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Dáil Éireann debate -
Thursday, 5 May 2022

Vol. 1021 No. 5

Saincheisteanna Tráthúla - Topical Issue Debate

Special Educational Needs

This is a very important topic, as I know the Minister of State, Deputy Madigan, appreciates. It relates to what was known as the July provision and now has a new name, that is, the summer school programme for all primary schools. I thank the Ceann Comhairle for selecting this important matter. Since I tabled it, the Department has published the guidelines, which is one of the issues I was going to raise. I welcome that the guidelines have been issued. I also welcome the sending of a letter to all principals. I will come to the good points contained in the guidance but I have no idea why it has been issued so late in the year. It creates huge problems for schools in terms of preparation, clarity and certainty. Will the Minister of State give an explanation as to why it is so late in coming and an assurance this will not happen again?

There are a number of positive elements outlined clearly in the guidelines and the letter to principals. There are 11 bullet points setting out proposed improvements, including that an overseer may be appointed, a preparation time will be given and there will be an additional ten hours of paid time. I want to highlight the positives. There is a difficulty, however, regarding the undertaking in respect of additional pay for teachers and special needs assistants, SNAs. I am not sure whether I am just being pedantic but there seems to be a difference in this regard between what is stated in the guidance and in the letter that went to principals. The letter indicates that teachers and SNAs working on the programme will receive an additional week's pay for each week of the programme based on their personal rate of pay. On page 15 of the guidelines, the position on payment rates is not so clear. It states that overseers, teachers and SNAs who work on the programme will be paid for this work based on what they are normally paid during the year, that is, their personal rate. The letter suggests there will be a doubling of that rate. Will the Minister of State clarify this? I welcome the other points set out, including that the application form will be simplified, there will be flexibility and so on.

My difficulty relates to the core number of pupils in special schools and special classes who are being left out of the summer schools programme. The Minister of State might disagree with me on this, so I will go into a little detail to explain my point. The reason the July programme came about in the first place was not as a result of a proactive move by any Department or Government. It came from a High Court action back in the late 1990s. Arising from that ruling, the Department had to provide for a system that ensured children with complex special needs would not be deprived of an education for a long period during the summer, which was leading to such pupils regressing. It was necessary to go to the High Court to get that basic recognition and out of that ruling came the July provision. I understand a review of the provision has been under way since 2019. Where is the outcome of that review? It is very important that we see it.

Some of the figures that have been pointed out to me in respect of the number of children in special schools and special classes who are not in a position to avail of the July provision because their schools are not providing it are truly shocking. It is done on a voluntary basis and if schools do not opt in, there is no service. Various people concerned with this issue have got the figures through freedom of information requests. There should be no need to have to find out the information in this way. A review of the July provision should be carried out each year and an analysis provided of the uptake, the feedback on how well it operated and, most importantly, why some pupils were not in a position to avail of it. This would ensure the Department can learn from what is happening each year and that more certainty can be brought to bear on the issue. I keep calling it the July provision even though the name has changed.

The Minister of State to reply.

Did I get four minutes?

The Deputy did, and a little extra.

I beg your pardon, Acting Chairman.

The Deputy spoke for four minutes and 23 seconds. She is correct that this is a very important topic and I am delighted the Ceann Comhairle selected it for discussion. I want to reiterate the importance and aims of the summer provision. It builds confidence in children, supports pupils to re-engage with education, increases their motivation and promotes well-being. For children at key transition stages, it helps to ensure they can move on to planned educational placements along with their peers in the coming September.

Before I speak more generally about the summer provision, I will try to answer some of the Deputy's questions. Regarding the timing, the announcement was made on 4 May, as she knows. This is perhaps the earliest date in any year on which the details of the provision have been given. The Deputy may be aware that I have set up a special education consultative forum, which met today with a variety of stakeholders to discuss issues pertaining to special education.

The Deputy asked a related question about the review of the provision.

An inspectorate review of the summer provision was done last year. That report was shared with stakeholders and was used to inform the summer programme. We wanted to wait until that was completed. Another one of the Deputy's questions was about the take-up of and participation in the summer provision. Because all 4,000 schools are eligible for this summer provision, we want to encourage as many as possible to engage in it. The Deputy outlined some of the incentives the Department has used to get schools to participate. Some of that was based on the feedback we received from that review, including the funding, the preparation time, faster payments for the staff, etc.

