Dáil Éireann debate -
Tuesday, 25 Mar 2014

Vol. 835 No. 1

Topical Issue Debate

Ambulance Service Provision

Deputy John Lyons

In the short time available to me I wish to speak about the valuable service provided by Dublin Fire Brigade in our capital city and the ongoing review of ambulance services. Dublin Fire Brigade and Ambulance Service has operated since 1898. Dublin Fire Brigade performs a dual role, which means that either an ambulance or a crew on a fire appliance will arrive at a scene and stabilise a patient until an ambulance arrives. As a result of this dual role and the brave work of fire fighters, Dublin has one of the best survival rates for out-of-hospital cardiac arrest cases in the world. Dublin Fire Brigade is a first class example of a fire service based emergency medical service, which is recognised internationally as best practice.

This model is used in many cities throughout Europe, such as Paris, Dusseldorf and Frankfurt, and also in cities such as New York and Detroit in the United States of America.

At present, the HSE pays about €9 million for the Dublin Fire Brigade to deliver this vital service for the capital city. This amounts to less than 7% of the total national budget for ambulance services, even though Dublin Fire Brigade responds to almost 40% of ambulance calls nationally.

As a Dublin Deputy, I have been contacted by many fellow citizens from all sides and staff of the fire services, including those I know personally, about the HSE plan from March 2013 and the current joint review of Dublin ambulance services by Dublin City Council and the HSE. This HSE plan from last year, details of which were revealed in The Irish Times recently, includes plans to take control of the Dublin ambulance service from Dublin Fire Brigade by the end of 2015. There are concerns among firefighters that the review that is currently under way will recommend this plan and not consider the exemplary service provide by the Dublin Fire Brigade, which I mentioned already.

I am out of time. I value the Dublin Fire Brigade service and the ambulance service that it offers, and anybody who lives in Dublin or receives its services will be aware that it is the best service in the country. The level of ambulance service that the Dublin Fire Brigade provides is where the bar should be set for all ambulance services throughout the country.

As a citizen, I am fearful of any changes to the way the ambulance service is run nationally and fearful of the prospect of its being taken into the control of the HSE. I note that Swords is covered by the Dublin Fire Brigade as well. I am merely concerned that the bar set by Dublin Fire Brigade in running the ambulance service in Dublin will be jeopardised and I ask that this be acknowledged in any review that is carried out. It is the only ambulance service, I believe, that almost reaches the HIQA standards even though it is not obliged to abide by them. I am aware that another Member is speaking on this, so I will leave it at that.

Deputy Billy Kelleher

I welcome the opportunity to speak on this issue.

When one looks at the leaked report that broke over the weekend before St. Patrick's Day regarding the HSE's plans to take control of Dublin's ambulance service from the fire brigade, it prompts two questions: the key question of why, and whether it is the right direction to take.

According to the report, the HSE is seeking to remove the emergency ambulance provision from the Dublin Fire Brigade because of two key points - a lack of HIQA oversight, and cost. The difficulty my party has with this is that the report was carried out by the HSE itself. That the HSE is the one drawing up the report would indicate that it may at least be partisan or biased on this issue. I would suggest that there be an independent assessment of whether this is the right action.

As Deputy Lyons pointed out, nobody complains to us - and I am quite sure nobody complains to the Minister - about the ambulance service being provided through the Dublin Fire Brigade. It is one of the most efficient in the country. If one looks at the basic cost analysis and breakdown, they seem to be cost-efficient.

I am concerned that a service that is working reasonably well is being taken over by an organisation whose ambulance service nationally is not working well. There have been the most catastrophic incidents throughout the country, with wheels falling off ambulances, children being locked in ambulances, delays, ambulances being dispatched to the wrong county, and an incident in which a person was taken from county to county after breaking their leg at a football match in Carlow, so that by the time they ended up in hospital they had been throughout the south east.

There are inherent difficulties. I note the Minister has acknowledged that and requested that HIQA carry out a full audit, but in the meantime the least the Dublin Fire Brigade deserves is an independent assessment of the service it provides. By and large, as Deputy Lyons highlighted, the vast majority of the people of Dublin are satisfied with the service provided by the fire brigade. I would ask that the Minister request independent audit and verification as opposed to relying on the HSE to carry out a cost analysis.

Regarding oversight, I am quite definite that this could be addressed with regard to HIQA through legislation or even a statutory instrument.

