Dáil Éireann debate -
Tuesday, 19 Jul 2011

Vol. 739 No. 2

Adjournment Debate

School Transport

Deputy Éamon Ó Cuív

I thank the Minister for Education and Skills, for coming to the House to join in what I hope will be a constructive debate on rural school transport. I am more than aware of the cost of rural school transport but I am also aware of its importance. I also know that we were forced to change the rules on school transport in the budget for 2011 due to the financial situation in which the country finds itself.

As the Minister is aware, the school transport system as we know it dates back many years to its introduction in the 1960s. The way it operates is that a pupil, who, depending on his or her age, is a certain fixed distance from the school, gets free transport. Up to now that transport was provided as long as there were seven pupils on the bus route. In recent years we reduced it from three miles to two miles for the younger cohort and made it one seat for one student. They were two very expensive changes, but very good changes. After two major steps forward, the budget introduced one step back, which was the requirement to have ten students on a bus route before a service will be provided. The reality is that this change will predominantly affect small rural schools with two or three teachers.

I believe we should consider a different way of providing the same service at the same cost to the Exchequer. In other words, there can be a win-win situation if we get our head around it. I propose that on a pilot basis and on a voluntary basis, small rural schools could apply to the Minister to get a block grant that would be approximately equivalent to the remote area grant the Department pays for the students who are too far away from the school and are entitled to free transport but are not on the school run. That would be added to the cost of the current arrangement for that school with the savings that were built in and the Department would agree to give that as a lump sum to the school. It would administer that fund, but schools would not do it on their own.

At the moment the scheme is run by the Department of Education and Skills and Bus Éireann, and it is all very rigid and fixed. In this way the parents, school management and the companies that provide the rural transport service generally would get together and regard it as an adjunct to the rural transport service in their area. With that money they would set about creating a service designed by the school management and parents, and delivered by the school in conjunction with the rural transport companies. I suggest this be done on a pilot basis with no school being forced into this new arrangement. Knowing the fabric and attitudes of rural areas, I have no doubt that kind of self-help approach would be taken up in quite a number of the more rural areas where it is much easier to do but where the problem is now much more acute for the Minister.

This is not a major problem in the big schools in the peri-urban areas. This problem is most acute for the very small schools, but their strength is knowledge of their people, co-ordination and their ability to get things done. If this proposal is accepted, we could get a win-win in the situation in which we find ourselves. We could make the savings and provide an even better service that works well and is utterly to the satisfaction of the parents and teachers in the school. I would not suggest this if we did not have rural transport companies that know the game, know how to tender, know how to do their work and have experience in this area. Many of these rural transport companies provide a service to the elderly in the middle of the morning. They could reorganise their business so that they are free at school times. I suggest we should start doing this with the small national schools and I believe we would get the synergies. When we were in government, some pilot work was done between the HSE and the rural transport companies. I had been very anxious that this would proceed much faster than it did. Even if the Minister cannot give me a positive response, I hope he will seriously consider implementing this on a pilot basis to see if it can work and become the new template.

For many years we were told that only the Department of Education and Skills could design and do all the background work for small schools. Parents used to come to us and ask that they just be given the money and they would do it cheaper and better. There was enormous resistance to this devolving of power to local boards of management. It was the best thing that ever hit rural schools.

Acting Chairman (Deputy Joanna Tuffy)

The Deputy's time is up.

Deputy Éamon Ó Cuív

It meant a great amount of work for parents and boards of management but they did it willingly. In many cases, when they did up the school, they went out and collected considerable extra money that allowed them to provide libraries, extensions and all sorts of other things that were never planned by the Department of Education and Skills. There are now fantastic facilities in schools because we looked to the very ethos of those communities, which is "give us the money and we will spend it efficiently and in a satisfactory way".

Minister for Education and Skills (Deputy Ruairí Quinn)

I am replying on behalf of my colleague, the Minister of State at the Department of Education and Skills, Deputy Ciarán Cannon, who has responsibility for school transport among other things. I thank the Deputy for raising this matter as it provides me with an opportunity to outline the general position regarding school transport services.

