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Dáil Éireann debate -
Tuesday, 12 Mar 2013

Vol. 796 No. 1

Topical Issue Debate

Labour Market Issues

I thank the Ceann Comhairle for the opportunity to raise the matter of parents who wish to return to the workforce after a period in the home raising children. They are not provided with similar rights and entitlements to those on the live register in terms of education and training initiatives and other labour market activation mechanisms. Although the proposal is couched in gender-neutral terms, in most cases we are talking about women who, mostly for reasons to do with child-rearing, opt out of the labour force for a number of years. As they are not in receipt of a qualifying payment, they are not entitled to participate in many of the labour market activation programmes available through the Department of Social Protection or its agencies.

I welcome the Minister of State, Deputy Fergus O'Dowd, and I appreciate that not every Cabinet Minister can be in attendance for these debates. However, I had hoped the Minister for Social Protection, Deputy Burton, would attend because she is interested in these matters. In recent days, she celebrated International Women's Day. It is not often I find myself comfortable in the company of the National Women's Council of Ireland and SIPTU but it must be acknowledged on such occasions. The two bodies combined to produce a very interesting paper called Careless to Careful Activation. It deals with a range of issues that arise on the basis that women do not present a homogenous group in terms of labour market activation measures. Women who have reared children have different requirements from those who are at the pre-child-rearing stage.

The challenge for the Minister is whether it is possible to have a gender perspective on labour market activation and to move away from what appears to be a gender-stereotypical approach, that one size fits all in terms of labour market activation. I acknowledge it is a lot to ask but, from the point of view of the State, there is a danger of locking out a large cohort of women, many of whom have acquired skill sets at the expense of the State that are in danger of being lost forever. This will have an impact on employment rates in the economy and contribute to household poverty.

On the other side, women in receipt of qualifying payments are, in some cases, harangued and harassed by the Department of Social Protection to participate in labour market activation measures. In some contexts, it places extraordinary pressure on them, including the obligation to participate in training or courses and, subsequently, low-paid employment, as well as leaving them with the onerous task of domestic, child-rearing and care responsibilities. While we can understand the argument that scarce resources must be allocated in a targeted manner, under the current arrangements we are in many instances reaping the worst of both worlds. A cohort of women wish to participate in activation measures and to avail of the initiatives tailored to that purpose by the State, while another cohort of women, by virtue of the fact they are in receipt of payments, are being hunted and obliged to participate in the labour market activation processes. In many instances, labour market activation processes do not subsequently lead to productive engagement in the labour market.

Does the Department of Social Protection, through its many agencies, have the capacity for a gender perspective on labour market activation that designs tailor-made solutions to individual clients? These will not be exclusively women, but in many cases women currently not in receipt of social welfare qualifying payments are locked out of the benefits of activation measures.

The publication I referred to, a joint effort between SIPTU and the National Women's Council of Ireland, addresses many of the issues. The only way to come up with a realistic solution is to allow greater autonomy and flexibility to those who decide who participates. Many participants are unwilling and many willing participants are locked out of these arrangements.

I will respond on behalf of the Minister for Social Protection, Deputy Joan Burton. It is estimated the Department of Social Protection will spend over €1 billion on working-age employment supports in 2013. This substantial expenditure, against a backdrop of significant fiscal consolidation, underlines the Government's commitment to enhancing support for activation and assisting people in returning to employment. Given the scale of the crisis, the key objective of activation policy and labour market initiatives is to offer assistance to those most in need of support in securing work and achieving financial self-sufficiency. This policy objective prioritises scarce resources for the benefit of those who are in receipt of qualifying welfare payments. Accordingly, the employment services and schemes provided by the Department are focused, in the first instance, on the cohort of unemployed people. The major elements of the Government's response are set out in the Pathways to Work policy, which is aimed at ensuring that as job vacancies are created they are filled by people on the live register. The Department maintains a particular focus on those who are long-term unemployed or at risk of becoming long-term unemployed.

The Government believes a work-first approach to activating the unemployed is better than a programme-first approach, given that many who sign on to the live register will exit it again within a short timeframe without any recourse to employment schemes or intensive activation measures. For example, in 2012, of those who signed on to the live register, 43% had left within three months of first signing on. Given these high exit rates, it is an efficient use of resources to use duration on the live register as a criterion for identifying those jobseekers who are most in need of additional support in order to re-enter employment.

