Seanad Éireann debate -
Wednesday, 1 Feb 2006

Vol. 182 No. 12

Adjournment Matters.

Special Educational Needs.

Mr. McHugh

I welcome the Minister of State at the Department of Education and Science with special responsibility for children, Deputy Brian Lenihan, to the House. I submitted this matter in the aftermath of a meeting with parents in Letterkenny, which is home to the Letterkenny branch of dyslexia workshops. Over 55 parents comprise the branch. They set up this workshop in light of deficits in the special needs area. They found that their children are not being catered for in primary and secondary schools in terms of facilities to meet their specific dyslexic needs, even though it is clearly stated in the guidelines of the Department of Education and Science that children with dyslexia have a specific learning disorder that should be met in terms of learning or resource support in some form. However, this is not the case.

The main issue I wish to highlight is that many parents, since the need has not been identified at primary school level, must get private assessments. As the Minister of State is aware — I do not have a clue about the level of fees in the greater Dublin area — some parents in County Donegal pay upwards of €420 for private assessments, without which they will not get into the workshop in Letterkenny. The system is inequitable and there are discrepancies.

In terms of special needs, there is an outcry from parents throughout the country, not just in County Donegal — I only cite Letterkenny as one example — for the Department of Education and Science to acknowledge the fact that dyslexia is a special need and requires resource support and not to pass the buck to the schools. The Department decides issues of funding and provision of resource support. Principals and boards of management must take the heat from parents of children who have dyslexia.

The reply by the Minister of State will be of interest and I hope that, down the line, the clustering system in general for special needs and resource learning will be addressed in rural and peripheral areas. Many schools in rural areas, such as Inishowen and Fanad, do not meet the specific requirements and needs of children with general special needs. It is a resource issue. The Department of Education and Science has the capacity and potential to address these problems.

Minister of State at the Department of Education and Science (Mr. B. Lenihan)

I am making this reply on behalf of the Minister for Education and Science, Deputy Hanafin. I am pleased to have been given the opportunity to outline to the House the position of the Department of Education and Science on the issue raised by Senator McHugh. A general allocation scheme has been introduced, under which mainstream primary schools have been provided with resource teaching hours based on enrolment figures to cater for children with high incidence special educational needs such as dyslexia and for those with learning support needs. All schools were notified of their general allocation for the school year 2005-06 in May 2005.

The reason for the new scheme is simple. Children with special needs such as dyslexia are found in almost every school. It makes sense, therefore, that every school should have a number of resource teaching hours based on the number of pupils in the school. This is a major improvement on the previous system, under which children with high incidence special needs required a psychological assessment before the Department of Education and Science allocated resource teaching hours. This time-consuming process often led to delays in children obtaining the support they needed. Resource teachers will now be in place in the school from the start of the school year, so that children who need their assistance can get it straight away.

In introducing the general allocation system, transitional arrangements were also introduced to ensure no child in respect of whom resource teaching support was allocated to a school would experience a loss of that support. As outlined in a circular to schools in August 2005 on the organisation of teaching resources for pupils who need additional support in mainstream primary schools, it is a matter for each school to determine the pupils with high incidence special education needs, such as dyslexia, who will receive this support. The school can then use its professional judgment to decide how these hours are divided between different children in the school to ensure that all their needs are met.

Research shows that some children with special needs will respond better with one-to-one tuition. Others, however, do better when taught in small groups. Often, it is best for resource teachers to work with children in the classroom rather than taking them away to a separate room, as the children then have to catch up on work done by the rest of the class in their absence. The point is that the type of response needed depends on the child.

Second level pupils with dyslexia are normally integrated into mainstream classes. Here they may receive additional tutorial support through the learning support teacher, guidance counsellor and subject teacher. Depending on the degree of the condition, they may also be eligible for special arrangements in the certificate examinations.

Significant progress has been made over the past number of years in respect of increasing the number of teachers in our schools who are specifically dedicated to providing education for children with special educational needs. At primary level there are now approximately 5,000 teachers in our schools working directly with children with special needs, including those requiring learning support. This compares to fewer than 1,500 in 1998. Indeed, one out of every five primary school teachers now works specifically with children with special needs. At second level, approximately 1,630 whole-time equivalent additional teachers are in place to support these pupils with special educational needs. This compares to the approximately 200 teachers that were in place in 1998 for such pupils. In addition, there are 532 whole-time equivalent learning support teachers in our second level schools.

