Dáil Éireann debate -
Wednesday, 25 Jun 2014

Vol. 845 No. 2

Topical Issue Debate

Hospital Consultants Recruitment

Deputy Ciara Conway

I am sorry to raise this issue but it is a crisis. This has been building for some time and it could have been avoided. I am sorry that anybody who has a serious skin complaint and who lives in the area served by University Hospital Waterford, UHW, does not have access to a dermatology service. There is no consultant dermatologist to serve the needs of the people who normally attend the former regional hospital and this is a disaster. Mr. Buckley is a retired consultant dermatologist but before he retired he went on record saying his position was untenable due to the volume of work. He stated: "It is a critical incident waiting to happen".

This is not only about a lack of consultants. Earlier this year, I raised the issue of up to 3,200 clinical letters that had yet to be processed. They have still not been typed or delivered. That means news, whether it is good or bad, has not been delivered to 3,200 people and that is not good enough.

Against the background of the letters waiting to be typed, a respected consultant having retired and another consultant going on maternity leave at the end of May, two posts lie empty while a third post is vacant. I have a letter from Mr. Richard Dooley, the hospital manager, which points out that a recruitment process is under way to fill the vacancies. The third consultant post is being re-advertised because it was not filled the first time and the word in Waterford is this was because the package being offered was not attractive enough. One has to wonder if the process will be better second time around. Is a position in the dermatology unit in UHW more attractive now than it was previously? In the meantime the dermatology unit in the hospital remains closed. Anybody with a serious skin complaint such as melanoma - the south east has one of the highest rates in the State - must be referred to a unit in Cork and this only applies to high priority cases. This serious issue needs to be addressed urgently.

Deputy Paudie Coffey

As a Waterford Deputy, I also have serious concerns about the cessation of dermatology services at UHW. In the past year, concerns were raised in the south east when the reorganisation of hospital groups was proposed. We received assurances from the Minister for Health and departmental officials that essential services would not be downgraded, which was welcomed. The Minister visited the hospital only recently.

However, the issue Deputy Conway has rightly raised relates to the future of dermatology services at UHW. I fully support what she said. Dermatology is a key health service for people suffering with serious skin problems, including melanoma. Regular monitoring of these lesions is essential for successful patient outcomes. UHW has three consultant dermatologist posts. One consultant has retired, one has gone on maternity leave and, in correspondence I have had with the HSE, it says it has consistently advertised for a third consultant without success. This has resulted in patients from the south east being referred to South Infirmary Victoria University Hospital Cork, SIVUH, increasing the burden on the dermatology unit there. This is not good enough. It behoves us as public representatives to voice serious concerns on behalf of the people of Waterford and the south east. These need to be addressed without delay.

I am not sure what the HSE and the Department can do because if they are advertising and no applicant is successful, we have a serious problem. One applicant was successful but when the contracts were drawn up, the applicant pulled out and we were left with no consultant in the region.

General practitioners have raised concerns regarding a backlog of communications between them and the dermatological unit in UHW. The HSE has addressed this by providing additional resources. However, this is a cry for help by two Waterford Deputies. The issue has been ongoing for a number of months. There has been continual correspondence between us and the HSE. It is with reluctance that we have brought our concerns to the House but we are seeking the direct intervention of the Minister of State and the help of the Department of Health to ensure these important positions are filled as soon as possible.

Minister of State at the Department of Health (Deputy Alex White)

I thank the Deputies for raising the issue and for affording me the opportunity to advise the House of the arrangements made for patients requiring dermatological services at UHW.

I assure the House that the HSE and the South-South West Hospitals Group are committed to ensuring the continuation of dermatology services for people in the south east, notwithstanding the temporary staffing and recruitment difficulties being experienced in UHW. I understand every effort is being made to fill the three vacant consultant dermatologist posts, two of which arose recently, one due to a retirement and the other because of maternity leave. Efforts are continuing to recruit temporary replacements until the posts are filled on a permanent basis. In the interim, UHW has put in place an arrangement with the dermatology service at South Infirmary Victoria University Hospital, SIVUH, in Cork. Arrangements for urgent referrals for a dermatology service, for example, melanomas or suspicious pigmented lesions and patients requiring emergency dermatology review, should be referred to the dermatology department at SIVUH or to the nearest dermatology unit, as appropriate. Patients with an established diagnosis of melanoma will be followed up at a designated clinic in the dermatology department, SIVUH. In addition, complex dermatological cases such as those receiving biologic agents for psoriasis will be followed up at a designated clinic in the dermatology department, SIVUH.

