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Dáil Éireann debate -
Wednesday, 6 Jul 2011

Vol. 737 No. 4

Adjournment Debate

Special Educational Needs

I thank the Ceann Comhairle for affording me time to debate this important issue, namely, the need for the Minister for Education and Skills to reverse cutbacks which are impacting adversely on young adults with special needs at St. Brigid's school, Mullingar, County Westmeath. This school is suffering from changes of services, coupled with staff reductions, which have directly affected the quality of education available for students. The valuable work carried out by the teachers and pupils is being further undermined by the refusal of the Department of Education and Skills to upgrade current substandard facilities, especially in the built environment. The dreaded word in education is "cutbacks". For St. Brigid's school it is especially heartbreaking as the work they carry out with children and young adults with special needs is, by its very nature, dependent on a reasonable level of staffing and adequate resources.

It says it all that an educational establishment should tell me that it feels as though its pupils are less valued than their mainstream peers. Should pupils with special needs not be entitled to special care and provision by the Department of Education and Skills? Dedicated, extremely talented and hard working staff can only do so much, and, believe me, the personnel at St. Brigid's give above and beyond the call of duty. However, if the official backup and support is missing, it makes for an uphill struggle. At present, 80% of the pupils at St. Brigid's have not had their much-needed psychological assessments which are essential to access the appropriate response and resources needed. These reviews are sourced through the Department of Education and Skills and, owing to the lack of such assessment, the school is receiving services on a crisis basis only. This fails to meet the ever-growing and complex needs of the pupils. St. Brigid's has nine classes with nine class teachers, 12 special needs assistants, SNAs, and 81 students who need much greater provision, especially in terms of special assistance. Pupils at the school include those with mild or moderate general learning difficulties, severe behavioural difficulties, sensory impairments, both visual and hearing, physical disabilities and autism. These diverse educational needs cannot be met without enhanced support by the Department. A high level of professional frustration is felt by the staff as they struggle to meet these needs with limited resources.

St. Brigid's primarily serves students from Longford and Westmeath, with some travelling from counties Meath, Roscommon and Offaly. The school's motto is "to learn, to love, to live", with student successes celebrated by fellow students, parents, teachers, principal, staff and the board of management. If pride in achievement were the only requirement, St. Brigid's would have no problems. Unfortunately, practical resources are essential to the continued success of this school. This school is an integral part of Mullingar and the surrounding areas. Its pupils are part of the community, which gives them great support. It is time, however, that the Government matched that support and goodwill. Apparently, in the view of the Department of Education and Skills, a school cannot be both special and disadvantaged at the same time. However, both descriptions are equally relevant to St. Brigid's. This fails to be realised in terms of funding and resources.

The school has been told it is to lose further resources, including two more SNAs, both of whom have worked in the school for seven years, an extra quota woodwork teacher who has been with the school for two years and one resource teacher who worked in the school for five years. The reality is that if the pupils at St. Brigid's were enrolled in mainstream schools, their support needs would total in excess of 54 SNAs and 11 resource teachers, compared with an allocation, as previously mentioned, of nine class teachers and 12 SNAs.

There are currently six applications for SNA support for six existing students at the school.

There has been no reply from the National Council for Special Education, NCSE. The board of management of St. Brigid's has also applied for the redesignation of two classes to reflect more effectively the abilities and needs of the students.

One of the most pressing issues at St. Brigid's is one of space. A recent application for the replacement of classrooms at the school has been refused. The system is failing St. Brigid's school. The dedicated staff has high expectations, not only from the pupils but also from themselves.

I must ask Deputy Bannon to finish.

Leaving this school to cope as best it can without essential help is educationally and morally wrong. I ask the Minister to rectify the problem that is hindering the progress of this remarkable facility which gives so much to those who are so dependent on it for the life chances others take for granted. I thank the Acting Chairman for his endurance.

I am taking this matter on behalf of my colleague, the Minister for Education and Skills, Deputy Quinn. I thank Deputy Bannon for raising this issue as it gives me an opportunity to clarify the position on the matter raised by him.

