Adjournment Debate

Autism Support Services

Deputy Thomas P. Broughan

The Minister of State is aware of the urgent need to provide full local day services for young school leavers on the autistic spectrum in Dublin Bay North and Fingal as we both attended a productive meeting with representatives from the HSE in Swords a few weeks ago which I understand Deputy Clare Daly organised. I, of course, wish the Minister of State well in his appointment to such an important portfolio. Given his knowledge of our shared constituency of Dublin Bay North, I sincerely hope he urgently progresses the commitments already set out in the programme for partnership Government. The programme states that the Government is committed to ensuring that all 18 year old school leavers with intellectual and physical disabilities continue education or training opportunities. However, the programme does not specify that these continued education or training opportunities should be delivered as an immediate follow-on to second level education.

I was informed by way of a parliamentary question that planning for the service provision for approximately 1,500 young people with disabilities and autism who will require continuing health-funded supports on leaving school or rehabilitative life skills training this year commenced in September 2015 but the 2015 cohort of school leavers were left, as the Minister of State knows, without appropriate local full-day services when Gheel Autism Services was unable to provide placements. The parents and children I regularly meet and represent were, and still are, very distressed by this, and I know the Minister of State has also met them.

What strikes me most are the experiences of parents of school leavers on varying points of the autistic spectrum. Many of the parents say their children had previously benefitted from investment in schools, special needs assistants and specialised places in local school services and they had seen improvements in their children's behaviours due to the level of service provided and especially the established routines so necessary for the cohort of young people in the service. However, since the upheaval and uncertainty caused by having no local full-day service available to them, many have reported regressions in the children's behaviour since September 2015.

The Minister of State's Department and the HSE informed me that €7.25 million has been allocated from the €1.56 billion health budget to provide services to the estimated 1,500 school leavers concerned. A HSE response stated that 2014 saw significant improvements in the way in which the health service responded to the needs of young people leaving school or exiting rehabilitative training and yet the lived experiences of the families to whom I refer shows otherwise. The reply went on to state that the HSE's mapping exercise identified 1,340 persons requiring a day service in 2015 and that capacity was available to just 508 individuals. This means that 832 young people were then placed in alternatively funded services. I am sure the Minister of State would agree that the number of young adults without a full-day local service is unacceptable and not in line with commitments in the programme for Government. While alternative services were provided, the parents have reported to me that they are wholly inappropriate for the needs of their children in terms of location, the time allocated and the quality of the service provided.

The Minister of State and I heard what the parents had to say about the existing provision, which went nowhere near providing a full-day local service. These families and young school leavers need well-resourced, local and needs-appropriate full-day services. Service providers such as Gheel and Praxis must be properly resourced so they can meet the needs of the families in their catchment areas and forward planning of at least four or five years in advance must be in place to ensure that there is a sufficient supply of places to meet the growing demand.

I understand the parents have outlined a number of issues with the proposed service of Praxis Autism Initiative and Prosper Fingal, including the need for a qualified nurse or a psychiatric nurse in each of the service providers. They have also requested that a floating autism specialist move between each of the service providers to review progress, measure goals, behaviours, etc. A similar initiative is employed by the National Learning Network. Respite services are, of course, required to give families much-needed respite time, as is an out of hours service.

I hope in his reply the Minister of State will specifically address the questions he and I asked our HSE colleagues a few weeks ago. Will he immediately provide more resources to Gheel Autism Services and other service providers and improve planning for future needs? September 2016 is just a few months away. Will all of the 2015 and 2016 graduates have places in their preferred local service providers? The HSE estimate of 1,500 young people with disabilities seems like a low number, given the large number of families I and the Minister of State have represented. A north-east HSE official spoke to us about its strategy for 2021 for a well-resourced provision for these young citizens. Has the Minister of State read the strategy? Would he immediately begin to implement it? Has he had a one-to-one meeting with the Taoiseach to discuss the priorities for the Dáil term?

