Education and Science received an application for capital funding towards the provision of new school buildings. As the Deputy will be aware, the school authority and a private construction firm, without the direct involvement of the Department, were involved in an initiative to build a 16-classroom school on land owned by the developer at no cost to the school or the Department. The Department has not been involved in the design of the school nor has capital funding been provided in respect of the proposed project.

I understand that the initiative to build a 16-classroom school on land owned by the developer has been changed to an offer of a site. To progress the gaelscoil's application using the traditional method, an assessment of projected enrolment trends, demographic trends and housing developments in the area will be required to determine the long-term projected staffing figure on which the school's accommodation needs will be based. Once the long-term projection has been determined and agreed with the school authorities, the required building project will be considered in the context of the multi-annual school building and modernisation programme. I again thank the Deputy for raising the matter and allowing me to outline the position regarding Gaelscoil Mainistir na Corann.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 5 February 2008.