Nithe i dtosach suíonna - Commencement Matters

Autism Support Services

I welcome the Minister of State, Deputy John Paul Phelan.

I also welcome the Minister of State.

The purpose of this matter is to seek that the Minister for Education and Skills provide an update on the proposal by fee-paying schools to waive their fees for students wishing to attend State-funded autism spectrum disorder, ASD, units in their complexes. This is about inclusion and ensuring that people have the same opportunities for education, regardless of whether they pay fees. There has been a major change in policy over the past decade whereby ASD special units have been set up throughout the country. Every parish now has one of these units and this has given rise to a major improvement in the services being provided. It is about inclusion and having these units in primary and secondary schools. However, there is an anomaly in the system. Fee-paying schools seemed to be looked upon differently by the Department of Education and Skills when it comes to these units. In correspondence, I have asked the Department to explain its policy on fee-paying schools and these units. The Department has replied that it currently has no policy to support the establishment of special classrooms in fee-paying schools. That is a major step backwards.

In 2017, Bandon grammar school was approved for such a unit but then had the approval pulled because it was deemed to be a fee-paying school. The school was willing to waive all fees for any student who wished to attend the unit. This is about inclusion and providing the opportunity for people to be educated in whatever setting they deem appropriate. The fact the Department of Education and Skills has no policy to support such a scenario is bizarre. We need to look at this in another light at how we can improve the actual scenario to ensure that people who want to be educated, whether privately or in a public school, will have the opportunity to go to these units.

These special units are a major step forward. They have brought clarity and freedom to families, as people have wanted for generations. Unfortunately, we have a system breakdown. We need to look at the establishment of a policy for fee-paying schools, so they have the opportunity, particularly in a scenario like that at Bandon Grammar School, to waive the fees they usually apply to students and the schools can provide the service that the community wants. That is what this is about, namely, providing the service that the community wants.

I put the proposal to the Minister of State that there should be a change in policy. The Department of Education and Skills needs to work with all schools, fee-paying and non-fee-paying, to ensure that these units, which are a godsend for so many families, can be established in every school.

I thank the Senator for raising the matter, which I am taking on behalf of the Minister for Education and Skills, Deputy McHugh, who is in London on Government business today.

It is the policy of the Department of Education and Skills that all children with special educational needs, including those with autism, can have access to an education appropriate to their needs, preferably in school settings through the primary and post-primary school network. In 2019, €1.9 billion is being invested in special education, almost one fifth of the overall education and training budget. Investment in the area of special education continues to be a priority, with the budget for 2020 also providing for an additional 1,064 special needs assistants and over 400 additional special education teacher posts throughout the country. The range of supports and services which are made available includes additional special educational support teaching, special needs assistant support, funding for the purchase of specialised equipment, services of the National Educational Psychological Service, NEPS, enhanced levels of capitation in special schools and special classes and additional teacher training.

The National Council for Special Education, NCSE, which is an independent statutory body, is responsible for organising and planning provision for children with special educational needs, including the establishment of special classes and special schools, in consultation with the relevant education partners and the Health Service Executive. An additional 1,050 specialised places have been provided this school year, with 167 new special classes being opened. This brings the total number of special class places to over 9,700, almost a trebling of the provision since 2011. Over 80% of these are autism-specific special class places. The number of special classes in mainstream schools has increased from 548 in 2011 to 1,621 for the 2019-20 school year.

Special classes offer a supportive learning environment to students who are unable to access the curriculum in a mainstream class, even with support, for most or all of their school day. Students enrolled in special classes should be included in mainstream classes to the greatest extent possible, in line with their abilities. Schools may apply to the NCSE to open a special class where a need has been identified in their area, for example, where a number of students have professional reports indicating they require the support of a special class.

Before approaching a particular school to request the establishment of a special class, SENOs take into account both present and future potential need within the area and must be satisfied that the class is sustainable and appropriately located. While it is not always possible to ensure that a special class placement will be available in the child's local school, the NCSE has informed the Department of Education and Skills that, in general, it is satisfied there are currently sufficient special class placements to meet existing demand.

The Department of Education and Skills does not currently have a policy supporting the establishment of special classes in fee-charging schools, as the Senator outlined. This is because the NCSE is required to satisfy itself that the class is both sustainable and available to all of pupils who may need special class placements in a particular area. As learning needs change over time, a student's enrolment in a special class should also be kept under continual review by the school. Where such a review indicates that the student's needs might be best addressed in a mainstream setting, the student should be supported in moving to a mainstream class in the school. A special class is, therefore, not a separate provision within a school, but forms part of the overall educational provision within the school, with interaction taking place between the two settings.