I have the programme for partnership Government here. Item No. 24 refers to day services for school leavers with disabilities and the programme makes a commitment to address this matter once and for all. I note the Minister of State has only been in office for three weeks and I accept he is settling in and acquainting himself with the many demands his position entails but he now has the opportunity to examine this issue in his new capacity as Minister of State. I hope he hits the ground running, takes urgent action and looks after this cohort of most vulnerable young Irish citizens.

Minister of State at the Department of Health (Deputy Finian McGrath)

I thank Deputy Broughan for raising this important issue. I am pleased to outline the position on services for young people with disabilities who need continuing support from the health service on leaving school, including young people with autism in Dublin Bay North and Fingal.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports to meet their needs and plan their lives.

The commitment to disability services as outlined in the programme for partnership Government is guided by two principles, namely, equality of opportunity and improving the quality of life for people with disabilities. With regard to the provision of day services for school leavers with disabilities, including those with autism, the programme for partnership Government states that the Government is committed to ensuring that all 18 year old school leavers with disabilities have continued education or training opportunities.

I recognise that this transition phase is a time of worry and uncertainty for families and I identified the needs of school leavers as one of my main initial priorities for disability services. I have already commenced meetings with the HSE on this issue. One of the first things I did on taking up office was to meet the HSE to obtain a detailed brief on this and a number of other issues. To ensure that the needs of school leavers are met in 2016, funding of €7.25 million is being allocated by the HSE to provide appropriate services and supports.

Once-off funding of €2 million is also being provided for the refurbishment and fit-out of buildings to provide suitable service locations by September, based on an assessment of the physical capacity within existing services to accommodate the additional numbers. A standardised process for the identification of support needs has been put in place and a detailed picture of each individual has been built up in order to ascertain his or her needs and preferences.

This process is almost complete and letters will be sent to the chief officers of each HSE community health care organisation shortly with details of the resources to be allocated for each individual young person. Notification will also be issued of the once-off funding for building refurbishment and fit-out to enable locations to be ready for September. It is also the intention that all young people and their families will be contacted by the end of May, something with which I strongly agree because we need to have these services planned for and ready by the end of May, with confirmation of the service which will be available to them from September. I have listened to what Deputy Broughan said and I will meet senior HSE officials and the Minister for Health next week to discuss many of the issues he has raised.

Speech and Language Therapy Provision

Deputy Dara Calleary

I thank Ceann Comhairle for allowing me to raise this Adjournment matter and the Minister for Health, Deputy Simon Harris, for coming to the House to take it. I refer to the provision of speech and language therapy services in County Mayo, in particular Ballina. A number of parents have brought to my attention that there is a serious deficiency in the delivery of the service. I tabled a parliamentary question about the same. The difference between the reply received and the reality in Ballina is quite stark. It shows that it is quite often the case that managers in the HSE seem to live in one universe while parents and others have to deal with the reality of a situation.

The initial response concerned a referral that was made to the speech and language therapy services in March 2015. The child was seen in August but for nine months, there has been no intervention. The parents are frustrated in terms of trying to get a service, access information and receive appropriate care for their child.

There has been no intervention and there has been frustration in terms of trying to get service, access information and to get appropriate intervention. As the Minister is aware, early intervention is crucial, especially when one is aged three, as this young child is. There is no backup or service. I understand a staff member was on maternity leave last year and there were other leave issues relating to the Ballina area which added to the waiting list but surely provision could be made in a case such as the one outlined for backup facilities and services to be provided.

When we tabled the parliamentary question we were informed that currently, following initial assessment, the waiting list in north Mayo has 60 cases categorised as high priority and 26 cases categorised as moderate. In north Mayo there have been 101 referrals to the speech and language therapy services up to 17 May, yet there is no full-time speech and language therapist assigned to the Ballina area. The area is covered by travelling practitioners from Castlebar on an irregular basis.

There was a line in the response from the HSE to the effect that waiting times after initial assessment can vary due the number of referrals in a given area and the severity of the cases referred. One would imagine, given that there are 60 high priority cases and 26 moderate cases, and 101 referrals in less than five months, that Ballina would be seen as a priority for a full-time appointment and for a backup service to deal with the list and to assess the groups of 60 children and 26 children and get them into a treatment plan as soon as possible.