The Department has a role in supporting people in moving from welfare to work. A range of employment support programmes are available to eligible unemployed people. These initiatives focus on allowing the long-term unemployed, lone parents and sickness-related welfare recipients to return to the active labour market by supporting them in participating in education, taking up employment or becoming self-employed.

A number of education and employment support schemes such as the back to education allowance, community employment schemes and the rural social scheme are also available to qualified adult social welfare recipients. The requirement to be in receipt of a relevant social welfare payment for a minimum period has always been a feature of employment support schemes and this is considered necessary to ensure that limited resources are directed at those most in need and where optimal benefit will arise for the individual.

It is recognised, however, that not all unemployed people, including those previously engaged in home duties, are dependent on the State for financial support. Some services, such as assistance with job-search activities and the use of online job-searching tools, are available to all unemployed persons, regardless of their duration of unemployment, if they register with the Department's employment services offices. Unemployed persons not in receipt of payments, including those recently engaged in home duties, may also be eligible to avail of skills improvement opportunities, for example, through FÁS training, but are not eligible to receive a training allowance while undertaking such training.

I am disappointed with the Minister of State's response. It was a single transferable speech. I have seen similar responses to parliamentary questions. It does not show any willingness to think outside the box on this issue, which is a significant impediment to a large cohort of women who have skills they acquired previously and who need to improve their skills, sharpen their presentation and so on in order to get back into the workforce. The Minister of State's response was like the dialogue of the deaf. I urge him to have a word with the Minister for Social Protection to see if we can at least get an acknowledgement that there is an issue in this respect. If we cannot have an acknowledge of that, we will not get a resolution.

The Minister of State's response raises an obvious question: what is the success rate of those who are availing of activation measures in transferring from labour market initiatives to the workplace proper? Obviously, if the system is not working - I suspect it is not, and that many people are pursuing course after course and are not successfully transferring to the workplace - that would be grounds for a review of the current regime. I would like to know the position in that respect. If people are not transferring successfully, there is a weakness in the policy approach that should be addressed.

The Constitution is often the last refuge in an argument, but it does contain pro-family provisions. For those women who opt out of the workplace to spend a number of years at home raising their families, surely there is a question, legally and constitutionally, about whether barriers to their re-entry into the workforce are in keeping with the Constitution. If this is the case, there may be an impediment in the future for women who wish to stay at home, if they are going to be treated in this way subsequently.

We need a gender perspective on participation in programmes, and we need to provide flexibility for local social welfare officers or employment service officers to use their discretion where people present seeking to participate in such programmes and avail of them in the same way as anybody else who receives social welfare payments. We must determine whether it would work financially for everybody, including the State, to allow such people to participate on an equal basis.

I will bring the comments of the Deputy to the attention of the Minister. Pathways to Work represents the Government's policy statement on labour market activity, which is committed, as I said, to more focused intervention. Given the limited public resources, it is essential that these activation measures are targeted. The current cohort of people who are long-term unemployed are a particular focus for interventions. More than 87,000 education and employment support programme places were provided by the Department in 2012. There are 450,000 State-funded places providing further education and higher education and training. There are other activation initiatives available to unemployed people which are not contingent on social welfare status, such as FÁS training courses. The Government spent almost €1 billion on employment supports in 2012 and will expend more than that in 2013. A significant number of schemes, such as the back to education allowance scheme, the rural social scheme and community employment schemes, allow spouses or partners to apply for schemes based on their spouses' primary social welfare payments. I will happy to bring the Deputy's comments to the attention of the Minister.