The Department of Education and Skills informs me it is satisfied that, based on the advice of the NCSE, schools in the free education system can continue to establish sufficient special classes to meet identified need.

Regarding the specific matter raised by the Senator, I will bring the details back to the Minister. In an Irish context, there are two types of fee-paying schools. In my constituency, Kilkenny college was one of the largest fee-paying schools in the country until it became part of the free school system a few years ago. I do not want to resort to categorising people, but Bandon grammar school would traditionally have served the needs of members of the Church of Ireland community in west Cork and that part of the country. I understand there would be specific issues regarding access for children from the Church of Ireland tradition who may have special educational needs. It is a legitimate issue to raise.

In a broader sense, in respect of fee-paying schools, it is appropriate that the NCSE has to be satisfied that classes being provided are available to everybody. By their very nature, fee-paying schools are not available to everybody. There is, however, a specific question to be answered in this case. I will ask the Minister to respond directly.

I acknowledge the Minister of State's recognition of the issue, particularly regarding Bandon grammar school. The trustees of that school have stated that there will be no fees for any student who attends the unit. Reference is made to being open to all and that is exactly what the trustees have done in stating that no fee will be applicable. Taking the sustainability issue into account, there is a real issue for the people of west Cork. This is a unique issue and people there feel discriminated against in many ways. They are doing the right thing in stepping up and stating that the unit is needed. Can people imagine what would have happened if they had stated that they did not want the unit? What kind of uproar would there have been? These people have instead put their hands up and affirmed that they want to be part of an inclusive society, they want to do the right thing and, therefore, the fee will be waived. They are now asking if we will work with them. I welcome the acknowledgement of the issue by the Minister of State and I am hopeful that the Minister will answer and correspond appropriately with the school. This is a major issue for the part of west Cork I represent and a significant issue for all sections of society.

Harbour Authorities

I welcome the Minister of State. It may be peculiar for those watching to see us talking to the Minister of State with responsibility for local government about Dún Laoghaire Harbour, which is one of the finest harbours in Europe and the world. It is renowned for its historic nature architectural beauty. With that, however, comes major responsibility, including financial responsibility. A number of heated responses in the House from the Minister for Transport, Tourism and Sport, Deputy Ross, regarding this matter have shown that there is dissatisfaction in the community in the Dún Laoghaire-Rathdown County Council area regarding ongoing obligations in respect of the maintenance and financial requirements needed to protect this national treasure. It is unfair, and considered unfair, that that should be the case. I want to agree with that sentiment.

At the outset, I must state that I am a former director of the harbour company, having served in that position for ten years. I left the post many years ago but I am intimately familiar with the workings of the company. I refer to its finances, corporate governance and attendant issues. Many Ministers with responsibility for transport have dealt with this issue, including the Taoiseach, Deputy Varadkar, the Minister for Finance, Deputy Donohoe and the Minister, Deputy Ross. Those are all influential people in politics and in this Government. They are also aware of the financial liabilities and difficulties.

I do not want to open up the issue of the governance of the company today. I want to focus on how we can secure from the Government some financial support and assistance for Dún Laoghaire-Rathdown County Council, its executive and elected members, to protect the future of this harbour. Financial liabilities are part of this issue. It is suggested that total liabilities might be some €30 million, but it is hard to quantify. Some provision, however, should be given. It is not appropriate that a State agency should saddle another arm of the State, in this case Dún Laoghaire-Rathdown County Council, with a financial liability of this significance.

I do not want to look back, I want to look forward.

Responsibility for this particular area now falls on the desk of the Minister of State. Can he give an undertaking that he will secure an incremental transitional fund for Dún Laoghaire-Rathdown over a period of between three and five years? I seek assurance about the status of the trading accounts for the Dún Laoghaire Harbour Company for the last year or two. There is a statutory obligation in law, and the Houses of the Oireachtas enacted the legislation, that provides for the audited accounts of the company to be laid before the Houses of the Oireachtas. The time is well lapsed and yet we still have not seen the accounts. I ask the Minister of State to enlighten me on the following. Where are the accounts? What is their status? Is he aware of any complications or reservations by anybody, including former directors or financial people who work for the company? Have they any difficult signing off on them? The Minister of State might share that information with us if he has it. More importantly, when can we expect the accounts to be laid before the Houses of the Oireachtas? Can he give us and the local authority, its members and executive comfort by saying what he might do or might be able to do to provide financial support to them? There may be elements of heritage and conservation and, therefore, the Minister for Culture, Heritage and the Gaeltacht, Deputy Madigan, may be able to provide funding. A number of State agencies may be able to provide funding for this particular issue.