School transport is a very significant national operation involving the transportation of more than 123,000 children each day to primary and post-primary schools, including more than 8,000 children with special educational needs. Furthermore, it involves approximately 42 million journeys and more than 82 million km on 6,000 routes every school year. These services are delivered using a mix of Bus Éireann, both school transport and road passenger vehicles, private contractor vehicles, including private operator scheduled services, and Dublin Bus, Irish Rail, DART and Luas where practicable.

The Deputy will be aware that the value for money review of the school transport schemes, which was published last March, considered a number of possible approaches through which the State can seek to support school transport in line with the overall objectives of the scheme. The report concluded that, particularly in the context of complexities of deciding on eligibility for school transport, procuring school transport and developing networks for school transport, a single national organiser with a regional dimension to operate the scheme is required.

The report further concluded that in the medium term the single national organiser should continue to be Bus Éireann. Bus Éireann is well placed to offer the possibility of integrating local transport services with the rural transport network to achieve significant economies of scale and the organisation and administration of school transport scheme services offers a successful model to follow and build upon.

The Department is co-operating fully in the development of practical initiatives, led by the Department of Transport, Tourism and Sport, to promote co-ordination of State supported transport services such as school transport, rural transport and the Health Service Executive transport services. Bus Éireann is also involved in this process. The Minister's priority is not only to ensure optimum efficiency and effectiveness between all programmes which receive State support, including school transport which, with a budget of €180 million is a significant area of expenditure, but also to establish how this work can assist in meeting the €17 million savings target in respect of the school transport budget by 2014.

The safety of school children, travelling on school transport services is of paramount importance to the Department and Bus Éireann. Not only does the company plan and manage the countrywide network applying a range of safety checks, it places onerous obligations and standards on contractors, drivers and vehicles used on school transport services, including the arrangement of random vehicle checks and maintenance audits conducted by independent experts, and the assessment of all routes and pick up points for suitability. In addition, the company assesses pupil eligibility, collects and accounts for pupil contributions, issues tickets or passes to pupils and provides day-to-day supervision and monitoring of service performance and standards. The company also manages the vetting of all personnel involved in school transport duties in conjunction with the Garda Síochána central vetting unit.

Given the practical issues which need to be undertaken, the reality is that it would not be possible or feasible for school managements, nor indeed would they have the expertise required, to assume the role of deciding on eligibility and procuring school transport on top of fulfilling their key roles in ensuring the education of each child.

In acknowledging our existing resource constraints, it is more important than ever that we streamline our processes and procedures to the greatest extent possible and help ease the administrative burden on schools. I again thank the Deputy for raising this matter and I will bring it to the attention of the Minister of State, Deputy Cannon.

Skills Shortages

Deputy Eoghan Murphy

I had hoped to address this issue with the Minister for Jobs, Enterprise and Innovation, but I appreciate the attendance of the Minister for Education and Skills as this matter is relevant to his Department and he is fully aware of the importance of the high-tech sector to the economy. Considering the attention the Government has given to the sector, be it in terms of gaming, research and development, digital design or cloud computing, it is clear that the Government understands its importance and is fully committed to it. From speaking to people in the industry, they are happy about this as it is a new approach.

I attended the Dublin web summit in June, at which a speaker addressed approximately 1,000 people working in the sector who were there to network, hear new ideas and get investments. The organisers had invited successful entrepreneurs from abroad to speak and pass on some of their knowledge. At a questions and answers session, someone asked how an entrepreneur decided where to set up and what his first consideration was. His answer was that he went where the developers and talent were. A friend of mine who works in the area looked over his shoulder and gave me a knowing look.

