Commencement Matters

National Training Fund

I thank the Cathaoirleach for selecting the matter and I thank the Minister of State for giving his time today. The national training levy is a crucial source of revenue in the context of the ongoing national debate on the funding of third level education. As the Minister of State will be aware, the Cassells report released last year has painted a bleak picture of the state of our higher education sector. The report has made it clear that we must act decisively to save a third level education sector which is in serious financial trouble. I firmly believe that the national training levy must play a central role in our response to this crisis.

The report correctly identified employers as major stakeholders in and major beneficiaries from higher education. Our highly educated workforce is a major structural advantage for Irish businesses and enterprise, and it is logical that they would contribute towards its funding. I welcome the public consultation process currently under way in the Department of Education and Skills on a proposal for an increase in the levy from 0.7% to 1% and strongly support such an increase.

I note that the consultation process is specifically framed with the intention of responding to the Cassells report and the challenges facing the higher education sector which include funding issues such as the poor spend compared with other OECD states and the lower spend in comparison with primary and secondary education, but also the STEM skills gap and the growing demographic of students expected to attend higher education, with a 27% increase expected by 2028.

It is welcome that the Department is aware of and preparing for these issues. However, since the Government recognises that the national training levy will be a key part of our response to the third level funding crisis, it is crucial for us to understand the administration of the revenue generated by the levy since its introduction in 2000. How much has been allocated for expenditure? Where has the money been spent? What money has not been spent and why? How are such decisions made? What does the Government plan to do with the increased revenue? It is important for us to properly examine the record of the levy and the national training fund. We need to ensure the fund is fit for purpose and is being managed well for the benefit of citizens.

I have a number of questions for the Minister of State. How will the additional income generated by an increased levy be distributed? None of us wants Irish businesses to play a direct role in higher education policy and decision making, and demanding that their skills gaps be prioritised above other important factors. Given that we need the arts and other such subjects to be supported just as much as STEM projects, how will this be managed?

Will the Minister of State consider investing the increased revenue in capital infrastructure in higher education institutions, as universities are not ready to respond to changing demographics or opportunities that may arise as a result of Brexit? Will the Minister of State give a commitment that this funding will come as an additional resource for the higher education sector and is not used as a replacement for the loss of any existing revenue streams?

I note that section 2.4 of the legislation provides that the Minister shall manage and control the investment account of the fund.

Can the Minister comment on what investment return the fund has achieved in the last five years? What is the investment strategy? Finally, can the Minister explain why there are unspent moneys in this fund, given the current condition of the education sector?

I look forward to engaging with the Minister on this issue. I have also provided a more detailed submission under the submission process.

I thank the Senator for raising these important questions and for agreeing to postpone this matter from last week for me.

The National Training Fund, NTF, is resourced by a levy on employers of 0.7% of reckonable earnings in respect of employees in classes A and H employments, which represents approximately 75% of all insured employees. The levy is collected through the pay as you earn, PAYE, and pay related social insurance, PRSI, system and funds are transferred monthly to my Department. Funding from the NTF is allocated by me, with the consent of the Minister for Public Expenditure and Reform, in accordance with the provisions of the National Training Fund Act 2000. While the NTF does not form part of the Vote of my Department, the allocation for each scheme is determined as part of the annual Estimates process. The NTF is included as an annex to the published Estimates of the Department and such funding has been included in the overall expenditure ceiling for my Department since 2011.

Prior to 2012 income from the NTF levy had fallen from a high of €413 million in 2008 to €299 million. However, since 2012, receipts from the NTF levy have increased annually, due to improved employment levels. The NTF levy generated €299 million in 2012, €317 million in 2013, €338 million in 2014, €364 million in 2015 and €390 million in 2016. It should be noted that the operation of the EU fiscal rules and the inclusion of the NTF in the Department of Education and Skills overall annual expenditure ceiling mean that, in the absence of an increased rate of contribution, additional expenditure cannot be sourced from the NTF without a corresponding drop in Exchequer expenditure.

The accumulated surplus in the fund has been critical in maintaining expenditure levels, particularly in the provision of training for the unemployed, in the years when receipts fell below the expenditure levels required. It is considered prudent to continue to maintain an adequate surplus in the fund to meet demand in future years and it should be noted that, while the current surplus of €232 million represents a very significant sum, it would only cover seven months of NTF expenditure at current levels. The surplus remains available for investment in education and training programmes to meet skills needs.