I think the Deputy also mentioned pay. To clarify, it is a week's pay plus an extra week's pay for the staff. Again, that is a strong incentive. In fairness to the staff, the SNAs and the teachers have worked hard over recent years, during the pandemic and subsequently. We do not want them to be exhausted but we do want them to avail of the summer provision work because we know how much it means to children and their parents. That is why we are trying to incentivise them.

We have also provided school transport. We have special transport services. If that service is not available, a grant will be given or the school can organise its own transport in order that we can get children to avail of it.

There are five different elements to this. We have the inclusion programme in primary schools, which lasts two to three weeks. We have special classes and special school programmes. We have DEIS as well. Let us not forget that this is about disadvantaged children as well. In addition, Ukrainian children will be able to avail of this programme for the very first time. I think the schools are very excited to be able to offer this to Ukrainian children this year.

Lastly, if you do not mind, Chair, there is enhanced funding-----

I have another 14 seconds.

Yes. I was just flagging that.

There is enhanced funding for special schools in recognition of the complexity of their needs. They enrol the children with the most complex needs.

I will speak very fast this time to keep within my two minutes.

The letter I have states that children with complex special needs feel abandoned. They are absolutely at their wits' end. The take-up for the July provision is very low. I do not have the time to go into the figures, but it is a very finite number of students who are in special classes and special schools. It is not beyond our capability to provide the service for them for four weeks during the summer, but that is not happening.

Let us look at the figures alone. There are 8,108 children in special schools and 8,500, approximately, in special classes. The number attending the July provision is minimal. I have the figures in front of me. I ask the Minister of State to recognise that and to let the parents feel they are being heard. I know that the Department has set up a consultative forum, and I welcome that, but I asked the Minister of State about the review that was started in 2019. Has it been completed? Will it be published? Is it available?

The deficits have been pointed out by the people on the ground for whom July provision was set up. They are losing out. The Minister of State knows that, as does the Minister of State, Deputy Rabbitte. They are absolutely at their wits' end from the time the schools close until they open. They had to go to the High Court in the first place, and now the take-up of the service makes it impossible. What the Department has stated in its guidelines and in the letter to the principal is that the children will be able to do this at home. That is not possible. They need to go out. Summer camps and all the other things that are available to most children are not available to these children with complex special needs. I know that personally and professionally from being on the ground, as I am sure everybody here does, so-----

I am just flagging your time, Deputy.

We lose a few seconds and lose our train of thought when you tap the bell, Chair.

In any event, this has to be taken on board by the Department. What provision will be made long term for next year? The people on the ground have made very sensible suggestions as to how to deal with this. It is bordering on insulting - this is not directed at the Minister of State - for a letter to go out stating that the children can avail of this at home. It is not possible. They need special provision for four weeks. There was an underspend-----

I will finish on the underspend.

There was a huge underspend in respect of the July provision. What has happened to that money?

Thankfully, we are not back in the 1990s, and significant work has been done since then on this, together with the supplementary Covid learning and support scheme. I totally agree with the Deputy and am ad idem with her on one thing, which is that the families really need this service and need respite for their children to bring them on. We gave some of this information to the Ombudsman for Children as well. Some children with autism, for example, in special schools and special classes are no longer in those classes but in mainstream settings. There are more children now in mainstream settings than there were in the past. In those circumstances the provision of support is not about the location but about the level of need. That is critical. As I said, there are enhanced supports and enhanced funding for special schools. Guidance has gone to schools. It was based on engagement with management bodies and unions, and states that the schools should prioritise those with the most complex needs. That guidance from the Department to schools has been very clear, and schools can take on as many students as they have the capacity to take on. There is no difficulty with that. That is really important.

The inspectorate did a review which has fed into this year as well. We never want to take away from one category to the other. As I said, this is based on need, not location. We have lots of statistics. There has been a 64% increase in special schools and special classes from 2019 to 2021, so we are making progress. We used the feedback this year in order that we could make it a more streamlined process and make it as attractive as we possibly could. We have doubled the funding from €20 million to €40 million, a 100% increase, to try to get schools to participate voluntarily in this scheme for the benefit of the parents and the children.