School Completion Programme

I am sure the Minister of State is well aware of the school completion programme and the vital role it plays in the school community and the community as a whole. He will know that one of its main purposes is to ensure that every child has the opportunity to complete the leaving certificate. In doing that, those involved in the programme work in some of the most disadvantaged communities in the country. As the school completion programme is ingrained not only in the school system but in the community, it has built up a wealth of experience over a number of years. It also recognises that a holistic approach is needed to deal with the issue of school completion, encompassing the community, families, schools and children. Therefore, each project throughout the State has built a number of relationships with outside agencies, the schools and the individuals concerned. As a result of this work and experience, those involved in the programme have developed a number of indicators by which they can identify children who are at risk of dropping out of school and they put in place strategies to try to combat that tendency before it becomes an issue. They offer a number of supports, including the provision of breakfast clubs, which not only provide children with a healthy breakfast when they go to school but also teach them how to socialise with their peers, as well as lunchtime clubs and after-school clubs, which help children in completing their homework. Such clubs foster a culture whereby children will go home and do extra study and go the extra mile to try to complete their education.

The programme also offers a number of academic supports to students who may need them. These are provided inside and outside the school environment. A key area on which the programme focuses is school attendance. Unless children attend school, it is difficult for them to be instilled with a culture of learning and to obtain qualifications. Those involved have developed a number of programmes to target school attendance among students. They have established a number of initiatives that reward attendance at school, which have proved to be successful. Any of the co-ordinators of the school completion programme would advise that in areas where these programmes are in place and are working well, school attendance is on the increase.

Similarly to every other section of society, the school completion programme has suffered a number of cutbacks in recent years. There has been a 20% reduction in its budget over three years, with a final cut this year of 6.5%. If cuts continue to be implemented, it is the children who will suffer. I ask the Minister of State to raise this issue with the Minister for Children and Youth Affairs. Some staff have already been let go under this programme and children will suffer as a result of the reduction in the supports that are available.

We have just passed a referendum on children's rights. The people working in the school completion programmes are the very ones who have the experience and the knowledge to help meet children's educational needs. The school completion programme is a vital component of the educational welfare board which has done great work in many areas. If we continue to target the funding to this group I fear that the school completion programme will collapse. If that happens the children will suffer. If we do not invest in education we are giving up on education. No one in this House, regardless of political persuasion, wants to see children, particularly those from disadvantaged backgrounds, lose the support and assistance they need to complete their education. I ask the Minister to revisit this budget cut.

I thank the Deputy for putting this matter on the agenda this evening. I am taking it on behalf of the Minister for Children and Youth Affairs, Deputy Fitzgerald. I assure the Deputy that I will bring his comments directly to her attention.

The school completion programme aims to retain young people in the formal education system to completion of senior cycle and generally to improve school attendance, participation and retention of its target cohort. The programme operates under the remit of the National Educational Welfare Board which has responsibility for the operational management and national direction of the programme.

In 2013, funding of €26.456 million is being made available by the Department of Children and Youth Affairs to support the 124 school cluster projects and related initiatives within this national programme. This funding enables the 470 primary and 224 post-primary schools in the programme to support educational interventions for approximately 36,000 students. The majority of schools supported by the school completion programme receive this assistance as part of the school support programme under the DEIS initiative.

As in all areas of the public sector, the Department of Children and Youth Affairs had to find savings as part of the comprehensive review of expenditure. The Department must play its part in the collective Government effort to reduce our unsustainable day-to-day deficit. That is the reality for the Department of Children and Youth Affairs as well as others. The comprehensive review published in December 2011, set out clearly the 6.5% per annum savings required in the school completion programme in each of the years 2012 to 2014. The extent of the adjustment was signalled to the projects by the Department in late 2011. In these circumstances it has not been possible to ring-fence funding at historical levels but we did protect individual projects from the full budget adjustment in 2012.

In order to remain within the 2013 allocation, however, the local management committee responsible for each project was notified last September that a 6.5% reduction would be applied for the coming academic cycle, in this way the full year budget for each project was confirmed earlier than in previous years to assist local management in refining programmes within available budgets.

The local management committee leading each project assesses local needs to devise an integrated, costed and targeted proposal of interventions to support educationally disadvantaged students at local level. This project model approach is a key feature of the school completion programme. It allows the local management committee the autonomy to be creative and innovative in developing tailored support strategies for young people.

Each committee was requested to review its proposed programme of supports and to finalise an approved programme with the National Educational Welfare Board. Projects were advised to examine all elements of expenditure and to seek to reduce costs and achieve efficiencies while prioritising evidence based services to support children's educational outcomes.

