Dáil Éireann debate -
Thursday, 5 Feb 2009

Vol. 673 No. 4

Adjournment Debate.

Hospital Accommodation.

Deputy Caoimhghín Ó Caoláin

Gabhaim buiochas leis an Ceann Comhairle as an deis seo chun géarchéim na noispidéil a chur arís os comhair na Dála.

I thank the Ceann Comhairle for this opportunity to again put before the Minister for Health and Children and the Dáil the crisis facing communities, patients and health care workers in Counties Cavan and Monaghan if the Minister and the Health Service Executive proceed with their plan to finally destroy Monaghan General Hospital and to push Cavan General Hospital to breaking point.

My raising the crisis today is prompted by this week's open letter from 41 general practitioners in Counties Cavan and Monaghan expressing alarm regarding the safety of the proposed ending of acute inpatient care at Monaghan General Hospital and the replacement of its 56 beds with six medical assessment unit beds in Cavan General Hospital. The letter announced the withdrawal of GP representation from HSE planning groups on the so-called transformation of hospital services in Cavan and Monaghan.

The withdrawal of the GPs removes the HSE's last pretence that this process has anything to do with improved patient care or moving care closer to the patient. These key primary health care providers have made clear that the safety of patients will be at risk if acute inpatient care at Monaghan is axed as planned.

The Minister for Health and Children Mary Harney must listen to the GPs who are saying that the safety implications of the plan are such that they require the HSE to provide a full independent risk assessment of the closure of the 56 beds and of the capacity of GPs to provide a safe service in such circumstances.

It is very significant that the GPs have pointed out that the HSE is attempting to replace 56 acute medical beds in Monaghan with six beds in the medical assessment unit in Cavan General Hospital. The GPs do not regard this as a replacement, and rightly so. It represents a cut in services overall and will place an untenable burden on an already over-stretched Cavan General Hospital. If the Minister for Health and Children and the HSE refuse to act on the call of the Cavan-Monaghan GPs, the gross irresponsibility of their plans will be more clearly exposed than ever.

Today the County Monaghan domiciled Deputies for Cavan and Monaghan met with the Minister for Health and Children, Professor Brendan Drumm, chief executive officer of the HSE, and Michael Scanlon, Secretary General of the Department of Health and Children. I have no hesitation in stating that there was no real engagement with the Minister, Deputy Harney, for whom the meeting appeared to be little more than a sufferance. While Professor Drumm did engage, it was deeply disappointing that he concluded by reaffirming that the HSE's pace of change will proceed. That is most worrying and, with potentially very serious consequences for me, my family, my community, my county and my constituency. At this 11th hour I urge that the madness now stop.

Deputy Seymour Crawford

I wish to thank Deputy Ó Caoláin for the opportunity to participate with him in this debate, which is extremely important as far as our constituents are concerned in Cavan and Monaghan.

On Wednesday, 10 December last, the Minister, Deputy Harney, met with a group of practitioners from Monaghan after which the doctors concerned sent a letter to the Minister emphasising their grave concerns regarding the proposed closure of acute medical services and causality services in Monaghan General Hospital. They also emphasised that the hospital provides safe, efficient and assessable health care.

Since that meeting and as Deputy Ó Caoláin said, 41 GPs from Cavan and Monaghan have demanded a full independent risk assessment regarding the safety of the proposed closure of 56 acute beds in Monaghan General Hospital and their replacement with six medical assessment beds in Cavan General Hospital.

The GPs are clearly worried about their own capacity to provide a safe service in the circumstances where acute services have been removed from Monaghan and have advised that there will be no further GP representation on any of the HSE planning groups regarding transformation or the medical assessment unit development. It is clear from the doctors' statement published in the Irish Medical Journal and from a discussion today between four Members representing the Monaghan part of the constituency, the Minister for Health and Children, Deputy Harney, Professor Drumm, chief executive of the HSE, and Mr. Michael Scanlon, Secretary General of the Department, that consultation between the general practitioners and the consultants has not been the order of the day.

While the Members had a frank and open discussion with Professor Drumm through the Minister, it was clear her involvement or interest was less than productive. It is vital at this late stage that the general practitioners and consultants be involved in any discussion or decision towards a safe service. This can only be done through the retention of the acute medical service, the intensive care ward and the accident and emergency treatment room.

