I wish to share time with Deputy Mick Wallace.
Adjournment Debate
Special Educational Needs
Is that agreed? Agreed.
I thank the Ceann Comhairle for allowing me to raise on the Adjournment the loss of six special needs assistant, SNA, posts at St. Senan's primary school, Enniscorthy, County Wexford, which will cause severe problems for the running of the autism centre there. The school has an autism unit with an open enrolment policy. The principal, Mr. Henry Goff, and his staff allow all children suffering with autism — mild, moderate or severe — to attend the school. The open enrolment policy has served the school well over many years.
When the autism unit was set up, St. Senan's was approved staff on a one-to-one basis. However, for some reason the Department has moved the goalposts, seeking to divide the educational and care needs of the children. Perhaps the Minister of State will explain what criteria was used in making the decision to reduce the SNAs by six. I, and many other Members, are aware of the excellent service provided by St. Senan's primary school, the purpose of which is to allow the children eventually attend mainstream education. Children with severe care needs will not be able to attend mainstream classes without the support of SNAs.
The school has been notified in recent days of the loss of six SNA posts. The Taoiseach stated in the House today that there would be a cut of 200 SNA posts throughout the country by Christmas. If one divides 41 constituencies by 200, that equates to five SNAs per constituency. For some reason, however, St. Senan's primary school in Enniscorthy is to lose six SNA posts. Parents of children suffering from autism and other disabilities have protested strongly about this cut during the past six months. While an appeals system was promised, the school was told when it appealed that no such system was in place. Perhaps the Minister of State might clarify the position in that regard. I was told by previous Ministers and officials in the Department of Education and Skills that an appeals system was in place and that the school would be allowed to submit an appeal, which it did. It has since been informed that no appeal hearing would be allowed, which appears strange to me.
The parents have medical reports from Our Lady's Children's Hospital, Crumlin, psychologists and general practitioners outlining the seriousness of some of the children's problems, but these were completely ignored by the special educational needs organisers, SENOs. I ask that the Minister of State visit the school, unannounced if he so wishes, to see first hand the importance of the autism centre at St. Senan's school and, more important, the need to have SNAs in the school on a one-to-one basis.
I reiterate what Deputy Browne said. It is grossly unfair. I was disappointed to hear the Taoiseach's remarks today. Last Friday, I received telephone calls from parents who were crying over this. When I suggested to them that they come up on Tuesday to protest, they jumped at the idea. They had no plans in place but feel so strongly about this matter that more than 100 people turned up here yesterday to protest.
I have no doubt there are abuses in the system. The Government is correct that reform is needed in respect of all forms of extra resources provided to schools. I honestly believe, however, there are many genuine cases, not alone in Enniscorthy or other parts of Wexford but also throughout the country. Come September-October, parents are going to be very angry. The Minister should rethink this proposed cut, which is not fair.
The Irish are reluctant to protest. I do not believe they would do so if they were hungry. However, their children are a different matter. Come September-October parents will be upset when these SNA and resource teacher numbers are cut, given the many other ways in which they have been hit.
I am taking this Adjournment matter on behalf of my colleague, the Minister for Education and Skills, Deputy Ruairí Quinn. I thank the Deputies for giving me this opportunity to outline the position in relation to the special needs assistant, SNA, scheme generally and also in relation to the particular school mentioned by them.
As the Deputies will be aware, the previous Government introduced a cap of 10,575 on the total number of SNA posts. This is a significant number of posts and represents an increase on the number of posts allocated in recent years. It is considered that, with equitable and careful management and distribution of these resources, there will be sufficient posts to provide access to SNA support for all children who require such care support to attend school in accordance with departmental criteria.
The National Council for Special Education, NCSE, is responsible, through its network of local special educational needs organisers, SENOs, for allocating special needs assistants, SNAs, to schools to support children with special educational needs. The NCSE operates within the Department's criteria in allocating such support which now includes a requirement for them to have regard to the overall cap on numbers.