I have discussed in the House the need to incentivise foreign entrepreneurs to set up companies in Ireland, especially in the high-tech sector, as part of the three pillar approach. We could cut all the red tape we desire, but entrepreneurs and foreign companies will not come to Ireland if they cannot get the staff. In July, a significant international player and large employer in Ireland briefed the Cabinet on its concern that the Irish system was not producing enough high-end, high-skilled graduates. This is a worrying development. The secondary effect is that, when this player can find the relevant employees, it hoovers them all up and smaller and start-up companies cannot get the staff because they cannot afford to hire any from abroad. Those companies end up relocating abroad, which means we lose them, the staff and the revenue.

I do not want to overstate the case, but it is important that we address it. The previous Government never did when it had the chance and knew it needed to. To our cost, that Government did not engage in future proofing, but we must consider what is necessary now and in future. Last week, the Irish Internet Association, IIA, told us that there were 2,500 unfilled jobs in the high-tech sector. If the Government continues focusing on this sector, trying to create jobs and trying to position Ireland as a digital or Internet capital for Europe, it will create further jobs. This is a good measure and we do not want to turn a positive into a negative.

We must examine the education system and get more children studying mathematics and science at a high level all the way through school, into relevant university courses and on into the industry. That is a longer-term solution, but we must act now. The battle to establish ourselves as European leaders in cloud computing, gaming, research and development and so on will take place in the next three to five years. That is when we will win or lose. For this reason, it is imperative that we examine immediate solutions.

The Minister will be interested in a number of near-term proposals, given his architectural background. For example, unemployed architecture and engineering graduates could be retrained as web developers. This idea has a great deal of potential and should be discussed by the House at another time. I wish to address a more immediate-term initiative proposed by the IIA in the context of the Government's wider jobs initiative. Under the latter, taxation measures will be used to increase employment levels in sectors where there is a need. The Minister has been briefed on the association's initiative, as I sent his Department the details. It is proposing a programme to identify the critical skills required, the areas of greatest skills shortage and the number of people available in the marketplace and to use this information to target and fill gaps by rewarding people financially, whether in terms of tax credits, PRSI initiatives or repatriation grants for those who are abroad. It is about providing financial incentives to those with the relevant skills who want to stay in or return home to Ireland to do so. It is an encouraging proposal.

The jobs initiative is not the solution, but it is a first step in underlining our commitment to making the sector a cornerstone of our future economy and a first step in rebuilding our international reputation for producing high-end graduates. It is about getting more of them, attracting them back from abroad and getting them working in our economy. It is also another crucial step in returning people to work.

Deputy Ruairí Quinn

I thank the Deputy for raising this matter on the Adjournment and for speaking directly to my office about it. I understand that he wished to discuss the recently published IIA report and proposals to provide incentives for people to work in the IT sector. As most such proposals would fall under the responsibility of the Department of Jobs, Enterprise and Innovation, I will for the most part restrict myself to comments on how the Department of Education and Skills is working to increase the ICT skills set of our population.

The ICT sector plays a critical role in the economy. It is composed of more than 8,000 foreign and Irish-owned companies, including 780 foreign-owned companies that employ 65,000 staff with exports valued at nearly €50 billion per annum and 400 Enterprise Ireland-assisted software companies that employ 8,000 staff and generate €1 billion in export sales per annum.

While the downturn has impacted significantly on levels of employment across the economy, significant employment opportunities are emerging in export-led sectors such as ICT. At a time of strong demand globally for graduates with high-level ICT skills, the sector in Ireland is also experiencing difficulties in filling some vacancies. In recent months, departmental officials have been working closely with the secretariat to the expert group on future skills needs, EGFSN, the Higher Education Authority, HEA, and the Department of Jobs, Enterprise and Innovation to clarify issues more precisely in respect of skills gaps in the sector and how they might be addressed. Discussions have taken place with more than 25 foreign-owned and indigenous companies to establish information on the scale and nature of positions involved and the reasons for reported difficulties.