This is a last ditch request from all the constituents of Cavan-Monagahan. Four Members of the constituency have united to some degree on this matter because we realise the damage that could be done to lives.

Minister of State at the Department of Health and Children (Deputy John Moloney)

I am taking this Adjournment matter on behalf of the Minister for Health and Children, Deputy Harney.

The overriding aim of the transformation programme for the north-east region, which the Minister fully supports, is to improve safety and achieve better standards of care for patients in the region. This process involves widespread and fundamental change and is designed to build a health system in line with the model of care emerging internationally. The transformation programme has been informed by the teamwork report to the HSE, which demonstrated the service configuration in the region was unsustainable.

A series of focused service changes is being implemented across the region. The immediate focus is the reconfiguration of existing services by moving acute and complex care from five hospital sites, including Cavan and Monaghan, to two, including Cavan for Cavan-Monaghan. With regard to the Cavan-Monaghan hospital group, the HSE intends to complete the transfer of acute inpatient services from Monaghan to Cavan over the coming months and to develop additional services in Monaghan. The transfer of acute medical care to Cavan is due to take place during the second quarter of this year. It is also subject to several dependencies first being in place, particularly the establishment of a medical assessment unit at Cavan and the development of an enhanced ambulance and pre-hospital thrombolysis service. The Minister has been assured the transfer will not take place until two months after the medical assessment unit has opened. The existing medical wards at Monaghan will provide rehabilitation and step-down services with 26 beds, including 13 for rehabilitation and 13 beds for step-down care. This will be in addition to the day surgery, outpatient and minor injury services.

The change process in Cavan-Monaghan is being managed through a network of sub-groups. It is important that all relevant stakeholders are involved in the change process. The HSE has sought the participation of general practitioners, and several sub-groups particularly, in the development of the medical assessment unit in Cavan. It is a matter of some concern that the general practitioners in Cavan and Monaghan felt it necessary to withdraw from engagement and involvement in these groups. The HSE has indicated it will ensure communication lines are maintained with general practitioners in the area. The sub-groups are being supported by specialist risk advisers to ensure the change process is managed smoothly and any associated risks or challenges are identified and addressed in advance of any service changes.

The changes proposed by the HSE, and fully supported by the Government, are for reasons of patient safety. We are committed to providing the best possible service for patients in a manner that ensures quality and safety. It is understandable there will be concerns about change but the Government is satisfied this is the best way forward. The HSE will work with all stakeholders to bring about the improvements in a carefully planned way that puts patients first.

Deputy Caoimhghín Ó Caoláin

The Government is the only satisfied party in all this.

Deputy Seymour Crawford

It is clearly the Government's situation.

Health Service Inquiries.

Deputy Alan Shatter

I thank the Ceann Comhairle for allowing me to raise this matter of particular and grave concern. It relates to several children, suffering from intellectual disabilities, who were the victims of physical and sexual abuse in institutions run by the Brothers of Charity in Galway in the 1970s, 1980s and later.

In 1999, the then Western Health Board was requested to put together a group to conduct an inquiry into allegations of the events that took place in these institutions. In April 1999, six people were appointed to the review group by the health board and asked to report. By August 2001, all members, apart from the chairperson, appointed had either departed or resigned. The chairperson subsequently departed the scene without any report being furnished or made available in January 2006.

After I kicked up a row in the House about this following my re-election in 2007, the HSE appointed Dr. Kevin McCoy to review the work done and, ultimately, a report was published of a limited nature in November 2007. The report was limited because Dr. McCoy was placed in an impossible position whereby he had to review documentation and notes of interviews put together by the first committee. In dealing with the totality of the allegations made about these institutions, the report was grossly inadequate. At a hearing held by the Joint Committee on Health and Children on 24 June 2008, Dr. McCoy accepted his terms of reference were limited, with the result that the job he could do was also limited. None of this is a critique of Dr. McCoy; he did the best he could in difficult circumstances.