The Department also provides funding to schools for the purchase of specialised equipment, such as computers, to assist children with special educational needs, including children with dyslexia, with their education where such equipment is recommended by relevant professionals. Schools can apply to the local special educational needs organiser, SENO, directly for this support.

Initiatives have also been taken in recent years to improve the training and support provided to teachers in respect of dyslexia. An on-line training course for teachers catering for pupils with dyslexia has been introduced. In addition, ten new learning support trainers have been recruited to the primary curriculum support programme, specifically to provide in depth support for the development and implementation of learning support guidelines for children with dyslexia. Also, in association with the Department of Education in Northern Ireland, an information resource on dyslexia has been produced which is available to schools in CD-ROM, DVD and video format.

The steps taken in recent years and those currently in hand represent significant progress in the development of services for children and young people with dyslexia. I assure Senator McHugh that the Minister for Education and Science will continue to prioritise support for children with special needs, including dyslexia, so that all children are enabled to reach their full potential.

Mr. McHugh

The Minister of State must assure parents. The holistic way in which special needs education is being addressed sounds good in general but it does not deal with the specific deficits experienced by parents who may have found their children in primary or secondary schools that do not have the teachers in place with the skills to deal with dyslexia. It is a bigger issue that must also be addressed on a mid to long-term basis at university and primary school teacher college levels.

Mr. B. Lenihan

The Senator has raised a relevant point. The council for special education would be the appropriate body to which it should be addressed. It is planning the future of this sector on a statutory basis, as I am sure Senator McHugh is aware.

Ambulance Service.

Mr. Kitt

I welcome the Minister of State to the House. The Minister of State knows of my interest in obtaining an ambulance base in Tuam, north-east Galway. I raised this issue on a number of occasions, pointing out that a design for a major health campus was completed in October 2002. This would include a community hospital, an Alzheimer's disease unit, a child care training centre, a primary care unit and an ambulance base in Tuam. A minimum of two ambulances and eight staff would cost between €600,000 and €800,000.

Ambulance bases exist in Galway city, Clifden, Carraroe, west Galway, Loughrea, south-east Galway, and Ballinasloe, serving the Roscommon area. A major gap exists in north-east Galway, where there is no ambulance service. The case is exacerbated by the fact that the service in Galway city, which normally serves north-east Galway, is now too busy to attend to the area. It was envisaged that the site of the former Bons Secours Hospital, Tuam would be the site for the health campus, serving north-east Galway and south Mayo, areas that were part of the former western health board region.

I was heartened by new proposals for ambulances services in Birr, Roscrea and Shannon but I wish to make my case as strongly as possible to the Department of Health and Children. I have already presented the Tánaiste and Minister for Health and Children with a petition containing 5,000 names. She is aware of how serious this matter is and met with members of the ambulance trade union who explained the pressure they were under to serve Galway city. The same service is expected to serve north-east Galway.

I thank the Ministers of State, Deputies Brian Lenihan and Seán Power, and the Tánaiste for the recent provision of staff for two cancer care beds to Tuam. This allocation of €250,000 was badly needed and I seek a sum in the region of €800,000 to set up an ambulance base with two ambulances and eight staff. The people of the area need the service quickly as it cannot be provided from Galway city, Mayo or Roscommon.

Mr. B. Lenihan

I am taking part in this Adjournment debate on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. Under the Health Act 2004, the HSE has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of ambulance services. I am aware of the many eloquent pleas Senator Kitt has made for a Tuam ambulance service.

Within the western area the HSE provides emergency and patient transport ambulance services to a population of over 350,000 people. The Department of Health and Children is advised that the emergency ambulance service is provided from ten stations across the catchment area. There has been a significant expansion of this service in recent years, the number of 24-hour bases has increased from three to five, while the hours of operation across all bases have increased significantly.

In 2004 six new high-specification ambulances were provided. In addition, two new rapid response vehicles have been introduced as backup to the new fleet. Facilities at ambulance stations in Ballina, Boyle, Clifden and Roscommon have also been improved. The executive has responsibility for the continuing development of the service. It is developing proposals for the establishment of a number of additional stations in the western area, including a station in the Tuam area.

The HSE's national ambulance office supports the development of a new ambulance base in Tuam. The provision of additional funding for this development is a matter for the HSE in the context of its capital priorities for 2006.

