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Seanad Éireann debate -
Friday, 12 Mar 2021

Vol. 275 No. 3

Nithe i dtosach suíonna - Commencement Matters

Health Services Reform

Ba mhaith liom i bharr fáilte a chur roimh an t-Aire go dtí an Teach inniu. That is my little bit for Seachtain na Gaeilge. I thank the Minister of State for coming to the House today. This week the Joint Committee on Disability Matters heard very compelling advocacy from members of the disability committee in the National Women's Council of Ireland and from Amy Hassett of Disabled Women Ireland. It was really quite an extraordinary and very powerful meeting of the disability matters committee. Ms Hassett's statement included a reference to the Assisted Decision-Making (Capacity) Act 2015 and the fact that it has not commenced, while also noting elements of the Disability (Miscellaneous Provisions) Bill and the Sign Language Act have not been enacted. I know the Cathaoirleach, in particular, has advocated for sign language. I appreciate the Minister of State is not here to talk about those matters, but I am sticking them in as a reminder.

I note that Inclusion Ireland highlighted that the Assisted Decision-Making (Capacity) Act states that everyone is presumed to be able to decide for himself or herself, unless the opposite is shown. That is important. The Act and the law set out ways to support people who lack capacity in making decisions. The Act also provides for a move away from the idea of best interests and a move towards a rights based decision-making capacity. It is designed to meet the standards of respect and the needs of persons with intellectual disabilities, for people with decision-making ability who have been affected perhaps by traumatic brain injury and for older people with diminished capacity or dementia.

I acknowledge the thrust of this Act is already in operation in the form of guidelines and great moves have been made in that regard. I have been involved in it from the privacy and general data protection regulation, GDPR, end, in training and in assisting people and ensuring their capacity is to the fore. Sage Advocacy has noted the commencement of this Act will also ensure that information is imparted in a way that people can receive it and are best informed and assisted in making their decisions.

We see the thrust of all our legislation. In the last year, in particular, since I have been in the Seanad and prior to that, I have noticed the move away from a paternalistic approach and very much towards the person who is most affected being party to a decision. We have seen many actions on the Statute Book that move in this direction and they are to be commended.

The difficulty here, and why it is particular to this week, is that women tend to survive to old age in greater numbers and can be particularly affected as a consequence. They disproportionately comprise an older age cohort and are more likely to be affected by diminished capacity as a result. There is a need for urgency in bringing in commencing this Act.

I believe that when it is commenced, we will need an information campaign to ensure everybody knows about it. I tend to get calls when people assume they have legal status as next-of-kin and do not quite understand the implications of enduring power of attorney and so on. When this comes in, it will be important because, naturally, if the decision-maker is the person most affected, he or she will have a power and agency not there heretofore. I would urge that is noted also.

I thank the Senator for raising the issue of the commencement of the Assisted Decision-Making (Capacity) Act 2015 and its importance for women with disabilities.

It also shows the relevance of the newly formed Committee on Disability Matters when we are getting into the nuts and bolts of discussing persons with disabilities and, on International Women's Week, bringing in such groups to show the impact of not having the proper legislation in place and how it is restraining them. I acknowledge that its commencement will benefit women with disabilities who have capacity difficulties and I assure the Senator that everything is being done to ensure the commencement of the Act by June of next year.

The Act is very important legislation that changes the existing law on capacity from the status approach of the wardship system to a flexible functional approach, whereby capacity is assessed on an issue and time specific basis. This addresses everything the Senator has spoken about. It will abolish the wards of court system for adults by repealing the Lunacy Regulation (Ireland) Act 1871. Adults in wardship will transition to the new decision-making support arrangements on a phased basis over three years from the date of commencement.

The Government made a commitment in the programme for Government to commence the Act, recognising the importance of the much-needed reform it represents. The delays in commencement of the Act arise from two principal factors. The decision support service, which will operate the progressive provisions of the Act, has yet to become operational. It will then be able to respond to the complex decision-making needs of people with capacity difficulties. Amendments are also required to the Act before full commencement can take place. Work is actively taking place on an assisted decision-making (capacity) (amendment) Bill, which we expect to have enacted by year end. These amendments will streamline the processes in the interests of those using its provisions. They will also strengthen the safeguards included in the Act.

Some provisions of the Act have been commenced to enable the recruitment of the director of the decision support service, the establishment of a multidisciplinary working group on advance healthcare directives and, most recently, on 1 February, the repeal of the Marriage of Lunatics Act, which means that a ward can now marry if she or he has capacity to do so.

The decision support service has made considerable progress in putting in place the administrative and IT systems needed to operate the Act. To this end, a budget of €5.8 million was secured to help fund the decision support service. A high-level steering group, chaired by the Department of Children, Equality, Disability, Integration and Youth, meets monthly to oversee and drive progress towards full commencement. The steering group comprises senior officials from the Department of Health, the Mental Health Commission, the Courts Service, and the decision support service. This is in recognition of the fact that successful operation of the Act will involve multiple stakeholders. It is working towards commencement of the legislation in June 2022, with the decision support service opening for business immediately thereafter. To be honest, all of the heavy lifting is being done at the beginning so that when the Act is commenced the decision support service will be open and ready for operation, with the staff in place and the ICT system ready to run.