I thank Senator Boyhan for raising this important issue. I am delighted to have the opportunity to address the House on the issue of Dún Laoghaire harbour and its future development. He is correct to say that we should focus on the future at this stage.

The Senator referred to the document entitled National Ports Policy 2013 when he mentioned the time the Taoiseach was the Minister for Transport. The policy provides for the transfer of certain ports to the relevant local authorities that they are located in and sets out the arrangements for giving effect to this. In that context, the Dún Laoghaire Harbour Company transferred to the Dún Laoghaire-Rathdown County Council on 3 October 2018, in accordance with Part 3 of the Harbours Act 2015, which provides, inter alia, for the dissolution of the port company and the transfer of its assets, liabilities and rights to the council.

The Harbours Act 2015 requires that the council presents final accounts for the former harbour company, which the Senator outlined, to the Minister for Housing, Planning and Local Government within six months of the date of dissolution. Again, as the Senator pointed out, that time has passed. It has taken longer than stipulated to finalise the accounts for the period 1 January 2017 to 2 October 2018 due to a technical legal issue regarding audit and sign-off of the accounts. I understand that the council will present the accounts to me before the end of the year. I will then lay the accounts before the Houses of the Oireachtas.

The Department has a prudential role with regard to the financial integrity of all local authorities and to ensure that local authorities' finances, as far as is practicable, are on a sustainable footing. In that regard, it is my Department's position that in the case of all port transfers, the relevant local authority should not be unduly encumbered or exposed to financial risk by the effective transfer of a commercial body to its control. As I said at the time, and reiterate here, there can be no question of all the costs falling on the local authority in question, which is Dún Laoghaire-Rathdown County Council.

I understand that due diligence undertaken by the council prior to the transfer had estimated that remedial works costing in excess of €33 million could be required if the port was to be brought to a standard to accommodate commercial shipping. However, a smaller infrastructural deficit of €10 million applies in the event that upgrading and maintenance for just recreational and amenity use needed to be addressed over a number of years.

It should be noted that Dún Laoghaire harbour is a substantial strategic asset and amenity, and a local and national one as pointed out by the Senator, which, notwithstanding its ongoing expenditure requirements, also generates income from a number of sources that can be directed towards investment needs. The Senators is aware of the latter from his own time as a member of the county council.

Dún Laoghaire-Rathdown County Council is currently working on an economic plan for the harbour. While central government responsibility for ports policy and associated issues remains a matter for my colleague, the Minister for Transport, Tourism and Sport, I am anxious to see local authorities realising the potential of their assets, on a sustainable basis, in the context of Project Ireland 2040. In that context, I look forward to seeing proposals from the council on the future development of this key strategic asset.

The Senator is right to point out that there will be other Departments under the aegis of Project Ireland 2040 from which funding can be sourced. First, the final accounts must be presented. Then it is a matter for the council to bring forward its proposals on regeneration works for necessary regeneration and also for further economic development of the port and the port's lands into the future.

I thank the Minister of State. I must say three things. It is extremely disappointing, despite numerous promises, new dates and deadlines constantly being pushed out, that we are being told there is a difficulty or glitch in the signing off of public accounts for public money by a company whose directors were appointed by the Government. It is very serious. This is about corporate governance, accountability and the public finances. It is exceptionally disappointing, but the Minister of State has nothing to do with what has been stated. I certainly will be pressing in respect of this matter outside the House in the coming days. I will seek further advice because this is an urgent matter.

It is unacceptable that the local authority, which had no hand, act or part in the finances of this company up to its dissolution, now finds itself in a situation where the accounts of a company which it had to take on under legislation have not been dealt with. I will pursue that. In the meantime I ask the Minister of State to consider meeting the executive of the council to tease out what is happening here. That is his call, but I ask him to consider it. In addition, bear in mind that there is a rates issue and a budget issue. This issue will have a huge impact on the rates that will be levied on business in Dún Laoghaire because the chief executive has to be prudent and make provision for bad debt.

There are two issues. It is unacceptable that we cannot see the accounts that were to be laid before this House months ago. It is a serious offence and I ask the Minister of State to look into what sanctions there are or whether we are open to any sanctions. I do not know. I am not asking a smart question, but are there any sanctions?

Within days, I will be upping the gear with regard to public accountability for public funds in respect of Dún Laoghaire Harbour Company.

To reiterate, I have no problem with meeting the executive or councillors about the proposals they have to draw down funding to carry out the necessary works in Dún Laoghaire. I presume the Senator was a member of the board when he was a councillor.

Did the council have any nominees to the board?

The council had no nominees in the latter years, but it did originally.