Mr. Kitt

Is the Minister of State hopeful that we might have some news of an ambulance base in 2006?

Mr. B. Lenihan

I do not have any information beyond what I have stated in my reply.

Mr. Kitt

I am sure the Minister of State will work to bring about what I requested.

Mr. B. Lenihan

I certainly will.

Health Insurance Industry.

Mr. Bradford

I welcome the Minister of State to the House. Hundreds of thousands of people across the country are concerned by the Government's decision to introduce risk equalisation in the health insurance industry. I have addressed this topic in both Houses over the past five or six years. The prospect exists of risk equalisation being adjudicated on in various domestic courts and also the possible, or in my view inevitable, impact on competition being examined from an EU perspective. These prospects are beyond our remit in this House so I wish to focus on the political decision the Government has taken to introduce risk equalisation.

I was amazed at the Tánaiste's decision to introduce risk equalisation. It goes against every recorded political comment on competition and choice for the consumer. Risk equalisation is a bizarre concept that will shut down competition in the Irish health insurance industry and return us to the days of one company being available to the Irish consumer. Her decision is inexplicable.

Current circumstances are no different from those of last year, when the Minister for Health and Children refused to introduce risk equalisation. The Health Insurance Authority makes recommendations to Government but on previous occasions when the introduction of risk equalisation was recommended the Minister refused to do so. She did not feel the circumstances warranted the introduction then but the circumstances have not changed. The Competition Authority and the Health Insurance Authority, charged with the responsibility of examining competition in Irish health insurance, expressed the view that the current situation allows for competition. The Health Insurance Authority has stated that there is no short-term prospect of instability in the health insurance market. In this context I cannot understand why risk equalisation has been introduced.

In the Irish health insurance market, where the dominant player has a major share of the market, this new policy is bizarre. It is analogous to asking a small local shopkeeper to hand over half his profits to Tesco or another major supermarket chain. Introducing risk equalisation will reduce competition in the health insurance market and we will lose the second largest player in health insurance, BUPA Ireland, and its enterprise in Fermoy, which employs hundreds of people. This will be detrimental to choice and runs counter to the Government policy of being pro-consumer and pro-choice.

From where did the impetus come to make the decision to change to risk equalisation? The circumstances which exist in the current calendar year are no different to the circumstances which existed last year, and 12 months ago the Tánaiste refused the recommendation to introduce risk equalisation. She seems to have reversed that policy.

Transfer of funding from BUPA through risk equalisation would result in a large proportion of its surplus being put into the VHI reserve. What will that do to ensure the VHI becomes more competitive and efficient? If we want to promote the cause of the VHI, a long-established and valid health insurance company in this country with hundreds of thousands of customers, we should promote efficiency within it. If the VHI has inefficiencies or faces financial issues that are difficult to resolve, simply taking the profits of the smaller company to prop it up will not be of any great benefit to the Irish health insurance consumer in the long run.

As the Minister of State is aware, the Irish health insurance market is unique by European and world standards. One company is dominant. If we want to change that situation and ensure that people have a choice not simply between VHI and BUPA but between five or six different companies, we must ensure that competition is welcomed and nourished in the Irish market. The introduction at this stage of a risk equalisation policy and transferring the profits of the small company to the large company goes against all that is good for health insurance in the long term.

The Minister for Health and Children must reflect carefully. If the Minister were of a different Government or from a different political party perhaps there would be some explanation. However, I cannot understand how the Tánaiste made the decision. Whether we are for or against most of her policies, we must concede she has attempted throughout her political career and in all of her utterances, to be a champion of competition, choice, the free market and opening up the market. Risk equalisation goes against all of that.

Who put on the pressure? Was it the Taoiseach, or was it at union or partnership level? Whoever put on the pressure and made the Tánaiste concede to the introduction of risk equalisation is not doing the Irish health insurance market or consumer any favour in the long term. This type of formula has no place in a modern economy attempting to foster competition. Even at this late stage, and leaving aside the prospect of an adjudication by the courts and Europe on the question of competition, we should be able to show political leadership by reversing the risk equalisation decision.

Mr. B. Lenihan

I will take the Adjournment matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. There is widespread support in this country, reflected in the decisions of the Oireachtas, for applying community rating to health insurance. Under community rating, subscribers pay the same amount for similar cover throughout their lives. Numerous references were made to the concept of risk equalisation. In truth, risk equalisation is simply the technical formula for the implementation of the principle of community rating.