I recognise the frustrations of all the groups that have come, and will come, before the Committee on Disability Matters. They will tell us how this is restraining them. However, the Senator now has a good understanding of the work being done. It is also important that we develop robust systems in the decision support service that respond adequately to the needs of those with capacity difficulties and of their families. I am confident that the time that we devote now to getting this process right will give us a person-centred approach and will pay dividends in the end.

I thank the Minister of State. It is very heartening that we have a locked down timeframe. It is really good. It is also really good to hear of the monthly meetings of the steering group. One of the things I really regard and respect in the Act is the complete abolition of the horrible names of the Acts of the past. We both recoiled, the Minister of State in saying them and me in hearing them. Moving to that place of absolute respect for the integrity of the individuals and their rights to make decisions about their lives is to be welcomed. I thank the Minister of State.

I assure the Senator that everything that can be done is being done and we have a timeframe and it will be measured. At the end, it is all about communication and it is exactly about how we can empower people so it is completely person centred.

Believe it or not, this is the only Commencement matter I will be taking that is from my brief. In this women's week, I also acknowledge the disabled women who were before an Oireachtas committee. There was a fantastic hashtag used on Twitter, which was #DisabilityIsNotADirtyWord. I commend them on this and it got many people talking during the week. They also asked some poignant questions. I compliment the disabled women's group for bringing disability to the forefront this week.

I note the Minister of State is replying to all the Commencement matters today, which is unprecedented. I thank her on behalf of the Seanad for taking time out of her busy schedule to come here to reply to the six matters today.

Health Services Funding

Gabhaim buíochas leis an gCathaoirleach faoi dhó agus fearaim fáilte roimh an Aire Stáit agus míle buíochas di as a bheith inár measc agus guím Lá Fhéile Pádraig sona uirthi, ar ndóigh. Tá súil agam go mbainfidh sí taitneamh as cibé beagáinín de shaoire a bheidh aici ar an lá sin.

It is now five years since the controversy surrounding charitable and voluntary organisations such as GOAL, Console and the Central Remedial Clinic. As the House might recall, taxpayers' funding that was given to these organisations, as well as funds donated by ordinary citizens, were abused and misappropriated. This behaviour went unchecked due to poor corporate governance, shoddy accountancy practices and the lack of proper oversight by government and particularly the Departments that provided funding. I hoped we had moved beyond that culture. I thought, as I am sure other Senators had thought, that strict governance and accounting conditions now applied before any State funding would be given to voluntary organisations.

I was surprised to read a report recently about an organisation called Transgender Equality Network Ireland, a company limited by guarantee, or TENI.

I urge the Senator to be cautious in referring to persons or naming any organisation outside the House.

Absolutely. I understand those concerns. In the preparation of this matter I supplied the details of this to the Government. For the avoidance of doubt, it does not matter to me what organisation is involved but it is the principle when it comes to using almost €750,000 in taxpayers' money over a period of years. It is of no concern to me what organisation is involved, what it does or what it stands for. It is the principle of how taxpayers' money is disbursed that is my only concern in bringing this matter before the House. What I have said so far is on the public record.

In January this year this group filed accounts for 2018 at the Companies Registration Office, CRO, and as I understand it this was almost two years beyond the point where they were due to be filed. The accounts for 2019, due to be filed with the CRO in early 2020, are still outstanding, and the accounts for 2020, due to be filed with the CRO earlier this year, are still outstanding. These filings are a matter of public record at the CRO, and despite apparently failing to file audited accounts for 2018, 2019 or 2020, this organisation received €326,000 from the HSE in 2019 and €180,000 in 2020. Moreover, it has been given a commitment to get €230,000 in 2021. Is it not extraordinary that a group three years behind in filing audited accounts continues to receive funding like this?

For the benefit of the Senators who represent political parties, I point out the following by way of contrast. Section 40 of the Electoral (Amendment) (Political Funding) Act 2012 introduced a requirement that political parties would receive no Exchequer funding in any calendar year unless audited accounts for the previous year had been submitted and signed off by the Standards in Public Office Commission. In other words, if a political party did what this group has done, it would not have got a single penny for 2019, 2020 or 2021. This organisation has had nearly €750,000 doled out to it by the HSE in that time. To put that in perspective, it is nearly double what the Labour Party got in Exchequer funding last year and this year.

I am not for a moment suggesting this organisation or any person in its management has committed any wrongdoing. I stress here again that my position here is that sauce for the goose is sauce for the gander. However, one of the reasons we provide funding in the first place is so these organisations can pay to put adequate systems of accounting and financial controls in place.

This seems to me to be totally unacceptable and I look forward to the Minister of State's response.