I understand UHW will ensure ongoing and close linkages between its dermatology department and that of SIVUH through the making of arrangements for the clinical nurse specialist from UHW's dermatology service to attend the Cork-based clinics. In addition to the SIVUH arrangement, the hospital is also endeavouring to make arrangements with other hospitals in the surrounding regions to take some of the patients. All these arrangements will be kept under review and GPs and patients-clients will be updated accordingly.

I share the hospital's regret and that of the Deputies that, in the current circumstances, dermatological services have been curtailed. It is important, however, to acknowledge that the HSE has the capacity to recruit consultants and other front-line staff where there is an established service need, notwithstanding the requirement to reduce the numbers employed across the health service to meet fiscal and budgetary targets. In light of the difficulties experienced by some hospitals in filling certain consultant posts, the Minister for Health established a working group, chaired by Professor Brian MacCraith, to carry out a strategic review of medical training and career structure. The review is aimed at improving graduate retention in the public health system and planning for future service needs. To date, the working group has issued two reports. The first report submitted in December focused on improving the training experience for trainees. The second report submitted at the end of April reviewed career structures and pathways following completion of specialist training. The final report, which will deal with workforce planning, is due to be submitted by the end of this month.

I again thank the Deputies for the opportunity to discuss this pressing matter and I assure them and the House that the HSE is making every effort to secure the services of permanent consultants. While the closing date for applications for the third vacant post is tomorrow, 26 June, I understand the HSE hopes it may recruit two consultants under this process. In the interim, every effort will be made to continue to provide urgent services to patients.

Deputy Ciara Conway

While I thank the Minister of State, I regret that the Minister for Health, Deputy James Reilly, is not here because the response was in direct contravention of what we were promised in the Higgins report. According to the response, the dermatology clinical nurse specialist will travel to Cork for clinics. We were told patients would not have to travel but that consultants would come to them. What plan, if any, is in place for the specialists in Cork to come and serve the needs of the people of Waterford? This is not good enough. It is not the health care to which we are entitled and which we were promised in the Higgins report. It makes a mockery of the name change to University Hospital Waterford which rings hollow in the wake of this mess. The south east, in which the hospital in Waterford is the leading cancer specialist centre, has the highest rate of skin cancer in the country, yet we do not have a consultant dermatologist. I ask the Minister of State to ask the Minister to do something very quickly to address this issue because this is contrary to what we were promised in the Higgins report.

Deputy Paudie Coffey

The HSE knew full well for some time that one consultant was due to retire, with the other to go on maternity leave, while the third post was advertised. I appeal to the Minister of State to use his good offices and officials to ensure the HSE will do all in its power to ensure the consultant posts are filled as soon as possible. The irony is that the dermatology unit in University Hospital Waterford was physically upgraded. The physical infrastructure is in place and we need the specialised staff which the people of Waterford and the south east deserve. We were assured of this in the House and correspondence when the new hospital groupings were established. Although we were informed that when specialist services were required in University Hospital Waterford, they would be delivered, it is not the case. While the HSE has stated it is a temporary problem, a temporary problem can lead to a very serious one for many patients who do not have access to these essential services. I want the Minister of State to take on board what Government Deputies are saying and ensure the problem is addressed as soon as possible.