I understand the issue to the effect that it is almost 12 months since the order was passed. The legislation refers to a six-month timeline. The council would be happy if it was finalised before the end of the year. With regard to ensuring that the accounts are laid before the Houses within the next number of weeks, it is perfectly legitimate for the Senator to ask that question. I will look into whether there is a sanction available and revert directly to the Senator.

Medicinal Products Reimbursement

I welcome the Minister of State, Deputy Finian McGrath. I refer to the issue of FreeStyle Libre. Thousands of adults with type 1 diabetes will have to wait until next year to find out whether the HSE is prepared to lift restrictions on them accessing the new blood sugar monitoring technology known as FreeStyle Libre. This device has been credited with greatly improving the quality of life of people with the disease since it was approved by the HSE in April 2018, but only for those aged from four to 21 years.

I am advocating today on behalf of a woman who is outside of that age bracket.

The HSE promised at the time to review the situation after 12 months once it was in a position to assess the cost of making the device available to children and young adults. In August, according to a spokesperson, the HSE had 12 months of data collated for review within the coming months. This would allow for the experience of patients and the "societal aspects of benefit" to be reviewed. Members may be aware that FreeStyle Libre, made by Abbott, is a small sensor worn on the skin with readings taken by scanning a hand-held device over the sensor. Unlike the finger prick test, there is no need to draw blood and continuous information about glucose levels can be obtained.

Diabetes Ireland has described the upper age limit on availability as "unfortunate" as it means that many adults cannot access the technology despite the support of their medical team. The HSE stated that it was committed to reviewing who can access this technology within a year but 18 months later, there is still no review. The device has been made available to some adults with type 1 diabetes based on exceptional need. However, diabetes specialist Dr. Ronan Canavan has said that he has made many applications over the past year with limited success. One such application on behalf of a 22 year old patient was refused initially and again on appeal. As I said, I am making representations on behalf of an adult woman. She needs this technology but is exasperated by the delay.

Diabetes Ireland estimates that around 20,000 people have type 1 diabetes, including almost 3,000 children under 16. What is the HSE doing to ensure that adults who have this condition can access this much-needed technology?

I thank Senator Ó Ríordáin for raising this important matter and for giving me an opportunity to address it.

The HSE has statutory responsibility for decisions on pricing and the reimbursement of medical devices under the community drug schemes in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE must also, under its governing legislation, manage the provision of health services within the overall resources available to it. In line with the recommendations of the HSE's health technology assessment group, the FreeStyle Libre product was made available in 2018 to children and young adults and, in some exceptional circumstances, to other patients. The health technology assessment group is a medical technology evaluation group that provides assistance to stakeholders when considering the various health technologies and innovations in the medical devices field. It includes expertise in medicine, pharmacy, health economics, devices and procurement. It reviews the clinical and cost effectiveness of innovative medical devices.

The FreeStyle Libre product is intended to be used as an alternative to current glucose monitoring methods for people who administer multiple daily injections of insulin. In contrast to self-monitoring blood glucose, this technology allows glucose readings to be taken non-invasively. Unlike continuous glucose monitoring, it does not need to be calibrated with a blood sample. On the advice of the health technology assessment group, the HSE decided that after 12 months the situation, including historical reimbursement data, would be reviewed to inform the next steps. The intention is that an update to the initial report will then be published.

In recent months, the primary care eligibility and reimbursement service of the HSE has taken steps to gather the relevant data for review by the health technology assessment group. It collated the reimbursement data on strip usage for persons approved for FreeStyle Libre, as notified to the HSE through individual pharmacy claims on a monthly basis. It liaised with the national clinical programme for diabetes and shared material received with the health technology assessment group. It collated the reasons for exceptional approvals, for example, in cases of older patients with visual impairment or dexterity issues and provided this quantitative data to the health technology assessment group for review.

It provided the Diabetes Ireland survey on the use of this product to the health technology assessment group.

The HSE intends that an update to the initial report, including details of the review, will be published after the review has been completed. Although the HSE must be satisfied that the expected offset reductions in glucose monitoring ancillaries materialise, the health technology assessment process expected to be completed by year end or early next year will not focus exclusively on cost savings. The process also allows for patient experience and societal aspects of benefit to be considered, including improvements in health outcomes and the quality of life.

I thank the Minister of State for reading that reply. Its key line is: "The HSE intends that an update to the initial report, including details of the review, will be published after the review has been completed." Would the Minister of State accept that statement if he were in my place or if he were a person with type 1 diabetes aged over 21 and waiting more than 18 months for news of this technology that could benefit his or her quality of life? If he were me or the women I am representing, would he accept that?