NTF funding is used to raise the skills of those in employment, to provide training to those who wish to acquire skills for the purposes of taking up employment and to provide information relating to existing or future requirements for skills in the economy. The majority of the funding is expended under the broad headings of training for employment and training in employment. Training for employment provides a range of training programmes for jobseekers, including training for early school leavers and for people with disabilities and targeted skills programmes such as Springboard and ICT skills conversion. Training in employment funding supports the training of employed people, primarily the apprenticeship programme and employer-led and contracted training through the Skillnets model.

There has been a shift recently in the focus of investment with more funding allocated to training those in employment and less allocated to training jobseekers, due to the upturn in our economy and growing numbers of people in employment. In 2017, I am providing funding of €366 million from the NTF. As part of this allocation, I have provided an additional €24 million to training those in employment to meet demand which will arise mainly in the expansion of apprenticeship opportunities. I am also reviewing the allocation of funding to programmes in the further education and training and higher education sectors as between NTF and Exchequer sources in terms both of the appropriate emphasis required on training for employment and training persons in employment and of satisfying the needs of enterprise to meet strategic skills requirements.

I hope I have answered the Senator's questions. There is a consultation process and she is more than welcome to contribute to that. I would appreciate her contribution. If I have omitted to mention anything, I will get that information from the Department. I will also be delighted to provide the Senator with any further information she requires.

That was a frank response. Is the Senator happy with it?

I have one or two more questions which I will send directly to the Department because the Minister will not have access to the information here. I wish to clarify whether I understood the Minister of State correctly. He said that additional funds cannot be allocated unless there is a reduction in the Exchequer fund. Will the increase be a replacement and not additional?

From what I can gather, it balances with the Exchequer all the time. Whenever funding is spent on something, if one overspends or underspends one is required to deal with the Exchequer. I will find out what the position is. I have contacted the Department of Finance to ask for a detailed analysis as to why that is the case and I will forward that to the Senator.

I have another question. Obviously, much of the additional spend in previous years has gone to filling skills gaps at jobseeker level and third level funding has not received a great deal from the national training levy. Will the percentage increase be directly for third level? If so, and this ties in with the Cassells report, is it expected that the Department would not decide where that money is spent and that it would go to the core fund of the Higher Education Authority, HEA, which would be aware of where the gaps are in third level?

How best to allocate the money, be it to higher education and so forth, will be part of the consultation process. I know the Senator has a great interest in this so I would value her contribution to the consultation process in respect of how she believes it should be spent. After the consultation process this will come back to the Houses for discussion. I urge the Senator to let the consultation proceed. I probably have almost the same view as the Senator as to how the funding should be spent. It is a balance of skills, apprenticeships, higher education and so forth. I ask the Senator to wait for the consultation process to conclude, after which I will refer back to her.

Wind Energy Guidelines

I thank the Cathaoirleach for selecting this matter for the Commencement debate and I welcome the Minister of State, Deputy Catherine Byrne. I am calling on the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, to introduce new wind energy development guidelines in respect of noise, proximity and shadow flicker as a matter of urgency. It is more than three years since the closing date for submissions under the public call for submissions on the proposed revision of the 2006 wind energy guidelines, but we are still no closer to the new guidelines being introduced.

The guidelines were first introduced in 1996 and they were revised in 2006. In the intervening years, the size and scale of wind turbines and industrial wind farms have increased dramatically. Where turbines were approximately 90 metres in height, many are now 170 metres to 200 metres in height. While we wait for new wind energy development guidelines to be introduced rural communities such as mine are sitting ducks for the highly subsidised wind energy industry.

It was highlighted that interest had been conveyed to timber companies about the development of a wind energy farm near to where I live in Castlecoote. The Minister needs to do two things. The subsidy for onshore wind energy is far too high. The industry is subsidised but it has created great difficulties for families and residents, particularly in the Slieve Bawn area. Coillte and Bord na Móna built a wind farm in the Roscommon-Strokestown-Ballyleague area but it has caused major difficulties for the residents. The Minister must introduce new wind energy guidelines where the setback is ten times the height of the wind turbine. For example, a 150 m turbine would be setback 1,500 m or 1.5 km from residents. The most critical things for consideration are the potential impact the noise generated will have on residents in close proximity, the associated effects on sleep and subsequent health, the potential for shadow flicker on residential homes, the overall impact on the landscape, the general amenity of the residents and the loss of tourism and economic benefits.