The National Educational Welfare Board, in its role to give direction and support to projects, has assisted each project in this process to review plans to ensure front-line services are protected to the greatest extent possible. The board continues to work closely with management committees, schools and local school completion programme co-ordinators to ensure student supports are tailored to meet local needs. As a further support to projects in managing the challenges presented by programme adjustments, the Department has recently commissioned Pobal to undertake an analysis of existing operational and staffing arrangements with a view to providing advisory support to local management in such matters. It is intended that this work will commence shortly after Easter.

I want to focus on a project in my area, the Le Chéile project which covers five DEIS schools. It is in Knocknaheeny on the north side of Cork city. The Government is investing huge sums of money in regenerating the physical environment of the area. It is knocking down houses and rebuilding them to a high standard. While on the one hand the Government is doing that, on the other it is cutting the budgets for programmes to improve the social environment in those communities which is contradictory. This project has three members of staff who work 35 hours a week, one who works 24 hours and two who work 22 hours. They access 170 students. These are schools where traditionally there is a high level of early school leaving and a higher than average number of children with special needs. As a result of the budget cut the decision has to be made whether to cut the two members of staff who work 22 hours or to cut the programmes. It is not possible to implement another cut on top of the cuts of the previous two years of 6.5% without affecting front-line services.

In his response the Minister of State said, "The Department must play its part in the collective Government effort to reduce our unsustainable day-to-day deficit. That is the reality for the Department of Children and Youth Affairs as well as others." The reality of a 6.5% cut to these communities is that children who now have the supports and resources to complete their education may not have them in September. They may not get the opportunity to complete their education. If we cut these resources and staff and the co-ordinators have to decide whether to cut back on programmes, children will suffer. That does not make any economic sense in the long run because if people leave school before they have the opportunity to realise their educational potential it will cost us more. The Department needs to consider that. In this project 6.5% represents approximately €25,000 or €26,000 which is not a large sum of money but one cannot put a price on the benefit to the community, the schools and the children of having it. I ask the Minister of State to ask the Minister for Children and Youth Affairs to reconsider the budget cuts which will be implemented in September.

I acknowledge the Deputy's points and assure him that I will bring them to the attention of the Minister, particularly the Le Chéile project in Knocknaheeny.

While there are significant financial problems everywhere the full adjustment identified in the comprehensive review of expenditure for 2014 will be further considered in the context of a review of the programme to be undertaken this year. A core objective of the review will be to ensure that available funds are appropriately targeted to support those pupils most at risk of early school leaving. The review will address the potential to achieve greater consistency in programme delivery, administration and examine the reforms necessary to consolidate the programme on a sustainable footing. Terms of reference are being finalised and the Department will consult with individual projects during the course of this review.

Services for People with Disabilities

I thank the Ceann Comhairle for allowing me to raise this important issue of the restrictions announced by the Health Service Executive, HSE, Beechpark services for autistic children in north Dublin and the Minister for Health, Deputy James Reilly, for being here in person to discuss it with me. When I previously raised it several months ago, I was told there was an ongoing review with which I should engage. However, that has not been successful from my end.

There are a number of autistic units in a number of Dublin northside schools with which I deal frequently, including Scoil Chiaráin CBS and Our Lady of Consolation in Donnycarney and Scoil Bhríde and Scoil Naomh Colmcille in Donaghmede. Beechpark services provide several services for children in these units such as speech and language services, occupational and play therapies and psychological services. These are vulnerable children and the staff are doing their best to serve their needs. There are varying viewpoints as to what Beechpark services can do for a school. Many schools state once they receive the services, they are delighted with them, while others say it is difficult to even access them in the first place. I have also been informed some private diagnostic assessments are not being recognised by the HSE for referrals to Beechpark services, which is an added problem.

Schools are now being told that new children will not receive these services. All children will be played off against each other, as the HSE will assess their needs and allocate resources on the basis of the needs various children have. One child may have more needs than another. I do not know how anyone can assess the difference between one autistic child and another. I accept that there are various degrees on the spectrum, but I would have thought any child admitted to a unit needed all the supports he or she could possibly get. School principals will be looking at older children in their units continuing to receive services, while new entrants - younger children - will not receive the same level of service or allocation of resources.