I have raised this matter on a variety of occasions by way of parliamentary questions to get a report of some description published. A report was eventually published in November 2007. On the Adjournment debate on 13 December 2007, I dealt with my concerns about the adequacy of this report and the need for an inquiry into why it took eight years for the Western Health Board to publish any sort of a report. Then I expressed the view, which I still hold, that it was an absolute scandal and disgrace that people suffering from intellectual disabilities, who came forward to make complaints about abuse and were interviewed, were left for eight years without knowing any outcome. There we were in December 2007, eight years later, with a raft of recommendations for the HSE, most of which had yet to be implemented.

On the Adjournment on 13 December 2007, the Minister of State, Deputy Devins, accepted the delay that had occurred was not acceptable. He announced: "I have arranged to have an immediate inquiry carried out by an independent person into the causes of the delay in preparing this report. The person will be asked to report to me as quickly as possible." He then made various commitments with regard to recommendations made.

Subsequently, Mr. John Hynes, the former Secretary General of the Department of Social and Family Affairs, was appointed to conduct an inquiry into the inquiry. It was to cover questions such as what went wrong, why did people resign, why did it take eight years to produce a report and was it adequate in addressing the issues raised. Mr. Hynes was to report by 31 July 2008, which was confirmed by a parliamentary question in April 2008. He failed to do so but from several parliamentary questions I learned he did report by 31 October 2008.

Since then I have been seeking to obtain a copy of his report. In the public interest, it should be published and made available to Members. We need to know what went wrong. The Western Health Board has already been the subject of a report on the Kelly Fitzgerald case 1996. At a time when a proper investigation was to be carried out into what was occurring in the Brothers of Charity institutions, it was the Western Health Board that was scandalously failing to provide the intervention and care needed for those children in Roscommon whose tragic plight was debated here last week. I sought this report under the Freedom of Information Act and have been told by the Department in reply, "While it would be in the public interest to have access to the report and show the decision-making process, I feel the public interest would be harmed with the premature release of the report." How can it be a premature release as we are now ten years on from when the Western Health Board was first requested to investigate the scandal? The reply continues, "Such a release would impair a future decision, could contaminate the decision-making process and would impair the integrity and viability of the decision-making process to a significant or substantial degree without countervailing benefit to the public."

I demand of the Minister, in the public interest, that there be transparency and accountability, and that this report be published. The victims of abuse should know why it took eight years for the Western Health Board to carry out its review — in effect, it took the Western Health Board five years and the HSE another two years. Why did these delays occur? We need the answers and to know the adequacy of the investigation originally conducted. The Minister should publish the report. This is a cover-up of the gross inadequacies within our health service and the particular failings of the former Western Health Board.

Deputy John Moloney

I apologise that the Minister is not here this evening. I also apologise for not being able to provide direct answers to the questions proposed by the Deputy. I agree it is nonsensical that it should take eight years for any report to come to public notice and examination. I will try to relay the views that have been put quite properly by the Deputy rather than just giving the standard response.

Deputy Alan Shatter

I genuinely thank the Minister of State for that. It is an unusual occurrence but I appreciate it.

Deputy John Moloney

I am taking this Adjournment on behalf of the Minister, Deputy Mary Harney. Most of the following has been outlined by Deputy Shatter but I will read it into the record.

In December 2007 the report of Dr. Kevin McCoy on the Western Health Board inquiry into allegations of abuse in the Brothers of Charity Services in Galway was published. The Western Health Board's inquiry had been formally established on 21 April 1999. I am really only repeating what has been said. Mr. John Hynes, former Secretary General of the Department of Social, Community and Family Affairs, was subsequently contracted by the Department of Health and Children to review the circumstances surrounding the lapse of time in bringing to completion the Western Health Board inquiry into allegations of abuse in the Brothers of Charity Services, Galway.

Mr. Hynes submitted his report to the Department of Health and Children on 30 October 2008. However, the Department of Health and Children is not in a position to release this report until all issues arising, including legal matters, have been fully considered. A request for the release of the report was recently made to the Department of Health and Children by the Deputy under the Freedom of Information Act. However, this request was refused by the Department's decision makers under section 20(1), Deliberative Process, 21(1)(a) and 21(1)(b) Functions and Negotiations of a Public Body, of the Freedom of Information Acts. It would be inappropriate for me or the Department of Health and Children to comment further on the matter raised.

