I wish to share my time with Senator Burke who, coincidentally, expressed an interest in this matter on the Order of Business. I was unaware of his interest – perhaps I should have been. However, he will make a valuable contribution if the House agrees.
Adjournment Matters. - Autism Services.
Is that agreed? Agreed.
I am sorry the Minister for Education and Science has left and will not be dealing with this matter, although I am not sorry to see the Minister of State, Dr. Moffatt. I am sure this information will be passed on to the Minister. It fits wonderfully into the context of the Minister's genuine concern – he is a very decent man and a good Minister for Education and Science – that facilities be made available to the young people of this country. This is true.
This evening I wish to argue for making these facilities available to a particularly vulnerable group. I have had strong support on this case from my friends in Fianna Fáil. However, for a variety of reasons, some technical and, perhaps, some political, they are not in a position to make it clear this evening.
This is the case of a young boy of seven years who is autistic. He comes from a remarkable family. The parents have one other child, a daughter aged two who has both spina bifida and hydrocephalus. These parents have provided a loving, cherishing environment and are prepared to fight like tigers for the well-being of their children. The condition of autism is a complex and difficult one. In a sense, children with this condition are internal refugees. We hear a great deal about refugees in our society. These internal refugees are in exile in their own minds. However, they can be facilitated if they get assistance early enough. This boy is seven or eight years old. If he is assisted by speech therapy now he can unlock some of the recesses of his mind and gain a degree of freedom. If we leave it too long it will never happen. Yet, he is being disbarred from access to speech therapy.
I have the psychologist's report here. The psychologist has told the boy's parents that he requires speech therapy. However, the clinical director of Stewart's Hospital special national school which he attends has told his parents it is not in a position to provide him with speech therapy, due to a lack of resources and that, even if more resources are allocated, it will not be putting them into speech therapy. It does not even have a speech therapist because the one who was there resigned. It is unacceptable that while it has been indicated professionally that this child needs speech therapy, none is being provided, either in Stewart's Hospital or through other health board services.
The psychologist's report states that the boy was seen in the department of child psychiatry, St. James's hospital in 1994 and attended the pre-school there from January 1995 to August 1995. The family went to India for a few months and he attended a local Montessori school on his return. He then attended the language unit in Ballinteer from September 1996 to June 1997. Psychological assessment in the department of child psychiatry in 1997 estimated his functioning as being within the moderate range of learning disability. He was also tested on the CARS and his score on this indicates that he falls into the mild to moderately autistic range. In other words, help is possible. His parents were seen on one occasion and he was seen on a further occasion.
He came readily for assessment and he co-operated well during the testing session. His speech during this time was echolaliac, in other words he tended to repeat the sound stimulus which was given to him. On the full range English picture vocabulary scale he obtained a score which is below the three year level. As regards his intellectual functioning, testing on the Stanford Binet intelligence scale fourth edition indicates that his current level of intellectual functioning is estimated as being within the moderate range of learning disability.
He performed particularly well on the quantitative reasoning area. With regard to reading and spelling, when presented with a set of distractors, he could not pick out his own name. However, his teacher reports that he can do so at school. As regards number skills he was able to give only one block on request consistently. As far as visual motor performance was concerned he could trace a vertical and horizontal stroke but not a circle on request.
There is more clinical data but I have given the most important in terms of his educative capacity. In the official opinion of the psychologist, he is a boy whose current level of intellectual functioning is estimated as being within the moderate range of learning disability. Adaptive skills are in line with his level of functioning on intellectual testing. The crucial issue is the recommendation that he should continue his school placement and that he also requires speech and language therapy.
This matter was the subject of parliamentary questions in the Dáil. The replies were totally unsatisfactory and do not even seem to be accurate. On Tuesday, 23 March 1999 Deputies Gregory and Lawlor, the family's local representatives, asked about this matter. The Minister for Health and Children, Deputy Cowen, replied that the recruitment of this type of staff, including speech and language therapists, for services to persons with disabilities in the eastern region is a matter for the Eastern Health Board. On the same date, Deputy Gregory asked the Minister for Education and Science if his department could assist with the provision of speech therapy. The Minister replied: "A speech therapist employed by Stewart's Hospital normally provides a service to the school attended by the pupil in question." However, this position does not exist any more. He went on to say: "However, I understand that the speech therapy post in question is currently vacant and that the hospital authorities are endeavouring to fill this post as quickly as possible." That is not correct.
I wish to refer to a letter from the general manager of the Eastern Health Board to the father of the child:
I refer to your recent correspondence which was sent to me regarding speech therapy for [this child]. Stewart's Hospital is funded directly by the Department of Health to provide extensive services for people with special needs in the area. It is a matter for Stewart's Hospital to prioritise their service needs. The Eastern Health Board does not have any remit in how they do this.
A letter from the director of Stewart's Hospital indicates clearly that there is no intention on his part to provide this, even if facilities should be made available. Other school reports indicate that this young boy is capable of using speech therapy to his advantage. I appeal to the Minister to make these resources directly available to him.