Deputy Alex White

I very much take on board what Deputies Paudie Coffey and Ciara Conway have said about this matter and the urgency attached to it. The closing date in respect of the third vacant post is tomorrow and the HSE hopes to recruit two consultants under this process. The matter is being addressed as urgently as is required and I accept what the Deputies said. On the future of dermatology services in Waterford, Deputy Paudie Coffey's statement on the physical infrastructure in the dermatology unit in University Hospital Waterford demonstrates the intention on the part of the HSE, the Government and the Minister to maintain these critical services in Waterford. There is no question about the intention to maintain these important and necessary services in Waterford. This is a temporary difficulty in the recruitment of consultants. As I indicated, there are issues about workforce planning, to which Professor MacCraith's report is relevant. I very much hope the recruitment process can be expedited and fully accept and share the Deputies' views.

Mental Health Services Provision

Deputy Seán Ó Fearghaíl

I am grateful to the Leas-Cheann Comhairle for selecting this matter which is of concern to all Members. We are aware that the Mental Health Commission has published its 2013 report today and of the concerns expressed in it about the 91 admissions of children to adult mental health facilities during 2013. We all have experience of the impact on families and individual children of the requirement to seek such help. We are aware of the inordinate difficulties with which families must contend, first, in dealing with a child who has mental health problems and, second, in dealing with a system that is, regrettably, not always as sympathetic or proactive as one would wish. To find, in addition to all of these problems, that so many children were placed in completely inappropriate adult settings at a time when, it appears, there were vacancies in the appropriate settings is particularly concerning.

The report indicates that although in 2013 there was provision for a maximum of 48 beds, they were not filled at all times. People were told beds were unavailable because the child and adolescent community mental health, CAMH, service does not operate an emergency response service, particularly at weekends. While we support the Government's ambition to develop and deliver up to 108 beds by 2015, we must judge the service based on what is available today. All the indications are that even the limited number of 48 beds are not in use full time and not accessible by those who need them.

Deputy Dan Neville

I thank the Leas-Cheann Comhairle for allowing me to raise this issue which, unfortunately, we have been raising for over a decade and a half. During that period the professionals have expressed concern about the proper care of children in need of psychiatric in-patient care. Having children, some under ten years of age, in the same ward as people aged 30 to 90 years is deemed by all psychiatrists, psychotherapists and general mental health service staff to be totally unsuitable and detrimental to their recovery. We must be concerned about the high number of children being admitted to adult psychiatric units. In 2013 there were 91 admissions to adult units, involving 83 children.

A Vision for Change 2006 included the recommendations of the expert group that mental health inpatient services for children up to the age of 18 years be provided only in dedicated child and adolescent psychiatric inpatient units. The HSE has failed to meet the code of practice on the admission of children under the Mental Health Act 2001, as drawn up by the Mental Health Commission. The code of practice specified that from July 2009 no child under the age of 16 years should be admitted to an adult inpatient unit and that the same should apply from December 2010 to any child under 17 years and from 2011 to any child under the age of 18 years.

The length of stay varied. In this regard, Deputy Seán Ó Feargháil was correct to raise the issue of emergency care at weekends. With 60 beds available and 48 in use, 12 were available, although the statement told us none was available. Some 105 beds are promised by 2015.

Perhaps the Minister of State might comment on the progress he expects to be made on the plans. I also draw attention to the fact that in the original plan 20 beds were to be provided in the mid-west region, but that has not happened and we are told it will probably not happen at all now. The Minister of State might have some information on this.

Deputy Alex White

I thank both Deputies for raising the issue for discussion. The Government has prioritised the reform of mental health services in line with A Vision for Change and is committed, in particular, to the delivery of more and better quality care in the community. To this end, funding of €70 million and 890 posts were provided to develop community mental health services in 2012 and 2013. In budget 2014 the Government again committed to ring-fencing a further €20 million for 250 to 280 posts to be recruited by the end of 2014. This means that despite serious resource pressures overall, funding of €90 million has been made available since 2012, specifically earmarked for new mental health and suicide prevention initiatives.