I wish to clarify for the Deputy that the Department has always valued the contribution made by special schools to the continuum of provision being made for children with special educational needs. The programme for Government clearly states education will be a priority for the Government and that we will endeavour to protect and enhance the educational experience of children, young people and students. In this regard, the Department has prioritised the level of supports being provided for special schools. It has issued Circular 0042/2011 to all special schools to advise them of the staffing arrangements which will apply in special schools for the next school year. While the data available indicate that there is a surplus of teaching posts throughout the special school sector, current teaching staff levels will be retained in special schools for the 2011-12 school year at existing levels, except in the case of schools with excess teaching posts which are losing such posts through retirement. The existing level of special needs assistant, SNA, supports will be rolled over in special schools for the coming school year, other than for schools with declining enrolments, with a review to take place in the autumn of the 2011-12 school year.

The school in question, St. Brigid's special school, is a designated school for children with mild general learning disability. Such schools operate at a pupil-teacher ratio of 1:11. I understand the school currently has 80 pupils enrolled and a staffing level of ten teachers, a principal and 14 special needs assistants. This results in an overall staffing to pupil ratio of 1 staff member per 4 pupils in the school. The nature of the disabilities of the children attending the school means that they have significant education and care needs. However, this is reflected in the level of staffing and SNA support allocated to the school. The NCSE has advised the Department that it considers this level of staffing to be sufficient to meet the special educational and care needs of all of pupils enrolled in the school.

I wish to clarify for the Deputy that the Department recognises that staffing levels and pupil-teacher ratios should reflect the complexity of need within individual schools and should not be solely determined by a special school's designation. As such, special schools will be staffed based on their actual current pupil profiles and the disability category of each pupil, as opposed to primarily by school designation. It is intended that school staffing schedules will be reviewed and updated each year by the NCSE.

I wish to confirm that the Department has received an application from St. Brigid's special school for improved accommodation. The application is being assessed and the school management will be notified of the outcome of the assessment in due course. The Department will continue to liaise with the school authority in this regard. I again thank the Deputy for bringing the matter before the House.

Health Services

Recently I had the opportunity to visit the acquired brain injury rehabilitation centre in Castleisland, County Kerry, which is administered by Acquired Brain Injury Ireland. The visit was an eye-opener. I have some experience of acquired brain injury in my family, but the visit will stay with me. Many of those attending the centre have been the victims of road or various other accidents or are people who got sick as a result of various infections or viruses, etc. which resulted in acquired brain injury. The service being provided in Castleisland is fantastic. It is the proper model for dealing with people with acquired brain injury and to help them to be rehabilitated and live as independent a life as possible. The service is run by fantastic professionals who do a wonderful job in which they are supported by the HSE, Kerry County Council and other agencies.

One major issue is the great stigma attached to acquired brain injury. People to whom I spoke at the centre took the view that the stigma of disability was attached to them. Rather than being seen as people with disabilities, they would prefer to be seen as people in rehabilitation.

Sadly, not everyone who acquires a brain injury in Ireland has the opportunity to avail of rehabilitation services. That is why I raise this important issue tonight. We must change our approach to the way we deal with ABI. We must ensure everyone who suffers a brain injury is given the opportunity to be rehabilitated. Some 10,000 people acquire a brain injury in Ireland every year, but only one in four get into the National Rehabilitation Hospital. This means some 7,500 do not get into the hospital. I realise there are other forms of rehabilitation and that other services are provided for those who acquire a brain injury. However, we must adopt a more community-focused approach. That is what I seek in the lifetime of the Government.

Some of the ABI injuries which I have encountered and of which I have been made aware by the professionals working in the field could have been prevented. The need for cyclists to wear helmets has been highlighted to me. It is simple, but many of those who suffer an ABI in Ireland every year are cyclists who fall off their bicycles or are involved in road traffic collisions. We must try to tackle this issue. It is a small simple matter but significant nonetheless and we must consider it.

The implementation of the national policy on and strategy for the provision of neuro-rehabilitation services in Ireland will make a difference, as the professionals working in the field are aware. The ABI model should be extended, where possible, but funding must also be made available. There must be understanding in the community and a focus on this model. That has not happened to date as much as we would have wished.

I would be grateful if the Minister of State gave this issue her attention during her tenure. This is an important matter and the numbers affected are considerable, some 10,000 people every year. We could start by trying to address the problem of stigma attached to ABI and proceed from there. Those who run the service are keen to help more people to help themselves, but they need support to do so. I hope the Minister of State will be in a position to deliver it.

I am pleased to take the opportunity to outline the position on the matter raised by the Deputy which I thank him for raising.

The aim of rehabilitation is to enable the person to achieve the highest possible level of independence. Desired outcomes range from a return to full independence in social and work activities to a person requiring long-term support and care but with a higher level of independence than in the absence of rehabilitation. Current services available to persons with an acquired brain injury, ABI, include: acute hospital services; the National Rehabilitation Hospital; multi-disciplinary community services; long-term assisted living supports; and rehabilitative training services. These services are provided directly by the HSE and several non-statutory organisations.