There are no audiology services available, so as well as difficulties speaking, many of the children in question cannot hear and cannot avail of support. The service is broken in the eyes of the children on whose behalf we speak and in the eyes of their parents. As one mother told me, she would travel to the moon to get a service, but because she lives in Ballina she is not allowed to access services in Castlebar. Neither can she go to Sligo because her address precludes her from getting the necessary treatment there. That is not good enough in any country, especially not in a republic.

We are either serious about the issue or not. The value of early intervention is crucial. The Minister is aware that if we get early intervention it would save further intervention down the line. Until such time as we get a full-time speech and language therapist and devote full-time attention to dealing with the waiting list, there will be many more children who do not get the necessary intervention who will become dependent on the services. It is no criticism of those working in the service. We need more of them. Parents are taking a stand for their children, their loved ones. Parents are at their wits end in trying to get even basic information. I highlight the difference between a reply to a parliamentary question and the reality on the ground.

Minister for Health (Deputy Simon Harris)

I thank Deputy Calleary for raising this very important matter and for presenting the starkness of the difference between what he was informed by the HSE by way of parliamentary question and the reality facing families in the community he represents. It is important that we hear that difference. It is something I will take back to HSE officials.

I advise the Deputy that each individual that presents to the HSE's speech and language therapy service has an initial assessment to determine their individual need for therapy. The therapist, in conjunction with the parent or carer, will determine the severity of the individual's difficulties and prioritise for therapy accordingly. The level of intervention is in line with clinical policy, age and severity of the diagnosis. The waiting period for intervention is dependent on the nature and severity of the disorder following assessment.

In terms of primary care services nationally, the HSE has prepared proposals to improve access to primary care speech and language therapy services and to address the waiting lists for assessment and therapy treatment. Dedicated funding of €4 million has been provided in the HSE's national service plan to specifically address this issue and details of the new proposals will be announced by me shortly. The HSE has advised me that current waiting times for initial assessment are standard across County Mayo for primary care cases. Clients are screened three times annually - in February, June and October - meaning children wait a maximum of four months from referral to initial assessment.

As I outlined, waiting times after initial assessment may vary due to the numbers referred and the severity of the cases referred. The Deputy quoted the same figures. Currently, following initial assessment, the waiting list in north Mayo has 60 cases categorised as high priority and 26 cases categorised as moderate. To date this year, in north Mayo, I am informed that 139 referrals have been made.

The HSE has advised me that there are no posts affected by sick leave or maternity leave in this area at present and it is continuing to manage and work through the waiting list. Children are entitled to HSE audiology services free of charge. These include screening, assessment, investigations, treatment, rehabilitation and devices. The HSE is conscious that the initial assessment and review of children is vital to ensure that they have the appropriate interventions and aids required for linguistic development and, as a consequence, improved social skills and educational capacity.

The report of the HSE national audiology review group, published in 2011, identified some inconsistencies and shortcomings in audiology services around the country, including unacceptable waiting lists. It made recommendations to address those issues. An integrated audiology programme was put in place and is now addressing the issues. With regard to County Mayo, audiology services to children aged over four years and adults are being provided in Ballina. The service to children under four years is currently provided from Castlebar. Waiting lists in County Mayo were tackled by a time limited overtime initiative last year. Following a procurement process, the HSE has now contracted an external provider and aims to clear the national paediatric waiting list for audiology services this year. A model for assessing and triaging children awaiting hearing testing is currently under evaluation. This model, if validated, will be used by the external provider to assist in reducing the audiology waiting lists for children nationally on a phased basis from the third quarter of this year.

I will continue beyond my script in the time available to me because the point Deputy Calleary made on speech and language therapy and early intervention is crucial. The point he made about the postcode lottery system and the inconsistencies based on where one lives is clearly not acceptable. That is something we have never quite got right in this country. I am informed that the care divisions in the HSE are now doing a detailed analysis of the inconsistencies in waiting times and resource deployment across the country. It is considering validating the waiting lists and standardising the prioritisation system. One cannot have a situation whereby one gets a better service because one lives in one county or one part of one county than another. We must consider increasing the number of speech and language therapy drop-in assessment clinics; agreeing flexible opening hours in the context of evening and weekend sessions; recruiting additional therapists; providing for maternity leave substitute posts; reviewing existing practice and considering examples of innovation and international best evidence; and agreeing performance monitoring and measurement arrangements.