Disability Services

I am contacted regularly about the lack of respite services in counties Cavan and Monaghan. Currently, respite services for both adults and children are provided in Annalee View, a respite centre in Cootehill, County Cavan. However, because adults and children cannot be facilitated together, the services are provided on alternating weeks, that is, adults one week and children the next. It is not sufficient to deal with the large number of people who require respite services throughout the two counties, so there is a need for at least two centres. Two in each county would be brilliant. I acknowledge that Steadfast House, in Carrickmacross, provides respite as well, but there is demand for its other services.

What plans are there to expand the existing level of respite in both counties? When Annalee View was closed for repair some years ago, for quite some time, for a while no respite services were offered at all. Then Killygowan respite service was opened. At full capacity it could facilitate only five people. I think during Covid that number was reduced to two. Again, it operated on an alternating basis, with children one week and adults the next. When Annalee View was reopened, why was it not designated for children, say, and the other centre, Killygowan House, kept open for adults? So many individuals are refused respite due to the increasing numbers of individuals seeking to avail of the services. Some have been informed that the service does not cater for those with mild or moderate intellectual disabilities. All individuals with intellectual disabilities should be entitled to respite care if they feel they need it.

In a reply to a recent parliamentary question it was indicated to me that there are plans to provide separate centres for children and adults in CHO 1. A submission is being made for funding to support those plans. However, the reply did not answer the question I asked, which was specifically about Cavan and Monaghan. It gave the information for just the CHO area in general. I want to know specifically what plans there are to provide additional respite services in those two counties and how far along those proposed services are.

I receive many queries about respite services from families, and they are at the end of their tether. These are families who have children sometimes with disabilities that are quite complex. They were in receipt of respite services before Covid, but that has not been resumed, or certainly not to the extent that they were receiving it prior to March 2020.

Many families need a break so that they can perhaps do some other activity with other children in the family or they just need some time for themselves. Children with complex disabilities might need a break from the family home too. Respite should be arranged in conjunction with the child to ensure that not only is the child properly and well cared for, but that he or she is interested in the activities provided in order that respite is enjoyable and the child looks forward to maybe going back and repeating it a few weeks later or whatever.

I am also contacted regularly by aged parents who may have adult children with disabilities living with them. They should be living independently but often they are on the local authority housing waiting list for houses for up to ten years and no supports are being put in. There were moves, and that is improving, but we still have a situation where there are adult children with some complex disabilities living at home with aged parents and they both need a break - the adult needs a break from the home situation and the parents need a break.

To repeat my questions, are what plans are there to expand existing services in Cavan and Monaghan and what is the timeframe for the expansion?

I thank the Deputy for raising this important issue.

As the Deputy will be aware, I am keenly aware of the critical importance of respite for loved ones and families of those with a disability and I am deeply committed to expanding the respite service, both in terms of quantity of hours and in terms of locations throughout the country.

Basically, let me explain it to Deputy Tully like this. When I did the budget in 2021, because of the cost involved my ambition was that I would provide one respite house in each community health organisation, CHO, around the country. We all know that each CHO could have multiple numbers of counties. In 2022, that went to ten houses, to 11 and to 12. I have enough funding for another respite house in each CHO again but this time I have built on it. What I have built on it this time is three complex needs ones - two for medical complex needs and one to do with Prader–Willi syndrome, which is costing €600,000.

The idea here is to put a respite house into every single county. By the time I leave Government or no longer hold ministerial office, my legacy will be that I will have built in respite houses. I believe that we need to create capacity. The capacity is needed. We understand clearly from Covid one of the issues was that parents of children and adults could not access respite and in order for us to ensure that relationships last for as long as possible, we need to give the parent the night's sleep and give them regular respite. Then, guess what? We can keep family connectivity for the better.

I met the Deputy when I visited Monaghan at the request of Deputies Niamh Smyth and Brendan Smith, and where I also met Senator Gallagher, the Minister, Deputy Humphreys, and Senator Joe O'Reilly. I was informed by the local CHO in Cavan that the disability services provide respite for adults and children in Annalee View Respite Centre, Cootehill, County Cavan, on alternative weeks. To be honest with the Deputy, I was quite shocked to hear that. I was quite shocked to hear that children and adults alternatively have only one house in the entire county to deliver respite. It is not what I would deem a fair or equitable access to services. One house in one county does not meet the needs by any manner or means. When I visited the primary care centre, one of the ladies within the HSE progressing disability services spoke to me at length about that. As I say, it is something that has to be prioritised.