Has the review of Beechpark services being completed? Can a communication which brings clarity to the issue be brought to all schools that depend on these services? There is significant uncertainty and trauma associated with this issue. Last Friday the Autism Bill 2012 was introduced to the House and it was graciously accepted by the Minister for Health. Several speeches were made on all sides of the House on how Ireland had grown up on this issue. However, when curtailment of services happens, parents who care deeply about their children and feel strongly about their advancement in life begin to wonder what will happen next. They had a sense of certainty that their child would receive these services but now that is gone.

I know budgets are tight and difficult, but it is the haziness, lack of clarity and total uncertainty surrounding this entire issue that need to be cleared up. The schools need to be dealt with in a more professional and compassionate manner. We need to ensure schools and the children's parents know where they stand. We cannot have a dichotomy of services in any autistic unit in which older children receive services younger children do not.

I thank the Deputy for raising this matter. The Government is committed to protecting front-line services, including services for children with disabilities and autism, to the greatest possible extent by seeking to maximise the provision of services within available resources. Beechpark is a regional HSE service which provides clinical supports for children with a specific diagnosis of autistic spectrum disorder up to 18 years of age who attend designated special schools, outreach preschools and outreach classes in Dublin, Kildare and Wicklow. The service has to operate within the financial and other parameters applying.

Importantly, the Beechpark service is working with local implementation groups to progress disability services for children and young people across the HSE's Dublin north-east and Dublin-mid-Leinster areas to focus on the current service model and service delivery structure provided by all service providers in the area with a view to addressing the realignment of resources in the context of the report of the national reference group, the national review of autism services report and the progressing disability services programme. This issue is also being examined by the Dublin Beechpark service review group.

Specifically on the issue of speech and language therapy services, the HSE aims to ensure the resources available are used to best effect in order to provide an assessment and ongoing therapy for children and adults in line with their prioritised needs. With the significant investment in the area of speech and language therapists employed in recent years, a range of new approaches has been developed and is used in many speech and language therapy services across the country. These include providing structures, training and support for parents and carers in order that they can work to help to improve the individual's speech and language. In addition, therapy is delivered in group settings, where appropriate.

These changes to speech and language therapy services aim to ensure services are provided based on the level of need in an equitable manner and in line with evidenced-based practice. It also facilitates access to services where vacancies arise having regard to the employment control parameters which apply. In that context, the Beechpark speech and language therapy service in north Dublin has been moved to a rotation system in the school-based model in an attempt to meet the needs of children across the entire service. The speech and language therapy service is due to rotate schools in April. The individual needs of the children will be kept under review. The speech and language therapist service will also continue to be available on a consultation basis for ongoing programmes.

While the current economic position presents challenges in how best to maximise the provision of services with available resources, I am committed to protecting front-line services, including children's disability and autism services to the greatest extent possible. I am less than happy with this situation or the level of service delivered. I am acutely aware of schools which do not have a service, even though they have special needs assistants. I have asked for a review in the Department. Today I spoke to Mr. Tony O'Brien, the HSE director general designate, about how staff were rotated and how the public sector recruitment moratorium impacted on front-line staff, especially therapists. For parents of a child with autism, each week without a service is a serious concern as the opportunity for the child to reach his or her full potential is compromised.

The position in the Beechpark service is unacceptable and I will take up the matter with the Minister of State responsible, Deputy Kathleen Lynch. I have always agreed with her approach that the service must be in place to ensure early diagnosis. Equally, once a diagnosis is made, the more specialist services required must be made available. I know the Minister of State will not be one bit happy about this either. I will revert to the Deputy on the matter.

I am impressed not just by the Minister's attendance in the Chamber but also his willingness to move off script to give an impressive and impassioned defence of the services the children in question need. I take it at face value that he will communicate with the Minister of State, Deputy Kathleen Lynch, on this issue and revert to me in due course. We are agreed on the need for the children in question to access the services they require. We must also acknowledge, however, that there is significant disconnect between schools, parents and the service providers. This is not good for the relationships that need to be built up over time. This issue needs to be ironed out. The very least the schools and parents should expect is clarity. I thank the Minister for his commitment to deal with this issue and appreciate his offer to revert to me on it. I hope we will have positive news for the parents involved.

