Saincheisteanna Tráthúla - Topical Issue Debate

Paediatric Services

The Minister of State, Deputy Butler, is dealing with this matter. She is multitalented.

I wish to record my appreciation to the Ceann Comhairle for selecting this important topic for discussion. Before the Covid-19 pandemic, the waiting list to see a paediatric rheumatologist was three years long. It may very well be worse now. There is also a year's wait for a private appointment. There are only two paediatric rheumatologists for the entire country. Clearly, this level of service is anything but acceptable. Down Syndrome Ireland, Irish Children's Arthritis Network, iCan, and Arthritis Ireland had a meeting with Crumlin children's hospital personnel almost a year ago in respect of these issues.

The family that has been in contact with me posed a legitimate question, on the their own behalf and on behalf of other families, about when the additional paediatric rheumatologist, promised by the then Minister for Health, Deputy Harris, in 2019 will be appointed. Some advocacy groups in this area are strongly of the view that the country needs six such consultants. Given the incidence of Down's syndrome in this country, this issue requires urgent attention. Research has been brought to my attention which shows that one in 50 children with Down's syndrome has arthritis and that annual screening is required. I also understand there is a long delay in getting MRI scans, which is also unacceptable. Appropriate access to such diagnostics is essential.

The parents who contacted me say that Down's syndrome-associated arthritis is a very aggressive disease and requires aggressive treatment with particular medication. Continuous monitoring, along with follow-up MRI scans, are essential to assess the progress and value of such medication. Parents emphasise that these children may also have other ailments, with additional consequences for their immune systems. As we know, delays in getting assessments and follow-up treatment will generally cause further damage to the child's health that cannot be rectified. It has also been represented to me that access to MRIs is further limited as most children with Down's syndrome need a general anaesthetic and cannot avail of the private option.

Children with Down's syndrome face enough challenges without the extra burden of not having essential rheumatology treatment provided in a timely manner. A few years ago, parents were promised that appointments would follow within three months of referral. Regrettably, this evening we are talking about three years, not three months, for referral and follow-up treatment if deemed essential. I appeal to the Minister of State to ensure that this issue is addressed in an appropriate manner without further delay.

I thank the Deputy for raising this serious and important issue. I am addressing the Dáil on behalf of the Minister for Health, Deputy Stephen Donnelly, regarding the unacceptable delays in appointments for children with rheumatism and those with Down's syndrome also.

First, the Minister and I sincerely regret that children can experience a long waiting time for rheumatology treatment. The Minister is conscious of the burden this places on them and their families. In response to the Covid-19 pandemic, the HSE took measures to defer most routine elective scheduled care activity. This was to ensure patient safety and that all appropriate resources were made available for Covid-19-related activity and urgent, time-critical work. This decision was in line with the advice issued by National Public Health Emergency Team, NPHET, international guidance and the national action plan published on 16 March.

Children's Health Ireland, CHI, at Crumlin has advised the Department of Health that during the initial phases of the Covid-19 pandemic, all face-to-face hospital outpatient reviews and most planned diagnostic tests were deferred in response to the pandemic. CHI at Crumlin has recommenced the majority of outpatient and diagnostic services, albeit at a reduced number in light of the need to ensure appropriate physical distancing. Patients are being seen by consultant rheumatologists in CHI's outpatient suite, including urgent patients and those who were deferred during the early phases of Covid-19. However, there is a significant waiting list at present and there is an increasing volume of referrals. In 2019, there were 1,705 referrals to CHI's rheumatology service, compared with 1,055 in 2018.

At the same time, there is an improvement in the numbers being seen. Even with the disruption caused by the pandemic, the rheumatology service has seen more outpatients in this year to date than it saw in 2019. Some 1,338 have been seen so far this year. This is in part due to the 2019 and 2020 investment in medical, nursing and healthcare and social care professionals, who have developed additional initiatives such as musculoskeletal physiotherapy led triage and clinics, further development of transition services with St. Vincent's University Hospital nurse-led clinics and speciality clinics for those patients on specific treatments such as disease-modifying anti-rheumatic drugs, DMARDs, biologies. CHI advises the rheumatology team is also seeking to run additional clinics in CHI at Connolly Hospital in 2021 within the current resources. It has further advised there is an active recruitment campaign for an additional rheumatology consultant under way. The closing date for applications for this post is tomorrow, 11 December. It is anticipated that the recruitment of a suitable candidate will allow an increased number of patients to be seen and diagnosed, with treatment initiated as part of a comprehensive rheumatology service.