I am taking this matter on behalf of the Minister for Health, Deputy Stephen Donnelly, and it is his script I am responding with. I thank Senator Mullen for raising the issue and giving me the opportunity to outline the position to the House.

The Department of Health's role is to provide strategic leadership for the health service and to ensure that Government policies are translated into actions and implemented effectively. This includes governance and performance oversight to ensure accountable and high-quality service. Any proposal to provide Exchequer funding would require detailed consideration of the service need and potential costs and the decision would then be subject to public procurement rules. Any organisation funded from the Exchequer is required to conform to the Government principles as outlined in the service arrangement and Department of Public Expenditure and Reform Circular 13/2014, Management of and Accountability for Grants from Exchequer Funds. This circular outlines the public financial management principles, procedures and additional reporting requirements to be followed in the management of grant funding provided from public money, as well as the reclassification of grants and grant-in-aid.

The overall principle is that there should be transparency and accountability in the management of public money, in line with economy, efficiency and effectiveness. In general, good governance is central to how State agencies direct and control their functions and relate to their stakeholders to manage their business, achieve their mission and objectives and meet the necessary standards of accountability, integrity and propriety. All bodies that fall under the Department must comply in full with the code of practice for governance of State bodies.

In relation to HSE-funded services, sections 38 and 39 of the Health Act 2004, as amended, provide for the HSE to contract with a non-statutory body to provide health and other allied services on its behalf. As part of a HSE-wide initiative to improve governance arrangements for the funding of non-statutory agencies, a national compliance framework has been developed to ensure a consistent approach.

Where the annual funding allocated for the contracted service is less than €250,000, the oversight and governance arrangements are defined via a grant aid arrangement. Where the annual funding allocated for the contracted service exceeds €250,000, the oversight and governance arrangements for the contracted services are defined via a service level agreement signed between the HSE and the voluntary agency. The provider is required to provide an annual report to the HSE in respect of the service no later than 30 September each year.

For all section 38 funding arrangements, as well as those section 39 funding arrangements in excess of €3 million in annual funding, an annual compliance statement is required to be submitted to the HSE compliance unit by the agency, which relates to compliance with corporate governance requirements for the prior year. Within the HSE, the non-statutory sector compliance unit evaluates the annual compliance statements received from the section 38 and section 39 agencies that are required to submit such a compliance statement and the compliance documentation and guidance are reviewed and updated annually, as required.

I thank the Minister of State for her reply but she is in the unfortunate position, as Ministers often are here, of having to deliver a speech on behalf of another Minister. I listened carefully but did not hear the answer to the core issue, which is whether an organisation that has not submitted audited accounts should be getting State money. The serious questions I have remain, namely, whether it is common practice that the HSE or the Department of Health would commit funding to organisations that have not filed audited accounts in successive years, whether the timely filing of audited accounts is not a condition of receiving funding in the first place and whether this is the only organisation that has been treated this way, which I would find hard to believe. Surely we all agree that every euro of taxpayers' money must be subject to the same controls and safeguards. It is no fault of the Minister of State but I am not happy that I have received any kind of response to the substance of the questions I have asked.

Perhaps the second concluding part of it will address that. I am scanning over it in the time allocated.

Additionally, it should be noted that, in accordance with the above, all providers in receipt of funding are contractually obliged to adhere to all relevant legislation, which includes company law legislation as applicable to other organisations.

HSE national mental health is aware of the Companies Registration Office, CRO, audited accounts filing by the company that has been referenced by the Senator. The reason these documents were late was due to a staffing issue, which has now been resolved. The 2018 accounts were filed with the CRO in December 2020 and were reviewed. The 2019 accounts are complete and are in the process of being signed by the directors and will be filed thereafter. The 2020 audit will commence shortly and will be filed on time from this point forward. The HSE is in constant communication with the group and receives regular finance and service updates. At no stage was there a reluctance from this organisation to engage with the HSE and all explanations were furnished. This addresses the point that the HSE has been continually in contact with the group. There was a staffing issue but files have been lodged. That is my understanding from the information given to me by the Minister.

Disability Services Provision

I thank the Minister of State, Deputy Rabbitte, for coming to the House and for making herself available for this important question. As the Minister of State knows only too well, the HSE is currently rolling out its reconfiguration of disability services for children and it hopes to complete the centralisation of services July of this year. I understand that when there are waiting lists as long as 25,000, and indeed a family in my area has been waiting for four and a half years for access to therapies, the HSE has to do something. When a school such as the Holy Family School for the Deaf in Cabra is told that it is to lose its on-site specialist speech and language therapy service to resource the development of another service, then the children, the parents, the staff and the principal all deserve answers as to why they are to lose their service.

My question is very much about the research, the evidence-based policy and the clinical framework that says it is better for children to access services in the community, which in reality is effectively them joining a long queue along with many other children in the community, when they already have timely access to a vital service within their school environment. A report produced by the HSE in 2017 related to the national advisory group on specialist services for deaf children. There were nine specific recommendations in the report but it has been there for more than three years at this stage and is gathering dust. The recommendations have been actively ignored by the HSE's current reconfiguration plan for disability services for children. Where is the leading role for specialist deaf services? Where are the specialist mental health services for children who are deaf and their families? Where is the automatic referral for those with severe or profound hearing loss? Where is the expertise in training within primary healthcare and within the community-based teams for children who are deaf or hard of hearing?