Acute inpatient admissions of children and adolescents are prescribed in A Vision for Change as being to age appropriate acute inpatient units which are approved centres registered with the Mental Health Commission. The provision of inpatient beds is an integral component of the range of services required to appropriately meet the needs of young people. Interventions are provided through community mental health teams in the first instance and, if required, access to the relevant inpatient service is provided. Nationally, inpatient bed capacity has increased from 12 beds in 2007 to 56 at present. There are 16 beds in Dublin, 20 in Cork and 20 in Galway, an increase of 400% in seven years. In 2008, 25% of admissions of children to HSE acute inpatient units were to age appropriate child and adolescent acute inpatient units. By 2013, this had increased to almost 80% of admissions. The Minister of State, Deputy Kathleen Lynch, considers - and I agree - that this is still not acceptable, nor is it in line with Mental Health Commission regulations which require that all children under 18 years be admitted to age appropriate acute inpatient facilities, except in exceptional circumstances. However, Deputies will agree that significant progress is being made on this matter.

The admission of children and adolescents to age appropriate child and adolescent mental health services, CAMHS, acute inpatient units reflects best practice and supports better outcomes for individuals. This is a key priority for the HSE and its service plan for 2014 includes a specific quality key performance indicator to ensure the focus remains on meeting this objective. Community child and adolescent mental health teams are the first line of specialist mental health services for children and young people. They provide acute secondary mental health care in the community. The assessment and intervention by such teams are determined by the severity and complexity of the presenting problem. The ring-fenced funding allocations for CAMHS I have outlined allowed for the provision of an additional 230 posts in 2012 and 2013, of which 80% are in place. Recruiting to the remaining posts is ongoing.

The foregoing is proof in real terms of the Government's commitment to the continued development of mental health services for children and adolescents. It is in this context that the Minister of State will examine in detail the report of the Inspectorate of Mental Health Services to determine the scope for further improvements and ensure the HSE can continue to make progress towards achieving the desired best practice as resources permit.

Deputy Seán Ó Fearghaíl

I accept that progress has been made. I also accept the expertise of my esteemed friend, Deputy Dan Neville, who has campaigned in this area for many years. However, people's eyes glaze over when they hear talk about the millions of euro expended in it. What they want to see is tangible improvement. They want to their adolescent children being able to find centres where they can be cared for when difficult and traumatic circumstances mean that care cannot be provided at home and to ensure the safety of the child and the family. All Members of the House went before the people to campaign for the amendment of the Constitution in the children's rights referendum. We said the rights of children had to take centre stage. I would love the Minister of State to provide the House with a commitment that in 2014 no child under the age of 18 years will be committed by CAMHS or any other State agency to an institution which is not age appropriate.

Deputy Dan Neville

I, too, recognise that the Government has allocated considerable funding to mental health services as promised and that progress has been made. However, I question the effectiveness of the HSE in using the funds to obtain maximum improvements to services. Does the Minister of State accept that one of the key aspects is to establish an emergency service, especially at weekends? Of all admissions, 23% took place on Saturdays and Sundays when emergency services were not available. If emergency services were to be introduced immediately, this would go a long way towards correcting the issues Deputy Seán Ó Fearghaíl and I have raised. We urge the Minister of State to ensure the moneys allocated to the HSE are applied to emergency services.

It is not a large number of children we are discussing, but it is a vital cohort for whom the service must be provided. I again draw attention to the concerns of the people who know about the admission of minors, some of them children under the age of ten years, to adult mental institutions. These children are in serious need of inpatient care. We do not want to see people going to mental institutions and units, but on occasion it is absolutely necessary. These are acutely ill persons in need of the maximum treatment leading to recovery. If we were even to get a commitment to the introduction of emergency services today, it would be progress.

Deputy Alex White

I thank the Deputies for their contributions. I understand Deputy Seán Ó Fearghaíl's point that sometimes people's eyes glaze over when figures are provided. Behind the figures, however, lies a considerable improvement in the real and actual experiences of people who need the services. For example, where more staff and resources are provided, even though we describe them to the House in terms of numbers, considerable improvements in the way the service is received are experienced by those who need it. I accept what the Deputy said about the objective of ensuring no child under 18 years should be admitted other than to an age appropriate, acute inpatient facility, other than in exceptional circumstances. That is the objective the Minister of State, Deputy Kathleen Lynch, is committed to achieving.