The priority criteria for the allocation of SNA posts include ensuring that the minimum SNA to special class ratio is maintained in special schools and special classes; ensuring support for children with incontinence issues; ensuring those schools which require full day cover for children receive full day cover; deferring the allocation of additional SNA supports to schools for junior infant pupils for whom behaviour is cited as the rationale for SNA support, other than in cases of well documented extremely challenging or dangerous behaviour; prioritising schools which have enrolled pupils with newly diagnosed care needs and which do not have any SNA support; and encouraging the effective use of SNA posts, for example, where two or more posts have been deployed in a single classroom. To distribute SNA posts fairly across the school system, it will be important for the NCSE to ensure that schools do not have an over-allocation of SNA posts, as this could prevent them from allocating SNAs to children with care needs in other schools.
I understand the school referred to by the Deputy currently has 532 pupils enrolled, including three classes for autism, which have an enrolment of 17 children. The NCSE reviewed SNA staffing levels in St. Senan's in June 2010. As a result of this review, 13 SNAs were sanctioned along with the three teachers to cater for 17 pupils in the autism spectrum disorder, ASD, unit. A further 8.5 full-time SNA posts, one infant post and ten hours were allocated to the school to support children in the mainstream. This gives the school a total number of 21.5 SNA posts, one infant post and ten hours. This level of support has been determined by the NCSE to take into account the significant care needs of the children.
The previous allocation, prior to this review of SNA posts, had been 17 SNA posts for the 17 pupils in the ASD unit, ten full-time SNA posts and two infant posts, and ten hours were allocated to the school to support children in the mainstream. The revised allocation of 13 SNAs for the three ASD classes will still provide an exceptionally high level of SNA support for these pupils and will still equate to an SNA to pupil ratio of one SNA per 1.3 pupils in these classes. Even taking into account the fact that the children in ASD classes have very significant care needs, this is a very high level of support. The current recommended SNA ratio for special class groups, as outlined in Department of Education and Skills circular 0038/10, is a ratio of two SNAs per special class group of six children for children with ASD. The NCSE has also advised it considers there are sufficient SNA posts to cater for all the children in mainstream.
The school has appealed the decision of the NCSE and I understand the NCSE SENO and a senior SENO will meet the school in the coming days to discuss its appeal and its SNA allocation for the coming school year.
Where schools have had a reduction in their level of SNA allocation or have not received the level of SNA support they feel is sufficient to cater for the care needs of pupils, the NCSE may review the level of care support. However, whereas I understand that schools may wish to maintain current staffing levels, the NCSE must ensure there is not an over-allocation of SNA posts in schools and ensure there are adequate posts for distribution across the school system. I thank the Deputy once again for raising the matter.
Forestry Sector
I seek to understand whether any plans exist in regard to the forestry sector. The background is the McCarthy report on the disposal of State assets, which refers to Coillte. This idea has not developed on its own within Ireland as there was an attempt to put a similar plan in place by the British Government in regard to disposing of tracts of National Trust forest land. This plan was abandoned due firstly to popular opposition but also because the amount of money that would have been generated was such that it was not worth doing in the first place.
We are all very much aware of the budgetary difficulties we face. One of the principles the Government has laid down in regard to the disposal of State assets is that it would seek to ring-fence any of the dividends that resulted to ensure they would be transmitted into job creation. I know this is a source of negotiation and a focus for the Government at present. However, another criteria that should be laid down is the appropriateness of certain decisions. An issue I would strongly question is whether a suitable response to the difficulties we are in at present is to sell off an asset we have inherited from generations past, which has a commercial value to the State that may yet be great.
I look forward to the Minister's response. I am particularly interested in understanding the distinction between Coillte as an organisation and the deeds that actually denote the ownership of the land upon which the trees are planted. I would like to know whether the Government is aware of that distinction and whether any plans exist in regard to either.