Coillte is the national company that organises and runs the timber industry. I am concerned by the fact Coillte has been approached by a German company with a proposal to develop wind turbines in my area. The German company is only interested in erecting wind turbines in the area. The project would have a detrimental effect on the communities in the area - for instance, Aghagad, Aghagower, Bracklin, Carrowkeel, Cornaveagh, Creemully, Aghagad Beg and Derryhippo, County Roscommon. A major project has been put forward by the local action group. It has met practically every week over the past number of weeks in order to put forward a very good policy decision or request to Coillte, which I hope will be considered in the very near future. I call on Coillte to desist from dealing with the wind farm proposal for the area. I also ask the Minister to introduce guidelines as quickly as possible. The guidelines are a number of years out of date. I look forward to the Minister responding in a positive manner with new planning guidelines for wind turbines that will be erected in the future.

The Senator has finished spot on time.

I call the Minister of State to respond.

I am taking this matter on behalf of the Minister for Housing, Planning, Community and Local Government. I thank Senator Leyden for raising this issue.

Since May 2016, the Minister has liaised closely with the Minister for Communications, Climate Action and Environment, Deputy Denis Naughten, having regard to his responsibility for renewable energy policy, on the focused review of the 2006 guidelines. The Minister recognises the need to bring the review to a close in order to give certainty to all stakeholders, local authorities, the energy sector and the wider community.

In light of the commitment in A Programme for a Partnership Government to finalise the guidelines and the ongoing policy and legal developments in this area, the Department of Housing, Planning, Community and Local Government, in conjunction with the Department of Communications, Climate Action and Environment, is continuing to advance work on the guidelines and related matters in order to bring the various issues to a conclusion as early as possible. The Minister, Deputy Coveney, expects to be in a position to make a statement on the matter in the coming weeks when he will outline the proposed revisions to the guidelines and the timelines for implementation of the various elements.

As part of the overall review, and having regard to a recent European Court of Justice judgment on the Belgian-Wallonian wind energy guidelines, it is proposed to undertake a strategic environmental assessment, SEA, of the proposed revisions to the 2006 guidelines before they come into effect. This is in accordance with the requirements of EU Directive 2001/24/EC on the assessment of the effects of certain plans and programmes on the environment. SEA is a process by which environmental considerations are required to be fully integrated into the preparation of plans and programmes that act as frameworks for development consent prior to their final adoption, with public consultation as part of that process. In light of the SEA requirement, which will take approximately nine months, it is likely that while the proposals for revisions to the guidelines will be available shortly the guidelines will not be finalised and come into effect until the end of the year. When finalised, the revised guidelines will be issued under section 28 of the Planning and Development Act 2000, as amended. Planning authorities and, where applicable, An Bord Pleanála must have regard to the guidelines issued under section 28 in their assessment of planning applications and in the performance of their functions generally under the Planning Acts.

In the interim, the 2006 guidelines will continue to apply to existing planning applications that are with either the local planning authorities or the board for determination. As mentioned earlier, there has been close engagement between both Ministers and their Departments with a view to advancing the revision of the guidelines to a conclusion. The Minister, Deputy Coveney, recently had a constructive meeting with the Minister, Deputy Naughten, and his officials. Both Ministers will further discuss the matter today. In light of the recent progress made on the matter, the Minister, Deputy Coveney, is confident that he will be able to make an announcement on the final proposed revisions to the guidelines which will be subject to the SEA process in the coming weeks.

It is encouraging that the Minister is moving in this particular regard. There have been numerous public consultations on this matter. Ireland has fully complied with European Union law in this regard and the Belgian case should not be used to delay or prevent the implementation of new guidelines. I welcome the fact that new guidelines will be announced shortly and that they will implemented by the end of 2017.

Hospital Staff Recruitment

Next is Senator Pádraig Mac Lochlainn. An bhfuil sé ullamh? The Senator has four minutes.

Will the Minister for Health attend?

I see the difficulty. Senator Leyden raised this issue on the last occasion and I can understand why Senators raise this matter. It is a Government decision and I have no say over it. The Minister of State is here and we should allow her to give a response.

We are not blaming the Minister of State who is here. I am sure she could find other things to do this morning.

I appreciate that but it has become regular practice for the Minister not to attend. This is the third time an important health issue in Donegal has been discussed in the Dáil and the Seanad. Let us remember that it takes many days and sometimes weeks to table a Topical Issue and Commencement matter. It is important and precious to have such an opportunity. The Minister for Health has not appeared before us and been accountable, which is completely unacceptable. I assume that he will read the transcript of this debate. It is unacceptable that he has not come here to answer our questions. With all due respect to the Minister of State, she cannot know all the details about this matter.