I will take on board the comments of the Deputy and will try to arrange a meeting between him and officials to see how we can move this on.

Multi-Denominational Schools.

Deputy Ruairí Quinn

I thank the Office of the Ceann Comhairle for facilitating me in raising this matter, which concerns enabling the Educate Together movement to be recognised as a patron to operate a secondary school in this country. I will give some context. We have 3,300 primary schools catering for a population of approximately 486,000 pupils. The Central Statistics Office estimates that figure will grow to anywhere between 500,000 and 650,000, depending on projections between now and 2025. We have a growing population that does not leave school when it reaches sixth class at 12 years old.

There is a demand among the 56 schools currently operated by Educate Together to be allowed continue that ethos into the secondary level. This ethos is basically a multi-denominational setting within which parents of all faiths — some are secular, humanist or would profess to have no faith in the traditional sense — would like their children to be brought up in tolerance and harmony with each other and with a mutual respect for the diversity of views that now represents multicultural Ireland.

In the greater Dublin area there are approximately 28 Educate Together schools, just over half the total of 56 around the country. The catchment area for a secondary school is much wider than that of a primary school and if located on a transport route, the catchment area can be extended further. The Department has consistently refused to recognise the Educate Together movement, which currently operates 56 primary schools and is the fastest-growing patron in that sector, as a patron for second level. No proper explanation has been given, although it has been indicated that educational policy is under review in some way.

Nevertheless there is a contradiction in north County Dublin where two primary schools have opened and are operating under the aegis of the VECs, which have no legal status as patrons of a primary school. I am grateful for the Minister of State's presence, although I do not believe he is attached to the Department of Education and Science. I have been trying to discover why it is that the Department of Education and Science will tolerate the operation of a primary school by a body, recognised as a patron in the secondary sector but which does not have the legal status to be a patron in the primary sector, while refusing to grant patron status to a clearly successful and growing body in multicultural Ireland. It does not make sense. They currently have 56 primary schools and, on foot of demand from parents and pupils, they want to have a secondary school to continue the ethos into which they have been educated at primary level.

We need more post-primary schools. In different parts of the urbanising population, as noted in county development and local area plans, there are designated areas for a post-primary school. Decisions have yet to be made as to what form of patron will be in that school. The Catholic church, which was the traditional patron in post-primary schools, is in retreat in that area. They want to maintain their own ethos and under our Constitution they are perfectly entitled to do so.

Approximately 50% of the post-primary schools in our country are in the VEC, community college or community comprehensive sector. We have professed in this country a commitment to a diversity of provision in education that is embodied in our Constitution. All that the Educate Together movement is asking is to be treated equally with other providers of post-primary education. Its track record is proven and it provides a service. It cannot cope with the demand for places coming from parents who no longer necessarily want to bring their children up in the traditional religion in which they were brought up. They may want diversity of exposure, even if they adhere to their own religious convictions or have converted to other religious convictions. They want, uniquely, to have their children brought up in a culture that respects and tolerates all faiths on an equal basis. For that reason, they are seeking to have this introduced to the secondary level and the Educate Together movement is seeking to be formally recognised as a patron by the Department of Education and Science.

Deputy John Moloney

My responsibilities in education are purely with regard to special educational needs.

Deputy Ruairí Quinn

I thought so.

Deputy John Moloney

I am just making that clear. I will seek responses to the questions asked by the Deputy and get them back to him.

I am taking this matter on behalf of my colleague, the Minister for Education and Science, Deputy Batt O'Keeffe. I thank the Deputy for raising the matter as it affords me the opportunity to outline to the House the current issues surrounding recognition and patronage in general and the position regarding the request from Educate Together to become a patron of second level schools in particular.

The Department is currently examining the application from Educate Together in the context of second level education, the Education Act and the Department of Education and Science regulations on patronage at second level. Section 6 of the Education Act 1998 sets out the objectives of the Act, one of which is "to promote the right of parents to send their children to a school of the parents' choice having regard to the rights of patrons and the effective and efficient use of resources". The Act also sets out the functions of the Minister. Section 7(4) states, "In carrying out his or her functions, the Minister shall have regard to the resources available and the need to reflect the diversity of educational services provided in the State."