I thank Senator Norris for sharing time with me and allowing me to support the case which he has made so eloquently in regard to the serious problem faced by this child. I am not sure whether this is a matter for the Department of Health and Children or the Department of Education and Science or both. However, there is a serious shortage of speech therapists throughout the country. I am reliably informed that only 24 places are provided annually by Trinity College for speech therapists; that is totally inadequate. A total of 754 adults and children in County Mayo are cared for by Western Care, which is a partnership involving the Western Health Board. I am sure that the Minster of State, who is from County Mayo, is well aware of the scale of the problem.
The association should have a complement of five speech therapists but only has one currently, which it may also lose. The reasons for the shortage are the low salary scale and the high level of qualification. Trinity College only offers 24 places annually and the points are pushed up to get into the course. The number of points required is similar to that required for medicine. However, these graduates are highly qualified and move into management positions, etc., thus leaving the health service. Is this a problem for health boards or the Department of Education and Science?
It is clearly the responsibility of the Department of Health and Children to provide the funding for speech therapists and other facilities. This is a serious problem. If there were a shortage of graduates in other sectors of the economy what would the position be? Funding should be provided by the Department of Education and Science to educate more speech therapists and the Department of Health and Children could then employ more of them with a better salary.
I thank the Senators for raising this matter and giving me the opportunity to outline the position concerning this issue on behalf of my colleague, the Minister for Health and Children, Deputy Cowen. The provision of health related support services to children with autism, including speech and language therapy, in the eastern region is a matter in the first instance for the Eastern Health Board.
I understand from the board that the child in question is currently attending a special school which comes under the auspices of a mental handicap agency in west Dublin. Health related support services are provided to the school by the mental handicap agency. The agency currently has a vacancy for a speech and language therapist and is actively seeking to fill this post. The East ern Health Board has been working closely with this agency in attempting to address the need for speech therapy services.
While the major proportion of health related support services, including speech and language therapy, occupational therapy and psychological services, to children with either a mental handicap or autism in the board's region are provided through specialist mental handicap service providers, the board provides such services, on an outreach basis, to the special classes for children with autism which have been established by the Department of Education and Science.
In addition to the £200,000 provided in 1998, a further £200,000 was provided to the Eastern Health Board for the enhancement and development of health related support services for children with autism in 1999, with a full year cost of £400,000 in 2000. The total investment in these services in the board's region between 1998 and 2000 will, therefore, be £600,000. In line with other health boards and agencies providing services to persons with disabilities, the Eastern Health Board has encountered difficulties in recruiting the multi-disciplinary staff, including speech and language therapists, required for both the outreach teams, which it has established to support the special classes for children with autism, and other services to persons with a mental handicap or autism in its region.
The issue of the recruitment of paramedical staff generally presents problems throughout the various health board regions. Following a Labour Court recommendation in 1997, an expert group was established to examine and report on various issues relating to paramedical grades, including speech and language therapists. One of the issues to be examined by this group is the problems which arise in regard to the recruitment and the retention of various paramedical grades. It is anticipated that the report of this group will be completed later this year. Health service employers have given a commitment to establish formal links with colleges and the professions involved. My Department, together with the Health Service Employers Agency, is examining how best to approach the issue to ensure that the views of all concerned are heard.
Since his appointment as Minister, Deputy Cowen has consistently identified the provision of additional services to persons with a mental handicap and autism as one of his priorities. This year he was pleased to provide additional funding of £12 million, with a full year cost of £18 million in 2000, for the further development of new services in line with the requirements identified in the Assessment of Need report. Included in this is funding amounting to £1.5 million in 1999 with full year costs of £2.5 million in 2000 for the enhancement of health related support services for children with autism.
I assure the Senators that both the agency and the Eastern Health Board will continue to endeavour, as a matter of urgency, to fill the existing speech and language therapist vacancy in the agency in question. My Department will keep in touch with the board regarding this matter and I will contact the Senator as soon as there are further developments. Senator Norris raised a discrepancy whereby the agency and the health board are both actively seeking to recruit a speech therapist. I will clarify the position for the Senator but, as Senator Burke said, there is a difficulty in recruiting speech therapists and perhaps not enough people are currently graduating. These issues will be examined.
I thank the Minister of State for his reply and his closing remarks, in particular, which I take very much to heart. I have a copy of a letter from the school which indicates clearly that if resources are made available they will not be spent in this area. The Eastern Health Board stated that it has no control over this and the school can do what it wants. I wish to meet the Minister, if possible, because some local children are already getting speech therapy from the health board. Can this child not even be facilitated since time is so much of the essence? He had speech therapy but it is now being withdrawn. He may be locked into this world. It is at his age that intervention is required. Perhaps it would be possible to arrange a meeting with the Minister of State or the Minister, Deputy Cowen, and myself – I understand the diplomatic difficulties – and, if possible, with the parents present in a non-aggressive way.
I feel strongly about this case. These people have two children, one autistic and the other with hydrocephalus and spina bifida. They are non-aggressive people. They are not picking a quarrel or seeking to provoke people but they are meeting a brick wall. We can help to remove that brick wall. I appreciate the Minister of State's helpful remarks.
The Seanad adjourned at 8.50 p.m. until 10.30 a.m. on Thursday, 13 May 1999.