Within disability services, the two main organisations funded to meet the needs of service users with an ABI nationally are Acquired Brain Injury Ireland and Headway Ireland. Acquired Brain Injury Ireland works in partnership with the HSE to provide a range of flexible and tailor-made services for people with an acquired brain injury in direct response to local identified needs. Services provided by Acquired Brain Injury Ireland nationwide include: 14 assisted living services; home and community rehabilitation and outreach services; day resource services; family support services, home liaison and social work; psychological services; and acquired brain injury awareness information, training and education programmes. In partnership with the HSE, Headway Ireland provides a range of services to people with an ABI. The services include day services, psychology and social work services, community integration programmes, supported employment, family support and rehabilitation training programmes.

Acquired Brain Injury Ireland received funding of €8.011 million in 2010, while Headway Ireland received funding amounting to €2.65 million in the same year. Both the Department of Health and the HSE have recognised for some time the need to develop comprehensive and integrated rehabilitation services. The Department of Health and the HSE have developed a national policy and strategy for the provision of neuro-rehabilitation services. The Department hopes to publish the strategy soon. The report recognises that given the current economic climate, the focus in the short to medium term must be on reconfiguration of services, structures and resources and the enhancement of the skills and competencies. Implementation of the neuro-rehabilitation strategy will require both an executive and a clinical lead who will work jointly at a national level to progress the implementation. To support the recommendations contained in the report, the HSE national service plan for 2011 includes a commitment to appoint a national clinical lead for rehabilitation to develop an implementation plan and an implementation structure for the provision of neuro-rehabilitation services. Implementation will have a particular focus on the development of a range of integrated services at regional and local level and to ensure regions have the capacity to respond to local needs. As part of its development of clinical care programmes, the quality and clinical care directorate of the HSE has established a rehabilitation medicine programme. This programme will improve and standardise patient care throughout the organisation by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to all users of HSE services.

The work of the rehabilitation medicine programme will be to achieve three main objectives, namely, to improve the quality of care, to improve access to services and to improve cost effectiveness. The HSE has appointed a clinical lead who will have responsibility for both the rehabilitation medicine programme and the implementation of the neuro-rehabilitation strategy. The appointment of a single clinical lead for both interrelated programmes will help to improve service quality, effectiveness and service user access and will ensure patient care is provided in the service setting most appropriate to the individual's needs. I again thank the Deputy for raising this issue, in which I have a deep personal interest.

Hospital Services

I thank the Ceann Comhairle for allowing me to raise this issue this evening and I thank the Minister of State for her attendance. I am sure she has a great awareness of and a deep interest in this issue as well. At the outset, I will outline the historical background. In 2006, the HSE decided to procure a PET-CT scanner for Cork University Hospital, CUH. In 2008, planning permission was granted for a €6.85 million diagnostic and treatment facility. Construction began in 2009 and in July of that year, it was advised that the PET scanners in CUH and St. James's Hospital were near completion. As the scanner in St. James's Hospital has been in operation for some time, what is the delay in the CUH? Why is its scanner not up and running?

I have been raising this issue for quite some time and in November 2010, the HSE advised that a total of 5,551 PET scans were carried out in the eight months from January to August 2010. The Minister of State might indicate at some point how many scans were carried out altogether in 2010 and to date in 2011, how many people in the HSE south region are awaiting PET scans and how long must they wait before being scanned because they must travel to Dublin for them. By September 2010, I understand that more than €1 million had been spent by HSE south on PET scans in Dublin, which sounds like a terrible waste when a €6.85 million facility lies idle in Cork.

During an Adjournment debate in November 2010, I was informed that funding had been made available for a consultant radiologist with a special interest in PET-CT and that this post was to be considered by the HSE's consultant appointments advisory committee at its November meeting. I was further informed that the recruitment process for a number of clinical support staff would commence in January 2011. As it was intended to proceed with the PET-CT service at CUH early in 2011, I thought everything was fine. On 14 February, I was informed that a letter of approval for the post of consultant radiologist with a special interest in PET-CT was received from the consultant and that sanction had also been received to recruit a principal physicist. On 22 June, six years after the original decision, I was advised that the CUH was now working on the final phase of the commencement of the PET-CT service and that the HSE national recruitment office was arranging to advertise for the post of clinical specialist radiographer. I also was advised that it was arranging to advertise for two senior radiographer posts and that because it was planned to have the service in operation by the end of the fourth quarter of 2011, until then patients would be obliged to continue to travel to Dublin for scans.