In recent times, the rapid pace of social and demographic change in Ireland is reflected in a radically altered and more diverse society from which our school communities are drawn. Added to this, it is expected that enrolments at second level will increase significantly from the 2007 enrolment of 335,126 pupils. As the Deputy will be aware, a new model of primary school patronage is currently being piloted in response to changing societal circumstances. The pilot primary community schools, which opened in September 2008 and which come under the patronage of County Dublin VEC, aim to provide education for diverse denominational groups, reflecting parental choice and based on an ethos of inclusion and respect for children of all faiths and none. This new primary model provides a valuable new option in ensuring that our school system is responsive to parental choice.

In ensuring that the range of patronage models, new and existing, collectively achieve this, it is important to build on ongoing dialogue with the education partners in encouraging a wider public discussion of the issues involved. In this context, the Minister recently announced a review of the procedures for the establishment of new primary schools under the Commission on School Accommodation. He has established a technical working group under the commission to undertake a full review of the criteria and procedures for the recognition of new primary schools. This working group has commenced its work and will report to the steering group under the Commission on School Accommodation. It is expected that the review of procedures for recognising primary schools will be completed and that revised arrangements will be in place within a two-year timeframe.

In the interim, it is not proposed to recognise any new schools, except in areas where the increases in pupil numbers cannot be catered for in existing schools and require the provision of new schools. This means that new schools will not be established for reasons not related to demographic growth in areas where there is already sufficient school accommodation or where increases can be catered for by extending existing school accommodation. It is proposed that locations where new schools are required for the coming years will be identified by the Department of Education and Science and the details will be circulated to all existing patron bodies.

In light of our increasing student population and moves towards diversity in education it is also timely to examine the broad issues of patronage at second level. The Department is, therefore, considering a number of issues relating to the recognition process for second level schools. The application from Educate Together to become a patron body at second level will be considered within this context.

I will ask the Department to correspond directly with Deputy Quinn in respect of the specific matters he raised.

Deputy Ruairí Quinn

I thank the Minister of State.

Special Educational Needs.

Deputy Finian McGrath

I thank the Ceann Comhairle for affording me the opportunity to raise the matter of St. Joseph's centre for the visually impaired, Gracepark Road, Drumcondra, Dublin 9 and its efforts to build a new centre of excellence to provide visually impaired people with appropriate accommodation in respect of the current and future delivery of services. I call on the Minister for Education and Science, Deputy Batt O'Keeffe, and the Minister of State, Deputy Moloney, to support this project and to use the recession as a reason to build the centre and provide jobs and investment on the north side of Dublin, particularly in the constituency of Dublin North-Central. This project is worth €40 million and represents a glorious opportunity. Damian O'Farrell, who is standing as an Independent candidate in the local elections, also wants these services for the visually impaired to be provided in our area and is fighting to ensure that this proves to be the case.

St. Joseph's currently provides education and health care services to all children in the State who are blind and partially sighted. Increasingly, it is working with children who also have multiple disabilities in addition to their visual impairments. In recent years, St. Joseph's has moved to provide, in addition to schooling, early intervention, assessments, preschool, vision-clinic services, primary and secondary education, recreation and sports activities and vocational training. This is supported by a residential provision, both on and off campus, which encourages children who attend St. Joseph's to be more independent. In addition, it operates a large print and Braille production centre, which provides classroom textbooks for all children in mainstream schools. Further, it continually trains and works with professionals and parents who are in direct contact with children with a visual impairment throughout Ireland.

This is a radical and exciting new project and has huge potential. I am aware that the Department of Education and Science is interested in it. I urge the Minister of State, who has a strong interest in and supports people with disabilities, to take the lead in respect of this matter. It is time to support St. Joseph's.

When one considers the services currently on offer, one is very impressed. For example, the assessment service offers a multidisciplinary process through which the needs and abilities of a child or young person with a significant sight loss can be identified. This service is the starting point for making recommendations with regard to which interventions best enable each child to reach his or her individual potential. The preschool and early intervention service provides specialised support and skills to children, from birth to six years, in partnership with their families. It also offers a holistic approach to the education of young children, as well as support, information and guidance to families and agencies.