I assure the Deputy and patients that the Minister is committed to ensuring that children have access to the service they require. The Department of Health will continue to work closely with the HSE in this regard.

I thank the Minister of State for her reply. I welcome the fact that she says there is an active recruitment campaign. We often hear about posts being advertised and interviews taking place, but the filling of the post is critical. That is where a timeline is required. I realise that sometimes the HSE cannot appoint consultants as quickly as they are needed, but I appeal to the Minister of State to ask the Minister to insist to the HSE and CHI that this matter be prioritised. We all understand the restrictions due to Covid-19 and the slowdown in services. However, there was a three-year waiting list before Covid-19 and a totally unacceptable waiting time for MRI scans.

There is another issue. I understand that University College Dublin, UCD, working with the parents of some of these children, has developed an information leaflet that would be of benefit to general practitioners and other healthcare professionals. That was to be distributed widely throughout the medical and nursing community, but I do not think it has happened. It was a partnership between UCD and parents to highlight and try to create a greater awareness of the incidence and prevalence of arthritis in children with Down's syndrome. That awareness campaign should be facilitated and brought forward as well.

I received another message from parents of children with Down's syndrome, particularly those who have arthritis as well. They want the public services to listen to them. Far too often the people providing services do not listen to the parents and families of the affected children. In many instances, unfortunately, these children are non-verbal. They depend on their parents to convey the pain they suffer and the treatment they need. I want this issue to be prioritised as much as possible. I am glad the Minister of State said there will be an active recruitment campaign. I sincerely hope we will not be discussing another year next year. We must have this appointment in 2021. As I said, before Covid-19 there was an unacceptable three-year waiting list and that has probably got worse. We need quick progress in ensuring that these children get the assessments and follow-up treatments they require. Their parents are not demanding, they just want fair play for their children.

I again thank Deputy Brendan Smith for raising this important issue. He has hit the nail on the head; the key word here is an "active" recruitment campaign, which is most important in order that we can pursue the intensely long waiting list. I restate the gratitude of the Minister, Deputy Donnelly, to the staff and management of Children's Health Ireland for the delivery of services to patients during a particularly challenging year.

As I indicated already, routine activity was deferred in the earlier part of the year and, inevitably, scheduled activity was significantly impacted by the necessary decisions. However, Children's Health Ireland has been phasing up services since June and activity has been increasing. Children's Health Ireland has been working not only to return services to their previous levels, but also to continue the ongoing improvement in service delivery that will culminate ultimately in the move to the new children's hospital facility. This is reflected in the increased level of service for rheumatology outpatients, despite the effects of Covid-19, which has come about as a result of innovative approaches by the rheumatology team. The service will be further developed by additional resources and it is hoped that the recruitment campaign, which is due to close tomorrow, will result in the key additional consultant resource being recruited.

The information leaflet to which the Deputy referred, which was formulated between UCD and various parents, is an extremely good idea. There is no doubt that parents need to be listened to, as do their children. Communication is key. Awareness is most important. I will refer back to the HSE on the information leaflet and I will ask the HSE to write to the Deputy directly on the matter. I agree that it is a very good idea to roll that out for the information of parents who have children waiting for rheumatology services.

Schools Building Projects

Thank you, a Cheann Comhairle, for facilitating the Members from north Kildare on this particular issue, which arose from a public meeting we had with the various school authorities in Celbridge in the past week. As we are all aware, heretofore Celbridge has experienced considerable pressure in terms of an increased population and will continue to so do for the foreseeable future. St. Raphael's Special School in Celbridge is a very old school, which is totally outdated. It is an unfortunate place for pupils and staff to work in and to operate in with job satisfaction. This school has been a matter of concern for up to ten years. It was hoped to make provision for it previously, but that did not happen for a variety of reasons. We hope it can be expedited now and that it and other schools in the area can be accommodated in the fastest time possible in order to ensure a high standard of accommodation for all of the children at primary and post-primary school in the area. I accept that Rome was not built in a day. We are not talking about Rome; we are talking about children with special needs and their parents and the reassurance that they require. There is also a requirement to associate this issue with the local authority because roads provision in the area will have a bearing on the location of the alternative schools and the resolution of traffic management problems that have existed for some years. We ask that these matters would be treated with extreme urgency and we look forward to the response.