Minister for Health (Deputy James Reilly)

I thank the Deputies for raising this matter, which has been the subject of some speculation recently, and I welcome this opportunity to clarify the matter for the House.

Dublin Fire Brigade provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council and the HSE. The HSE National Ambulance Service also provides some emergency capacity in the greater Dublin area, as well as non-emergency patient transport.

The ongoing development of pre-hospital emergency care involves a range of initiatives, including the development of a single national control and dispatch system. The new national system will deploy all emergency ambulance resources in the State, including emergency ambulances, rapid response and intermediate care vehicles, first responders and aeromedical services, as well as ambulances in Dublin. This move to a single dispatch system will represent a significant change in clinical governance, as Dublin Fire Brigade currently dispatches its own ambulances. The Dublin city manager and the HSE's chief operating officer have, therefore, commissioned a joint review of Dublin Fire Brigade ambulance services in Dublin city and county. I hope Deputy Kelleher heard that bit.

Deputy Billy Kelleher

I did.

Deputy James Reilly

It is not merely a HSE review.

Deputy Billy Kelleher

I note that.

Deputy James Reilly

The review will consider all aspects of ambulance operations provided by the Dublin Fire Brigade in Dublin, including the capacity and capability of ambulance services. This will inform consideration of the optimal and best-value model for provision of emergency medical services in Dublin. It is part of the process of ensuring a clinically driven, nationally co-ordinated system supported by improved technology so that emergency pre-hospital care can continue to be modernised and services can be delivered in an appropriate and timely manner to the benefit of patients.

I am aware that concerns have been raised about this review, with suggestions being made that it should be suspended or cancelled entirely, and that there is no necessity for a review as the Dublin Fire Brigade ambulance service is operating in a fully satisfactory fashion. I want to assure the House that I am fully aware and appreciative of the excellent historical tradition of service provided to the citizens of Dublin by the Dublin Fire Brigade and, in fact, due to my previous life as a GP in north Dublin, I myself can attest to that. This review should not in any way be interpreted as a criticism of that service. We are obliged, however, to ensure that pre-hospital emergency care across the entire country is ready to meet the challenges of the future. This review is being carried out with that in mind, and I look forward to the outcome of the process.

Deputy John Lyons

I appreciate the Minister's comments.

Unlike a lot of Deputies, I do not go running around the House shouting concern too often, but on this matter I genuinely feel concerned. I am concerned that we are going to throw the baby out with the bathwater here. Dublin Fire Brigade, as I stated already, is the most impressive and exemplary fire service in the country, operating a fantastic, efficient and cost-effective ambulance service for Dublin city - the one that every other citizen in this country should have. I am just a little concerned, to say the least, that any plans for the HSE to be involved in running this service will throw the baby out with the bathwater. I ask that all that can be done is done and that the voices of the Dublin Fire Brigade officers and ambulance officers, who are joint officers, are heard properly, but, most importantly, that the baby not be thrown out with the bathwater. I really do have concerns. As somebody who may need that service in the future, I have complete confidence in Dublin Fire Brigade's delivery of it. Unfortunately, the stories I hear from other places - I have a brother who is in the National Ambulance Service - are a little daunting. I want everybody to have the best service, and Dublin Fire Brigade offers the best service.

Deputy Billy Kelleher

I concur with Deputy Lyons.

I accept the veracity of the Minister's statement that the review is not a criticism of the service provided by Dublin Fire Brigade. I also note that it is the Dublin city manager, in conjunction with the HSE, who is carrying out this report. It is not that I would question anybody's integrity in this issue, but there should at least be an independent evaluation. Who is to say that the Dublin city manager or Dublin City Council would not encourage a hiving off of the service to some other organisation? The least it deserves is an independent assessment.

The cost breakdown suggests that the Dublin Fire Brigade provides an exceptionally efficient service. When one looks at the difficulties and the complaints nationally, one can see that most of the complaints derive from outside of Dublin. Maybe the Minister should look at that as well. All I ask is that there be an independent assessment of whether moving the Dublin Fire Brigade ambulance service to the HSE would make any difference or would compromise or enhance the service. That would be useful. In general, people have not expressed any complaints about the service.

The issue of HIQA oversight is a red herring. The Dublin Fire Brigade already subscribes to that in its commitment to providing a service.

With a tweaking of legislative proposals or statutory instruments, Dublin Fire Brigade could be brought within HIQA oversight in meeting HIQA guidelines.

