Dáil Éireann díospóireacht -
Thursday, 5 Jun 2008

Vol. 656 No. 3

Other Questions.

Special Educational Needs.

Martin Ferris

Ceist:

6 Deputy Martin Ferris asked the Minister for Health and Children if she will establish a national working group comprising children with specific speech and language impairments and their parents and key agencies involved in service provision including her Department, the Department of Education and Science and the Health Service Executive, with a view to reviewing and establishing agreed terminology and diagnostic criteria for specific speech and language impairments and addressing policy and service development. [22274/08]

Ruairí Quinn

Ceist:

66 Deputy Ruairí Quinn asked the Minister for Health and Children if she will meet the Irish Association of Speech and Language Therapists to establish a national working group to address issues regarding speech and language impairment; the co-operation and interaction between her Department and the Department of Education and Science; and if she will make a statement on the matter. [19707/08]

Deputy John Moloney

I propose to take Questions Nos. 6 and 66 together.

Recognising the cross-cutting nature of the national disability strategy, the Government established the Office for Disability and Mental Health in January 2008. This office helps me in exercising my functions as Minister of State with responsibility for disability and mental health across the Departments of Health and Children, Education and Science, Enterprise, Trade and Employment and Justice, Equality and Law Reform. The office brings together responsibility for a range of different policy areas and State services which directly impact on the lives of people with disabilities and mental health issues. The office will aim to bring about improvements in the manner by which services respond to the needs of people with disabilities and mental health issues by working to develop person centred services, focusing on the holistic needs of clients and service users and actively involving them in their own care.

A key priority for the office is to support the implementation of the health sectoral plan under the Disability Act 2005 and the planned implementation of the Education for Persons with Special Educational Needs Act 2004. The office will focus in particular on facilitating the delivery of integrated health and education support services for children with special needs by further developing existing mechanisms for co-operation and co-ordination between the health and education sectors at national and local levels.

A cross-sectoral team consisting of senior officials from the Office for Disability and Mental Health, the Departments of Health and Children and Education and Science, the Health Service Executive and the National Council for Special Education meets on a regular basis to address issues arising in respect of the implementation of both Acts, as well as issues of cross-sectoral responsibility. The focus of the team is on the interaction required between the education and health sectors in order to advance and enhance services to people with disabilities. The matter raised by the Deputy regarding the provision of appropriate services to children with specific speech and language impairment must be considered within the overall context of preparations within the health and education sectors for the implementation of the Education for Persons with Special Educational Needs Act. I have asked the cross-sectoral team to consider the matter in this context and to report back to me in due course.

Deputy Caoimhghín Ó Caoláin

I tabled this question last week for a written response and I received almost exactly the same reply. I do not wish to begin on a feisty note but nowhere in the reply is reference made to speech and language therapy, even though this is the critical focus of my question. I ask the Minister of State to pass that on to those who assist in the preparation of these responses.

The Minister of State might take this opportunity to correct the remarks made by the Taoiseach on 14 May. He caused concern within the sector by suggesting that the shortage of speech and language therapists was caused by the requirement on new graduate therapists to undergo a one year period of supervised clinical practice. Does the Minister of State agree with the statement of the Irish Association of Speech and Language Therapists that the Taoiseach's comment was ill informed and does he accept that one year of supervised clinical practice is an internationally recognised best practice approach for all health professionals? Does he agree that the problem is not caused by the requirement on new graduates but by inadequate resourcing, insufficient posts to meet the demand for speech and language therapy and poor management by the HSE?

Does he acknowledge that the services are not properly co-ordinated? Implementation is required of the recommendation by the Irish Association of Speech and Language Therapists on a national working party. The Minister of State referred to the cross-sectoral team but the critical difference between that and the proposed working party is that the latter would directly involve service users, including children and their parents, and the Department of Education and Science and the HSE. That is clearly absent from the formula used in the replies given to the questions tabled today and last week.

