I welcome the Minister of State, Deputy Sean Sherlock.
Adjournment Matters
Health Professions Admission Test Administration
I also welcome the Minister of State. I wish to raise an issue related to HPAT which is the examination students who wish to study medicine must undertake.
Concerns have been raised recently in the media. I think this examination was introduced in 2009. I am not too sure about the extent of what it has achieved since 2009. The concerns raised relate to over 700 people who attended a particular two-day course in preparation for this examination which was not part of their school curriculum. It would appear that some of the questions were very similar to those they were given during this two-day course. My understanding is that the course costs €595; therefore, we are now pushing entry into medicine into an exclusive area and it is an unfair system from the point of view of people who cannot afford to get the grind or attend these preparation courses.
I ask that the entire idea of HPAT be reviewed. Has it actually achieved anything? Someone who might not get through HPAT this year might do it next year. Does that make them a better doctor in six years time? I am not sure it does and I am not sure it is a way of assessing someone as regards working in medicine. I know it was a system adopted from Australia, but it is time we reviewed it to see whether it has achieved anything to date, whether it is likely to achieve anything and whether it is just an additional cost being imposed on parents which is unnecessary and will not achieve anything in real terms.
Two thirds of all medical graduates are leaving this country within 12 months of graduating. They have decided even before they have come out of college that once their intern year has been completed, they will leave. The cost of medical education in this country per annum is €90 million because it is a five year course. If one works it out at €30,000 per student per annum, it is €150,000 and with 600 students per year, it adds up to €90 million. Within 12 months of that investment, 60% of it goes out of the country. It is time that we looked at the issue of medical education and also at HPAT to see if there is real value in it and whether it is necessary.
Did the Senator indicate that he wished to share time with Senator John Crown?
I have no difficulty with that.
I am very grateful to the Cathaoirleach for giving me a small amount of time. I did not realise that this item was on the agenda and I wanted to take advantage of the Minister of State's presence to state that this is an area about which I have had some concerns. When the examination was first introduced, there were a number of high-profile cases of youngsters in this country who had full marks in the leaving certificate but who were not accepted for medical school. The clear logic of that is that there was something that these children could be assessed on at the age of 17 or 18 which determined that 15 years hence, they would not be suitable to be appointed as specialists in hospital medicine or as general practitioners. I do not accept that this is possible. I expressed grave concerns at the time. When we have a national examination in the leaving certificate which, in truth, is as incorruptible as anything can be and if we are going to accept children into professional courses like medicine after secondary school, this should be the final authority.
Let me go further. The idea of accepting children into medical school after the leaving certificate is a mistake. The time to do this is after they have had a phase of education at third level for three or four years. We should move towards the models in north America and other parts of the world where medicine is invariably a graduate programme. Simply put, I was 14 years old when I was making the subject choices for the leaving certificate in terms of going into medicine. As it happened, I am extraordinarily happy that I did go into medicine, but I do not think this is the way we should be educating and selecting people. People should get a relatively broad education with a strong science focus, go on to third level education, get a full mature understanding of what is involved in a career in medicine and then make a decision as to whether they wish to practice it.
I thank Senator Colm Burke for raising this Adjournment matter which I am taking on behalf of my colleague, the Minister for Education and Skills.
We should clarify that the selection criteria and process for admission to medical schools is a matter for the medical schools and universities in line with their statutory autonomy in respect of academic affairs. I genuinely take the points raised by Senators Colm Burke and John Crown in respect of the culture around admissions to medicine. I am not delivering the script entirely in that sense. An international tender process was undertaken by the medical schools and the Australian Council for Educational Research, ACER, was chosen to administer the new entry process to medicine, which we know as HPAT.
The introduction of HPAT in 2009 had regard to the findings of "Medical Education in Ireland: A New Direction. Report of the Working Group on Undergraduate Medical Education and Training" or the Fottrell report. It recommended that leaving certificate results should no longer be the sole selection method for entry to medical education at undergraduate level. It recommended that a two-stage mechanism should be applied consisting of the results obtained in the leaving certificate and a standardised admissions test which would assess non-academic skills and attributes regarded as important for the practice of medicine.