Deputy James Reilly

I understand the concern of Deputy Lyons about what is an excellent service and anything he construes as impairing it. Far from it; this is designed to improve the service. It may transpire that the report will make unexpected findings which Deputies in this House are presupposing. It is not fair to compare an urban service like the one in Dublin with rural services in the light of the distances that must be travelled, the number of hospitals available and the density of population. A review is taking place and let us await its outcome. We will revisit the issue at that point and give everyone in the House the opportunity to engage. The ambulance service in Dublin is a critical part of infrastructural services within the city and has a long and proud tradition. I do not want to see anything interfering with this. I am a believer in not accepting the status quo if something can be improved and there is no service that cannot be improved. There is unanimity on this point. It is an excellent service which has nothing to fear from a review other than seeing how we can improve it further. Therefore, let us not prejudge the outcome.

Student Grant Scheme Administration

Deputy Paul J. Connaughton

I thank the office of the Ceann Comhairle for selecting this matter and the Minister for being in the Chamber to take it. This issue has come to my attention in the past few weeks and concerns students who have applied for third level grants. I will give details of three cases in which people were awarded grants and then had them taken back in different circumstances which was upsetting for them and their families. I acknowledge that we know about the difficulties SUSI had when it was first set up. With the assistance of the Minister, the kinks in the system have been ironed out and it is working much better this year. Students who have contacted me are being paid on time, which is welcome. When I heard about the first student in the past few weeks, I thought it was unfortunate; then, on hearing it had happened a second time, I thought it was unlucky; but on the third occasion I thought a pattern was forming. When I ran it by some of my colleagues, I found it was happening across the country. I do not have the exact number which might be quite small, but it should not be happening.

The first case involves a student in Galway who received a grant in first year. The grant was paid up to Christmas in second year, but after Christmas it was no longer paid and the student was not notified that it had been stopped. When he went to see what was going on, he was not given straight answers as to why he was not receiving the grant. When he received an answer, he was told he had been receiving the back to education allowance, which came as a surprise to him because he had never sought, applied for or qualified for it. It was used as a reason he was not receiving the grant. I cannot understand why he had the grant taken from him after it had been awarded to him.

The second case involves a student from Galway who is studying in Limerick. He was told in 2012 that he would receive full fees and a maintenance grant. Some months later he found out that he was only receiving the contribution fees for a course that finished in 2013. He did not have the money in the first place, which was why he was looking for the grant. He cannot pay the full fees to the college which is withholding his qualification until they are paid. He has qualified but not in the eyes of the college. It is remarkable.

The third case involves a student from Galway who is in St. Patrick's College, Drumcondra and who was informed in writing by SUSI on 17 October that his grant had been awarded. He received an e-mail from it to this effect, but he was then informed on 17 December that the grant had not been awarded and that the fees would not be paid. He is halfway through the year and was proceeding in the belief he was receiving full fees. He is another student who cannot understand why he does not now qualify. This is causing great anger, frustration and concern for students and their families who believed they were financially safe for the year ahead. I am worried and concerned that this is happening on a wide scale. I understand there are issues with applications, but in every one of these cases SUSI had informed the students that they would receive the grants for which they had applied. We now find ourselves in a situation some months later where the grants have not been paid. This is causing great concern and anger and must be brought to a head.

Minister for Education and Skills (Deputy Ruairí Quinn)

I thank the Deputy for raising this important matter. The project to establish a single authority for student grants was of a very significant scale within the education system. It required the enhancement and development of systems, management and governance structures and new ways of working in order to progress the realisation of benefits both for grant applicants and the Government. Although very considerable challenges were experienced in the initial year of operation, a comprehensive review enabled the identification of key improvements to be addressed and a focused programme of development was implemented.

Additionally, a major benefit in having a central database of information in a single awarding authority is that it enables efficient electronic data sharing with relevant authorities of income and other data necessary for a speedier and more effective processing of applications. For example, SUSI now has data sharing arrangements in place with the Department of Social Protection, the Revenue Commissioners and a range of other bodies. On occasion, these arrangements have highlighted discrepancies between the information SUSI has to hand on specific applications and the relevant data received from these other authorities. Section 24 of the Act allows an awarding authority to recover moneys from an applicant where it has been demonstrated that he or she was not entitled to receive a payment.