In summary, in reviewing the availability of these products, the HSE must be satisfied that the expected offset reductions in glucose monitoring ancillaries materialise. It was anticipated that offset efficiencies would materialise to improve affordability and this is a very important aspect of the HSE's consideration of whether further expectations are possible within current financial resources. However, the process also allows for patient experience and societal aspects of benefit to be considered, including improvements in health outcomes and quality of life. In reply to the Senator's specific question, no, I would not accept that indication if I were in that situation. I will raise this issue again with the HSE. The key section of the response outlines that societal aspects of benefits can be considered. All patients should be treated with respect and dignity. I will relay the Senator's concerns to the HSE.

Health Services Provision

I thank the Minister of State for taking time out of his schedule to discuss the matter of the Respond care home in Carrickmacross, County Monaghan. The building was finished in 2017 but, regrettably, has been lying idle for more than two years. It is designed to cater for people with physical and sensory disabilities and is badly needed in the community but, unfortunately, has been dogged by delay after delay. The people of Carrickmacross and the wider south Monaghan area are significantly disappointed, frustrated and angry with the delays. Families are suffering as a result and people are rightly angry that a much-needed facility is lying idle two years after construction was completed.

Part of the problem is that up to five agencies are involved in the project but none has the lead on it. That is a contributing factor in the delay in delivering this group home. The net result of the delay is that the system is failing special and deserving people and, indeed, their families. We need to learn from this debacle and ensure that projects of this nature which involve multiple agencies have one lead agency that can take control and have sole responsibility for delivering the project.

In the meantime, I hope the Minister of State will be able to provide us with a definitive date for the opening of this facility which is badly needed by people with physical and sensory disabilities. I hope his response will provide good news for them on this debacle which has been going on for more than two years.

Can he provide us with a date for when the doors of this facility will be open?

I thank Senator Gallagher for raising this important issue and giving me the opportunity to respond to the House today. The Government's ongoing priority is the safeguarding of vulnerable people in the care of the health service. We are committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. Significant resources have been invested by the health sector in disability services in recent years. This year alone, the Health Service Executive has allocated €1.9 billion to its disability services programme.

As part of its ongoing service provision, the HSE will provide over 8,500 residential places this year to families in need right across the country. In fact, residential services make up the largest part of the disability budget. Our policy is for people with disabilities to be supported to achieve their full potential so that, where possible, they can live ordinary lives in ordinary places doing ordinary things.

The need for increased residential facilities is acknowledged and the HSE continues to work with agencies to explore various ways of responding to this need in line with the budget available. With regard to the particular centre mentioned by the Senator today, I am advised by the HSE that a procurement process for an external service provider to run the HSE Respond group home in Carrickmacross has been completed. After the closing date, tenders from a number of service providers interested were assessed and one has met the criteria. However, the cost of provision greatly exceeded the budget available to the HSE to deliver the service. The HSE community healthcare organisation, CHO 1, has engaged with that provider with a view to bringing the cost of provision in line with the available budget. However, this has not been successful. CHO 1 has sought the additional funding required to open this group home through the 2020 Estimates process. As it has not been notified to date of its 2020 budget allocation, CHO 1 is not in a position to confirm a start date for this service. The budget has increased to more than €2 billion this year. Residential services are very important. I will bring this matter forward in the process of dealing with the service plan.

My initial response to the Minister's reply is one of great disappointment. This project was first mooted over 15 years ago and it is difficult to fathom how a much-needed facility such as this has lain idle for over two years. It is simply not good enough. I ask the Minister to intervene personally in this debacle to ensure that the doors of the facility are opened without further delay. I ask him to keep in touch and to revert to me when he makes contact with the HSE. It is crazy that taxpayers' money has been used to build a much-needed building but that, two years after its completion, the doors remain firmly shut. This is not how business should be done.

The Senator said there should be one lead role in the centre of the agency and this is important. I also accept his argument that the facility is much needed and two years is a bit too long to wait. We share a common desire to have the best possible policies and services for people with disabilities. I want everyone with additional needs to have access to the necessary support in every aspect of their lives to enable them to achieve their full potential, maximise their independence and live rich and fulfilling lives. This includes ensuring that the residential services we provide are of the highest standard and are tailored as far as possible to meet the individual needs and preferences of the service users. I am pleased that I have been able to build on significant existing resources and obtain additional funding for disability services in 2020. With these additional moneys secured, the overall budget for disability service for 2020 is in excess of €2 billion.

That is the highest disability services budget in the history of the State. I agree with the Senator about this particular issue. I feel very strongly about it and will do my utmost to support the development of this service as we need this kind of service in our community for all people with disabilities.