In 2012 the group undertook a comprehensive evaluation of HPAT to determine the educational impact, reliability, validity and stakeholder acceptability of the new entry and selection approach. It made the following recommendations. HPAT-Ireland scores should be valid for a period of one year only instead of two years. A redistribution should be applied to the weighting of HPAT-Ireland sections to reduce the contribution of section 3 scores to the overall score in order to reduce the impact of repeat effects. Further practice material should be made available to all HPAT-Ireland applicants, which also includes some examples of correct responses and the rationales to these to ensure adequate opportunities for all to become familiar with the test format and sample items. It was agreed that due consideration would be given to the need to ensure students were given adequate notice of the changes proposed by the expert group.
An investigation is under way by ACER amid allegations that students who attended a HPAT preparation course had seen and were coached in how to answer certain questions that appeared in this year's HPAT examination. ACER takes very seriously the integrity of candidates' results in HPAT. The reliability and validity of its tests is therefore of paramount importance to ACER. The investigation will first attempt to establish the degree, if any, of similarity between the test questions and those allegedly believed to have been provided by the coaching college in question. I am given to understand that based on the briefings we have received that this process is extremely thorough. Candidates' optical mark recognitions have to be scanned and re-scanned. Data analysis has to be carried out by a minimum of two psychometricians. There are many areas of analysis involved; the detection of anomalies is just one part of the standard analysis process. The results of the investigation may lead to some test units being removed from all candidates' scores obtained in the 2014 examination. The Department has asked that it be kept informed by the Higher Education Authority of progress on addressing this issue.
Does Senator Colm Burke have a supplementary question?
The fact that it costs €595 to attend a two-day course is not dealt with in the reply. We are now making getting into medical education beyond the reach of some people financially. This is probably not the only grind they are attending. The second issue I am concerned about relates to the second last paragraph in the reply, which states "the results of the investigation may lead to some test units being removed from all candidates' scores obtained in the 2014 examination". This is causing a lot of uncertainty. People who sat the examination and think they have done a very good paper are now left in a state of total uncertainty as regards what is in and what is out.
This is an unsatisfactory position and the issue should be reviewed.
I acknowledge the points made by the Senator. However, I do not wish to be pedantic but the Senator's question did not speak to costs specifically, rather it spoke to the current operation of the HPAT medical school entrance exam amid recent claims that students who attend a certain revision course had prior knowledge of several of the questions that appeared in the examination. I am happy to revisit the issue of cost and the admissions system.
I note the points made by the Senator about the grind school effect. This is endemic in Irish education and should not happen if one wishes to have a completely equal system for all. It is one of the quirks of the education system that there is a way of gaming the system, so to speak. I do not mean "gaming" in any kind of underhand way, but there will always be a market for a grinds methodology. I agree with the Senator in that regard because this excludes many citizens who simply cannot afford grinds but who have more than adequate ability to become wonderful physicians. It is an aspect we need to address. I will raise the matter with the HEA.
With regard to the Senator's second point, I will undertake to provide clarification for him.
Residential Institutions
I welcome the Minister of State. I have spoken before about the importance of providing some kind of memorial or monument to the victims and survivors of abuse in industrial schools. Many of these schools opened in the late 1800s at a time when Ireland was coming out of the traumatic event of the Famine. They operated for almost one hundred years until the 1960s, 1970s and even the 1980s in some cases.
I raised this matter previously with the Minister for Education and Skills, Deputy Ruairí Quinn. At the time I referred to the report of the commission of inquiry into child abuse and, in particular, chapter 8 which dealt with Letterfrack. It stated corporal punishment was severe, excessive, pervasive and created a climate of fear. That situation obtained in many of the industrial schools where young children were frightened out of their wits. Revelations are still coming out in the inquiry being held in the North. I paid a visit to Letterfrack - a bleak place - in order to pay my respects to the many thousands of people who had passed through the gates. There was not so much as a signpost or a memorial plaque in the place to tell the visitor what had happened in this place. The home that housed the brothers who were the perpetrators of the abuse was being used as a hostel and it took a great deal of digging and looking around to find the little graveyard which is hidden by a grove of trees up at the back and which held many children who died in care.
I was amazed that these horrors and memories seemed to have been brushed under the carpet. It seems to me that not much has happened since my visit. These places were located throughout the length and breadth of the country, from Glin in County Limerick to Grangegorman, from Cashel to Ballaghadereen. There were approximately 130 of these places.
We cannot even begin to understand the psychological scars left by clerical abuse on families and many members of the community. When I was working in London I met Irish men and lads who were homeless and the common thread between them was that they had come from these institutions. For example, a man who was abused as a child wanders around in my own village and he is still trying to come to terms with what happened to him.