Deputy Dan Neville makes the point about the actual use of funds, which he understands very well. He is right to say those who know the services should always have their views taken into account and implemented as far as possible. Something in the order of 17,000 children are availing of CAMHS and all community teams screen the children and adolescents referred to their services on the basis of urgency of need. Children and adolescents in need of an urgent appointment are seen as a high priority, as one would expect, while those with a lower acuity may have to wait longer.

I accept what was said about the configuration of services and the importance of emergency services and will communicate everything the Deputies have said to the Minister of State who is very engaged with the issue and on which she has made considerable progress.

Mental Health Services Provision

Deputy Caoimhghín Ó Caoláin

Gabhaim buíochas leis an gCeann Comhairle as an deis seo chun ceist fíor-thábhachtach a phlé.

It is a very serious matter that nine clinicians in the area of mental health in the Carlow-Kilkenny, south Tipperary area have withdrawn their confidence in the HSE's management of the service. They cited nine suicides in the area over a period of just 17 months, as revealed in an investigation aired last Sunday on RTÉ's "This Week" programme. I have raised this as a Topical Issue, while our party leader raised it with the Taoiseach yesterday, because the HSE and the Minister of State with responsibility for mental health services, Deputy Kathleen Lynch, must account publicly for the fact that these clinicians believe their concerns have not been taken seriously, despite being raised repeatedly.

In a letter received by RTE under freedom of information, the nine doctors wrote to the Minister of State, Deputy Lynch, to express "serious concerns" about local services in light of the nine fatalities. The doctors questioned the safety of governance in the service and said they felt devalued and ignored in their attempts to raise their concerns internally in the HSE. That a group of front-line clinicians should feel strongly enough to co-sign such a letter is alarming. The clinicians highlighted nine deaths in the period from August 2011 to January 2013. What makes this most worrying is that they raised their concerns first in November 2012 and by the following June they were writing to the Minister of State to say that those concerns had not been properly addressed. The clinicians said they were not informed of the outcomes of HSE reviews of these tragedies. The fatalities concerned included three suicides of inpatients by the same means, four suicides in home-based settings, and a further suicide in a crisis house.

I have a number of specific questions. Did the Minister of State act on the consultants’ call to intervene with the HSE to ensure proper investigation of incidents and that review findings would be properly communicated and appropriate reforms implemented? Did the Minister of State accept the contention of the HSE briefing document supplied to her, which claimed the fatalities in the service are not out of line with figures for the preceding 11 years, citing Central Statistics Office statistics for Counties Carlow and Kilkenny and south Tipperary? What does the Minister of State say to retired consultant Alan Moore, who said on RTÉ that CSO figures do not reflect the number of suicides occurring in hospitals, which he believes is unusually high? Can the Minister of State confirm that an investigation is being carried out by the Irish Mental Health Commission into governance structures within the service and that a separate review is under way by Dr. Colm Henry of the national lead clinical directors programme?

It is also serious that the local consultant group has described clinical governance systems in the area as unsafe and that participation in them would be a dereliction of duty. This is serious. These revelations came just three days before today’s publication of the annual report of the Mental Health Commission, including the report of the Inspectorate of Mental Health Services. That report shows that only 44% of psychiatric hospitals and mental health facilities are compliant with staffing level regulations. I ask the Minister of State to answer the questions posed.

Deputy Alex White

I am taking this matter on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch. I thank the Deputy for raising this issue for discussion. As Deputy Lynch has indicated on several occasions in the past, the HSE has been reconfiguring mental health services in the Carlow, Kilkenny and south Tipperary, CKST, area to provide a modern mental health service in line with the recommendations in A Vision for Change, including the strengthening of community mental health teams for adults and children. It is acknowledged by the HSE, and by the Minister of State, that the CKST mental health services have undergone a radical reform programme and that considerable work has been done to date to achieve this fundamental objective. Significant additional investment has been provided to underpin this reform. It is also noteworthy that the mental health resources allocated to CKST on a per capita basis are some of the highest in the country.