Respite services for adults in Cavan-Monaghan catchment area are provided from Steadfast House, Carrickmacross, County Monaghan. The Annalee View facility had previously closed due to major repair works on-site. Following the temporary closure of Annalee View and throughout the Covid pandemic, respite continued to be provided in a new location called Killygowan Respite Centre, Cavan. Funding was allocated in 2020 to the community healthcare organisation of Cavan, Donegal, Leitrim, Monaghan and Sligo to develop respite services. The 2020 funding is required to be allocated based on assessed respite service needs across the community health area. This year Sligo and Leitrim area of the community healthcare area have been identified as the area in which respite service developments are required initially.

The question Deputy Tully has asked me is, where the house going or what is happening in CHO 1? I am telling the Deputy it is going to the Sligo-Leitrim area, not to Cavan-Monaghan. To be honest with the Deputy, the Cavan-Monaghan situation only came to light when I was with Deputy Smyth two weeks ago.

The house in Cootehill actually caters for Cavan and Monaghan - it is two counties. I accept Steadfast House cater for some in Carrickmacross as well but for children in the two counties, it is Annalee View.

The day the Minister of State refers to in Carrickmacross, I was talking to some of the people in the HSE as well. I will not name the place they mentioned but they were talking about some of the settings that are now being decongregated. Is there a possibility that some of those could be now turned into centres for respite? They are not suited for long-term residential purposes for all the reasons that people are better in their community but I wonder whether that could be an option because I had a conversation with someone about that. I thought that might have been something that was on the cards. I can tell the Minister of State privately the place they mentioned as well.

I want to raise another issue that has been raised with me about whether something can be done in the case where someone, who could have been waiting for weeks or months, is offered some respite but then an emergency cases arises and the respite care is cancelled at very short notice or even in the middle of the break the person may be having. Emergencies will arise on a continuous basis. A man I spoke to told me that he and his wife had hardly any breaks at all before their daughter was given respite for two nights. They booked two nights away but on the second day, they received a telephone call telling them they would have to take their daughter out of respite because an emergency case had arisen. It was heartbreaking because they never got away for a break. Can something be done about that as well?

For adults, I hope there might be less need for respite in the long term if we have more community settings with supported independent living provided. We will always need it for children going forward. At the moment, though, unfortunately, we have to focus on both.

I thank the Minister of State for her response.

I thank the Deputy. I will have a conversation outside of the House about what the Deputy is saying, but she is correct. The structure and the design of the houses I have come across perhaps do not address the needs, the challenging behaviour needs or the emergency cases that I would normally have come across. I saw a really good house design recently in Swords. The Talbot Group is changed with the delivery of the care there. I describe it as the house with two front doors. One front door caters for four or five children who have mild to moderate needs and the other front door caters for children with more challenging behaviours. At all stages, one part of the house will always function because we always cater to those with mild to moderate needs. Then if there is a child who needs access, whether it is an emergency case or more challenging behaviour, he or she can access the house the other way. It meets the HIQA, requirements. It can be HIQA-approved. We need to look at our designs and what we are purchasing or renovating. What the Deputy has described in relation to the decongregated setting would be a large space. Clearly, it was HIQA-approved in the past. In fact, the changes and the alternations, and perhaps the capacity to be able to cater to the two front doors, could possibly be easily remedied to ensure that we could have quicker delivery without having to go out looking to see where we could find a house. In this challenging market, if there was one there already that we have decongregated, I would be asking the CHO whether we can review that and look at it to see what costings would be involved to ensure we could create that capacity. I am aware, from the nine houses that I delivered in the 2021 budget that I put in an extra 10,000 bed-nights for children and adults, which is significant. By the time I put in place another 12 houses this year, the Deputy will be able to see the potential capacity I will have created to support families, to support the children and also the complex cases that sometimes get forgotten about.

Mental Health Services

I wish the Minister of State, Deputy Butler, a good evening and thank her for joining us.

The Minister of State will be well aware of the child and adolescent mental health services, CAMHS, located in Arden House, Wexford. After a three-year absence of a child psychologist, I am glad to say an appointment finally was made in August last.