I refer to the reports about clerical abuse, the Ryan report and the report on abuse at Cloyne. The psychological scars take a lot of healing. The last time I raised this matter in the Chamber the late Christine Buckley was in the Visitors Gallery. I salute her bravery in speaking about the abuse she suffered as a child in Goldenbridge. That took tremendous courage on her part. It took Christine Buckley 15 years of therapy and counselling to be in a position to speak. There are many individuals and families who are still going through that trauma and suffering. I am aware that planning permission for a proposed memorial in Parnell Square has been refused. I suggested to the Minister that places under the control of the VEC such as the former industrial school in Letterfrack should be opened up to allow for a lasting memorial to be created where people can go and see what went on. I am sure the Minister of State will welcome the €10 million provided by the Catholic Church for the Nano Nagle centre. While celebrating a fantastic woman who is to become a saint, the church should really be looking into commemorating the darker side of what happened rather than shying away from it. Memorials will be a means of helping the healing process and allow people to move on.
I thank the Senator for raising the matter. I take the point he makes about Letterfrack. The building is being used as a furniture and craftwork school. I have visited the village of Letterfrack. Sometimes out of misery and turmoil comes something that is creative. The folk memory of people who live in the area of Letterfrack will ensure what happened there will never be forgotten. I note his point about the creation of a physical memorial in that region.
The provision of a memorial to victims of institutional abuse was one of the recommendations of the Commission to Inquire into Child Abuse. The Ryan report noted the importance of the State's formal recognition of the abuse that occurred and the suffering of victims being preserved in a permanent place. A committee was appointed in October 2009 to oversee the design and commissioning of the memorial and a budget of €500,000 was set aside. The committee was chaired by Sean Benton, a former chairman of the OPW. The committee consulted widely during 2010 and it then pursued a two stage international competition in conjunction with the OPW. The competition was launched in July 2011 and the design brief noted that there were no preconceived ideas regarding the design of the memorial. The OPW agreed to make the site adjacent to the Garden of Remembrance available as a permanent location for the memorial in the event of it taking the form of a physical artefact. However, entrants were not limited to this site and could make a submission for other State-owned sites. Six of the 32 submissions received in the first stage of the competition were short listed; four of these short-listed entries were proposals for the site in Parnell Square. Having met with the short listed entrants and assessed their detailed, specific proposal, the competition jury unanimously decided to award the commission to Studio Negri and Hennessy & Associates, for the Journey of Light memorial. The jury felt that the manner in which the proposed memorial integrated with the Garden of Remembrance would provide an enduring symbol of lost innocence to inspire future generations to ensure the protection of all children.
Following the announcement of the competition winner in July 2012, the OPW sought and received planning permission from Dublin City Council, subject to a range of conditions, in May 2013. The grant of permission was appealed by a third party and An Bord Pleanála refused planning permission for the proposal in November, as the Senator outlined in his submission. The board believed that the proposed memorial would have had an adverse impact on the setting, character and function of the Garden of Remembrance.
We sought the views of the memorial committee on the decision's implications. The committee has advised that the journey of light proposal is not transferable to another site, as it is inextricably linked with the Garden of Remembrance. Neither does it consider that the board's decision should be appealed, as it would be divisive and not in the best interests of the project. It believes that any new competition should be open to conceptual and site-specific proposals and that a central Dublin location should be identified as a cost neutral basis with appropriate zoning. The officials in my Department are consulting the OPW on the identification of a suitable central Dublin location.
I thank the Minister of State for his response. It is good that the proposal is still being pursued. The city centre location should be prominent. I urge the Minister of State to consider using other buildings under the control of the Department of Education and Skills, for example, that at Letterfrack. I am sure there are others across the country. A former school in my neck of the woods was sold for big money to Limerick FC. As Mr. Mannix Flynn stated, what happened was like our Holocaust. Let us not underestimate what occurred in the institutions. I visited Germany and saw stark memorials that were very much in keeping with what happened there. Buildings and various methods were used. If there is not to be a city centre memorial, one of the living, breathing buildings in question should be used to commemorate what happened in them. This suggestion should be considered by the Department.
Special Educational Needs Service Provision
I welcome the Minister of State . I tabled this debate to highlight the impact that the underfunding of Beechpark Services and child and adolescent mental health services, CAMHS, is having on children in the north Dublin area. It makes it impossible for children with autism and other special needs to get a proper education and puts their welfare and that of their fellow pupils at risk.