The skills needs of the ICT sector are not uniform and are continually evolving. A key issue that has been identified is a shortage in the domestic supply of honours degree level computing and electronic engineering graduates. This stems from the fall-off in demand from students for ICT related programmes following the dotcom collapse, allied with the significant recent growth and expansion of the sector. While it is positive that third level enrolments in these disciplines have increased by some 30% since 2008, there will be a time lag before this increased demand from students feeds through into increased graduate output.

The Minister has met representatives of the ICT sector in recent weeks and has confirmed his commitment to working collaboratively with them on measures to increase the numbers and quality of graduates in the longer term and to address the skills needs of the sector in the interim through an expansion of conversion and re-skilling opportunities.

A key initiative that can make a contribution in the short term is Springboard, which is providing 6,000 part-time higher education places for unemployed people as part of the Government's jobs initiative. The tendering documentation for Springboard was developed in close collaboration with the EGFSN and with input from industry representatives to ensure programmes would be provided in areas where future employment opportunities are expected to arise. The selection criteria for Springboard took account of the extent to which providers engaged with employers in the development of their programmes. A number of the programmes also provide work experience opportunities with employers.

More than 2,000 of the Springboard course places are on ICT programmes ranging from certificate to masters degree level. Some 65 separate ICT programmes are being funded in areas such as computer programming, cloud computing, computer game design and digital forensics. A number of the programmes being offered are designed to build on and support the conversion of existing graduate skills in engineering and other disciplines, as the Deputy mentioned. A further 1,400 Springboard places are being provided on programmes designed to address cross-sectoral skills needs, including programmes on six sigma, manufacturing, technology commercialisation and entrepreneurship, with the balance in other areas of potential growth, including the bio-pharma, medical devices and food sectors. Applications for places on all of these programmes can be made through the www.bluebrick.ie website.

A key priority for the Government and the Department is to continue to work with the ICT sector to identify measures to increase the domestic supply of graduates with the appropriate levels of skills to support the expansion and growth of the ICT sector.

Asylum Support Services

Deputy Derek Nolan

I take the opportunity to acknowledge the commitment given in the programme for Government to "introduce comprehensive reforms of the immigration, residency and asylum systems". This is certainly an area in urgent and dire need of such reform. I hope this commitment includes as a given the reform of the system of direct provision. In Galway city alone there are three direct provision centres and although the residents are not permitted to vote in general elections, I interact with them on a weekly basis: they visit me at my clinic; I meet them at community events and encounter some of them who have even ventured further and become politically active. What is so obvious to me and what I find lacking so often in the debate on these matters is that the residents in these centres — refugees and asylum seekers — are normal people with hopes, dreams and ambitions, as well as problems, troubles and challenges, just like every other human being.

There is a political difficulty in raising this issue because of a backlash from sections of the media, rage among small elements of the public and stark indifference on the part of many. I have received hate mail only once in my life in response to a letter I wrote to a local Galway newspaper on this topic. In the letter I cited as an example a middle aged woman whom I had met the previous weekend. She was from central Africa and had been in the asylum system for three years. She did not know how long her application would take to be processed or what her future might be and she was frightened. She shared what was once a small hotel room with two other women whom she did not know and she had no personal space or privacy. Her life was tedious; she could not work or afford to access education and her allowance of €19.10 a week did not allow her much scope when a return bus fare to the city centre cost €3.20. For three years she did little or nothing, the only exceptions being taking English lessons and interaction with fellow residents. Comprehending a life of doing nothing for a prolonged period is all but impossible. The very tedium, nihilism and pointlessness of it all has huge implications.

During a visit to one centre in Galway I witnessed a fist fight, the cause of which was the rota for access to the communal washing machines. I am told by residents that such outbursts are a regular occurrence, the result of built-up tension, frustration and aggravation. They are also worried about the prevalence of depression, but they are often very dubious about reporting problems or concerns. They are afraid to report matters for fear their application might be prejudiced.