I thank the Deputy for raising the matter, which is one on which I hope we will have conversations outside the Chamber also because I can understand the Deputy's views and concerns. It is a useful opportunity for me to update the House on the Government's thinking on this issue.
Members will know Coillte was set up 22 years ago under the Forestry Act as a semi-State company operating on a commercial basis. Its core business is to operate 442,000 hectares of land, 390,000 of which is commercial forest while much of the other land is for recreational purposes. It is the dominant player in the Irish forestry business, supplying 80% to 85% of timber to sawmills. Even though it has not been involved in afforestation to any great extent in recent years, as it is the private sector which has been doing that very progressively, it is still a hugely dominant player.
The reason the questions are being asked today is predominately because Mr. Colm McCarthy's recent report on the sale of State assets recommends:
The state should initiate the disposal of Coillte's forest and non-forest assets (but not its forest land), possibly using the New Zealand Crown Forest Licence template modified to make it suitable to Irish conditions. Unforested land surplus to Coillte's requirements should be sold and the proceeds remitted to the Exchequer by way of special dividend.
I remind the House that Mr. McCarthy's report makes many recommendations. It is the Government's job to consider those recommendations and to make a political decision as to whether it is appropriate to pursue them. That is the process we are in at present. I followed the McCarthy recommendations by asking Deloitte on a pro bono basis to examine Mr. McCarthy’s recommendations as they apply to my Department, to value the assets referred to and to make a series of recommendations around how one would go about a sale, given certain considerations I had in regard to those assets and in order that we would have more information before any decisions are made.
The State will not sell the land Coillte owns — this is an issue I feel strongly about. I am considering whether it is appropriate to sell immature forest, as Coillte itself has done. More than 11,000 hectares of immature forest has been sold in recent years by Coillte. It is the harvesting rights for the timber that was sold, so, in other words, the company cashes in when the crop is immature and the timber is harvested at some stage in the future. Therefore, one can raise capital from the asset now without losing or having to sell the underlying asset, which is the land on which the forest is grown.
This is the kind of approach Mr. Colm McCarthy is recommending. We are considering whether that is appropriate in the context of the contributions the forest will make towards carbon sinks in the future, and the State will certainly want to hold on to that asset. We are also examining whether it is appropriate to sell the entire company as a forestry company with harvesting rights without selling the strategic asset, which is the land. Coillte owns a number of companies in the wood panel industry, including SmartPly Europe Limited and Medite Europe Limited. They are profitable companies, which are exporting significant volumes of wood panelling. My preference is not to break Coillte up into various parts and then sell them off independently. That would not be the best way to realise the full value of the company but I am not convinced yet that Coillte or its forests should be sold at all.
We are a long way off making that decision. Currently, I am maximising the information available in order that I can make an informed, sensible, well-thought-out decision which will not compromise the State's core asset, which is the land it owns. Coillte manages 7% of our land mass and we will not sell out in the context of land ownership. The calculation we need to make is whether we should realise value from a company that does not necessarily need to be in State ownership and from the forest assets, most of which are immature or semi-mature, by selling harvest rights in the future. I am informing myself about, and putting a valuation on, these questions in order that I can come back to the House and the Cabinet with properly thought out recommendations.
Accident and Emergency Services
Gaibhim buíochas leis an Cheann Comhairle as an deis chun an ábhar seo a phlé. We have a looming crisis in our public hospitals because of the total over-reliance of the hospital system on non-consultant hospital doctors, NCHDs. A total of 400 junior doctor posts must be filled. I regret the absence of the Minister for Health, although I commend the Minister for Agriculture, Fisheries and Food on coming to the House to take a debate designed for his address. If the NCHD posts are not filled or if sufficient numbers of those posts are not filled, we are facing, as admitted by the Minister for Health, the loss of emergency services, especially in our smaller hospitals.