I understand from SUSI that as part of its ongoing internal examination of the quality, efficiency and effectiveness of its operation, quality checks are conducted at both grant award and payment stages on an ongoing basis. Where it is discovered and confirmed, following a reassessment of an application, that such discrepancies show that an applicant is, in fact, ineligible for grant assistance from SUSI, this is communicated to the applicant and the award is withdrawn. While any inconvenience caused is regrettable, SUSI endeavours to identify such issues at the earliest possible stage. The Deputy will appreciate that, in the context of SUSI having received in excess of 69,000 applications in year one, some errors inevitably arose in handling such a high volume of applications within a relatively short timeframe. For its second year of operation in 2013-14, SUSI has continued to make significant improvements to its systems and procedures to streamline the grant application, processing and payment process. There will be an ongoing focus on this work in 2014 to achieve ongoing improvements.

The Deputy has brought to my attention three cases, of which I was not aware. Without reservation, if he can demonstrate that a person was clearly told by SUSI that he was entitled to and was receiving a grant and that if he, in good faith, made arrangements and commitments, he will not be penalised in the way suggested in my reply. If it is bona fide, the cost will have to be carried by SUSI. If there was misinformation and SUSI stated to a student who had applied for a grant that he or she qualified for it and would receive it, the obligation rests on SUSI, irrespective of what might be said. I will explore the matter with the Deputy and perhaps he might give me the full details.

Deputy Paul J. Connaughton

I thank the Minister for the last element of his response, which is the most important. I will supply the details of the three cases. I would not have raised them if the students had not been told they would be receiving the grant. If a student is not deserving of a grant, that is another matter. The initial problem in SUSI was in getting payments out, but now they are being made a lot quicker. Mistakes can happen, but it is disturbing for families who have been told they will receive a grant and then do not receive it. I welcome what the Minister said and will supply him with the details of the three cases. I hope this is not widespread and that SUSI can focus on this issue in order that no student or family will have to deal with this situation. I hope we can bring the three cases to a positive conclusion.

Deputy Ruairí Quinn

I thank the Deputy for bringing the matter to my attention. Some 42% of third level students are receiving some grant. The amounts of money involved are substantial. If the fault in administration is clearly seen to lie with SUSI, not the applicant, the responsibility lies with it to make good on its promise and certification. It may need to change its procedures in this respect, but the Deputy has brought to my attention something of which I was not aware. We will investigate the matter.

My intention is that the students will not be at a disadvantage. Having been told in good faith that they were getting the grant, they in turn made the necessary commitments and arrangements and they are now out of pocket.

Local Authority Housing Evictions

Deputy Dessie Ellis

Tenants in this State are not protected adequately from summary eviction or eviction with no justification, while local authorities can legally evict without due process. Section 62 of the Housing Act 1962 allowed local authorities to adopt a summary procedure for evicting local authority tenants without a requirement to justify the decision before the District Court or an independent tribunal. This section was deemed by the Supreme Court in 2012 to have been in direct contravention of the European Convention on Human Rights. Specifically, it was found in two cases to be in contravention of Articles 6 and 8 - the right to a fair trial and the right to respect for a person's private and family life, home and correspondence.

In April 2013 the Minister of State, Deputy Jan O'Sullivan, said a Bill to repeal section 62 would be before the Dáil in the same year. As the one-year anniversary of the statement approaches, we still have not seen the Bill. Currently, despite the ruling of the courts, there is legislative backing in the State for a local authority to summarily evict tenants without any real justification and in some cases in direct opposition to the public good and the rights of the individual and his or her family. The inaction of the Government on this issue is particularly troublesome, while a number of cases in recent times show that councils in some cases still evict people without a proper and fair hearing and without justification.

Even if section 62 were repealed, there is a need for legislative protection from eviction for tenants, given the devastating effect it can have on people and its potential to put them out on the street. In Kerry in November 2013 a pregnant woman who was unemployed and had problems with alcohol was evicted by the council and forced to find shelter in emergency homeless accommodation. That was despite the securing of a District Court order. The action was in violation of the UN bill of rights, which states that evictions must be a reasonable and proportionate response, subject to due process and fair procedures, and subject to a further state obligation to take all appropriate measures to ensure that evicted individuals are not rendered homeless.