I appreciate the Deputy's comments. Many years ago I was involved in the setting up of the Beechpark service when I was a member of the then health board.

The service was based on the south side but was to serve the entire area I referred to, including Dublin, Kildare and Wicklow. I am not happy that we have unequal distribution of services and I have asked for this to be addressed. I have allocated €1 million per annum for three years to the area of autism and I await more complete reports on how that money is being spent and how it is impacting on the service. In all areas of patient care we need to focus not on inputs but outcomes and we need to measure outcomes. Having said that, if there is no therapist available to support special needs assistants then children will not receive the optimum care that they should receive.

Earlier Deputy Áodhan Ó Ríordáin referred to the review and I did not respond on that point. The review is not complete. However, we are the first Government to put in place at principal officer level an individual across the Departments with responsibility for health, education and children to deal with intellectual disability and autism. We have done the same thing to address childhood obesity as well. Certainly, I will come back to the Deputy. I believe this is a serious situation and one I will address aggressively with the Minister of State, Deputy Lynch. I believe she is as committed as I am to seeing the situation corrected. We are keen to see the type of flexibility applied to the moratorium on recruitment that will not prevent people taking up posts in this specific area because of its significant importance to the future of children.

Cochlear Implants

I welcome the Minister to the House and thank him for attending personally. This issue is topical. There have been interviews in recent days involving parents of children who are waiting for a bilateral cochlear implant. The debate has been passionate at times. I record the words of the mother of Anna Murphy, the little girl who featured on TV3's "Temple Street Children's Hospital" and "Ireland: AM" programmes last year following her cochlear implant surgery. Her mother contacted us and I sought permission to relay her words to the House. She said:

At present children in Ireland are implanted in one ear only, which, while fantastic that the child hears, is not acceptable as bilateral implants are recognised as international best standard. Ireland is one of the only countries limiting children to one implant. Beaumont Hospital has been begging for this funding since 2009 and the HSE acknowledged that this is best practice in its audiology report of 2009. However, after four years the HSE is still not funding bilateral implants and this is affecting 350 children in Ireland who time is running out for. These children have a window of three and five years between the first and second implant, including my daughter Anna. After this time the nerve dies and there is no hope of implantation.

We also heard from Julie Anne Cunneen who spoke passionately on behalf of her son, Liam. I realise that times are very difficult with the budgetary position that the Minister is faced with on a daily basis but we must act if we are to allow children to reach their full potential. By allowing only implantation we are compromising their ability to flourish and their ability to fulfil their ambitions and hopes and aspirations. I recognise that advances have been made and I realise there has been a meeting with the HSE chief operations officer, Laverne McGuinness, and some representatives of children who are waiting for the second implant. I urge for this to be made a priority and for the sequences needed to be set out to ensure the resources are in place following the appointment of Dr. Gary Norman as the national audiology clinical lead.

I realise that not much can be done between now and the Estimates for 2014 but at least a process could be put in place and the services could be nailed down. Then we could go ahead with the sequential implantation and simultaneous implantation for those who are born from here on. I urge the Minister to use this opportunity to put in place the necessary procedures. I realise there will be a significant drain on resources in Beaumont Hospital because it will have to play catch up with the sequential implantations but this change is necessary and time is not on the side of some of these children. If we are to allow them to have an opportunity in life to play their fullest and most meaningful role in society then surgery for a bilateral cochlear implant is a necessity. It complies with best international practice and this fact has been acknowledged by everyone concerned.

While people welcome the fact that one implant is provided at this stage most take the view we must proceed in the interests of giving children born with disadvantage and who will confront many obstacles a better service. Giving them one implant gives them hope but by giving them two it would give them opportunity. I hope the Minister can provide a positive response to the impassioned pleas of Julie Anne Cunneen, the mother of Liam, and the mother of little Anna who spoke passionately about the need to have this programme rolled out as quickly as possible.

I thank the Deputy for raising the issue of cochlear implantation services. The Taoiseach addressed the matter during Leaders' Questions today.