I thank Deputy Durkan for sharing this Topical Issue with the north Kildare Teachtaí Dála. We had a meeting on Monday evening with the principals and representatives from St. Raphael's Special School, Celbridge Community School and St. Patrick's National School. They have located a site. I am anxious to assist these schools, which go above and beyond every single day, but especially in the past six months with Covid. In the case of St. Raphael's, some of our most vulnerable and important citizens receive their education there. The school at the moment is grossly neglected and the buildings have certainly seen better days, decades ago, but they still provide a magnificent service. A new school is needed.

The school gave us a great presentation the other night outlining its needs and plans. A site has been located but road access is a main impediment. We have an Oireachtas Members meeting with Kildare County Council tomorrow morning and we will certainly try to bring it up. I urge the Minister of State, and everybody involved, to make this happen, to heed the schools and to provide the services that are desperately needed in terms of vital infrastructure and otherwise. We are blessed in Kildare to have school principals with such skill, devotion and vision and, above all else, the heart they need to provide great school communities for the wider community. It is a privilege to represent them.

We take a census every few years. When I was a councillor on Kildare County Council, Maynooth University was involved in the All-Island Research Observatory census data. We know that where new houses are built, children come next. It would be great if we could plan ahead and make sure children do not have to go to school in deplorable conditions. I hope we can work this out.

Is Deputy Lawless here? No. I call on the Minister of State, Deputy Madigan, to respond.

I thank Deputies Durkan and Cronin for so eloquently outlining the issues faced by St. Raphael's school and the details of a public meeting, of which I was not aware, concerning the issues St. Raphael's in particular has been facing. The Deputies will be pleased to hear that a building project to provide a new school building for St. Raphael's is included in the Department’s school building programme. As was mentioned, a site is required for that purpose. At present, the Department is at a very advanced stage in the process of acquiring a suitable site, which is located at Donaghcumper. When this has been acquired, the architectural planning process for the new school can be initiated. In the meantime, the Deputies will be aware that my Department approved three temporary classrooms for the school in May 2020. The project has been devolved to the school for delivery. I understand that a decision on the planning application is due shortly. When that is secured and the accommodation is tendered, the school will submit a tender report with a recommendation to my Department for approval.

It is important to me, as the very first Minister of State with responsibility for special education, that we look after children with special needs. Education is a right and it should be vindicated as such. We must look after the most vulnerable in society and that includes children with special needs. In recognition of that, 20% of the Department's budget, or €2 billion, is dedicated to special education. Since 2011, we have increased the number of special classes by 235%. We have gone from approximately 548 special classes to approximately 1,800 such classes. That is progress. This year alone, we have 197 new special classes and approximately 189 of those are autism spectrum disorder, ASD, special classes. Notwithstanding this investment, we are always looking to increase the provisions we make for children with special needs by adding to an existing school, setting up a new special school, setting up a special class or integrating children into the mainstream.

The National Council for Special Education does a significant amount of work and has overall responsibility for co-ordinating and advising on education provision for children with special needs. At this stage, it has well-established structures in place for engaging with schools and parents. It is important that we get the co-operation of schools when we are trying to expand a school or improve it. I clearly heard what the Deputies said about the existing facilities, in particular at St. Raphael's school, not being in any way sufficient.

Therefore, I am glad a new site is required for a school campus development in order to cater for the permanent needs of St. Patrick's National School, Celbridge Community College and St. Raphael's Special School. As I stated, the Department is at a very advanced stage in the process of acquiring a suitable site located at Donaghcumper.