I am certainly not alone in having concerns. The Free Legal Advice Centres argue that the system of direct provision does not adequately meet the health, legal, social and cultural needs of residents. The Jesuit Refugee Service warns of the long-term negative institutional effects of direct provision centres. Human rights academics question the dubious legal standing and human rights implications of their operation. There are seriously worrying reports from agencies such as the Galway Rape Crisis Centre on the exploitation of women and children both within and without the centres. I sometimes wonder if we are looking at the source of the Cloyne reports of ten or 15 years time.

It is not true to say there is no function or use for the system of direct provision. For many of those entering the system it provides a welcome immediate environment in which to base oneself, engage with health and legal services and acclimatise oneself to the country. That period, however, should not be excessive and a maximum limit should be imposed. The system was introduced with the intention of housing people for no more than six months and that limit should be enforced. We cannot continue to institutionalise people in these circumstances indefinitely. For these reasons, I am calling for a comprehensive review of the system of direct provision to address the concerns I have raised, including a statutory maximum stay of six months; the introduction of an independent complaints body to hear and investigate the concerns of the residents of these centres; and an overhaul of the immigration and asylum process in order that people receive quick, just and fair decisions in a transparent manner.

Deputy Ruairí Quinn

I am responding on behalf of my colleague, the Minister for Justice and Equality. I propose to explain what the direct provision system is; how it came about; why it remains a necessary feature of the State's asylum and immigration system; and why legislative proposals before the House will, if passed, of necessity reduce the length of time persons stay within the system.

The accommodation of asylum seekers through the direct provision system is the responsibility of the Reception and Integration Agency of the Department of Justice and Equality. Direct provision means that the State, through the RIA, assumes responsibility for providing for asylum seekers suitable accommodation and certain other services on a full board basis. All accommodation costs, together with the cost of meals, heat, light, laundry and maintenance, are paid directly by the State. Asylum seekers in direct provision accommodation also receive a weekly cash allowance which takes account of board and lodgings and other ancillary benefits provided through the direct provision system. Asylum seekers can also apply to community welfare officers for assistance to meet a particular once-off need by way of an exceptional needs payment under the supplementary welfare allowance scheme. Payments under this category cover once-off costs such as back-to-school clothing and footwear.

In addition to full board accommodation, the RIA co-ordinates, through other Government bodies, a number of ancillary services for asylum seekers in direct provision accommodation. All asylum seekers are offered free medical screening on arrival in the State which provides access to health services for asylum seekers on the same basis as for Irish citizens. Asylum seekers in direct provision accommodation will generally qualify for a medical card whereby they are eligible to receive a wide range of health services free of charge, including GP services and prescribed medicines. Other HSE provided supports include the public health nurse service, as well as a dedicated asylum seeker psychological service.

Asylum seeker children are entitled to access free primary and post-primary education on the same basis as an Irish citizen. In addition, English language supports are made available to adult asylum seekers; in some cases, facilities are provided on-site in RIA accommodation centres for such classes. At a number of centres the RIA has provided facilities for on-site pre-school services.

As of today, the RIA has 45 asylum seeker accommodation centres across 18 counties accommodating just over 5,700 residents. The system is constantly evolving, taking account of the ebb and flow of residents and the financial resources available to the RIA. Overall, demand for RIA services is declining. At the beginning of 2009 the RIA was accommodating an overall number of 7,002 asylum seekers. Today it is accommodating just over 5,700 persons, a reduction of 18% during this period.

The direct provision system did not come about by accident. It was a necessary response to the increasing number of asylum seekers arriving in the State. Before 1999 asylum seekers were treated as homeless under the structures then in place. These structures were entirely unsuited to the situation facing Ireland; the homeless service of the then Eastern Health Board could not cope and there was a serious prospect of widespread homelessness among asylum seekers. In response to this serious and unprecedented challenge the organisation subsequently named the Reception and Integration Agency was established to co-ordinate the scheme of dispersal and direct provision for asylum seekers

The direct provision system is only one element of the State's response to its international obligations on the asylum issue. As well as educational, health and welfare costs, there is the asylum determination system, as well as the downstream judicial and policing costs. In the past five years the total amount spent across government on asylum seekers was €1,275.31 million, of which €424.43 million was spent on the direct provision system. Clearly, meeting our international obligations in this respect consumes considerable public moneys. Ireland is not unique in this respect. All countries which take their responsibilities in this regard seriously are faced with similar calls on their financial resources.