As the Minister of State is aware, Beechpark is a regional, community-based HSE service that provides specialised clinical supports for children with autism who attend designated special schools, outreach preschools and outreach classes in Dublin, Kildare and Wicklow. The speech and language therapy, occupational therapy and psychological services that Beechpark provides are essential to the personal development and education of children with autism. Without these therapeutic services, children with special needs cannot get a proper education. It is distressing for the children and their parents and teachers to be deprived of this essential service.
Schools that have opened special autism spectrum disorder, ASD, units want to be able to provide the education that the children in their care need and deserve, but they are being frustrated in their efforts by the lack of therapeutic and psychological supports. One school has advised me that the underfunding of Beechpark Services and the CAMHS has created a serious risk to the welfare and safety of its pupils as a whole. The school has asked me not to identify it on the record, but I have sent details of its name and specific incidents to the Ministers and Minister of State, Deputies James Reilly, Ruairí Quinn and Kathleen Lynch, via private correspondence.
The school was traditionally served by Beechpark Services. Eight of its existing 24 pupils in ASD classes are getting services from Beechpark, but the others are not because Beechpark is not in a position to take on new enrolments. Children who need therapeutic interventions like occupational therapy and speech and language therapy are not getting them. As a result, some of those students have become impossible to manage and are presenting a danger to themselves and others. The primary school in question has had to expel a child this year due to a serious assault. One of the students about whom the principal is concerned is an eight year old boy who has self-harmed. Another has assaulted the principal and other staff a number of times. There was a further serious incident yesterday. The principal rang me extremely upset after a student ransacked a classroom and created a dangerous situation for the student in question, the teacher and the other children who were present. The principal is concerned that a pupil or teacher will be seriously hurt if these children do not get the help they need as soon as possible.
In addition to needing occupational therapy and speech and language services from Beechpark, some children also need mental health interventions. Some pupils were previously being served by the CAMHS, but it was withdrawn and they were referred to Beechpark. Since Beechpark cannot take them, they have been left with no services. The principal has also told me of instances of children who, having received a mental health service from the CAMHS at preschool age, saw it withdrawn as soon as they were enrolled in a special ASD unit in the school, presumably on the assumption that they would receive the service there. However, there is no one at the school to provide it. Yesterday, the principal was determined to stress to me that an ASD class in a mainstream school was not a medical intervention and that it was inappropriate for children to have medical interventions withdrawn simply because they had been enrolled in an educational service.
I am sure the Minister of State will appreciate the seriousness of this issue. I have called for this debate to bring the matter to his attention. I appreciate that he is representing the Minister for Health, Deputy James Reilly, and I hope he will raise it with the Minister. I hope the reply he has been given by the Department on the Minister's behalf will outline when funding will be provided to ensure that Beechpark and CAMHS can serve all of the children who have been assessed as needing their services. When will early intervention teams be in place in Dublin North in order that children with special needs can receive the assistance they deserve?
I thank the Senator for raising this matter which I am taking on behalf of the Minister for Health. The HSE's 2012 report entitled, National Review of Autism Services Past, Present and Way Forward, and the programme for progressing disability services for children and young people, that is, zero to 18 years of age, set out the overall policy context for the provision of ASD services to children and young people. The latter's objective is to achieve a national, unified approach to delivering disability health services for children with disabilities, including those with ASD. It provides for a clear pathway to services for all children regardless of where they live, what school they attend and the nature of their disabilities and that available resources be used to the best effect. A key part of the programme is its emphasis on strong links with primary care and specialist services such as CAMHS. The programme aims to remedy the variations in service provision that persist throughout the country.
In 2014 the HSE is taking a number of key steps in implementing the reorganisation of services in line with the programme. An additional €4 million has been allocated, equating to 80 additional therapy staff, to support the initiative. As part of the programme's roll-out in 2014, local implementation groups, LIGs, in Dublin North, including the north city, and Dublin South, Dublin South-East, Dublin South-West and Dublin South-Central will finalise their consultation phase, complete implementation plans and begin reconfiguration and service delivery in line with the new service model. The Minister is confident that this will have a positive impact on the provision of therapeutic services for all children requiring access to health-related supports, including those with ASD.
I recognise the distinction made by the Senator and the challenge facing the principal of the school in question. As the Senator is aware, Beechpark is a regional HSE service that provides clinical supports for children with a specific diagnosis of ASD up to 18 years of age who attend designated special schools, outreach preschools and outreach classes in Dublin, Kildare and Wicklow. The HSE indicates that in recent years demands on this service have increased through a growth in the number of new classes for children with ASD.