This month, Sinn Féin councillor John Brady received an eviction notice from Bray Town Council. His family now has just under a month to vacate their home. They have lived there for 13 years without issue and are an important part of their community. The reason given was that they had done work to their home more than ten years ago when the council told them it did not have the funds to carry out the work. The eviction notice comes after a prolonged period of campaigning by Councillor Brady for the rights of local authority tenants in the area, which saw him undertake an occupation of the town council offices with two women who had been made homeless with their children.

Another case is that of Patrick Collopy of Limerick city. The 26-year-old, who is living in Bishop Street, has been told by Limerick City Council that he will be kicked out of the home he shared with his mother Rita until her death last year. After her sad death, aged just 50, Patrick received a phone call from the council telling him that he must vacate the house on the grounds of the two-year tenancy rule. He has been up to date with his rent and has never been in trouble with the law.

In those cases the evictions were not fair or reasonable and they were not in the interests of the wider public good. That is why we need protections for tenants and why section 62 must be repealed. The Private Residential Tenancies Board, PRTB, should be given a remit to work with council tenants as a residential tenancies board.

Minister of State at the Department of the Environment, Community and Local Government (Deputy Jan O'Sullivan)

I thank Deputy Ellis for raising this matter. I found the issues he raised most interesting. Each housing authority is responsible, under section 58 of the Housing Act 1966, for the management and maintenance of its own housing stock. It would therefore be inappropriate for me to comment on management issues relating to particular dwellings, as I have no function in individual cases and under the Local Government Act 2001 local authorities are, subject to law, independent in the performance of their statutory functions. It would be inappropriate for me to comment on the two specific cases raised by Deputy Ellis.

I wish to set out the position on the law under which local authorities repossess their dwellings following termination of tenancies. Section 62 of the Housing Act 1966 currently sets out a summary court procedure for repossession. The procedure withstood constitutional challenges over the years but the enactment of the European Convention on Human Rights Act 2003 resulted in further challenges. The Supreme Court declared in February 2012 that section 62 was incompatible with the State's obligations under Article 8 of the convention by reason of the absence of procedural safeguards where there is a factual dispute as to whether a tenancy has been properly terminated for breach of the tenancy agreement. Section 5 of the 2003 Act provides that a declaration of incompatibility does not affect the validity, continuing operation or enforcement of the statutory provision in respect of which it is made.

Nonetheless, I have reviewed section 62 of the 1966 Act in consultation with the Office of the Attorney General and housing authorities and the housing (miscellaneous provisions) Bill currently being drafted provides for a revised procedure for repossessing local authority dwellings. The new procedure will involve an independent hearing on the merits of the proposed repossession where there is a dispute about the basis for terminating the tenancy, which is often the case where anti-social behaviour is involved. The housing Bill, which also provides for the new housing assistance payment and a new tenant purchase scheme for local authority housing along incremental purchase lines, will be published in the coming months with a view to being enacted by the summer. Deputies will therefore have an opportunity in the near future to debate fully the new procedure for recovering possession of local authority dwellings. The Bill will also include measures to strengthen the powers of housing authorities and approved housing bodies to secure court orders to exclude from their dwellings and estates individuals engaged in anti-social behaviour.

The legislation currently going through the Oireachtas will bring tenants of approved housing bodies under the remit of the PRTB. In future, we wish to bring local authority tenants under the same remit. While we have not been able to do everything in the one go, in principle we agree that it is the next step in the process.

Deputy Dessie Ellis

I thank the Minister of State. She is aware that there is an urgent need for the District Court or an independent authority to judge each case on its merits and to be able to question the reason an eviction is being sought and not to merely give such decisions a rubber stamp, as was the case previously.

While we accept that evictions might take place for good reasons, such as anti-social behaviour, it is imperative that such mechanisms go through a robust legal process and are judged on that basis. The previous system was most unfair in that the decision was processed through the courts and could not be challenged, and there was no input from residents or tenants. No mechanism existed to scrutinise each case and examine it on its merits.

I agree with the recent Constitutional Convention recommendation that housing should be a right. We must have a proper procedure in place in the case of families being evicted. We must put in place a mechanism to deal with that and to follow up with families in such circumstances. Being evicted should not mean a person or family will end up homeless, and we must deal with such families in a proper way. That is the crux of the issue. Like others, I have experience of neighbours who cause major trouble in their areas and whom local authorities have sought to evict. I do not want a system that involves a rubber stamp; I want a proper, legal mechanism to deal with such situations. It is extremely important that such a system be above reproach and not involve hearsay.