Arising from concerns at both clinical and management level in this area, two reviews have been undertaken in recent months relating to governance and patient safety issues in the CKST service. In 2013, the HSE quality and patient safety, QPS, division commissioned a review of governance structures within CKST mental health services. The findings of the review are being finalised. In March 2014, on the initiative of the Mental Health Commission, the Inspectorate of Mental Health Services carried out a targeted intervention in safety and governance for service users in CKST. The outcome of this comprehensive review of service delivery in the area will be reported to the executive of the Mental Health Commission as soon as possible.

Following completion in 2013 of a national QPS audit by the HSE of sudden and unexplained deaths within community mental health services, the HSE mental health division has progressed implementation of its recommendations over the past year. These include engaging with the Mental Health Commission to consider how to encompass the expansion of community services within the notification process and offering additional training in HSE incident management policy and procedures to staff in the mental health services, which incorporates a formal recording and reporting process. I agree with the Minister of State, Deputy Lynch, who welcomed the significant governance and management changes which have taken place in the CKST area in recent times, a process that is continuing. We recognise also the significant leadership being provided by consultants, other health professionals and HSE management in this process. We share the common goal of having the best possible mental health services in this particular area, as we are doing elsewhere in the country. We urge, therefore, that all parties in the CKST region facilitate implementation of the recommendations that may arise from the reviews when these are finalised, in tandem with co-operating on all remaining policy and service management issues reflected in A Vision for Change. Our priority must be to continue to strengthen the community mental health teams in this area to meet the needs of all service users.

Deputy Caoimhghín Ó Caoláin

I appreciate that the Minister of State is delivering a response on behalf of his colleague, but the critical questions were about whether the Minister of State had acted on the consultants' call to intervene with the HSE to ensure proper investigation of the incidents and whether the review findings would be properly communicated, with appropriate reforms implemented. The Minister of State said that the findings of the review commissioned by the HSE quality and patient safety division are being finalised, that the Inspectorate of Mental Health Services carried out a targeted intervention into safety and governance for service users in CKST, and that the outcome of this comprehensive review of service delivery in the area would be reported to the executive of the Mental Health Commission as soon as possible. This is work in progress and has not reached a critical point. If we were to look at the shelves for matters pertaining to Carlow, Kilkenny and south Tipperary, we would find reports aplenty that have not been acted on. There is a serious problem in progressing with the required speed reviews and reports that are pertinent to the level of service provision in mental health services and across the health services generally, particularly where there is the potential for loss of life. On many occasions we have had documented tragic outcomes in respect of the general hospital network, but we are talking specifically about service users within the mental health services. In the view of the clinicians, there is an inordinate level of suicide in this area. It is a hugely worrying situation when clinicians of experience act with such unanimity. It is an alarm bell ringing loud and clear for all of us to hear. I must ask the Minister of State to speak to his colleague, Deputy Kathleen Lynch, and to appeal to her to make the necessary interventions of which I have spoken and to encourage the conclusion of the process of review and reporting and, most critically, to oversee and ensure implementation of all recommendations at the earliest possible date.

Deputy Alex White

That will certainly be done. The Minister of State, Deputy Lynch, will do so. I reassure the Deputy and the House in respect of the apprehension that reports could be prepared and concluded with no action taken. Following the completion of the QPS audit in 2013, the HSE mental health division has been progressing the implementation of those recommendations. As well as the two examples I gave in my initial contribution, I should report to the House on tangible work that is ongoing and critically important in this area.

First, the mental health division has ensured there is engagement with the Mental Health Commission to consider how to encompass the expansion of community services within the notification process. Second, additional training is being offered in HSE incident management policy and procedures to staff in the mental health services, which incorporates a formal recording and reporting process. Third, all executive clinical directors, area directors of nursing and integrated service area, ISA, managers have been written to and reminded of their responsibilities in regard to the notification and investigation of sudden and unexplained deaths, in line with legislative requirements, policies and procedures. Fourth, all of the mental health services are reviewing their internal clinical protocols to ensure the clinical director is formally advised in writing of an incident and that this notification is formally recorded. Fifth, the national mental health division has formally appointed an assistant national director for quality and patient safety and he is formally notified of all sudden and unexplained deaths, in accordance with the policy requirement, with immediate follow up put in train. Sixth, all executive clinical directors and ISA managers have received the final quality and patient service audit, QPSA, report and have been reminded of their obligations in regard to the creation and management of records of incidents.