I acknowledge and welcome the 300% increase that has been made to the number of training places for speech and language therapists. However, that will not work on its own if it is not matched by the development of critical posts. With the recent HSE cuts, we face the prospect of increasing numbers of trained therapists leaving the country while children are deprived of the therapy they desperately need. I ask the Minister of State and his departmental colleagues to ensure that the increased numbers of trained therapists are retained within the system and that posts are opened up. They are clearly required given that children need intervention as early in their lives as possible.

Deputy Jan O’Sullivan

I congratulate the Minister of State on his new position.

I support Deputy Ó Caoláin's comments regarding the need to establish this group. I am also concerned about the Taoiseach's claim that one year of supervision was somehow holding up the provision of services to people who need speech and language therapy when that is in fact the international norm for ensuring new therapists are clinically safe. The record needs to be corrected by somebody in Government.

Does the Minister of State consider it acceptable that children have to wait up to two years to receive the speech and language therapy they need at a crucial stage in their lives? What will be done about that situation? Due to embargoes and posts going unfilled despite the availability of trained graduates, that is the reality on the ground.

I understand that disability services in certain parts of the country have not yet been given their budgets for 2008. Can the Minister of State clarify that?

Deputy James Reilly

I concur with the previous two speakers. There are precedents for clinical supervision. A newly qualified doctor has to serve an intern year under full supervision before being considered a fully fledged professional or continuing on to post-graduate training. The Taoiseach was unwise to use that example.

As I noted earlier, 4,136 Dublin children are waiting an average of 18 months for speech and language services. If a child with autism does not receive an intervention between the ages of three and six, the window of opportunity is closed. Half of that period could be spent in waiting. It is an unacceptable situation and the Minister of State will have to address it in a more forceful manner than has formerly been the case.

An entire class of physiotherapists have been trained at great expense and are badly needed for community and primary care, yet they are leaving the country because they cannot find employment.

Deputy John Moloney

I am not in the business of correcting the Taoiseach because he is usually right. I will not speak on his behalf until I consult him directly.

Deputy James Reilly

He is achieving a status similar to that of papal infallibility.

Deputy John Moloney

He is close enough to doing so. I do not want to make little of the response. However, I want to be as direct as possible. I made the point that those involved with education for persons with special needs and the cross-sectoral team will meet shortly.

The former Taoiseach, Deputy Bertie Ahern, established the new office with responsibility for disabilities and mental health, which has only been up and running since January last. Prior to that issues had always arisen in respect of the HSE and the Departments of Health and Children and Education and Science. The establishment of the new office represents an attempt to deal with these issues in one place. All of the issues to which the Deputy refers come within the remit of the office. As reports are received in the coming months, it will be our responsibility to decide how to proceed, particularly in the context of learning and special educational needs.

From the figures, one might obtain the impression that we are downgrading services. I do not wish to use the time available to rattle off details of what has been achieved. However, it is worth placing on record the fact that the number of physiotherapists has risen by 230, or 20%, that the number of occupational therapists has risen by 320, or 45%, and that the number of speech and language therapists has risen by 140, or 28%.

Deputy James Reilly

From impossibly low bases.

Deputy John Moloney

I accept that we are coming from a low base. However, I ask the Deputy to bear in mind that the office was only recently established. The Government recognises the importance of the work of the office. It also accepts that we need to catch up quickly and that is what we are doing.

The first priority on the agenda of the cross-sectoral teams is how the issues should be resolved and how the required professional staff should be put in place. I ask the Deputy to give the office a 12-month settling down period. When we return with a proposal in September or October, we will clearly show how we intend to deal with the matter of recruitment. It must be remembered that there are industrial relations issues with which we must deal.

Deputy James Reilly

Will the Minister of State offer those physiotherapists who achieved of the order of 580 points to gain entry to courses and who are now fully trained an opportunity to earn decent incomes?

Deputy John Moloney

The awful reality is that when the jobs in question were advertised three to four years ago, we could not get people to even apply for them.

Deputy Jan O’Sullivan

Now the Government is going to export them.

Deputy James Reilly

Are we going to live in the present or is the Minister of State determined to remain in the past?

Deputy John Moloney

The establishment of the office underlines the commitment on the part of the Government to ensure that the issues raised by the three Deputies will be dealt with. We will communicate further with them in October or November when the process has been properly evaluated and when the position regarding need and demand has been established.