This school deserves to hear the rationale as to why it is losing its service. It seems like a retrograde step. The impact of this on the children in the school will include lost days out of school. Children come from as far as Monaghan, Longford, Meath and Kildare, as the Minister of State knows only too well. What are we saying to them with regard to their right to access a comprehensive and full education in this State that they must stay at home to access a service where they reside and not go to school on those days? It is shameful we would have to tell them to miss school. It is about providing a consistent support service to them. Any family that has a child with a disability will say that it has to be consistent as opposed to meeting a different clinician or therapist on each day. There is also a cost to the HSE.

From my conversations with the Minister of State on this I know she is concerned. The Taoiseach has also spoken publicly about this. The school and I received correspondence from the HSE on Wednesday. It was a series of justifications for why it is doing this, which is nothing short of shameful. The HSE has sought to rely on the Ombudsman's report on unmet health needs for children with disabilities. The HSE is relying on that report to justify what it is doing.

It is saying that the report states that we need to review the access path and criteria for accessing services. Is the HSE saying that the children in the Holy Family School for the Deaf do not currently need access to speech and language therapy services? That is what it said in its letter. I want to hear the HSE's justification. If this goes through, it will be a hugely retrograde step for the children in this school. I thank the Minister of State for coming into the House.

I do not know whether to start with the opening or concluding statement at this point. I have an answer but I would like to give the Senator the opening piece on the HSE first. I will then show how I have intervened, as a follow-up to the emails and the conversation the Senator and I had at back of the Chamber last Monday, and the work that has happened in the last four days. The Senator must recognise that what I have been trying to do in four days actually started in 2016. I am coming in at the tail end of a project that has started and been unleashed. I am now trying to manage it. I will put it in that context. I will read the opening script, which outlines where we have been over and back with the HSE prior to my intervention. It is important that I put this on the record because it gives parents who are watching an understanding of how we have come to this space. I will then address the issue about which the Senator has asked. I thank her for giving me the opportunity to do this.

In October 2017, the national progressing disability services, PDS, working group signed off on the report it had received from the national advisory group on specialist supports for deaf children. The report recommended a model of national specialist support to be delivered through a three-tiered approach: training for front-line staff in primary care and children's disability network teams; consultation with staff regarding individual children; and individual specialist assessment only in the very small number of instances when all efforts for assessing a child's needs have been unsuccessful.

The proposed model, as outlined, is in line with the PDS model and the 2016 report regarding guidance on specialist supports. A working group was subsequently formed under the integrated care programme for children to focus on services for children who are deaf and hard of hearing. The national PDS steering group was represented on this group. The findings and recommendations of the PDS national advisory group informed the deliberations of the working group. The national working group for integrated care for children who are deaf or hard of hearing incorporated the relevant PDS recommendations regarding specialist support into its draft report. A draft version of the group's report was circulated in March 2020. However, the subsequent onset of the Covid-19 pandemic has interrupted the work of the group. It is expected that the group will resume its work as soon as practically possible.

At this intervention, it is important for me to say that the remodelling of the PDS network has started and is rolling out. We are still going to reconfigure to have a meeting of the steering group. Therefore, the horse has bolted on this one. I am trying to get a hold of it at the moment. I acknowledge and totally understand the concern, upset and frustration of the parents and staff in the school about which the Senator spoke. I would like to be able to tell her that this school is an isolated incident, but we have many of these schools around the country. Certain things are happening and the programme is being rolled out. As the Senator will be aware, the HSE is currently rolling out the PDS programme, which requires a reconfiguration of all current HSE and HSE-funded children's disability services into 91 children's disability networks across the nine community healthcare organisations, CHOs.

The programme aims to achieve an equitable national approach to service provision for all children based on their individual need and regardless of their disability, where they live or where they go to school. A really positive piece of work is going on right across the country. The reconfiguration of services under the PDS programme is in line with the health service reform and implementation of community health networks under Sláintecare. I have discussed the issue of the PDS with the HSE a number of times over the past week to air some of my concerns, which have been brought to my attention by parents and Members of the Oireachtas. I believe the PDS is the best way forward. I have more to contribute in my concluding remarks, but I get the Senator's point.

I thank the Minister of State for her response and I understand that she understands the seriousness of the issue. Any of us who have dealt with families and children with a disability who are waiting know the distress involved. I understand what the HSE is doing across the country but not for the schools where there is already a good service in place and this had caused the greatest distress to me. There is already a good service in place and the HSE is seeking to remove that. So we are robbing Peter to pay Paul and we simply cannot allow that to happen. The Minister of State is right in that the Holy Family School for the Deaf is not an isolated school. The Carmona School in Glenageary was in contact and there are other schools across the country, including a school for the deaf in Cork.