We now have the utterly bizarre and totally unacceptable situation that the hospital system faces meltdown in just over a fortnight from now unless sufficient numbers of junior doctors are recruited before the 11 July turnaround date. We are used to looking with trepidation towards 12 July and now we have another reason to do so. There is an unseemly scramble on the part of the Government to put in place legislation to facilitate the recruitment from abroad of junior doctors whom we should not have to import at all. There are sufficient numbers here if only medical staffing were properly organised.
This is not a new problem. It has been known and widely recognised for years that the hospital system is totally over-reliant on junior doctors. Successive Governments have recognised this but have failed to address the problem and now it is looming again, worse than ever. No one is trying to place all the responsibility for this on the shoulders of the current Minister for Health or the Taoiseach but their response so far — and make no mistake about it — has been far from adequate.
Last week, when this was first raised in the House by Sinn Féin leader, Deputy Adams, the Taoiseach stated that the Minister for Health would make a statement last Friday; there was no statement. The Minister then went on "The Frontline" programme on Monday to say:
We may well end up with some accident and emergency departments that cannot be safely manned. It will not be any of the major ones. It will be small rural hospitals that will be the real difficulty.
For a start, there are no so-called small rural hospitals. Dundalk and Monaghan are large urban areas with densely populated rural hinterlands. Their hospitals have lost accident and emergency services. Nenagh and Ennis are also large towns with wide hinterlands and their hospitals have also lost accident and emergency departments. Navan, St. Colmcille's in Loughlinstown, Roscommon, Mallow and Bantry hospitals all serve large urban and rural populations and are losing, or are set to lose, accident and emergency services.
I have no doubt that the junior doctor issue is being used as a convenient excuse to close emergency departments in fulfilment of long-standing but ill-conceived plans on the part of the HSE and successive health Ministers. On the anniversary of the Government's 100 days in office, 16 June, there was an unprecedented number of 52 patients on trolleys awaiting an inpatient bed in Our Lady of Lourdes Hospital, Drogheda.
In April, the Irish Nurses and Midwives Organisation sought a meeting with the Minister to discuss this critical situation but this meeting has not yet taken place. The INMO industrial relations officer, Tony Fitzpatrick, has stated that overcrowding in the north east has been a critical and unresolved issue for ten years which has been exacerbated by the downgrading of services under the guise of reconfiguration, when in reality all changes have been driven by economics and not patient need. I can attest to the truth of that statement.
If the Minister's prediction is allowed to come true, the north east and all regions will face even worse situations in emergency departments from 1 July onwards. What will the winter be like? Unfortunately, recruiting sufficient additional junior doctors will be required in the short term but that will not be enough, despite suggestions from the Taoiseach to the contrary.
Root and branch reform of medical training and staffing is needed. Nurses need to be freed up to fulfil more responsibilities in our hospital accident and emergency departments, for which they are qualified and willing to undertake. Hospital consultants must be required to fulfil their contracts to serve the public hospital system, because they are being widely breached. More consultants are required in our public hospital system and the current excessive remuneration for consultants needs to be reduced to facilitate the employment of additional consultants. The coalition has promised real change and I am asking that it now delivers on that.
I am replying to this matter on behalf of my colleague, the Minister for Health. He is conscious of concerns about some hospitals in advance of the next rotation of NCHDs. Departmental officials are in constant contact with the HSE and relevant authorities to make certain the necessary steps are being taken to ensure ongoing safe delivery of service in hospitals and in accident and emergency departments, in particular.
The shortage of suitable NCHDs is an issue worldwide. The HSE has taken a range of actions to address NCHD vacancies to ensure the resulting impact on services is minimised and patient safety maintained. A recruitment drive abroad is included in this process. Officials from the Department of Health are at an advanced stage of drafting a Bill to amend the Medical Practitioners Act 2007 to support the recruitment process. This will empower the Medical Council to register doctors in supervised posts for a defined period. The aim is to ensure a speedy availability of suitably trained NCHDs. The Minister has stated publicly that it will be a challenge to maintain current services in all accident and emergency departments because of the difficulty in recruiting NCHDs. The measures he is taking are designed to address this challenge as effectively as possible.