Deputy James Reilly

What will be the position as regards the class of 2008?

Acting Chairman

I must allow Deputy Ó Caoláin to put his supplementary before the Minister of State answers that question.

Deputy Caoimhghín Ó Caoláin

In a previous reply, the Minister for Health and Children, Deputy Harney, referred to the National Treatment Purchase Fund. Will the Minister of State, in the context of question I posed, indicate where stands the commitment in the programme for Government to ensure that any child under five waiting more than three months — not the two years to which Deputy Jan O'Sullivan refers — for occupational or speech and language therapy will be allowed to access these services automatically through the National Treatment Purchase Fund? How many children have been given such access?

Deputy Jan O’Sullivan

Will the Minister of State indicate the position in respect of the disability budget for 2008?

Deputy John Moloney

I am evaluating the commitment to which Deputy Ó Caoláin referred. That evaluation will not be completed for at least six weeks.

Deputy Jan O’Sullivan

Has the disability budget for 2008 been allocated?

Deputy John Moloney

Not yet.

Deputy Jan O’Sullivan

This is a matter of serious concern to people who cannot return to the community and who are occupying hospital beds.

Nursing Homes Repayment Scheme.

Jimmy Deenihan

Ceist:

7 Deputy Jimmy Deenihan asked the Minister for Health and Children the status of the nursing homes repayment scheme; the reason only one appeals officer has been appointed to deal with the large number of appeals; and if she will make a statement on the matter. [22214/08]

Joan Burton

Ceist:

32 Deputy Joan Burton asked the Minister for Health and Children the reason it is taking so long to process applications and appeals relating to the health repayment scheme; if she plans to address these delays; and if she will make a statement on the matter. [22149/08]

Deputy Mary Harney

I propose to take Questions Nos. 7 and 32 together.

The Health (Repayment Scheme) Act 2006 provides a legal framework to repay recoverable health charges for publicly-funded long-term care. The Health Service Executive, HSE, has advised that as of 16 May 2008, more than 14,000 offers of repayment totalling more than €250 million have been made. Further offers continue to be issued every week. As a result of these offers, almost 10,500 payments worth in excess of €200 million have been made. The HSE has indicated that the time taken to process each application varies depending on the complexity of the application and the availability of accurate records. Every effort is being made to complete repayments as quickly as possible. However, there have been some delays in making repayments under the scheme due to legal and technical issues.

A very high number of deficiencies have appeared on claim forms and these must each be rectified before claims can be processed. These claims have taken longer to process because the scheme administrator must be provided with certain information in order to ensure that the correct amount is repaid to the correct person. The scheme administrator and the HSE have taken a proactive role in clearing these deficient claim forms. They have conducted an intensive roadshow campaign throughout the country in order to address these issues. This campaign was widely promoted through advertising on local radio and in regional media.

More than 12,000 estates which lodged claims to date had not extracted a grant of representation in respect of the estate of the deceased patient. In these instances, the person entitled to extract the grant of representation must be identified before an application can be processed. To date, more than 11,000 certificates of entitlement permitting individuals to apply for repayments have issued. The scheme administrator is confident that the majority of claims submitted by the public will be dealt with by the end of this month.

The health repayment scheme appeals office is independent and was established to provide an appeals service to those who wish to appeal decisions made by the scheme administrator. Following the establishment of the office, a temporary appeals officer was seconded from the Office of the Chief State Solicitor. Subsequently, a recruitment process was undertaken by the Public Appointments Service and a panel of appeals officers has been established. A second appeals officer is due to begin work shortly. In addition, four administrative staff have been appointed to support the current appeals officer.

Up to 23 May, the health repayment scheme appeals office had received 3,173 completed appeal forms. The appeals officer must investigate each of these independently and his investigations can require additional reviews by the HSE and the scheme administrator. Certain appeals present a high level of complexity. In addition, a high percentage of appellants have requested oral hearings. Up to the end of May, the appeals officer had completed 471 oral hearings at locations throughout the country. Up to 23 May, the appeals officer had carefully, thoroughly considered and assessed 1,293 appeals and issued decisions in respect of all of them.