I plead with the Minister of State and the Government because this is an education and health issue. It is not just a health issue. I understand that the HSE must do what it must do but I ask that the Government takes control and creates an initiative now to protect the education of these children. These children are in mainstream education. We need to protect that and ensure they do not suffer a loss because of a HSE action.

The Senator is right because I have been approached by my colleague, Deputy Cormac Devlin, and Deputy Jennifer Carroll MacNeill has come to me about the Carmona School. I have heard about it from all over the country. The Government has taken control of this issue. I took control of it last Monday and I have continuously engaged with the HSE for the past week.

I will now read an important piece. In the context, the HSE introduced the national policy on access to services for children and young people with disability and development delay to ensure that children are directed to the appropriate service based on the complexity of their presenting needs rather than based on diagnosis. If a child travels from Galway or Donegal to attend a special school for deaf children or the hard of hearing, that is his or her specialist school. So it is up to every CHO to understand the national policy, and how they implement it and how they communicate it. It is very clear to me regarding communication within the HSE that while I am dealing with the best of people at the top they are not understanding the policy at a CHO level. I rest my case.

Vaccination Programme

As the Minister of State well knows, family carers are an invaluable but undervalued element of the healthcare service in Ireland. Over 350,000 carers provide essential care on a daily basis to over 400,000 people saving the State an estimated €10 billion a year, which is very significant. Many of these carers devote a major part of their lives to caring for a loved one in situations that are often, let us be honest, very lonely. These carers remain silent and isolated. They accept their lot and get on with the task in hand. If it was not for the sacrifice made by family carers, many of those who are cared for would have to be provided with long-term State care that would cost multiples of millions of euro, which would place an intolerable financial burden on the State.

Like many other politicians - I talked to Senator Malcolm Byrne on my way in about this matter and he recognises the same problem - we have all been inundated with calls from family carers wondering why their work is any less valuable than other front-line workers in the health service or elsewhere. This is not about pitting one worker against another in a race for people to get vaccinated. The practical question is as follows. Who would mind the person who needs the carer if the carer is struck down with Covid? That is a very simple question for the Minister of State, for me and for everybody else.

We know that younger carers have a lower risk of hospitalisation or death if they contract Covid. However, we have being continuously told by the National Public Health Emergency Team, NPHET, and others, and rightly so, that this disease can have very serious implications across all age groups.

Many family carers are frantic at the thought of contracting the virus because they do not have a plan B to provide care for the people or individuals who they are caring for. Let me give an example. Yesterday, I spoke to two different carers. One is a teacher in her 50s. She is a single woman and she provides critical care to her three elderly relatives in the early morning, at lunchtime, in the evening, at night and at weekends.

That is her task. They are her parents and her aunt. The four of them live together. She is back in school and, consequently, is more susceptible to contracting the virus but she is doing her duty at both ends, as a teacher and as a carer. While her mother, her father and her aunt who she minds at home have been vaccinated, the carer, who is just over 50, is unlikely to be vaccinated for the next couple of months. She is worried sick that if she comes down with Covid-19 she has no one to turn to for help. She asked me a simple question: where will her parents and her aunt go? They suffer from various illnesses, have very poor mobility and certainly could not manage 24 hours on their own, let alone a week or two, if she were to be out of commission. If she contracts the virus, she is in the house and no one else can come into it. As a result, she is in an intolerable position.

Another very sad case involves a single mother who was in contact with me. Her husband died in tragic circumstances two years ago. She has three children under the age of ten. Two have autism and are at the severe end of the spectrum. She does not have any family locally so therefore has no support. She is petrified that she will be infected. She is concerned about the older child who is in school and might bring the virus home. She has no idea where she would turn to in the event of falling sick with Covid.

Those are just a sample of the cases that have been relayed to me daily but, in particular, over the past couple of weeks. We need to do what is right by these people who provide an enormous service to the State. They usually ask for nothing. They carry their burden with dignity and always in silence. It is time we recognised their plight and prioritised their vaccinations.

I thank Senator Dooley for raising this matter. He is right. He and I and Senator Byrne have had these conversations. For a few minutes, it felt as if we were having a parliamentary party meeting, with just the three of us having the conversation until Senator Conway came along. To be honest, I have to read this answer as it is the answer from the Minister for Health. However, I hope time will allow me to give my personal input because, ultimately, I am representing people with disabilities and that vulnerable group the Senator spoke about so eloquently. He has laid out the position very clearly. All of us recognise the invaluable work that carers do and if we take them out of their role as the cog in the wheel, so to speak, who will look after the most vulnerable? That is the concern. We can talk about the child who might never be vaccinated because he or she is under 16 years of age. The parent who is under 65 years of age is happy and healthy but if that parent or, God forbid, the two adults in the house, were to contract the virus who will mind the child? The child might not be an only child. There may be other siblings in the house. The complexity of issues within a household is unbelievable.