The Minister for Health met the Donegal Diabetes Association last December at Letterkenny University Hospital and was made fully aware of the crisis in diabetes care in the county. In Donegal as many as 700 adults and children have type 1 diabetes and 6,000 adults and children have type 2 diabetes. We need a team of endocrinologists and nurse specialists who can deal with children and adults. We need a centre of excellence in the north-west region of Donegal, Sligo and Leitrim. The nearest centre of excellence for diabetes care is in Limerick and the paediatric endocrinologist at Sligo University Hospital has left her position to work in the centre of excellence in Limerick. The Minister has known about this matter since January. The position has been advertised and God knows how long it will take to fill the post. There is no commitment to provide cover, which is the vital issue from a Donegal perspective, in the clinics for children. There are 161 children with type 1 diabetes who rely on the monthly clinics for pump therapy. The pump therapy is the accepted way to deal with diabetes care and prevent long-term issues. Type 1 diabetes is a chronic condition and these children must live with it. We urgently need reassurance that the monthly clinics will continue and that the post will be filled.

The Donegal Diabetes Association has also made it clear that we need to double the number of endocrinologists and specialists at Letterkenny University Hospital. We need to ensure that we have the correct number of specialists to deal with a population living with diabetes types 1 and 2 in the county.

I am disappointed the Minister is not present and ask the Minister of State to convey to him the urgency with which he must meet representatives of the Donegal Diabetes Association to provide reassurance on these issues.

Perhaps the Senator might write formally to the Committee on Procedure and Privileges on the issue. I, too, have been annoyed on occasion by the absence of the Minister when I raised issues related to farming, fishing and so on. We cannot, however, pin blame on the Minister of State. I ask her to respond to the Senator on the matter he raised.

The Minister apologises for his absence. I will relay the Senator's concerns about the failure on occasion of Ministers to appear in the Chamber to deal with Commencement matters.

A paediatric insulin pump service was initiated in May 2015. The service is based in Sligo University Hospital, with outreach clinics in Letterkenny University Hospital. The Saolta University Healthcare Group has confirmed that the consultant paediatrician with specialty interest in diabetes who was instrumental in commencing the service is leaving the post in mid-April. It has recently advised the Department that a consultant paediatrician has been appointed to the post on a temporary basis. The permanent post is to be filled through public competition via the Public Appointments Service and this process is ongoing.

To address the issue of continuity, the clinical service arrangements for the management of the insulin pump service are being examined in consultation with the relevant clinical teams. There is one consultant endocrinologist at Letterkenny University Hospital providing the adult diabetes service which serves approximately 700 patients with type 1 diabetes and 6,500 patients with type 2 diabetes. The consultant endocrinologist is receiving support from a locum consultant general physician who has a diabetic interest. Additional clinics are being run on a monthly basis, with one or two extra clinics per month, to address waiting lists for the service.

The major focus in the past 12 months has been on seeing newly referred patients. The overall waiting list for no patients to be seen by the consultant endocrinologist has been reduced by 20% from 313 patients in 2015 to 249 patients at present. More significantly, the number of new referrals waiting for more than one year for a clinic appointment has been reduced by 80% from 97 in 2015 to 19 at present.

With regard to addressing waiting times for patients who require repeat appointments, work is continuing with the diabetic service to address this pressure, while simultaneously ensuring newly referred patients are seen promptly. The Saolta group advises that an adult insulin pump therapy service is provided for patients in the north west. The current number of adult pump therapy patients is 24. However, eight additional patients are transitioning to the adult service, while a further eight will move to the service in three to six months, bringing the number of adult pump patients to 40.

On the future of diabetes services in the north west, the Saolta group advises that a business case is being prepared in support of a second consultant endocrinologist, a diabetic nurse specialist and a diabetic dietician to further support the Lettekenny diabetes service. On the recruitment of health care workers generally, significant efforts are ongoing at national and local level to address staffing issues across the health service. It should be noted that the numbers of consultants increased by more than 130 between February 2016 and February 2017, while numbers of nurses and non-consultant hospital doctors increased by approximately 460 and 230 whole-time equivalents, respectively, in the same timeframe.

I note the Senator's dissatisfaction about the Minister's absence. I will convey to the Minister the various issues raised, in particular, the Senator's view that the Minister should be present in the Chamber. While I am not familiar with the process in place in County Donegal, I have provided a response to the matter raised.