According to the Government's A Vision for Change document, a full complement of staff, were it to be had, would comprise one consultant psychologist, which Wexford has; and one doctor in training, which Wexford has not, although there is one non-consultant hospital doctor, NCHD. There also would be two mental health nurses, which Wexford has; two clinical nurse specialists; and two clinical psychologists, of which Wexford has one. There would be two social workers - Wexford has one agency social worker - and one occupational therapist, which Wexford has, as well as one speech and language therapist - it has a half-time speech and language therapist. It would have one childcare worker - we have none - and two administrative staff, which we have.

The referrals are being rejected at a rate of knots at CAMHS in Wexford. Basically, Arden House has done no attention deficit hyperactivity disorder, ADHD, assessment since December 2021. Some 46% of all referrals are for ADHD, according to the HSE's statistics, and not one has been carried out in Wexford for six months. I have received numerous representations from GPs who have complained that they sit down with mental health patients, be they young children or adolescents, and they spend a long time filling in arduous forms, only to have them rejected by CAMHS. The services are just not seeing them. I then get representations from the families who make the same complaint. What is happening is that these children end up some weeks later in the department of psychiatry, DOP, in Waterford, having tried to take their own lives. They are referred back by the DOP to Arden House to be seen then. That is just not good enough in any woman's or man's language. Families are in despair that their children are being rejected even though they are being referred by their GP. The worst-case scenario is they try to take their own lives before they are seen.

What has me here today? Before I proceed to that, I want to quote the psychiatrist, Dr. Kieran Moore, who resigned his position in CAMHS three years ago because there were no support services, from a published article he wrote. He is a consultant paediatric liaison psychiatrist. Basically, he was saying the HSE does one thing well and that is hire managers. The extract states:

According to its own website: “the health service executive (“H.S.E.”) in Ireland provides health and social services to everyone living in Ireland…. young and old, in hospitals, health facilities and in communities.” The website also says: “The H.S.E. is required under section 35 of the Health Act 2004 to have in place a code of governance. Governance can be defined as the framework of rules, practices and policies by which an organisation can ensure accountability, fairness and transparency in an organisation’s relationship with its stakeholders.

Almost every employee working in the HSE is regulated externally. However there is no external regulation of managers.

What has arisen today in Wexford is all over national media and social media. A clinical nurse specialist with 30 years experience, and 14 years in CAMHS, is being moved from his position in Arden House to north County Wexford at a time the other clinical nurse specialist is going on maternity leave. Both are being replaced by what is referred to as an acting clinical nurse with two years 'experience to take care of 170 families. I have been inundated with the distressed families who are suffering at the hands of whoever made this decision. I plead with the Minister.

I thank the Deputy for raising this. We have spoken across the floor many times, and I acknowledge the number of times and the interest she has in mental health services for both young people and older people.

As does the Minister of State.

I thank the Deputy.

With regard to the south Wexford CAMHS clinical nurse specialist, CNS, the HSE has indicated that the south Wexford CAMHS CNS is moving to north Wexford CAMHS and the north Wexford CAMHS CNS is moving to south Wexford CAMHS on 16 May next. There is, therefore, no diminution of the nurse staff complement in Wexford CAMHS. There will be two CNS posts at Arden House and two CNS posts at Arnold House for north Wexford CAMHS. That is the situation as set out to me.

The Deputy mentioned the multidisciplinary teams. The teams are very important and it was very difficult to get that consultant psychologist into place. It went on for a long time. Since I took office a year and a half ago, we have spent a long time trying to make sure that the post was prioritised and expedited. Thankfully, it has now been filled. I note that the Deputy went through the team. There are some gaps. There are 73 CAMHS teams throughout the country. As a result of what happened in Kerry CAMHS we are doing an audit of every team in the country. The audit is in three parts. One part, which is independent and outsourced, is to look at the composition of all 73 teams in Ireland, the gaps in the teams and to look at governance and whether they are operating to standard operating procedures. I will have all that data available to me.

We are doing another audit, which is also independent and is being carried out by one of the universities. We are going to talk to the children, the parents and the families using CAMHS to see what their experience has been, if they were or were not able to access CAMHS and how they got on. That is the second part. The third part is the piece relating to the audit of potential over-prescribing, which happened in south Kerry. That is a big body of work.