The Deputy has pointed out that Beaumont Hospital is the centre for delivering Ireland's national cochlear implant programme, with surgical provision for patients under the age of six years carried out in the Children's University Hospital, Temple Street. Since the national cochlear implant programme commenced 17 years ago more than 700 patients have received cochlear implants. I understand that in 2012 a total of 90 cochlear implants were carried out with 42 children and 48 adults receiving implants.

In 2009 a national review of audiology services was carried out by the HSE to examine the services provided to children and adults nationwide and to formulate a national plan for the services. The report of the national audiology review group, published by the HSE in 2011, provides the blueprint for the planning, development and delivery of HSE audiology services from new-born screening to assessment and management of adults and children with hearing problems, including cochlear implantation. Two of the main recommendations in the report include the national roll-out of a universal new-born hearing screening programme and the establishment of a bone-anchored hearing aid programme. The report also included a recommendation that continued ring-fenced financial support be provided for the cochlear implant programme, but at levels which allow for simultaneous bilateral implantation for children.

While no dedicated programme for simultaneous or sequential implantation is being carried out in Ireland at the moment some bilateral implantation has already occurred for patients, mainly very young children with certain medical conditions such as a history of meningitis or blindness. It is estimated that there are approximately 200 children in Ireland today who may be suitable for a second implant. The HSE has established a national clinical care programme for audiology, which is overseeing the implementation of the recommendations detailed by the report of the review group. Progress is being made on the modernisation of audiology services in Ireland. The introduction of a universal national programme of new-born hearing screening is a key priority, the aim of which is that all babies have their hearing screened shortly after birth. One recent development has involved the appointment of a national audiology clinical lead, as Deputy Kelleher noted. In addition four assistant national lead posts have been advertised to support the implementation of the audiology clinical care programme.

The HSE is working closely with Beaumont Hospital to progress plans for both simultaneous and sequential bilateral implantation. I understand that representatives from Beaumont Hospital, HSE management and the HSE's audiology clinical care programme have met recently to discuss a joint process to identify the options for developing and resourcing a programme of simultaneous and sequential cochlear implantation. An important element of this process will be the development of clear clinical criteria to prioritise clients for assessment and follow-on implantation. Each child must be assessed to determine if he or she is suitable for a bilateral implant. The provision of information about the advantages and potential disadvantages of bilateral implantation is required to facilitate an informed decision on whether to proceed. Not all suitable patients proceed with the second implant when appraised of all the issues involved. The development of the service will require additional resources for Beaumont Hospital. I am pleased to report that these plans will be progressed through the HSE 2014 Estimates process.

The parents of the children in question are committed to ensuring that their children are allowed to reach their full potential. Clearly what is needed in the context of the clinical lead care programme is a commitment that funding will be provided. I realise it is difficult for the Minister to give a guarantee in the House today. However, the sequential implantation process should be given priority as should the simultaneous implantation process for those born thereafter.

Time will run out for some of these children if the resources are not made available in 2014.

I do not expect the Minister to make a grand announcement today, but the priority must be the establishment of the clinical lead and the appointment of Dr. Gary Norman, followed by an assessment of who is suitable for sequential implantation. It will be a demand-led scheme for several years because if a cap is put on the amount of funding available prior to completion of an audit of suitable candidates, some children will be placed at a disadvantage. Until the backlog is addressed, all those deemed suitable for cochlear bilateral implants should be treated. I urge the Minister to make every effort to convince those who have a say in budgetary matters that it is critical to maximise the opportunities for the children concerned in their future lives.

I do not wish to make a political argument on this issue. The Deputy and I want to give children the opportunity to reach their full potential. It has not been possible to implement the recommendations made in 2009 because of budgetary considerations, but we are providing as many children as we can with single implantations in order that we can begin sequential bilateral implantations in 2014. I have discussed the matter with the director general designate as recently as this morning. High priority is being given to this matter and, without being a hostage to fortune, we will have provision to undertake the bilateral implantations next year in order to give children the best chance. I do not want any child to miss out on the opportunity to have bilateral hearing and the same chances as other children. The Estimates for this year do not allow us to immediately engage in bilateral implantations, although some have been carried out. It is a priority for me to start providing them next year and we will enter into negotiations with Beaumont Hospital in this regard.