I can confirm that agreement in principle has been reached with a landowner for the acquisition of that site and that ongoing work is progressing in respect of the technical matters that are crucial to the delivery of this acquisition. We are, of course, continuing to engage actively and regularly with both Kildare County Council and the landowner, who is currently preparing a master plan for the site as a whole. I note what the Deputies have said about roads and infrastructure in the environs.

I thank the Minister of State for her helpful reply. My immediate response is that the location, site and infrastructure will be determined in the first instance by the local authority and its road traffic management proposals. A previous proposal was unveiled a year or so ago and it was not acceptable because it did not deal with the traffic problems at all. It is important to remember the location of the site for the schools in question will be determined to some extent by the location of the roads, hence the importance of that element.

The Ceann Comhairle will know the importance of St. Raphael's Special School in Celbridge to special needs children over many years, catering for north Kildare, west Dublin and further afield. Tremendous work has been done in very difficult circumstances in a building that was constructed in the 1960s. It is therefore of vital importance that the project be moved ahead to provide that facility to the school and the other schools that require a permanent location in the shortest possible time. We should minimise delays because of the urgency and the special needs element.

I ask the Minister of State, in the first instance, to make contact with the local authority to iron out any problems that may exist. We will also have to help the local authority come to a conclusion on how fast it will be able to deliver the goods in terms of alternative traffic routes.

I thank the Minister of State for her response and I wonder if I could get it in writing. The meeting between Oireachtas Members and representatives of Kildare County Council will go ahead in the morning and I will try to raise this matter. Will the Department also put on a bit of pressure and stress the importance of the infrastructure that will be required for this proposed site in Celbridge? I know the other Teachtaí Dála who are not here know how important this matter is. I urge everybody to make this happen and provide the services that are so desperately needed. I used to work in Celbridge and I know many of the teachers and special needs assistants in the school. The conditions are really bad and we must get on urgently with the case. We must move heaven and earth to get this done as soon as possible. I thank the Minister of State again for her response.

I thank the Deputies for shining a light on the matter because it is important that we look after children with special needs as best we can. I want to try to expedite the process as much as I can and it remains an absolute priority for me and the Department to progress the acquisition. Unfortunately, due to the very specific and commercially sensitive nature of the site acquisition, I am not able to elaborate further on the issue. The Deputies can rest assured that the project is being given priority and our full attention.

When the current technical appraisal process is deemed satisfactory, the acquisition will advance to the legal conveyancing stage, when draft contracts can be prepared and legal due diligence can be undertaken in respect of the proposed transaction. It is expected that at that stage, the project to deliver the new school accommodation can simultaneously progress to the architectural planning stage. I assure all parties that they will be kept apprised of progress on this priority project.

The process is very complex and subject to the completion of successful negotiation and conveyancing processes, as I have said. It is not possible to give Deputies a definitive timeframe for the completion of the acquisition, although I would like to. My officials and I will endeavour to bring the process to a conclusion as soon as possible. I expect this to be sooner rather than later.

I appreciate the fact that both Deputies are caring for their community and they have taken the time and trouble to engage not just with Kildare County Council but with the schools, constituents and parents. They have attended public meetings, and it shows that they care about these children with special needs, who are often forgotten. I commend the Deputies on this.

Environmental Schemes

I thank the Ceann Comhairle for choosing this matter and the Minister for being here. During the programme for Government discussions there were a number of conversations about this proposed competition. It did not make the final draft but it was something that we engaged on.

We must mobilise communities right across the country in the climate change challenge. The green schools initiative has been a particularly good example of mobilising the next generation and we must bring that sense of spirit and adventure to communities.

My town of Ballina is very proud of its daughter, Mary Robinson. At the last major public gathering in the town before Covid-19 arrived, she set a challenge, saying that if somebody does something on their own, we wonder what difference it makes, but what if whole communities do it? She said that if the entire population were to live differently, it would change the system. With those words in mind, a large number of groups have come together, including Ballina Chamber and the Ballina Community Clean Up. One of our natives, Mr. Kevin Loftus, is a young man from the town working with a Dutch-based architectural practice in urban regeneration. All these people and groups are looking at how we can make Ballina Ireland's greenest town.