Deputy Jan O'Sullivan

As the Deputy said, this is a balance we have to strike. There are some cases in which people make the lives of the people who live around them a misery. As the Deputy will be aware, we will make it easier in the residential tenancies Bill in that the person living next door would not have to directly confront the people causing the problem because, for example, a residents' association would be able to do it on his or her behalf.

I am in the course of preparing the housing Bill, which will be published and debated here before the summer recess. We will address the issue covered in section 62 of the Housing Act, which was found to be in contravention of the European Convention on Human Rights.

There are individual cases, as the Deputy said, that are distressing for the people concerned, but it is a question of getting the balance right. In the small number of cases in which people cause misery to their neighbours, we must have a mechanism in place to address that. We will have an opportunity to debate these issues when the housing Bill comes before the House.

Adoption Services Provision

Deputy David Stanton

I thank the office of the Ceann Comhairle for allowing me the opportunity to raise this issue and I am pleased that the Minister for Children and Youth Affairs is in the House to discuss it with me. This matter came to my attention a short while ago when two parents came to see me. They had adopted a baby a number of years ago from a foreign country in quite poor conditions. The parents were very loving and caring, loved their daughter and provided her with everything, as one would expect, but when she reached puberty things began to go wrong. She began to self-harm, developed an eating disorder and exhibited regression and other behaviours which were very disturbing. Obviously they sought assistance, and after quite a period a diagnosis was made that the child was suffering from post-adoption trauma, post-traumatic stress disorder or other mental health problems suffered by adopted children as a result of being put forward for adoption. Not every adopted child experiences these symptoms or issues. It is related to a child being separated from his or her biological mother at a very young age. These parents eventually discovered that they had to go to an agency in the UK which provided the specialist services needed, and progress was made, but it is a slow and painful process for everybody concerned.

I have a number of questions for the Minister in this regard. Has her attention been drawn to this post-adoption trauma issue? Has any research been carried out in this country on it? I have been informed that there are currently more than 300 referrals from this country to that agency in the UK. I have also been informed that there is not any specific service here to treat this condition. I am informed that intensive psychological therapy and counselling of a very specialist nature is needed to assist families and that not only the child but the family as a whole must receive assistance and support in cases such as this one.

I have checked with the HSE and other bodies and I have been informed that they do not provide this form of intensive therapy, which, given that families have to travel to the UK to avail of it, is quite expensive and traumatic. Will the Minister consider officially engaging private or charitable organisations outside the State to provide this level of service or to train people here in this level of service? I understand it is not possible to access that travel abroad scheme in such cases, even though the service is not available here. I have had it confirmed in writing from the HSE that the intense level of service is not available in Ireland.

I am sure the Minister will agree that this is a traumatic and serious condition. Thankfully, it does not affect every family with an adopted child, but the families who are affected need assistance and support. I am pleased that the Minister has come into the House to hear me speak on this matter and I would be grateful, following this debate, if she would arrange for this issue to be researched and examined to see what can be done in the Department and the health service to assist families who find themselves in this position.

Minister for Children and Youth Affairs (Deputy Frances Fitzgerald)

I thank the Deputy for raising this issue and I have listened to what he has had to say about it. I realise that he is concerned about this issue. Adoption can be, as he said, an emotional and sometimes traumatic experience and the effects can vary at different stages of the process. We know there are many successful adoptions - of that there is no question - but there is no doubt that a range of issues can arise post-adoption. The majority of adoptions in this country are inter-country adoptions, and a range of post-adoption issues can emerge which vary in severity and type. Families very often have successful adoptions, but we have all come across situations in which families, sometimes quite unexpectedly, have to deal with very difficult issues, often because of the very difficult start some of the children had and their pre-adoption experiences in residential centres. As more and more children are adopted at a later age, having had poor experiences before they were adopted, this issue is likely to be significant for an increasing number of families.

Under adoption legislation, when a child is placed on the register of inter-country adoptions, he or she is deemed to be, as the Deputy is well aware, the fully legal child of the adoptive parents - the couple - having the same legal status as any biological child of the couple born to them within their marriage. Accordingly, in the first instance, it is open to any adopted child and his or her family to access the full range of services which are currently available to all Irish children. These include specialist psychiatric and psychological services, educational services, health services, speech and language and disability-related services as well as having access to the normal GP and family support services in their areas, whether it be a local family resource centre or a CAMHS clinic. Children facing these issues clearly have access to the services that other Irish children have. These are adopted children with all the rights that other children have. There are some private services available as well, some of which specialise in attachment and behavioural problems, which the Deputy particularly mentioned.