The Deputy mentioned ADHD and said that 40% to 45% of presentations are ADHD. The HSE was clear that it only wanted to audit ADHD presentations, but I was adamant from the start that it had to be a full audit that included self-harm, suicidal ideation, depression and anxiety. In addition, the Mental Health Commission is doing a review in parallel with this, which I also welcome.

I have to be honest with the Minister of State. The HSE is just not fit for purpose. The Minister of State mentioned that the HSE only wanted to audit the 46% that were ADHD. It would be easy to audit them when it is not actually seeing them. When CAMHS has not done an assessment for six months, what is it going to audit? The next thing it will be telling the Minister of State is that it will not do one for 12 months and it will audit that year, when there is nothing to audit.

The reality is that CAMHS in Wexford has had 28 anorexic patients, but we do not have a paediatric dietician. I have persistently asked for a full-time equivalent to be placed in Wexford. We got no more than a half-time post, but the position has not been filled. How long will it take the HSE to stop looking at its model of employment? CAMHS has been telling me for two years, and saying in writing, that it is following the model set down by the HSE. We must apply on a critical skills basis for people outside the country. Permit employees needs to be done today; it needed to be done yesterday. The Minister of State is sick of hearing it, I am sick of hearing it and, most of all, the patients are sick of hearing it.

When it comes to Wexford, I suppose what the Minister of State said with regard to rotation would make practical sense on some level, but not in this case. I will explain why. The man has been in Wexford for 30 years. He made a written complaint about the consultant psychiatrist. I am telling the Minister of State that now, and that is at the back of this. I am glad to hear there is an audit, because this man will not be moving on 16 May. We will be down a clinical nurse specialist either in the north or in CAMHS in Arden House. He is not going anywhere; he is certainly not moving. He did not ask to move and there is no need for him to move. There are four clinical nurse specialists in the north. There are only two in south Wexford and one is going on maternity leave. She has ten years' experience. Both are going to be replaced with the lesser clinical nurse, one who is acting with less than two years' experience.

I do not mean to raise my voice to the Minister of State. I know perfectly well that she and I have come through this together. We are both learning, but I am learning very quickly because I have been getting the same letters for two years. I cannot stick it anymore. It is not good enough to be providing a service in name only. We have to show the fruits.

First, these decisions relating to staff rotation are part and parcel of strategic workforce planning. That decision is taken by the local area director of nursing, who is fully entitled to do that.

I want to make a second point.

Over the past two years, I secured an extra €97 million for mental health. It is the largest ever budget. I will always be looking for more when I am in this post. There are some positives out there. As a result of the budget I secured last year, 55 new staff were hired in CAMHS throughout the country. One of them is the psychologist we are speaking about. A total of 45 people were hired for eating disorder teams. A new eating disorder team is coming to CHO 5 this year. It will be in place towards the end of the year. I am building them-----

Is it for paediatrics?

It is not for paediatrics. It is for adults first and then paediatrics. I have to put 16 in place and I will have nine at the end of this year. It is incremental. It is the only way we can get the staff and that is what we are doing.

It is important to point out that we know CAMHS is a specialist service for people under the age of 18 with moderate to severe mental health difficulties. It is not for everyone. Only 2% of young people will need the support of CAMHS. Sometimes what happens is that young people are referred to CAMHS by their GP, their family or one of the NGOs but primary care is probably more suitable for them. They are not always accepted. They do not always meet the criteria for CAMHS. This is a clinical decision I cannot interfere with. It is a decision taken by clinicians to determine whether they can give the best support. We have seen an exponential growth in eating disorders. When the clinical programme was devised in 2016 and 2017 it expected 60 referrals. Last year we had 504. Capacity is being pushed and pushed. I am trying to put the capacity back into it.

Disability Services

I thank the Ceann Comhairle for selecting this Topical Issue matter to be brought to the House for this very late debate. It is good to be here. I also express my gratitude to the Minister of State, Deputy Rabbitte, for coming to the Chamber and taking the issue. Her dedication to following through consistently on this matter must be astounding many officials in the Department, I am sure. They would probably like to see her being reshuffled to give themselves some respite. That is probably a sad reflection of where the Department is at, unfortunately.