There are a number of commitments in the programme for Government, including a commitment to "mobilise "Challenge Calls" to identify and fund fresh, disruptive ideas to help meet our targets from broader society". If the Minister issues such a call and gives me the details, Ballina will answer that challenge. The programme for Government also commits to expanding the environmental fund to invest in biodiversity and climate initiatives. I invite the Minister to come to see the work being done in the town this year alone around biodiversity through the work of the "Beelieve in Ballina" initiative led by Ballina Community Clean Up. Supporting towns in an ambition to be the country's greenest town is a perfect fit for that fund, and there is also a commitment to a local environmental innovation fund to enhance community participation.

All this could be based on the very successful European Green Leaf Award, which involves towns that are bigger than I would envisage - between 20,000 and 100,000 people - but we could adapt the model. Limerick has previously been a winner in the competition. The European Green Leaf Award recognises urban centres with good environmental records and commitments to generating green growth and it encourages centres to actively develop citizens' environmental awareness and involvement. It also encourages centres to be green ambassadors and to encourage other towns and communities. Ballina is up for that challenge and many other towns across the country are up for it too.

I remember in the very early days of the Internet there was an Information Age Town competition, which mobilised towns across the country in seeking the benefits of the Internet and how they could apply them. We should do something similar to bring people on board with this challenge and get them to recognise the urgency of this matter. We must realise that we can no longer put this on the long finger but at the same time we can see the positives of communities uniting that can be brought to people's daily lives. The best thing we can do in taking on this challenge is to do this as a collective and a community.

As I mentioned, the programme for Government speaks of a challenge and we are up for that challenge in Ballina. I am sure many other towns in the country are up for it too. If the Minister sets the challenge, we will take it on.

I thank the Deputy for raising this topic. The programme for Government sets out our ambition to more than halve our carbon emissions over the course of the decade.

The action we take in the coming years will be critical in order to address the climate crisis which renders our current economic model redundant and threatens our safe future on this planet. In order to deliver on our expanded and deepened climate ambition, additional far-reaching policy changes will be developed across every sector. The development of the next iteration of the climate action plan has commenced and cross-cutting measures such as those related to citizens' engagement will be important to involve the wider community in the formulation and implementation of the plan.

While there is no commitment in the programme for Government for a greenest town competition, the programme does commit to support a new green flag programme for communities building on the successful programme in schools. To achieve this we need to bring communities with us as new energy infrastructure gets installed. The climate action plan includes a number of relevant actions on renewable connection policy, community elements in the renewable electricity support scheme, RESS, and microgeneration to promote community involvement in renewable energy. It provides for training and support for initiatives where community and voluntary stakeholders to support community, local and national low-carbon development, incorporating community outreach elements.

Accordingly, the Government will prioritise the development of microgeneration, letting people sell excess power back to the grid by June 2021. We will ensure community energy can play a role in reaching at least 70% renewable electricity, which included a community benefit fund and a community category within the first RESS auction last summer. We will continue to work with the EU to agree community participation as an integral part of installing new renewable energy and a route for community participation in the projects. We will conclude the review of the current planning exemptions relating to solar panels to ensure that households, schools and communities can be strong champions of climate action.

The Government is also progressing a number of related initiatives, including the transposition of the renewable energy directive by June 2020, continued funding for the SEAI's solar PV programme, the roll out of the smart meter programme by 2024, implementation of the support framework for microgeneration targeted for June 2021 and revision of the exemptions under planning regulations in relation to solar installations. In addition, a review by the Commission for Regulation of Utilities, CRU, of network charges in Ireland is planned in 2020. The CRU also proposes to implement a new connection policy for micro and small generators above 11 kW hours and below 50 kW hours by June 2021.

The RESS includes a ring-fenced community preference category within the auction that will support community projects and future renewable auctions will seek to increase the community preference category volume as a larger pipeline of shovel-ready community projects develops. Seven community projects qualified for the community category in the first auction which shows the way for more community projects to follow in subsequent auctions. The RESS auctions also include a mandatory community benefit fund requirement for all projects, the proceeds of which can be used by communities to progress sustainable community projects.