Deputy James Reilly

I am impressed that a single appeals officer has been able to deal with so many appeals. If that sort of productivity existed throughout the health service, we would be doing extremely well.

It is extraordinary that KPMG has been paid €23 million — €15 million exclusive of VAT — to administer the scheme. Some 70,000 claims were expected, 39,000 were lodged and 14,000 have been settled and it is hoped that the matter will be dealt with in its entirety in the near future.

People feel bamboozled and intimidated. When they appeal, it becomes clear to them that the process is not about fairness but instead revolves around saving money. That money was taken from the elderly illegally and now these people are being thwarted, in their later years, from obtaining justice. Some 12% of processed claims have been appeals and only 25% of the appeals lodged and considered to date in respect of these claims have been successful. A further 10% of applicants whose claims rejected were subsequently judged to be entitled to payment.

It is clear that a great deal of activity is being focused on preventing people from recouping what is rightly theirs. Despite the fact that 130,000 people work for the HSE, KPMG is being paid €23 million to administer the scheme. When people undergo the claims process and are obliged to appeal, they discover that there is only one appeals officer. The Minister indicated that a recruitment process has been completed, that a panel has been established and that a second appeals officer will be appointed shortly.

What is happening is nothing short of scandalous. What sort of message is being sent to the elderly? Having being short-changed by the State, the latter is now doing everything in its power to obstruct them from obtaining what is rightfully theirs. Will the Minister indicate the number of appeal officers she intends to have in place by the end of the month so that this major issue might be dealt with?

Deputy Jan O’Sullivan

I will be very brief. What exactly is the role of KPMG and why was it brought in? Does the Minister consider its service good value for money?

Deputy Mary Harney

It was brought in because the HSE felt it would not be able to cope. It has dealt with 39,000 claims and €15 million exclusive of VAT would be regarded by any standards — especially with the overtime bills I see — as enormous value for money.

Deputy Jan O’Sullivan

There are many administrators in there already.

Deputy Mary Harney

If we were to make the system, with its current staffing complement, deal with this issue, it would have been dealt with on an overtime basis. It would have taken substantially longer and cost substantially more. An assessment was made and that was the recommendation.

Deputy James Reilly

What about the thousands in the HSE who do not know what their jobs are? They could be seconded for this.

Deputy Mary Harney

Perhaps some of the Deputy's friends in some of the vested interests could have done it. Perhaps the Deputy should have put in a bid for it. Some 39,000 claims have been dealt with.

Deputy James Reilly

That is desperation.

Deputy Mary Harney

This money must be paid in accordance with the law enacted by the Oireachtas. We must ensure, in the first instance, that the correct people are paid their money. We do not want a family member or distant relative who may never have visited the old person getting money that somebody else may be entitled to. There is no doubt that it is a very complex legal process but this is necessary because of the law.

With regard to the scheme, we appointed at the beginning an oversight group representative of various groups advocating older people. Ms Sylvia Meehan is on it, for example, and it is chaired by Bernard Walsh, a geriatrician in St. James's Hospital. They oversee this and have given me three reports. I know they remain very satisfied and confident in the manner in which this scheme is being executed. The purpose is to get money to the right people as quickly as possible.

As I indicated in my initial reply, the HSE has told me that by the end of June, all the applications will have been processed and determinations will be made. We expect to finish it during this calendar year and do not envisage it going to 2009. I am delighted this is the case.

Sometimes, as a result of what we are dealing with, people who make the applications pass away. We are dealing with very old people in residential care who may have been there for some time. Many issues arise but the administrator and the HSE have operated this scheme very professionally and thoroughly. Unfortunately, when legal letters are sent to individuals, particularly older people, I accept they can be intimidating. Every effort is made to talk to people and I understand approximately 800 people were spoken to by telephone about their applications. For example, different parts of the form may have been filled out that were not required or were inaccurate. Every effort is made to deal with these people in as human a way as possible, particularly where older people are concerned.