In 2013, additional funding of €20 million was provided to strengthen primary care services. That comprised more than €18.5 million for the recruitment of more than 260 primary care team posts and more than €1.4 million to support community intervention. Additional funding of €4 million was provided this year specifically for speech and language therapy services and new initiatives. I look forward to developing those proposals and announcing them shortly.

I accept the valid criticism Deputy Calleary made in terms of speech and language services. The current waiting lists are unacceptable. It is something we are going to need everybody in this House to work with. We are going to need to put the resources in place. There are additional resources this year. The current situation is inadequate, but it is not fair that some children in the country receive less of a service purely based on where they are located. Part of the process the HSE is examining at the moment relates to those inconsistencies so that fairness can be provided throughout the country. I will revert to the Deputy on the matter.

Hospital Services

Deputy Catherine Connolly

Táim buíoch an deis a fháil an cheist seo a chur. Tá ospidéal nua thar a bheith tábhachtach do Ghaillimh. I dtús báire, ba mhaith liom comhghairdeas a dhéanamh leis an Aire Sláinte nua, an Teachta Simon Harris. Guím gach rath air ina ról nua.

A new hospital for Galway is something the people of Galway and the region have sought for some time. Since my election to the regional health forum in 2006, I and the other 39 councillors, on a cross-party basis, have recognised the inadequacy of the hospital site in Galway and the acute crisis that exists because of the congested site. The hospital we know as the regional hospital Galway provides a leadership role in acute service delivery, providing regional services for a wide range of specialties and is also designated as a supra-regional centre for cancer and cardiac services serving a catchment area in the region of 1 million people from Donegal to Tipperary north. That is the catchment area the hospital is serving, yet waiting lists in the hospital for every single medical specialty on both inpatient and outpatient waiting lists have repeatedly made local and national headlines, primarily because of lack of capacity on the site, in addition to lack of resources. The waiting lists are damning for ENT procedures and operations, orthopaedic operations, urology, anaesthesia, pain management, rheumatology and dermatology. The list goes on. In addition, we have the repeated cancellation of elective surgeries and procedures due to the input of patients through the accident and emergency department, which is causing great distress and pain to the patients.

Moreover, there is a trolley crisis despite the best efforts of staff, nurses and management. There is research to the effect that over a particular age, a person who spends more than two days on a trolley will spend a longer time in hospital, thereby incurring a greater cost to the Exchequer, not to mention the psychological and physical hurt to the patient. I accept that projects are planned and under way, including the construction of a 75-bed ward, a 50-bed replacement ward, a 50-bed mental health unit and a planned emergency department unit. However, the important point is that, notwithstanding these planned projects, both the clinical director of the hospital and the management of the Saolta group have acknowledged recently that all of these developments on the congested site are simply fire-fighting exercises and that there is an urgent requirement to have a new hospital and to begin planning for such a new hospital as quickly as possible. Furthermore, it has been highlighted that even when all these developments are in place, there will be additional capacity of only 25 beds on that congested site.

It is recognised by everybody in Galway and the region that the University Hospital Galway, UHG, site is congested and cannot cope with the existing demand. Its parking facilities are inadequate and cars must wait for hours to get in. As I noted when raising this matter, the lack of capacity in the hospital was the most worrying aspect when the risk assessment was drawn up to produce the risk register. I refer to this risk and the open, frank and welcome acknowledgement by the management and clinical director that they cannot go on like this. They are doing their best but they need a new hospital. In view of such candour and honesty, I ask the Minister to address whether he has met the management and the clinical director. If not, when will that happen and what steps are being taken to establish plans for a new hospital?