Why is it taking so long to get this service up and running? It is an awful shame that this service, costing €6.85 million, is lying idle while in the meantime people, many of whom are quite ill, must travel to Dublin at great cost and inconvenience. I ask the Minister of State to find out and then inform Members of the reason for the delay, what has been holding up the service and the date on which it will be in operation. Will this be done by the end of the year? I note the project's history and suggest that if this continues for much longer, the scanner will go the way of the electronic voting machines as the technology will be out of date. This makes no sense and I hope the Minister of State has some good news.

It probably is unusual for Ministers not to read out their scripts in response to Adjournment matters but having heard what the Deputy had to say, were I to so do I would be embarrassed, which he would not like. I believe the reply in the script is precisely the same as that which the Deputy has been getting all through the years. Yes, a principal physicist now has been hired but that is about it. The other posts as listed are being advertised. I will not read out the response I have to hand but having heard the Deputy's contribution, I will make further and more in-depth inquiries. I will find out what is the delay, whether the posts have been advertised and, if so, whether there has been a response and will then revert to the Deputy.

I thank the Minister of State.

Health Services

I thank the Minister of State for coming into the Chamber to debate paediatric diabetes services, which is an issue with which she has great familiarity. I am sure other Members present also have been contacted lately by constituents and parents on this matter. There are almost 4,000 children with type 1 diabetes in Ireland, which is an auto-immune condition that cannot be prevented or reversed and the incidence of which has doubled in the past 20 years. These children attend hospital an average of four to five times a year to monitor their diabetes. Monitoring children and adolescents with diabetes in hospital aims to limit damage that diabetes can cause to the eyes, kidneys, nerves and smaller blood vessels as a child grows older.

The long-term complications of type 1 diabetes like retinopathy, kidney disease, nerve and microvascular damage cost the health service millions of euro each year. The short-term complications among children with diabetes usually arise from low blood sugars and very high blood sugars and result in hundreds of children being admitted to hospital accident and emergency units nationwide each year. The fact is that 50% of children and adolescents with diabetes will have some form of serious and costly long-term diabetes complication by the time they reach 30 years of age. However, for many children with diabetes intensive treatment such as, for example, insulin pumps, can hugely reduce the development of long and short-term complications.

At present, 21 hospitals provide diabetes care to children but only three hospitals in Dublin are adequately resourced to provide intensive treatment to children who could benefit from improved control of their diabetes. The 2008 diabetes expert advisory group report admitted that "Ireland has [a] very poor paediatric diabetes care [service], with over half the patients having no access to a proper multidisciplinary team and many of the rest travelling long distances for care", such as the cases to which I refer this evening. Children with diabetes outside Dublin are at a geographical disadvantage because of a lack of local services. Those in Dublin, where there are services, are at a numerical disadvantage because so many children from outside Dublin are forced to travel here. Dublin services are being stretched at both levels, the care for those in the Dublin area and the care of children from outside the Dublin region. Dublin services are literally inundated with referrals of children and adolescents with diabetes from the rest of Ireland.

The proposal by Diabetes Action has the full support of all the paediatricians and nurses working with children and adolescents. I am aware also that the Department, the HSE and the new national clinical lead in diabetes, plan to discuss a model of care for children with diabetes in the coming weeks. This is a welcome development.

I ask the Minister of State what measures the Department and the HSE plan to take to balance this system and to make treatments equitably available to all children with diabetes. The Minister of State will be aware that Diabetes Action is proposing the establishment of regional teams or networks of clinicians who would offer intensive treatment at the 21 hospitals where diabetes care is currently given. The reorganisation being sought seems to involve only a modest increase in staffing resources and it should be given full and proper consideration.

In my constituency of Cork South-Central, Cork University Hospital, which serves over 300 children and adolescents with diabetes, will have a new consultant who will be well placed to deliver intensive treatments for type 1 diabetes to County Cork and County Kerry but he will need more nursing and dietetic support. While the arrival of the consultant is welcome, a support team will be required. In the delay of those additional appointments being made, in Cork an unknown number estimated to be between 40 and 60 children have been referred to Dublin hospitals in an attempt to access intensive treatment for diabetes, such as insulin pump treatment, which is not available in CUH. Referrals from across the country have congested the Dublin diabetes services and have robbed CUH of the opportunity to develop the expertise to offer these services to the whole HSE south region.