The wider difficulties in accident and emergency departments, where patients wait unacceptably long periods, cannot be resolved solely within the departments themselves and must be addressed on the basis of a health system-wide approach. In particular, overcrowding in these departments is caused by many factors and any solution to problems that may arise from this issue must reflect this reality. We must ensure patients are treated in the most appropriate way in the most appropriate location. This means that, where and whenever possible, patients who can be treated in the primary care setting receive that treatment in a timely manner. This means that patients can be confident of receiving the necessary treatment on time and that there is less need for patients to attend at accident and emergency units.
The Minister recently established the special delivery unit, SDU, and assigned to it, as a priority, the task of addressing the issues arising in accident and emergency departments. The SDU is a key part of the Government's plans to reform the health system in Ireland radically, with the ultimate goal of introducing a system of universal health insurance. Its establishment was one of the Minister's key priorities for the first 100 days of the Government's term of office. Dr. Martin Connor has been appointed as adviser to the SDU. He has extensive experience in the NHS and led a similar initiative in Northern Ireland with considerable success. His principal task will be to build the SDU and to prepare proposals for the Minister on how best it can be placed on a permanent footing within the next six months. The SDU will work to unblock access to acute services by significantly improving the flow of patients through the system and by streamlining waiting lists, including referrals from GPs. The SDU is already working closely with the HSE, building on initiatives already under way, which include the clinical programmes developed by the HSE's national directorate for clinical strategy and programmes.
The SDU's priorities, set by the Minister, will encompass: emergency departments where waiting times for admission have been unacceptably high in several hospitals, often breaching the current six-hour maximum waiting time target; inpatient waiting times, where the trend recently has been upwards, despite the work of the NTPF; outpatient waiting times because the time from GP referral to an appointment with a consultant is unacceptably long in many specialties; and access to diagnostics which forms an essential part of the patient journey for all the areas of access mentioned.
I am confident that with improved processes for the recruitment of NCHDs, leadership from the special delivery unit, the implementation of the HSE's emergency medicine programme and related clinical programmes, we will be in a position to reassure patients that the challenges for the delivery of services related to emergency departments will be quickly and decisively addressed.
Hospital Waiting Lists
There is a backlog of 4,478 orthopaedic outpatients on the waiting list at Cork University Hospital who have been waiting two years or longer. The patient longest on the list has been on it for three and a half years. Each week an average of 100 new patients are referred to the hospital. The average waiting time for what is described as a "routine" patient is 24 months. A routine patient is likely to be an elderly person who will suffer "routine" pain every single day of the two years he or she is waiting to be examined. During this time, pain management often has to be administered by the local general practitioner while the person awaits that initial appointment with the consultant. As a result, the quality of life for this person is greatly diminished while he or she is waiting for the procedure.
For administration purposes, pain may be described as "routine" but it is far from routine when examined in real human terms. Only this week on TV3, we saw an example of a woman on this waiting list, who, rather than go through the daily grind of dealing with the pain, went to her local credit union, borrowed €5,000 and got on an aeroplane to Poland to have her procedure carried out. To take another example, a 72 year old patient came to me last year who was also classed as a "routine" patient. He was advised that an urgent MRI scan was needed but that it could not be carried out until a hip examination had been completed. This makes no sense. Furthermore, patients classified as urgent wait an average of 18 months for an appointment at CUH. It is hard to conceive how a patient classed as "urgent" by a consultant can be expected to go on a waiting list for so long.