While Beechpark, like other health service providers, must live within the financial and other constraints applying, it endeavours to provide services on the basis of prioritised need. In respect of Beechpark North, the HSE has indicated that all permanent staff vacancies that arose in 2013 have been filled. In addition, six posts which have been approved are currently in the recruitment phase with the HSE national recruitment service. Importantly, the HSE has also assigned a disability manager to oversee the reconfiguration of services for children with disabilities in Dublin North and Dublin north city in line with the national progressing disabilities programme for children and young people. The Beechpark service is actively involved in the change process in the context of the local implementation groups that have been established across Dublin North-East and Dublin Mid-Leinster under the HSE's progressing disability services programme.
The Senator also raised the issue of access to child and adolescent mental health services. A major reform of mental health services is also under way, in line with the recommendations of A Vision for Change. That is being led by the Minister of State, Deputy Kathleen Lynch. Additional funding of €90 million has been provided over the last three budgets to support this reform programme. A key priority in this regard is to enhance and streamline the way in which the mainstream mental health and disability care programmes look after children and young people up to 18 years of age. There are currently 61 multidisciplinary child and adolescent mental health services, CAMHS, teams in place. Work is under way to enhance the skills mix of these teams and to recruit additional CAMHS posts.
Notwithstanding an increasing demand for mental health services, the focus on improving services will continue. Targeted investment of €20 million has been provided by the Government for new initiatives this year. This will include CAMHS services in north Dublin and the provision of services for hyperkenetic and other attentional problems among children and young people. While the current economic situation in the country is presenting challenges, the Minister is committed to protecting front-line services, including children's disability and autism services, to the greatest extent possible.
I appreciate that the Minister of State is replying on behalf of the Minister, Deputy James Reilly, but I have written to the Minister about Beechpark Services previously and the issue has been raised by my colleague, Deputy Billy Kelleher, and other Deputies in the Dáil in the past two years. To be honest, the reply has not really changed since. The Department is still referring to the fact that a review is being undertaken. The reality is that the services are massively under-funded. There are no early intervention teams in Dublin North at present and children are waiting for massive lengths of time to access the child and adolescent mental health services. One of the children I mentioned earlier is an eight year old who self-harmed. Before the child self-harmed, the school principal referred him to CAMHS but it was only after he had hurt himself that the parent was able to get an urgent appointment. The reality is that the services simply are not there. Beechpark is not serving most of the children in the ASD classes in this school.
The Department's reply referred to the fact that there is an increase in demand because more ASD classes have opened. However, they did not open for no reason, but because the Department of Education and Skills and the National Council for Special Education have been working with schools to get them to open the classes in response to the need. They have been doing their best to provide the services required on the educational side. The special educational needs organisers, SENOs, are doing a good job in matching children with the resources available. However, the missing part of the picture in all of this is the health provision. Despite the best efforts of the SENOs and the schools involved, the health provision is simply not available.
As I said, I appreciate that the Minister of State is replying on behalf of the Minister. I ask him to bring this issue to his attention, stress the urgency and ask him to look at that correspondence personally, rather than just having it looked at by somebody else in the Department. He must ask the Minister to look at the letter I sent to him about the specific incidents I have mentioned.
I accept the point made by the Senator, but I must be frank with the House. Economic history did not start in 2011. In terms of the allocation of resources, we were handed a deck of cards in 2011 and to be fair, with regard to this service, I will defend the Government. It has provided over €90 million in the last three budgets to support a reform programme. In respect of the roll-out of a more networked system of provision of services for young people, we are facing these challenges across the country. As a Minister of State, I am facing the same problems in my area as the Senator is facing in her area. Only last week I had a meeting with some of the teams there to see how we can work through some of the problems.
There is no question that there is a deficit and a growing demand with regard to CAMHS. I openly acknowledge this, but we are doing our best to work on addressing these deficits within the economic constraints. The economic constraints continue but I envisage that they will get better, because we have a Minister who is determined to ensure there is a specific silo, as it were, to provide for these services. While I acknowledge what the Senator has said, she must also acknowledge, if we are to be realistic and objective in any debate of this nature, the reasons we are in this position.
The Seanad adjourned at 3.55 p.m. until 2.30 p.m. on Tuesday, 1 April 2014.