On the matter of application processing times and consequent length of time spent in the direct provision system, the Minister has asked me to point out that some cases can take significantly longer to complete owing to, for example, delays arising from medical issues or because of judicial review proceedings. All asylum applications and appeals are processed in accordance with the Refugee Act 1996 and high quality and fair decision-making in all cases continues to be a key priority at all stages of the asylum process.

For the sake of completeness, the Minister has asked me to point out that persons who are refused a declaration under section 17 of the Refugee Act 1996, as amended, enter what is commonly referred to as the "leave to remain" process which generally has two elements to it: an application for subsidiary protection and further consideration to be given under section 3 of the Immigration Act 1999, as amended. This is separate from the asylum or refugee status determination process. The processing of cases at this point is also complex and extremely resource intensive and there are no quick or easy decisions to make. Given the life changing consequences for the persons involved, these are decisions which must be taken with the most scrupulous care and attention.

The Deputy might like to note that the Minister has taken steps to speed up the processing of applications by redeploying staff from the refugee determination bodies primarily. The Immigration, Residence and Protection Bill 2010 which the Minister recently restored to the Dáil Order Paper provides for the introduction of a single procedure to determine applications for protection and other reasons to remain in the State. This should substantially simplify and streamline the existing arrangements. This reorganisation of the protection application processing framework will remove the current multi-layered processes and provide applicants with a final decision on their applications in a more straightforward and timely fashion. The Deputy is probably aware that the Minister is developing a number of amendments to the Bill before commencing Committee Stage which he hopes to be in a position to take in the near future.

Health Services

Deputy John O’Mahony

I thank the Ceann Comhairle for selecting this matter for discussion. It is by no means an exaggeration to use the word "plight" when describing the way in which people with type 1 diabetes deal with their condition. It is a difficult task for them. In County Mayo alone, there are approximately 100 children and adolescents living with the condition. That figure increases to 400 when the counties of Galway and Roscommon are factored in. In County Mayo, an average of one person per month is diagnosed with diabetes.

Many people living with type 1 diabetes receive their care locally but others travel to Dublin to access intensive treatment as the local diabetic care teams are under-resourced and underdeveloped. Nonetheless, I cannot speak highly enough of the under-resourced staff in Mayo General Hospital, which includes one paediatrician with an interest in diabetes and two specialist nurses to cater for those 100 people.

However, while the access to the treatment in Dublin is of benefit to patients, because of how it is resourced and the amount of technology available, it is far from an ideal solution. Children with diabetes, who should be seen four or five times a year in hospital to help limit the damage which high blood sugars can cause to the eyes, kidneys, nerves and smaller blood vessels in adulthood, are not seen as often as recommended.

As we all know, if diabetes is not well managed, it will cost a huge amount in future health care. In an attempt to address this issue, Diabetes Action has proposed a reorganisation of diabetic paediatric services in eight networks. It is envisaged that one of those networks would serve the 400 affected children in Mayo, Roscommon and Galway, so that they could avail of intensive therapies locally.

To ensure the equal availability of life-changing intensive treatments for those living with the condition, seven of the networks outside Dublin would require additional staff. I am aware that money is not available at the moment, but there are huge amounts of money in the health service. If reconfiguration took place there would be a lot of money saved down the line. The financial cost is estimated to be approximately €750,000 per annum but research has proven that by making the appointments, the potential is there to reduce the development of complications in adulthood by as much as 76%. That is a hugely significant figure, given that the treatment of diabetes complications normally account for 60% of the diabetes care budget, while the budget for diabetes care itself can account of as much as 15% of Ireland's health budget.