The daily needs of the older relatives of the teacher the Senator mentioned are different but they must also be attended to. If that teacher comes down will the illness, not only is a classroom down a teacher but, importantly, the vulnerable relatives who are dependent on her from a feeding, shopping, going to the post office and medication point of view are also affected.

I acknowledge that what the Senator has outlined is very important. I will give him the answer but I wanted to explain to him my understanding of what I am articulating daily with NPHET. I met Paul Reid only two weeks ago about this issue. I have spoken also to the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Butler. I have to lay out the position in the answer.

The Covid vaccination allocation strategy sets out a provisional list of groups for vaccination. The strategy was developed by the national immunisation advisory committee, NIAC, and the Department of Health, endorsed by NPHET and approved by the Government on 8 December but it is important to say that a lot has happened since 8 December.

Vaccination allocation is a matter for the Department of Health and it is rolled out by the HSE. The aim of the Covid vaccination programme is to ensure that the vaccines will become available over time to vaccinate all of those for whom the vaccine is indicated. Given that initially there will be a limited number of vaccines available it will take some time for all to receive them and it has necessitated an allocation strategy. All of us recognise that because the most need was in the nursing homes and our front-line staff. However, we are now into the parallel approach.

This is very welcome. What we have managed to see is the reprioritising of the medically vulnerable and of the 60- to 65-year-old citizens within the disability groupings or under other conditions. What the Senator is saying here today is that as the allocation of vaccines comes on stream, perhaps NIAC will need to come go back and look at this again. The Minister, Deputy Stephen Donnelly, is continuously doing that. When we have 250,000 vaccines arriving from 1 April, with the help of God, perhaps we can have another parallel group. If I am hearing the Senator correctly, that is the group that he is speaking about. Senator Byrne and I have always said that the vaccine could be allocated to them as key workers. They should be moved to the current cohort 6. It is not in my discretion but I have a clear understanding of the request that Senator Dooley has made. As NIAC undertakes reviews and as allocations of vaccines become available, we should continue to make the case that the carer group should be within that grouping.

I thank the Minister of State and welcome her very honest appraisal. I am not for a moment suggesting that this is simple. The numbers may not be that great when it comes down to it. There are many family carers who are elderly. A husband or a wife who is looking after his or her spouse is likely to be in or around the same age, or a little younger in some cases. These people will be addressed in the over-70s grouping. They are being addressed. That is being resolved. I am aware that in certain medical practices where there may be a little vaccine left over at the end of the day's vaccinations, there is a practice of looking after spouses who are within or close to the age group.

We must target those who might be considered to be younger carers. Those who could be waiting for the next two, three or four months to get vaccinated do not see light at the end of the tunnel. We need to help them because they are the people who will suffer most.

I will conclude by returning to the comparison between a key worker and a healthcare worker. Healthcare and front-line workers were vaccinated in order that they would be in place to deal with people in hospitals. That was the right thing to do. If we do not address these carers, the people for whom they care will create an intolerable burden on our hospital services. I thank the House for its patience.

We have all spoken to the Minister, Deputy Stephen Donnelly. To be fair, he has been very open in his approach. As we are limited in our supply, there has to be a strategic approach. The Minister and the Minister of State, Deputy Butler, have directed the supply towards the areas of greatest need, as demonstrated over the past 12 months. Of the 110,000 medically vulnerable people who have been moved to cohort 4, some 10,000 will get a vaccination this week. This is very welcome progress. As supplies come on board, the next step is for the cohort of people who give support to, for example, children who might never receive the vaccine to be deemed to be a significant priority. We must signal that we recognise the valuable work they do and the contribution they make. I will bring this question back to the Minister, Deputy Stephen Donnelly.

Higher Education Institutions

Cuirim fáilte roimh mo chara, an tAire Stáit, an Teachta Rabbitte. Gabhaim buíochas léi as an ábhar seo a ghlacadh ar son an Aire Oideachais. I endorse the remarks of my colleague, Senator Dooley, about the importance of designating family carers as key workers. I know that the Minister of State is very passionate about doing this as well.

I am raising the issue of higher education funding. This country's economic success and many of its social developments have been built on the fact that we have a highly educated citizenry and workforce. If we look at some of the statistics, we will see that other countries are almost jealous of us because a majority of people in their 20s and 30s in this country are graduates. This year, approximately 50,000 new entrants will go into our higher education institutions and approximately 70,000 graduates at different levels will come out of them. We have nearly 200,000 people studying at undergraduate level in this country, as well as 45,000 postgraduate students. These are statistics to be celebrated.

The problem has been chronic underfunding. As we continue to expand the system and provide more opportunities, and the technological changes we will face over the next decade mean there will be greater demands on us to upskill and reskill, we need a higher education system that is fit for purpose and is adequately funded. No one should be in any doubt about the challenge of some of those costs. Part of the problem has been that despite the continued dramatic increase in numbers over the last decade, the level of public funding until recently has continued to be cut. This year, we are finally beginning to see additional investment in the area. I asked about the full economic cost and how much it costs in every case, so that we get an idea of the scale. I understand the estimate is around €8,000 to €10,000. We need to provide that sum every year to ensure we can provide more of the quality graduates for which this country is well known and we need to have the capital and research investment, particularly in the emerging technological university sector.