St. Joseph's also provides primary and secondary education. The primary school is inclusive in nature, with pupils following a broad and balanced curriculum and where all children are given opportunities to participate in a wide range of learning activities. The secondary school is situated adjacent to the St. Joseph's campus and students who are visually impaired and sighted are educated together there. The school offers a wide range of academic and practical subjects. The staff includes six dedicated teachers for the visually impaired. These people work and provide a service in the public sector. It may not be trendy or fashionable to praise public sector workers at present but I take this opportunity to do so once again.

St. Joseph's also provides vocational training. Its vocational training programme is designed to meet the particular needs of young adults of 16 years and older who have a visual impairment. These individuals are likely to have recently completed the special education cycle in secondary school and have an additional disability or special needs arising from a developmental delay and also needs relating to their independence, social and personal skills.

The family resource centre, FRC, at St. Joseph's offers an extensive outreach programme to young people with a visual impairment and their families. The service is accessed through a yearly calendar of events and is open to all visually impaired children, from birth to early adulthood, throughout Ireland. The FRC caters not only for children with a visual impairment but also for those with additional disabilities. It hosts a variety of events — training days, seminars, exhibitions and information, advice and discussion groups — for the families of these children in these groups.

I urge the Minister for Education and Science to meet the project team from St. Joseph's and to strongly support the new centre of excellence for the visually impaired, which is essential for many people. I urge that there be movement, that action be taken and, above all, that a common-sense approach be adopted. I support St. Joseph's.

Deputy John Moloney

I thank Deputy Finian McGrath for raising this matter and apologise on behalf of the Minister for Education and Science, Deputy Batt O'Keeffe, who could not be present. I am pleased to have an opportunity to clarify the position regarding the proposed centre.

The Deputy may be aware that a decision was taken in 2003 that the centre as originally proposed should not proceed, having regard to the low and declining pupil numbers in the school for the visually impaired and the development costs involved, estimated to be in excess of €30 million. A scaled down version of a national centre was subsequently proposed, to be staffed by a range of professionals, including expert in-house assessment such as speech and language therapy, physiotherapy, occupational therapy, mobility therapy and ophthalmology as well as counselling, pre-school and outreach support services.

The Deputy will also be aware that in the context of inclusive education, the Education for Persons with Special Educational Needs Act 2004 provides that a child, defined as a person who is not more than 18 years, with special educational needs must be educated in an inclusive setting unless such an arrangement is inconsistent with the best interests of the child or with the effective provision of education for those children with whom the child is to be educated.

In the past, children who were blind or had a visual impairment were unable to attend their local schools and had to travel distances to avail of specialised intervention. Today, many of these children attend their local schools with additional special educational supports, where necessary. My Department, through the NCSE, funds additional teaching and special needs assistant support for these pupils where such additional supports are necessary. In addition, funding is provided for specialist equipment and-or assistive technology. My Department also funds the National Braille Production Centre which translates textbooks into Braille, large print and other formats. Current policy and best practice in regard to health service delivery for blind and visually impaired pupils is that they remain and are supported in their local communities.

As the Minister indicated in his response to the Deputy's parliamentary question on 27 January, he met with representatives from St. Joseph's school recently and a further meeting is being arranged to discuss the matter. The Minister advised the delegation that his Department is willing to work with St. Joseph's school in the context of identifying any upgrading work required to the school that is consistent with the use of the premises for educational purposes. Any refurbishments will be considered in a prioritised manner. As in all other areas of expenditure, the timing of these refurbishments is dependent on the resources available to the Government.

The Minister is pleased to inform the Deputy that he confirmed to representatives of the school that his Department will provide a grant of €12,000 to St. Joseph's school towards the costs of its hosting the seventh European conference of the International Council for the Education of People with Visual Impairment next July. This grant was furnished to St. Joseph's last December. On behalf of the Minister, I thank Deputy McGrath for his ongoing interest in this issue.

The Dáil adjourned at 5.20 p.m. until 2.30 p.m. on Tuesday, 10 February 2009.