Modern Language Teaching

Deputy Simon Harris

I am grateful to have the opportunity to raise the issue of the need for the Minister to provide an update on the provisions in place to assist primary schools in the teaching of foreign languages within our education system. Every Member will know and appreciate the importance of modern languages and of familiarising ourselves with such languages, particularly in the ever more globalised and interdependent world in which we live and in which our economies and societies operate. We also know, and this is clear both from the point of view of experts and anecdotally, that the earlier a person learns a language, the greater his or her ability to soak it up, absorb it and become familiar and fluent with it.

I wanted to raise this issue because I visited a school in County Wicklow recently, the Jonathan Swift national school in Dunlavin, and was struck by the efforts being made there to teach the school pupils Spanish. I wish to share some of the comments made by the school principal in an e-mail to me. She said that the children are very much at a disadvantage for their future careers because of the lack of other language skills. To this end, the school was part of the initiative and pilot scheme for modern language tuition, which has since been abandoned. It had built up a lot of resources and skills from being part of this programme, so decided to keep it going using its own resources. The children love learning Spanish and it has improved their attitude to learning Irish greatly, which they now see as another language. This school has been extremely creative. It has a Spanish secretary within the school, it has twinned with a Spanish school and the students come on exchanges. I visited during a recent exchange when there were teachers and students from Spain there. The school has been creative and has developed a culture and relationship with other schools.

I understand the modern languages scheme was a pilot scheme and know there is a body of work being done in regard to literacy and numeracy and how modern languages can fit into that. However, there is a need to report progress on this. This is not just my opinion. As recently as the week before last, the Minister for Education and Skills urged more Irish students to learn Chinese and pointed out the importance of Mandarin as the most widely spoken language in the world. He also spoke about how big a market the Chinese market is from the economic point of view. Therefore, I know the Minister and Minister of State recognise the need for educational skills in the area of languages.

However, when it comes to where we stand globally and in regard to our European colleagues, the situation is embarrassing. An OECD report from last year, June 2013, entitled Education at a Glance, used the school year 2010-11 as a reference point. It found that modern foreign languages account for an average of 6% of compulsory instruction time across the OECD at primary level and 7% of compulsory instruction time across the EU, in contrast to a near negligible amount in Ireland for that age group. When we look at the table on page 18 of that report, we see the "No Grade" that Ireland gets.

I know the situation here is further complicated by the fact that our students, quite rightly, learn Irish as well, that there is a limit in terms of the length of the school day and that the Government has focused on numeracy and literacy. I understand the rationale behind that. However, we must recognise the importance of modern languages. We must work out how we can fit this into our curricula and into numeracy and literacy, because foreign languages can be dealt with in that context also.

Learning and introducing people to languages at second level, when their European and global peers have been introduced to a foreign language perhaps ten years earlier, puts our students at a disadvantage. The Minister of State and his ministerial colleagues and people in the Department of Jobs, Enterprise and Innovation will have seen that when it comes to trying to fill vacancies, including the PayPal jobs in Louth, there is a demand and requirement for applicants to have a second modern language. While we cannot fix this overnight with our primary system, we can send out a clear message that we want our students to be more proficient in modern European languages and languages like Mandarin Chinese, as the Minister suggested.

Minister of State at the Department of Education and Skills (Deputy Ciarán Cannon)

I thank the Deputy for raising this matter as it provides me with the opportunity to outline to the House the position in regard to the teaching of modern languages. There is considerable investment by the Department in language provision across all levels of education and officials are currently working on the development of a language strategy which will address language learning at all levels of education, including primary level.

At primary level, the Department's policy, as detailed in the Government's National Literacy and Numeracy Strategy 2011, is that pupils will learn two languages, English and Irish. The National Council for Curriculum and Assessment is currently developing an integrated language curriculum for primary schools, in the context of the national literacy and numeracy strategy. A consultation on the draft curriculum from infants to second class is under way and will remain open until 11 July.