Five years ago this month the Cassells report was published. In many ways, it did not tell us anything that we did not already know. The problem has been that the can of university funding has continued to be kicked down the road since then. It was sent to a joint committee, views were sought from Europe and there were various reports, none of which told us anything different. The Cassells report outlined the three possible models to funding our higher education system. I favour a publicly funded system for the most part, that we, as a State, should invest in our future because education is what matters. A potentially big achievement of this Government, and it resulted from Fianna Fáil input into the programme for Government, is the creation of the Department of Further and Higher Education, Research, Innovation and Science. That is not just an administrative Department; it has to drive Ireland's economic and social development and our recovery coming out of this Covid period but that can only be done if we have a properly funded system.

The Minister, Deputy Harris, said the time for reports is over. We need to make a decision now. We need to ensure we have a proper, publicly funded higher education system and that it is fit for purpose to be able to meet the technological changes we are going to face over the next decade.

I am taking this matter on behalf of the Minister of State, Deputy Collins. It is wonderful that we have this Department. It puts a strong emphasis on higher education as a stand-alone where a Minister and Minister of State work with a team in the Department.

The full cost of a higher education place can vary depending on a variety factors, including the type of course and the specific arrangements for course delivery. At present, there is some differentiation in the costing approach within the sector. The university sector collects full economic costing data. The institute of technology and technical university sector collects unit cost data which involves a different methodology to full economic costing, FEC. Details provided by the Higher Education Authority, HEA, give a sample of both the costs in various disciplines. For instance, laboratory-based undergraduate disciplines, such as science or engineering, will have a greater cost at around €10,000 to €11,000 per student than non-laboratory disciplines such as arts or business courses, which cost in the region of €7,000 per student. Taking all disciplines into account the average undergraduate cost for a student would currently be in the region of €9,000 or €10,000 per student per year, as the Senator said.

The latest university FEC data for 2016-17 indicate that the average cost for a laboratory-based postgraduate taught student is circa €15,000 per student per year while the average cost for a non-laboratory postgraduate taught student is in the region of €12,000 per student per year. An average cost for a laboratory-based postgraduate research student is approximately €18,000 per student per year. An average cost for a non-laboratory postgraduate research student is circa €21,000 per student per year.

The Department is very much aware of the need to understand the costs of higher education course provision. In 2016, the HEA appointed an independent expert panel to review the current allocation model for funding higher education and to make recommendations on the most appropriate funding model for the future.

The completed review recommends reforms to the Higher Education Authority funding distribution model. A key recommendation of the review of the allocation model, RFAM, report is the development of a costing model to be applied consistently across higher education institutes. At present, there is some differentiation in the costing approach as between universities, technological universities and institutes of technology. Deloitte was appointed by the HEA in 2019 to undertake a scoping exercise on an appropriate model. In 2021 the HEA, working with the Departments of Education and Public Expenditure and Reform, the Irish Universities Association, IUA, and the Technological Higher Education Association, THEA, will commence development of a conceptual framework on the journey towards adoption of a universal costing system applying across the entire higher education sector.

Regarding the implementation of the Cassells report, the expert group report of 2016, Investing in National Ambition: A Strategy for Funding Higher Education, confirmed that higher education makes a hugely positive contribution to the development of individuals, employers, society and the State. The report concluded that the current approach to funding was unsustainable and that substantial increases in investment in higher education must be made to ensure that the sector can remain viable and provide the capacity to meet the major increase in student demand projected up to 2030. The expert group report has opened up an important debate in Ireland on how our third level education system should be funded.

The report made three major proposals, namely, a predominantly State-funded system; increased State funding with continuing student fees; and increased State funding with deferred payment of fees through income contingent loans. The development of a sustainable funding model for higher education is essential in light of the centrality of higher education to our progress as a country. The future development of Ireland as an inclusive society and a knowledge economy, against the backdrop of the rapid technological changes referenced, will be critically dependent on the quality of our graduates.

I thank the Minister of State. We all know how important higher education is. I accept that the Government has made a good start with the new Department and increased public funding. However, while it talks about the scale of the ambition, we have to be able to put the resources behind that. I plead with the Minister of State to take back to the Minister of State, Deputy Niall Collins, and the Minister, Deputy Harris, that we finally have to address this funding question. We could commission many more reports and they would all tell us the exact same thing. The sector is responding as effectively as it can. There is little more that can be trimmed back in the sector. If we are going to continue to provide the opportunities, expand and meet the technological challenges we are facing, we have to address that funding question. The Cassells report cannot be left to be kicked down the road any further.