The reality of the current arrangements leads to Cork children and their parents facing four to five trips to Dublin hospitals each year. This affects school attendance for children and annual leave for parents. The most unsatisfactory and potentially dangerous effect of this situation is that CUH does not have access to the child's Dublin file in the event of an emergency admission to CUH because of their diabetes or indeed any medical condition.

I ask the Minister of State what steps will be taken by her Department with regard to diabetes services in the Cork region and the southern region of Cork and Kerry.

Currently it is estimated there are between 3,000 to 4,000 children and young adults under 16 years of age with diabetes in this country. The majority of patients have type 1 diabetes, more than 90%, but unfortunately there is an increasing number of young patients developing type 2 diabetes. The incidence of type 1 diabetes is also increasing by about 2% to 3% per year and experts anticipate that over the next ten to 15 years the incidence of type 1 diabetes will double.

Type 1 diabetes is a particularly complex condition in children and young adults and so it is recommended that their care be delivered in a multidisciplinary setting with access to a consultant paediatric endocrinologist, paediatric diabetes specialist nurse, paediatric specialist dietician, psychologist and social worker. Because of the complexity of the condition and the significant dangers of hypoglycaemia there can be a clinical advantage in having continuous subcutaneous insulin infusion therapy for children and young adults with type 1 diabetes.

The HSE has established a national clinical programme for diabetes in 2010 with the express aim of defining the way diabetic clinical services should be delivered, resourced and measured. One of the key priorities is to facilitate future organised care and screening for diabetes-related complications. There are two proposed models of care to improve the situation for paediatric diabetes care.

The first model is from the HSE expert advisory group report, chaired by Dr. Colm Costigan, paediatric endocrinologist in Our Lady's Hospital for Sick Children in Crumlin. This model proposes that care be centralised for each region in a dedicated paediatric-adolescent diabetes centre looking after at least 150 children-adolescents and ideally, the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to adulthood. The centre should be led by a paediatrician with a special interest and training in diabetes. The report also recommended amalgamation of the Dublin centres into a national tertiary centre that would act as a resource to assist the regional centralisation.

The second model comes from the recent Diabetes Federation of Ireland Diabetes Action report. This report recommends the establishment of eight to ten regional networks with the three existing Dublin centres acting as tertiary reference centres and continuing to see one third of the national paediatric-adolescent diabetes population. Within each hospital in the region from existing resources, a paediatric nurse would be identified to care for children with diabetes in that hospital. The network team would deliver care at existing centres around the country and travel to outreach clinics as required. To move this plan forward, the national clinical leads for diabetes and paediatrics are to meet in the next couple of weeks to propose the following: the establishment of a joint subgroup with representatives from the paediatric and diabetes working groups to address paediatric diabetes care; to perform a gap analysis to determine the current existing diabetes service across the country for paediatrics and young adolescents; to agree on a model of care for children and adolescents with diabetes; to standardise paediatric diabetes emergency care across the country; to standardise hospital diabetes care across the country; to develop criteria for use of continuous subcutaneous insulin infusion therapy in children and adolescents with type 1 diabetes; and to work on prevention and public health policy to prevent and to aid early detection of diabetes in young children and adolescents.

Ultimately, the function of the HSE national programme for diabetes, among others, is to consider which model is most appropriate and it is working to this end. In parallel, the Department of Health and the HSE will be meeting the Diabetes Federation of Ireland with a view to progressing the issues around the appropriate model of care for children and adolescents with diabetes.

Finally, there have been the following important developments in this area. The national diabetes programme is continuing the development of a national diabetic retinopathy screening programme. While retinopathy screening is continuing in the north-west region, the intention is that services be rolled-out nationally in 2012. This programme is significant because diabetic retinopathy is the leading cause of blindness and serious visual impairment in Ireland. A total of 90% of people with diabetes will develop retinopathy while 10% will be sight threatened if undetected and not treated. A national foot-care model has been agreed. The aim for 2011 is to establish 16 specialist multidisciplinary foot care teams across the country in line with indicative national hospital reconfiguration which will have different levels of care for patients depending on their risk of diabetic foot disease. Taken together, it is envisaged that these planned services, once operational, will enhance overall diabetes care provided for children and adolescents in Ireland.

I thank the Deputy and I hope we can at long last provide a service to these people.

The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 7 July 2011.
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