The governance and safeguarding report into CHO 1 published by HIQA last Friday has confirmed many of the points I have been making on the handling of the Brandon case and the subsequent Brandon report in the public domain for past year and for the past six years through my interactions with HSE management. Importantly, HIQA states in the report, and I have reiterated it many times throughout this saga, that no fault lay with the front-line staff in the centres and that safeguarding concerns were being responded to appropriately at that level. It is important to reiterate this. I know the Minister of State has done so at every opportunity and it is important for the staff and the residents.

As HIQA acknowledges, the problems are in areas of communication, governance and oversight of safeguarding procedures, especially follow-up and sustaining positive change. It points to this occurring at middle management, regional and national management levels. The one point in the report I take issue with is HIQA's assertion that this was prevalent only in the Donegal area of CHO 1. It highlights the Sligo area of CHO 1 as something of an exemplar. If there are problems with the identification, reporting and escalation of incidents of a safeguarding nature in the CHO 1 area, then to my mind it is hard to come to the conclusion the report did, which is that it is only in Donegal. I believe that if an in-depth audit was carried out nationwide, it would find similar systemic failures in management, reporting and oversight, and probably not just confined to disability services either. The previous Topical Issue debate gave us an example of this.

The problems all stem from a basic resource issue. Front-line staff are being asked to do a job for which there is often no capacity. Budgets are dictated from the top down and woe betide the local managers who would be brave enough to raise their hand and say that they cannot do the job with what they have been given. It is an ingrained institutionalised attitude found in management across all levels. It is not a public sector problem; it is a management problem. The other major institutionalised attitude found in management is to admit nothing, bury the problems at all costs and save the company first. Sadly, this is the way it works. It is borne out of an arrogance at senior management level and filters down through the layers unspoken, where people know that to raise their head above the parapet will do their career prospects no good. We only have to look at the performance of the Secretary General of the Minister of State's Department at committee this week to recognise it. It was out of touch and privileged but typical of many at that level, unfortunately. That is the problem we see across the board. This problem can be seen in what has happened in the Brandon case and others. We can say it looks good as a performance at a committee meeting but when it feeds down through the programme to ground level then people get hurt. These people are constantly neglected and it is a real problem. I know the Minister of State is active and will try to sort it out and I pay tribute to her for it. If it were not for her and the work she has done we would not have got this far. I would have been shouting into a vacuum and not getting anywhere. It is important that we raise this issue.

I thank the Ceann Comhairle for selecting this Topical Issue matter. If memory serves me correctly, this is our fourth time to have a Topical Issue debate on this and it is normally on a Thursday night and it is normally No. 4. In saying that, I thank Deputy Pringle for raising this important issue for discussion and his continued work and advocacy on such issues in Donegal. I welcome the report by the chief inspector of social services in HIQA into the governance and safeguarding in HSE-designated centres for people with disabilities in Donegal. I welcome the comprehensive nature of the report. It provides clear, practical indications of areas for improvement.

I read the Brandon report which was not made available to the general public. I am still calling on the HSE to make it available. What I have seen in numerous reports that have been published is mirrored in some of what is in the Brandon report. The overview report is the outcome of a regular programme of unannounced inspections by the chief inspector in County Donegal. Eighteen centres were visited in January, bringing the total number of centres inspected in the period from September 2021 to January 2022 to 27. All 27 centres are operated by the HSE.

The chief inspector's regulatory programme followed an escalation of inspectors' concerns about the HSE's governance and oversight of designated centres in Donegal. The purpose of the programme was to assess the HSE's compliance with specific regulations under the Health Act 2007. It is important to recognise that the report found that most residents lived in pleasant comfortable environments and that the centres were managed by experienced and knowledgeable persons in charge. It is also important to recognise that when I travelled to Donegal last October and met family members, they were more than complimentary of the front-line staff. They asked me to acknowledge this at all times, as the Deputy has done this evening. However, the inspections found there was poor oversight arrangements in place in the HSE in Donegal. I wish I could say I was surprised by this but unfortunately some of these issues mirror those outlined in the Brandon report and other HIQA reports from the county.