The Department is working closely with the European Commission and the independently appointed consultants on this matter. The completion of this work will allow for an informed debate on the appropriate policy approach to future planning and funding of higher and further education provision, which is fundamental to Ireland's economic sustainability. The universal costing system and the work being done on it will lay the foundations for how to fund the sector fairly and equitably across universities and technological institutes. To be fair to the Minister and the Minister of State, that is what the Department is focusing on at the moment, because if we do not invest, it will not work at all. It is a broken system.

School Accommodation

Tá fáilte roimh an Aire Stáit go dtí an Teach. As this is my first time addressing the Minister of State in the House, I wholeheartedly congratulate her on her appointment. She is a very strong female voice in the west of Ireland and it is good to see that. I have tabled this matter on behalf of the community of Ennis that attends the Educate Together school there. Educate Together is a wonderful model of teaching young people. It is non-denominational and there is no involvement of the church or any other institution in it.

It is an excellent model, the type of which we need to see going forward. Educate Together in Ennis is a particularly good school with excellent teachers. It has an excellent autism class with young autistic students who are doing exceptionally well. It is a small but an effective school.

The problem, however, is that the school needs a new building. It currently operates in prefabs and bits of extensions. The Department of Education has provided several new schools in Ennis and across County Clare in recent years. I welcome the amalgamated secondary school in Ennistymon, my own home town, which is making significant advancement. This particular national school in Ennis badly needs a new building.

Where are we at with this project? Are we in a position to significantly advance it? What type of a timeframe are we looking at?

I am taking this matter on behalf of the Minister for Education, Deputy Foley. She has provided a comprehensive reply which will address the concerns of the parents and children of the school in question eloquently raised by the Senator.

In order to plan for school provision and analyse the relevant demographic data, the Department divides the country into 314 school planning areas. It uses a geographical information system which employs data from a range of sources to identify where the pressure for school places across the country will arise. Where data indicate that additional provision is required at primary or post-primary level, the delivery of such additional provision is dependent on the particular circumstances of each case. It also may, depending on the circumstances, be provided through one or a combination of the following options, namely, utilising existing unused capacity within a school or schools, extending the capacity of a school or schools or the provision of a new school.

As a result of analyses, it has been determined that a new school building will be required for Ennis Educate Together National School. Under Project Ireland 2040, the Department continues to make progress to increase the infrastructural capacity in the schools sector in order to meet demographic and other demands. The capital programme details the school projects being progressed under Project Ireland 2040. The current status of large-scale projects being delivered under Project Ireland 2040, including projects in County Clare, may be viewed on the Department's website,, and this information is updated regularly. In addition, a list of large-scale projects completed from 2010 to date may also be viewed on the website.

The capital programme also provides for devolved funding for additional classrooms, including accommodation for pupils with special educational needs, if required, for schools where an immediate enrolment need has been identified. Details of schools listed on this programme can be found on the Department's aforementioned website. The Ennis Educate Together primary school has an enrolment of 35 boys and 29 girls. The school is operating on a Clare County Council-owned site at Gort Road, Ennis, in temporary accommodation. It has been determined that a new school building will be required in order to cater for the permanent accommodation needs of the school. To this end, a site acquisition process is under way in order to acquire a site suitable for the school's needs. A new site will be required for the subject school and the Department is at an advanced stage in the process of acquiring a suitable site for the new school building. This site acquisition process has been progressed in respect of the requirement in question and in line with standard acquisition protocols. The Department is liaising closely with Clare County Council under the memorandum of understanding between the Department and local authorities for the acquisition of school sites with a view to securing a suitable site for this school.

The Department has engaged the services of a site acquisition consultant to assist in technical matters in this analysis. Arising from this exercise, the Department has identified a preferred site and is working with Clare County Council to bring this process forward to the legal conveyancing stage. The Senator will appreciate the commercial sensitivities attached to a site acquisition such as this and given that negotiations are at a critical point, the Minister, Deputy Foley, is not currently in a position to disclose further information. Should agreement on the proposed acquisition be reached, the process will advance to the aforementioned legal conveyancing stage, when draft contracts are prepared and legal due diligence is undertaken in respect of the proposed transaction. It would be expected at that stage that the project to deliver new school accommodation can simultaneously progress to architectural planning. I assure the Senator that the school authorities will be kept apprised of the situation and will be informed of the permanent location for the school as soon as possible.

I welcome this update about the future of the Educate Together school in Ennis. It is comprehensive. It is accepted by all parties that a school is needed. I welcome the fact that negotiations and the necessary work to acquire a site are at an advanced, critical stage. I understand that there are commercial sensitivities but I think that, on the record of the House today, we have it confirmed that we are at an advanced stage. Councillor Ann Norton, who is chair of the board of management, will welcome that, as will David Quinn, who is the principal of Educate Together in Ennis. Most importantly, it will be welcomed by the parents of the pupils who are attending the Educate Together school in Ennis. The Minister of State might come back to the House and update us in due course, when there are further developments and more details available.

I will. I will pass on the Senator's acknowledgements to the Minister, Deputy Foley.

Sitting suspended at 11.42 a.m. and resumed at 12 noon.