I will conclude by noting there are 150 acres of land on the Merlin Park site. I support fully the residents there who do not wish to see the woods demolished, and they should be preserved. However, on the footprint alone, without touching a tree, a new hospital could be built. There is also another site in Galway if the Merlin Park site does not prove to be suitable - namely, the airport site. I do not mind where the site is located, as what people in Galway want is a new hospital.

Deputy Simon Harris

I wish to take this opportunity to thank Deputy Connolly for raising this matter and for her good wishes. I am pleased to have this opportunity to update Members regarding hospital developments in Galway.

Galway University Hospitals, GUH, which encompasses University Hospital Galway and Merlin Park University Hospital, provide a comprehensive range of services to emergency and elective patients on an inpatient, outpatient and day-care basis across the two sites. UHG has approximately 700 beds and is a tertiary referral centre for the western region. Its emergency department has approximately 62,000 patients attending annually.

The programme for a partnership Government has committed to progressing a new emergency department facility for University Hospital Galway. The development of this new emergency department is a capital priority for the Saolta University Health Care Group. The HSE's capital plan for 2016 includes funding for a full option appraisal and cost-benefit analysis to inform planning and funding requirements for a new emergency department at University Hospital Galway. The cost-benefit analysis with regard to a new emergency department is in its final stages and it is anticipated that this will be completed shortly. If favourable, this then will progress to design stage this year.

While there are no plans for a new hospital to be built in County Galway, as outlined by the Deputy, considerable developments have been ongoing to improve facilities at University Hospital Galway. Pending the development of a new emergency department at the hospital, in order to alleviate pressures and to ensure that patient experience in the existing emergency department is improved, 30 additional beds opened at the hospital earlier this year. In addition, a number of significant projects have been completed at University Hospital Galway in recent years. These include the clinical research facility, the upgrade to the maternity unit and the cystic fibrosis outpatient department, which was completed in 2014 and is now operational. Furthermore, two major developments are currently under way in Galway. Construction work is ongoing on the new 75-bed ward block, which will provide single-room inpatient accommodation. In addition, a new acute mental health department is under way and is expected to be completed early in 2017. Following the transfer of mental health services to the new acute department, work will begin on the construction of a project under the national plan for radiation oncology for which the Health Service Executive, HSE, already has obtained planning permission. Further investment in individual hospitals must be considered within the overall acute hospital infrastructure programme and the establishment of hospital groups.

As for Deputy Connolly's question on whether I have yet met the hospital group, I have not, but it is my intention to meet all the hospital groups in the coming weeks. At present, I am engaging with all the front-line stakeholder organisations. I had a productive meeting with the Irish Nurses and Midwives Organisation, INMO, today and with the Irish Medical Organisation, IMO, last week. I will have further meetings with more of the front-line union representatives tomorrow. However, I expect to meet the Saolta board-----

Deputy Catherine Connolly

In respect of this issue?

Deputy Simon Harris

In respect of all the health care issues.

Deputy Catherine Connolly

My question was about this issue.

Acting Chairman (Deputy Declan Breathnach)

Deputy, please allow the Minister to respond.

Deputy Simon Harris

Obviously, there will be an opportunity for the hospital, through the hospital group structure, to raise whatever issues it wishes to raise with me. This will be a meeting for me to ascertain the priorities of that hospital group in terms of the development of health care facilities in the region.

The Deputy also made a valid point regarding the ongoing need to tackle the trolley crisis, which has shown some signs of improvement this month although, overall, the numbers are still marginally higher this year. I acknowledge that Galway is a particular area of difficulty at certain times. I will attend my first meeting of the emergency department task force, which is co-chaired by the INMO and the HSE, with relevant stakeholders next Monday and I certainly will seek an update on the position in Galway at that meeting. I am happy to keep in touch with Deputy Connolly on these important matters and I hope I have had an opportunity to outline some of the planned service improvements and capital projects. I look forward to having an opportunity to meet the Saolta hospital group in June in order to discuss further its priorities for the region.

The Dáil adjourned at 9.45 p.m. until 10.30 a.m. on Thursday, 26 May 2016.

Dáil Éireann debate - Wednesday, 25 May 2016