The Child and Family Agency advises that there are a small number of adoptive parents who seek post-adoptive support from the adoption assessment team in their area. It is interesting that some of the parents who have been through the adoption assessment go back and look for support if difficulties arise, and these are often due to attachment-related behavioural issues. I want to inform the House that the agency also funds a post-adoption service operated by Barnardos in the Dublin area. Essentially, the post-adoption service would be available from the new Child and Family Agency plus the Barnardos service and the other range of services.

The Deputy made a point about specialist services and people having a particular skill. I would think Barnardos or any of the adoption agencies would have this skill to a degree. Regarding the range of expertise the Deputy described with respect to the service that is available in England - with which I am not familiar - and whether there is an equivalent service available here, the Barnardos service could perhaps be equivalent. It is the type of service we will see developing in the years to come if it becomes clear that there is an issue here, given the thousands of children who have been adopted from abroad, and that a more specialist service is needed. I can certainly have discussions with Barnardos, given that it already does some work in this area. The Deputy mentioned training; perhaps it could establish some links with the agency in England. I can certainly explore that possibility and see what training could be done that has not already taken place here.

It is very important that prospective parents are realistic about the psychological, behavioural and health issues which may arise post-adoption, particularly where a child has spent a period of time in a residential service in institutional care prior to adoption. The Child and Family Agency advises that the adoption assessment process that all applicants must undergo in order to be considered for adoption includes education, information and discussion about these issues with people who are going to adopt.

This is also very important. Couples who are adopting also need to show they can support the financial needs which may arise with regard to the child being adopted.

It is important we have increased understanding with regard to these issues and that time is spent during the assessment process discussing them with the couples. The Deputy asked about research. In 2007 the Children's Research Centre at Trinity College published a study on inter-country adoption outcomes in Ireland. This included discussion on post-adoption experiences and the publication is on the website of the Adoption Authority of Ireland.

I take the point made by the Deputy, and I have no doubt parents are looking for more and more specialist help with regard to the issues which arise in the children whom they have adopted. Very often these are attachment issues. I will take up the points made by the Deputy with Barnardos in the first instance and see whether the training needs outlined by the Deputy which must be met in Ireland can be developed.

Deputy David Stanton

I thank the Minister for her very comprehensive reply and I am very grateful to her for it and for the research put into her response. I am aware of Barnardos' adoptive parents' training network and the work done but I understand it is only in the Dublin area.

Deputy Frances Fitzgerald

Yes.

Deputy David Stanton

I am interested in whether it can be expanded nationally. In the meantime I am sure the Minister realises that parents with a hyperactive child who suffers from fears of abandonment, anxiety, aloofness and phobias and who is acting out in all types of distressing ways really do need assistance. I take the Minister's point that parents must be understanding of financial needs, but this is exceptional and it goes beyond this. It is something which is not expected and they need support. Will the Minister examine whether the treatment abroad scheme could be used in exceptional cases whereby children and families can get assistance in the UK if they find themselves in this awful dilemma whereby parents adopt a baby and love and care for the child for many years and all of a sudden, when puberty arrives, everything goes wrong? They need assistance and help.

I understand assistance and help is there to a point in Dublin through Barnardos but it is not available nationally. We need to move fairly quickly to put in place this assistance and help. I am sure the Minister can put herself in the position of these parents. It is harrowing and difficult. The behaviours described to me are very distressing. Boys are lying, stealing and do not integrate with others. According to research it appears adopted children suffered this trauma 13.3% more than children who are not adopted. There is a need for help and assistance and a focus on this. Most of the children who are adopted thankfully have no difficulties but for some the difficulties are severe and profound. I thank the House and the Ceann Comhairle for giving me the opportunity to raise this issue and I thank the Minister for responding.

Deputy Frances Fitzgerald

I would not underestimate the help that CAMHS and other specialist child and adolescent mental health teams can give.

Deputy David Stanton

They cannot.

Deputy Frances Fitzgerald

A well-trained psychologist or psychiatrist should be able to deal with some of the issues outlined by the Deputy in terms of attachment difficulties and the problems children, adopted or not, show. They can be similar. I take the point about some specialist help being available for certain cases and we will examine with Barnardos whether there is a way to move forward on this.