The national outpatient department, OPD, project has been established to improve the delivery of OPD services and I commend the medical staff who are making every effort to reduce the backlog. Nonetheless, waiting times are increasing. Comparisons must be made with the private sector where it is commonplace for a patient to be treated for hip replacement in about eight to ten weeks. That suggests there is a major organisational difficulty at the heart of the problem and this was seen to be the case for a great number of years before the creation of the national treatment purchase fund, NTPF. In CUH we saw that patients were seen within three or four months. They may have been waiting two years for a procedure but were seen within that short period. Since the NTPF was put in place those patients must now wait for two years before they can get a first appointment. If they are not treated by that time they are then seen within the NTPF. There is something very worrying going on in Cork University Hospital and this has been the case for several years at an administration level. This must be sorted out. Cork University Hospital has made improvements in processing other areas of outpatient treatment. The same skills must be employed to improve orthopaedic services in the Cork region.
I share the Minister's objective of renewing the health service as set out in the programme for Government but 4,478 mainly elderly patients must not be expected to suffer in silence during this period of renewal. I ask him to make these patients his priority.
I will respond to this matter on behalf of my colleague, the Minister for Health, Deputy James Reilly.
This Government finds the situation of waiting lists for orthopaedic services totally unacceptable. Patients need a service that is timely and effective. Statistics such as those given by the Deputy prompted the Minister to establish the special delivery unit as a priority. The SDU will focus in particular on those waiting for consultant appointments, as the Minister views the consultant appointment key to diagnosis and treatment of a patient.
Reducing waiting times for outpatient departments is a priority for 2011, especially in specialties, including orthopaedics, that have the highest waiting times and numbers. There are a number of encouraging initiatives under way to alleviate this problem, in addition to the SDU. In HSE south, these include: additional staffing; a physiotherapy initiative; validation of waiting lists; improved management of OPD processes, including reducing missed appointments; and increasing the numbers of new patients seen at clinics.
In HSE south, there are five permanent consultant orthopaedic surgeons in post in the trauma and elective service, with two locum consultants in the trauma service. There are currently 100 referrals per week. This has increased over the past 12 months, with two new permanent consultants providing revision surgery. HSE south has approval for three consultant orthopaedic surgeon posts at Cork University Hospital and South Infirmary Victoria University Hospital, namely, two new posts for orthopaedic surgeons with a special interest in paediatric orthopaedic surgery and one replacement post of orthopaedic general surgeon. Recruitment has been completed and it is anticipated that formal letters of appointment will issue soon.
Physiotherapist-led clinics were introduced in 2010 to address the waiting list for OPD appointments. The physiotherapists triage patients based on those waiting longest, patients primarily from the hip and knee lists. Some 35% of the patients seen at these clinics were referred to an orthopaedic consultant for surgical review. A review of this initiative has been completed, to continue to improve patient flows.
Approval for three additional physiotherapists under the outpatient programme for rheumatology and orthopaedics has been sanctioned. These posts will allow for more musculoskeletal physiotherapy led clinics. The recruitment process has begun.
At national level, an outpatients department performance improvement group has been established to improve OPD services throughout the country. The project aims to address the significant numbers on waiting lists for some specialties and will standardise all aspects of OPD, including waiting lists validation, management of those who do not attend, DNAs, improvement in new to return ratios and improved triaging. Cork University Hospital and South Infirmary Victoria University Hospital have been selected to participate in the initial phase of this project. Cork University Hospital is undertaking a validation exercise on its OPD waiting lists. This exercise will link with the national OPD programme on the validation protocol, particularly for the clinical governance process for removing patients from waiting lists and for GP involvement in the process. It is expected that this exercise will reduce the numbers on the waiting list.
Under the reorganisation of acute hospital services in counties Cork and Kerry, electronic GP referral to acute hospitals is being piloted. This will enable more efficient processing of referrals and allow patients and GPs to see waiting times for individual consultants.
The implementation of these initiatives will greatly improve waiting list numbers. The Minister and his officials will closely monitor the situation to ensure that these statistics become a thing of the past.
The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 23 June 2011.