We must not shoot the messenger. The Minister of State may be minded to ask the Minister to visit Letterkenny to see at first hand the problems Senator Pádraig Mac Lochlainn has raised.

I appreciate the Minister of State's response and ask her to convey to the Minister the need to meet representatives of the Donegal Diabetes Association, as promised, as soon as possible to address their concerns. In her response the Minister of State omitted to mention that there is a 21-month waiting time for repeat referrals for adults with type 1 diabetes in County Donegal. This is a serious issue, given that it has been well documented that diabetes care will prevent long-term interventions such as amputations and long-term conditions such as loss of sight. The paediatrician endocrinologist at Sligo University Hospital has moved to the centre of excellence in Limerick. The failure to deliver a centre of excellence in counties Donegal and Sligo, as justified by the numbers involved, has resulted in the needless loss of top class professionals to another centre of excellence. I reiterate my request that the Minister meet representatives of the Donegal Diabetes Association as soon as possible to assure them that the monthly clinics for their children which offer pump therapy essential to their care will not be lost. We urgently need reassurance on the issue and that the number of specialists in Letterkenny University Hospital dealing with patients with diabetes will increase.

I am sure the Minister of State will convey that point to the Minister.

I have taken a note of it and will ask the Minister to communicate with the Senator on the matter.

Mental Health Services Provision

I welcome the Minister of State at the Department of Health, Deputy Helen McEntee. It is good to have the correct Minister of State in the House. It is not the case that Senator Pádraig Mac Lochlainn was shooting the messenger because this issue affects all Senators.

The issue I raise is the care of children outside the State. A small number of children need special care which cannot be provided here and are sent abroad to avail of a broader range of treatment options, supports and interventions. In the past two years six children were sent abroad for this reason. However, records are not held for other years. Data must be collected nationally for future reference and use. Of the six children sent abroad, three were sent to the St. Andrew's facility in Northampton in England. I do not know where the other three were sent, but perhaps the Minister of State might provide that information. The lack of facilities for children who require them means that some children are sent abroad where they do not have access to family, friends and someone who will fight their corner. These disturbed and vulnerable children do not have a voice abroad and are in a dire position. The cost of placing three children in facilities abroad for one year is €1 million.

A few weeks ago Channel 4 broadcast a "Dispatches" documentary, "Under Lock and Key", which painted a damning picture of disgraceful conditions at the St. Andrew's facility. It found that children were held in an institution that did not meet their needs, make them better or keep them safe. The facility is operated by one of the largest and wealthiest health care charities in Britain. Serious concerns arising from the "Dispatches" programme include that patients were subject to restraint, seclusion and frequent sedation. An inspection by the Quality Care Commission, the British equivalent of the Health Information and Quality Authority in this jurisdiction, noted the use of a technique known as prone restraint. This face-down method of restraining a person, with which I am familiar, is widely used across all wards in the St. Andrew's facility which caters for young children aged between 11 and 18 years. The use of prone restraint has been banned here because it compromises respiratory function and has caused deaths in the past. If someone sits on a person and restrains him or her in a prone position, it cuts off his or her airways.

In a six-month period between 2015 and 2016 prone restraint was used 600 times in child and adolescent wards. One 15 year old patient remained mainly in segregation for 22 months in a room with very little natural daylight.

Four patients died within seven months of each other in one ward between October 2010 and May 2010. All of those patients had been prescribed the drug clozapine, which has been lauded as the new wonder drug for schizophrenia in particular, but it is also what we consider quite a dirty drug, having too many side effects and needing constant monitoring.

It is a damning report of a healthcare facility to which we send some of our most vulnerable and disturbed children. What is our oversight? Tusla claimed that St. Andrew's was highly regulated. Do we have any input or impact there? Do we carry out cross-balance checks to ensure our children are safe over there when they are all alone?

I thank the Senator for raising this extremely important issue. I know a programme such as the "Dispatches" programme can be very upsetting, particularly for someone with a child with a mental health problem or disability, and even more so for a parent whose child is there. As the Senator said, three young people with mental health problems have been sent over there. I am sure people in Tusla and the disability sector are speaking to the HSE officials who, I know, are over and back quite frequently. They were over in October before the new facility was occupied. They have been over since then and have assured me they have not found any issues with the three young people currently over there. However, it is extremely important we are not complacent and that we ensure the checks and balances we have are up to the highest standard possible.

The HSE is committed to ensuring that all aspects of mental health services are delivered in a consistent and timely fashion. However, on occasion as we know, the presenting clinical need of children is such that current service provision is not in place to address identified need here in Ireland.