Community rating means that individuals can continue to afford health insurance right into those decades of their lives when they are most likely to need it. The position in Ireland, with community rating and lifetime cover in place, is in marked contrast to countries such as the United Kingdom and the United States where risk-rated health insurance products result in older subscribers no longer being able to afford to maintain their insurance cover. That is the fundamental policy here and it is certainly subscribed to by my party. I cannot speak for the party of the Tánaiste. However, as Senator Bradford referred to that issue, it shows how compelling a case can be made for risk equalisation and community rating that the Tánaiste decided as she did.

Risk equalisation is the mechanism that supports a community-rated health insurance market. Provision for risk equalisation has been part of the framework for health insurance since the enactment of the Health Insurance Act 1994. The risk equalisation scheme of 2003, having been affirmed by Seanad Éireann, took effect from 1 July 2003. The scheme had previously been submitted to the EU Commission which, in May 2003, found that the scheme is justified, given the open enrolment, community rating and lifetime cover requirements that apply in our health insurance market.

This is not about taking from a small company and transferring to a large company. It is about maintaining the principles of open enrolment, community rating and lifetime cover in our health insurance market. Risk equalisation involves transferring funds from insurance companies which have a large proportion of young, healthy subscribers to companies which have a larger proportion of older persons who are more prone to illness and therefore more likely to make claims on their health insurance policies. This ensures that younger and older subscribers pay the same amount for similar health insurance cover.

The Health Insurance Authority submitted its report, in accordance with the provisions of the Health Insurance Acts and the risk equalisation scheme, in respect of the period January to June 2005 on 27 October. The authority, the relevant statutory body, recommended the commencement of risk equalisation transfers having analysed returns made by insurers and having considered representations made. The authority's report confirmed a significant divergence in market risk profiles between insurers. Having considered the authority's report, letters containing a proposed determination were sent to the insurers involved on 21 November last.

On 23 December, the Tánaiste made the decision that risk equalisation transfers between insurers in the market is necessary, having carefully considered the report submitted by the Health Insurance Authority and representations made by insurers in the market. The Tánaiste did so in accordance with the provisions set out in the risk equalisation scheme and in the Health Insurance Acts, having regard to the best overall interests of health insurance consumers. Commencement of risk equalisation transfers on foot of a recommendation from the authority is subject to specific statutory processes and considerations. The Tánaiste is satisfied that the decision made was the correct one and the question of reviewing it does not arise.

Senator Bradford refers to the need to defend and promote competition. The Health Insurance Acts specifically provide for taking competition into account. They state that the best overall interests of health insurance consumers include a reference to the need to maintain the application of community rating across the market for health insurance and to facilitate competition between undertakings. Given this obligation, the Tánaiste notes that the York economic report commissioned by the Health Insurance Authority concluded that, "there is no satisfactory case for the non-implementation of risk equalisation payments as long as there is a fundamental commitment to community rating".

The advisory group on the risk equalisation scheme in its report to the then Minister stated: "If the primary policy had been to facilitate and encourage competition and the secondary objective had been the protection of community rating, the Advisory Group would have recommended a scheme of risk equalisation based only on age and gender." The risk equalisation scheme as currently constituted allows the insurance authority to base its calculations on age and gender only, and has been commenced on this basis.

The Tánaiste and the Government are committed to a vigorous community-rated private health insurance market. It is clear that risk equalisation is not in itself inconsistent with a competitive market and it should shift the focus of insurers away from commercial advantage arising from risk selection which is of no benefit to consumers. The Tánaiste is committed to the development of greater competition in the market and has asked the Competition Authority and the Health Insurance Authority to report to her on related measures within six months.

Mr. Bradford

Does the Minister of State take seriously the statement by the health insurance company, BUPA, that if risk equalisation is implemented as scheduled and proposed, it will have no choice but to withdraw from the Irish health insurance market? Does he consider that to be a genuine statement based on fact or simply based on posturing?

Mr. B. Lenihan

I am not in a position to speak for BUPA. Neither am I briefed or informed this evening to make a considered judgment on an utterance or statement it made. BUPA participates in the Irish health insurance market in the full knowledge and understanding of the applicable statutory provisions enacted by the Oireachtas.

The Seanad adjourned at 7.50 p.m. until10.30 a.m. on Thursday, 2 February 2006.