The new curriculum is drafted in the belief that language plays a vital part in the expansion of the student's conceptual framework and growth of the student's conceptual knowledge, dispositions and skills. The draft curriculum underlines that language learning is a developmental process, in which students engage at their individual rate or pace. Learning languages, whether at home, in an early years setting, in school or in community settings enables children to extend their linguistic experiences and to deepen their understanding of and connection with culture and heritage.

Within the draft language curriculum, integration is defined in terms of interaction between the three strands of oral language, reading and writing; connecting language across the curriculum; and the transfer of skills learned across languages. Although discrete language skills associated with each strand are essential, engaging with all three strands together enables the child to become a more effective communicator. In this context, it is important to note that Ireland is a linguistically and culturally diverse country which has two official languages, English and Irish. However, most schools and classrooms include children whose home language is a language other than English or Irish.

Languages, by their nature, are interconnected and developing skills in one language will help children develop similar skills in another language, provided they have adequate exposure to the language and adequate motivation and opportunities to engage with the language. An explicit focus on integration between languages enables children to make cross-lingual connections and to develop an awareness of how language works, which leads to learning efficiencies for students. The intention is that the new integrated curriculum will provide primary students with an excellent base to transfer to learning modern foreign languages in post-primary school.

Deputy Simon Harris

I thank the Minister of State for that informative and timely reply. I welcome the development of a language strategy and look forward to seeing how that will interact with our numeracy and literacy strategy.

The Minister of State correctly pointed to the complexity of the Irish education system, in terms of this country having two official languages, both Irish and English, and I understand from engaging with parents and teachers that our curriculum at both primary and second level can be quite jam packed. However, we must look at how we integrate the learning of modern languages within the context of our overall numeracy and literacy skills within our schools. To that end, the most constructive line in the Minister of State's response is the one that stated: "However, most schools and classrooms include children whose home language is a language other than English or Irish".

This is about how we harness the potential of the diversity within our classrooms, where we have children in our classrooms whose native tongue is not Irish or English. Rather than making them conform to the school setting, how can we encourage the other children to benefit from the experience of having a linguistically diverse classroom? This is something we should examine. We must get to a point where our students are leaving primary school not as linguistic scholars, but with a foundation in European languages or languages like Mandarin Chinese. This is perhaps a policy decision that needs to be taken.

I call on the Minister of State and his officials to look at the example of Jonathan Swift national school, which has not received extra funding. The funding stream has gone since 2012, but it has continued in a progressive and creative way to keep the links with the Spanish school, to keep the twinning programme going and to keep up the exchange. It is not just an exchange of language.

It is also an exchange of culture. I would also encourage the Department, in the context of European funding for twinnings, to look at how we can encourage more schools to twin with other European schools. Much of the debate to date has been about why the pilot scheme was axed and what would replace it but let us be creative about embracing foreign languages. There are many resources in schools, including secretaries, ancillary staff and students who come from foreign countries. Let us look at how we can harness those resources and pull everything together in the context of our literacy strategy.

Deputy Ciarán Cannon

I agree completely with everything Deputy Harris has said. The wonderful twinning opportunities available through the Comenius project are only now becoming apparent to a number of schools across the country, which allow for intercultural exchanges between schools across the teaching profession and the student body. I agree with the point the Deputy makes about availing of the opportunity to benefit from the fact that there are many children in school here whose native language is neither English nor Irish. There are significant opportunities that have yet to be developed in that area and we need to think through how we can do that. We should never underestimate the power of schools to innovate and provide new learning experiences with very few resources. I have seen that happening in the context of technology and digital learning in schools. When teachers and students combine their innovative and creative skills, they can be quite powerful. What has been achieved in many schools in the field of digital learning could also be replicated in the area of enhancing foreign language skills.

As I pointed out earlier, a new language strategy is being developed which, when finalised, should ensure that language learning is considered as a coherent whole across all levels of education. At primary level the focus of the new curriculum, for the moment, must be on English and Irish. The integrated approach should help children to transfer skills acquired in one language to another language and so establish a sound foundation for the learning of a foreign language in post-primary school. I must reiterate the importance of a continuing focus on the implementation of the literacy and numeracy strategy.