Child and adolescent mental health services fall within the secondary and tertiary levels of care provision, based on the increasing severity of the mental health need. Tertiary services provide specialist mental health services for those children and adolescents who have complex and severe mental health problems or who are at high risk of harm. It also includes those with an eating disorder.

The four HSE CAMHS units operate as a national network of inpatient care. Each has a regional remit and co-operates with other units to ensure optimal utilisation of available bed resources. I know we have a difficulty in recruiting staff at the moment which, of course, has a knock-on effect on the ability to use all our beds. We are trying to deal with that.

There is a small group with particularly complex needs who may require a level of specialised intervention not available in Ireland. In such cases, a child or young person may be placed in out-of-State care at a facility abroad, which offers a wider range of treatment options or interventions than those provided in Irish facilities. In such cases, priority is always given to the care of the young person's needs, and placements are made in the best interests of the child.

The HSE operates a treatment abroad scheme for people entitled to treatment, along with associated costs, in another EU state. The scheme is governed by EU regulation, and in accordance with Department of Health guidelines.

The scheme allows a consultant, based in Ireland, to refer a patient normally resident in Ireland for treatment in another EU member state or Switzerland, where the treatment in question meets various relevant criteria as follows. Following clinical assessment, medical evidence must be provided by the referring hospital consultant, giving details of the patient's medical condition, the type of treatment envisaged and the proposed provider of the treatment abroad. The referring consultant, having reviewed the patient in the immediate previous two weeks, must certify that they recommend treatment in another EU or EEA country. The treatment must be medically necessary and meet the patient's needs. The treatment must be a proven form of medical treatment and not be experimental or test treatment. Care must be in a recognised hospital or other institution and under the control of a registered medical practitioner. The treatment must not be available in Ireland or otherwise not available within the timeframe normally necessary for obtaining it in Ireland, taking account of the young person's current state of health and the probable course of the medical condition.

The HSE keeps the needs of young people with mental health issues of greater severity under review, where the treatment abroad is considered necessary and in the young person's interests.

The process of finalising the design brief for the national paediatric hospital is near completion. This will include a 20 bed CAMHS inpatient unit, incorporating an eight-bed specialist eating disorder service. We know the reason that many of our young people are sent abroad is to deal with eating disorders. The provision of a ten-bed adolescent secure unit is part of the planned redevelopment of the national forensic services at Portrane. We hope the contracts will be signed in the coming weeks so that we can get moving on that. Such additional service initiatives should assist in providing services not currently available.

Children with difficult life experiences and mental health difficulties require the highest possible standard of multi-agency supports to address specific needs. The HSE is committed to working to ensure this is attained. It is also committed to ensuring that those children who are on the island of Ireland receive the same level of care as those here.

That was a very thorough response.

I thank the Minister of State for her response. She has outlined the process and criteria for the treatment abroad scheme. However, my concern is with the oversight of the care of those children and the facilities in which they are being treated as opposed to the rigmarole of getting them such treatment. It is about where we are sending them to. This report was damning of St. Andrew's and we cannot stand over that.

The Minister of State said HSE officials carried out a visit. Did they do so on the back of this report or was it prior to the report? How often do they visit? Patients in voluntary and mental health facilities have a mandatory six-month review involving all concerned - case workers, health-care workers and family - to ensure the patient's needs are being met. I do not know how they are being met in a very unsuitable and scary environment for children.

If the Minister of State has the answer, I am sure she will respond to it.

It has been brought to my attention that many of the cases shown in the programme were historical cases and since then HSE officials have made regular visits to the children sent over there. As I said, there were visits in October before the new facility was occupied and there have been visits since then.

Those high-intensity cases or the ones with most specific needs are kept under regular scrutiny. It is important for us to continue to develop our own specialist services so that young people do not need to be sent abroad. Our new paediatric hospital as well as the new forensic hospital will provide much needed support. In addition there is the development of clinical programmes around eating disorders, dual-diagnosis, self-harm, all of which, we know, affect our young people. Where that is not possible and our young people are sent abroad, they are monitored closely. I am assured by the HSE that any young person who is abroad is monitored closely.

Where concerns are raised, as has happened with this "Dispatches" programme, all of these issues are investigated. I am assured that no issues have been raised in respect of the three young people who are there and that there have been no problems. The matter will be kept under close scrutiny and monitored.

Sitting suspended at 11.18 a.m. and resumed at 11.30 a.m.