The programme for Government also commits to the development of a new model of engagement with citizens, sectors and regions as an early priority for Government, building on the learning of recent years. The new model will embrace dialogue on a structured basis so that diverse elements of society can contribute to the process. There will be a specific youth dialogue strand and we will also promote citizen, sectoral and regional involvement in delivering actions within their own sphere of influence.

Since 2017 Departments, the EPA and local authorities have engaged with various elements of Irish society to engage citizens on the need for climate action and a number of regional town hall meetings have been held. A number of other initiatives across Government, including my Department, are in progress which are raising awareness and calling citizens to action. These include the nationwide green schools national climate action and awareness programme, engagement with the arts community, the youth climate justice fund and local authority initiatives. My Department has recently commenced a series of meetings with other key Departments to plan for a widespread public consultation process on a 2021 climate action plan. It is anticipated that this public consultation will take place early next year and input will be sought from citizens, businesses and academics. The 2021 climate action plan will be informed by this consultation and the plan's overall structure and focus will remain flexible to adapt and evolve over time as Ireland strives to first achieve and then maintain its long term climate objectives.

I thank the Minister for that information but what we need is a structure that makes information and resources accessible to communities that want to act. Communities like Ballina have plans in place and they want to start acting on them, involving the people of the town and the wider region. I would love to get some information from the Minister on the status of the community green flag initiative and the various other initiatives I mentioned such as the challenge call, the environmental fund and the local environmental innovation fund. We must put a structure in place that communities will find easy to access. These community initiatives are being led by volunteers who are passionate about their communities and about the environment. They want to make sure that the environment is there for the next and subsequent generations to enjoy. They are busy people and we need to engage them. The Minister of all people knows that when the passion is there to act, we need to act quickly and put supports in place. A national competition would rally communities. It is not a case of winning but of raising awareness and giving a sense of achievement. It would provide a target for communities and encourage them to put plans in place, knowing that there is funding available at the end to implement those plans.

This week Ballina lost a community champion, the late Mr. Cyril Collins, the founding chairman of the Belleek Woods Enhancement Project. Belleek Woods is one of the biggest urban woods in the country and Mr. Collins, together with a number of his friends and colleagues, as well as Coillte and the Minister's Department, transformed the woods. He went to his eternal reward this week and in his memory I would love to see a long-term structure put in place that will inspire more people like him to take on protecting and minding the environment of towns like Ballina for the next generation.

Deputy Calleary is absolutely right about the need for this to be something from the bottom up that is community led. I could not agree with him more and Ballina would be a fine town to lead that. There are very few towns in Europe that have salmon jumping upriver in the town centre in the dramatic way that can be seen in Ballina, which is such a beautiful town.

I will give the Deputy a couple of pointers for the people of Ballina. Yesterday evening the GAA launched a new greener clubs scheme. Forty five clubs were represented at the launch. I must check if there was a club from Ballina but my own local club, Kilmacud Crokes, is involved along with clubs from all over the country. The scheme is just like the green flag scheme for schools. The aim is to get local GAA clubs involved in supporting biodiversity around their own grounds, in carbon reduction through new and clever ways of using transport to move teams around, in developing waste plans, making efficient use of energy and so on. It is exactly what the Deputy spoke about in terms of encouraging the sharing of best practice and learning from each other. It is really clever because it involves clubs working with local authorities, energy agencies and those with real expertise in the area. Clubs will also learn from each other. It is a really good example of a green scheme and the launch last night was really enthusiastic. The scheme is only beginning but it could be really transformational along the lines outlined by Deputy Calleary.

A second very practical approach that the town of Ballina might consider involves working with the local authority. Last week we announced a competitive fund for local authorities outside of the metropolitan areas. We invited them to present bids for investment in walking and cycling infrastructure in local areas. Some €50 million is not a huge amount of money when divided among all the counties but if we can keep doing this on a regular basis, it will make a difference. If counties and towns start coming up with plans, that will have a transformative effect. It is exactly as the Deputy suggested in terms of being an open fund for which bids can be made to the National Transport Authority.

I have given the Deputy two very practical examples there but on the wider issue of a consultation process with a community-led approach to climate change, I will take the Deputy's suggestion on board and make sure it is delivered within Government because it is absolutely the correct approach to take. We will start that in the new year.