The central message of Diabetes Action is that people with diabetes have not been helped or served well by the generalist health policy. Instead, it proposes that the various issues need to be addressed by a national diabetes strategy. If the Government were to implement such strategic policies, the health of those living with diabetes would be greatly improved while simultaneously saving the State hundreds of millions of euro each year caring for people who will develop health complications in their diabetes care over the next decade.

I was speaking this evening with the parent of a ten-year-old child with diabetes. The parent went through the care the child needs, including five injections per day. The mother has to administer one injection in school at lunchtime. Technology is available in some areas, including, for example, an insulin pump that is available in Cork and Dublin, but not in Mayo General Hospital. The pump used to cost €5,000 but now costs only €2,500. The cost of some such technology and the appointment of an endocrinologist would make more sense. It would amount, in other words, to a centre of excellence. I acknowledge that one cannot have it in every hospital, but it could be in some hospitals to serve the regions so that people with diabetes would not have to travel to Dublin where facilities are totally overrun.

Deputy Ruairí Quinn

I thank Deputy O'Mahony for raising this matter on the Adjournment which I am taking on behalf of my colleague, the Minister for Health, Deputy James Reilly.

It is estimated that there are currently between 3,000 to 4,000 children and young adults under 16 years of age with diabetes in this country. Over 90% of patients have type 1 diabetes but, unfortunately, there are 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. Given 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 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.

A clinician was appointed to take the lead on the diabetes clinical programme. He has engaged with all stakeholders, including the Diabetic Federation of Ireland, clinicians and podiatrists, to establish a multidisciplinary package for diabetic patients. A multidisciplinary working group is currently working through a number of key projects.

There are two proposed models of care to improve the situation for paediatric diabetes care. The first is based on eight to ten regional networks, with the three existing Dublin centres acting as a tertiary hub of excellence and continuing to see one third of the national paediatric/adolescent diabetes population. This model has been proposed by the DiabetesFederation of Ireland.

The second model came from the HSE's expert advisory group. This proposes that care be centralised for each region in a dedicated paediatric/adolescent diabetes centre looking after at least 150 children or adolescents. Ideally, the centre should be in a regional hospital that has an adult diabetes centre to facilitate transition to adulthood.

The national clinical leads for diabetes and paediatrics are to meet in the next couple of weeks to assess current services across the country, to agree a model of care, and to standardise these across the country. They will also develop criteria for use of CSII therapy — that is, insulin infusion — in children and adolescents with type 1 diabetes, and work on policy to prevent and aid the 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.

Diabetes service implementation groups have been established countrywide, including in HSE West. The group's regional work plan includes a focus on primary care, hospitals, children and adolescents, support services and linkages to the local diabetes implementation groups. The group is supported by three local diabetes services implementation groups.

Services are provided for children and adolescents with diabetes in all the major hospitals across HSE west. These services are provided by paediatricians with a special interest in diabetes in Galway University Hospital, Portiuncula Hospital and Mayo General Hospital. The consultants are supported by clinical nurse specialists in diabetes and the diabetes teams have access to dieticians, psychologists and social workers. In addition, transitional clinics are provided across HSE West for adolescents who are transferring from the paediatric service to the adult service.

Nationally, the diabetes working group has undertaken to roll out a diabetic retinopathy screening service for all diabetics over the age of 12 years in 2012 to ensure early detection and treatment of diabetic eye disease, thus helping to prevent blindness due to the complications of diabetes. The group is also working closely with the chronic disease watch programme to increase GP awareness of diabetes.

Paediatric care is recognised as an important element of the diabetes programme required to maintain the health of the diabetic population. Taken together it is envisaged that the services planned, once operational, will enhance overall diabetes care for children and adolescents.

The Dáil adjourned at 10.50 p.m. until 10.30 a.m. on Wednesday, 20 July 2011.