While substantially compliant with one of the three regulations inspected, the HSE, as service provider, failed to comply with two of the regulations, as has been reported to the Minister for Health. We both received a letter late last year from the CEO of HIQA detailing the agency's serious concerns regarding safeguarding in Donegal. The concerns raised in the letter are echoed in most of the recent HIQA reports. This is a concern for me. Ultimately I, as the Minister of State, need to be assured that services are operating to the highest standards for service users and that families can be reassured their loved ones are being cared for appropriately and their trust in the health service is not damaged.

I took particular note that HIQA states its inspectors found the supervision and governance of centres by middle management and senior management was poor. It is clear from the HIQA report that the HSE can be too reactive to issues instead of being proactive. It does not appear to be a CHO-wide deficit as HIQA notes that in Sligo similar incidents do not occur. It is quite clear that safeguarding arrangements need to be strengthened to ensure any issues that arise are identified, escalated and responded to quickly.

A compliance plan has been submitted to HIQA by the HSE outlining plans to address the governance gaps identified by the chief inspector and improve overall safety. I know HIQA's chief inspector has commenced an inspection programme of individual centres that will take place over the course of 2022 to verify the implementation by the HSE improvement plan.

I saw that finger waving at me.

I thank the Minister of State for her response. I echo her calls for the HSE to publish the Brandon report even at this late stage. Its constant excuses as to why it cannot publish it do not stand up at this stage and do not wash at all. I think everybody knows that. The HSE probably knows it but will never admit it.

While this HIQA report is good, HIQA is not in the clear itself. It has been compliant to a large extent with what has gone on in Donegal over the years. I am glad to see it has come out now and is doing its job. I hope this continues because it is vitally important. The one thing that needs to be said and cannot be said often enough is that this is not a Donegal issue. It is an issue for the national body. It says in the report that it goes right up to national management. One of the things that struck me as we were approaching the publication of the report was that what happened in Donegal was supposedly not being covered by management in Dublin but then all of a sudden when it went to Dublin, everything changed. We must get to the bottom of what actually happened. I am loath to think that this would be contained to Donegal because we have seen this in the past. The Minister of State will probably remember the Morris tribunal regarding what was happening in An Garda Síochána. The response from officialdom at that time was that it was confined to Donegal and that it was only a Donegal issue. To our cost, we saw that it did not just happen in Donegal. We must make sure that this is not the case in the future. National management must be addressed.

We all agree that the safety and protection of vulnerable people is paramount and continue to strive to work together for this objective. If one of the reasons why the Brandon report was not published was industrial relations or human resources issues because of the identification of a particular layer in HSE management, well HIQA has done it now.

The chief inspector has indicated that there is an inspection programme in the CHO to verify the implementation of the HSE improvement plan and to confirm where the actions taken by the HSE are effective in delivering safer and better quality support. I am also working with officials in the Department of Health and the Department of Children, Equality, Disability, Integration and Youth to develop some form of review or oversight of safeguarding in Donegal. I have been open about my belief that this needs to be led by an expert, independent person specialising in social care and safeguarding who is independent of the HSE and HIQA. My ask is that the powers that be in the HSE and HIQA work with this independent person or group or be part of the team but it will be led by an independent expert where they can share the findings of whatever reports I cannot publish.

Not too long ago, Deputy Connolly stood behind Deputy Pringle and listed all the reports done on Donegal since 2015 and 2016. By pulling all those reports together, the terms of reference can be identified. Yet again, it would be wonderful to have the co-operation of the HSE and HIQA in terms of working with me to review safeguarding and reassure families with loved ones in centres in Donegal that not only are their loved ones receiving the best possible care but that if an issue is identified, the front-line staff working there will be supported when they identify an issue and will know how to identify issues and patterns. For far too long, we have adopted the medical model when it comes to institutionalised care. We need to look at the social care model, stop calling issues episodes and start understanding where that pattern came from and how to support staff but most importantly, the service user in the centre.

Work is underway and I hope that with the co-operation of the Minister for Health and the Minister for Children, Equality, Disability, Integration and Youth, this will be expedited. We hope to have a framework by June.

So there is no finger this time.

No, because the Acting Chairman let me go.

Cuireadh an Dáil ar athló ar 8.05 p.m. go dtí 2 p.m., Dé Máirt, an 10 Bealtaine 2022.
The Dáil adjourned at 8.05 p.m. until 2 p.m. on Tuesday, 10 May 2022.