Deputy James Reilly

I have no wish to row with the Minister on the issue, which is very important. I am glad she at least admits that letters can be intimidating, as can telephone calls. People are confused. I wish to ask her questions which require a "Yes" or "No" answer. Is she concerned at the high level of successful appeals, at 25%? That is very significant. Considering the large numbers, how many additional appeals officers will the Minister put in place by the end of the month if she hopes to finish the work? The Minister has indicated the process is expected to finish at the end of this year.

Deputy Dan Neville

The Minister might clarify the case of those in psychiatric institutions and the procedure for refunding such patients. What is the position for psychiatric patients in community groups or supervised houses where deductions have taken place?

Deputy Jan O’Sullivan

On those phone calls which have been made to elderly people, I understand they are mainly for clarification purposes. Have there been any complaints regarding people feeling intimidated about phone calls received?

Deputy Mary Harney

The only one I am aware of is that which arose in the newspaper last week and which was the subject of a Dáil question by one of the Deputy's colleagues. When I sought to establish the facts, they were very different from what had appeared. The individual who made the application was in her early 80s, which in itself was unusual because generally the applicants are younger relatives or members of the family of the older person.

I understand it related to the form not having been completed accurately, and a legal letter was sent. The person who received it felt somewhat intimidated by the letter and thought the letter was indicating she would not get her money, which was not the case. The letter — in legalese, which is intimidating for most of us — simply asked the applicant to clarify the documentation.

Many of the applications are made by lawyers on behalf of individuals and I know of a large number of people where the solicitors have made an application on an applicant's behalf. I understand that with the high number that came in just before Christmas, many were applications made by legal representatives of deceased persons. The same procedure applies for everybody under the Act in terms of the application process and scrutiny.

On the appeals officers, we have indicated we need whatever number of appeals officers required to deal with the level of activity. It has not been brought to my attention that there is a shortage, as I indicated. More are being appointed on a temporary basis, and there are four administrative backup staff to help. I have not heard that there is a shortage of appeals officers but if additional manpower is required to clear the appeals in a short space of time, it will not be a problem.

Deputy James Reilly

Is the Minister concerned at the high number of successful appeals at 25%, given the amount paid to KPMG?

Deputy Mary Harney

Is it 35%? I do not have that data.

Deputy James Reilly

It is what I have in front of me.

Deputy Mary Harney

I do not have it. If there was a high level of successful appeals, it would indicate first that the appeals process is working. I do not have the figure read out by the Deputy from some note I presume he has from the HSE. It is not in my note that it is as high as 35%. I did say that of the number of appeal applications made, 35% have been dealt with.

Deputy James Reilly

I stated one in four — 25%.

Deputy Mary Harney

Yes, one in four has been dealt with but my note does not tell me they have been successful. I am sorry I do not have that information.

Deputy Dan Neville

There is no point in me staying here if the Minister will not answer my question.

Acting Chairman

I wish the new Minister of State, Deputy Mary Wallace, well in her new position.

Health Services.

Dinny McGinley

Ceist:

8 Deputy Dinny McGinley asked the Minister for Health and Children the reason no action has been taken on foot of the Health Service Executive expert advisory group on diabetes report which was completed in September 2007; and if she will make a statement on the matter. [22245/08]

Minister of State at the Department of Health and Children (Deputy Mary Wallace)

The diabetes expert advisory group was established by the Health Service Executive and presented its first report to HSE management in April 2008. The expert advisory group made a number of recommendations relating to, for example, an integrated model of care for diabetes, clinical guidelines, ICT, education and empowerment of patients, retinopathy, podiatry and paediatric services.

The expert advisory group is currently progressing recommendations related to standards and it is hoped to publish these shortly. Clinical guidelines are to be formally launched by the Minister, Deputy Harney, on 16 June 2008.

As regards other recommendations that relate to service provision, the expert advisory group is currently in discussion with the key service deliverers in primary and secondary care to progress an integrated model of care, paediatric services and retinopathy screening. The expert advisory group continues to meet on a monthly basis and localised meetings in the four areas are also being undertaken at present to raise awareness of the work of the expert advisory group.

Deputy James Reilly

The Minister of State has not really answered the question. The group has met and the report is completed, yet nothing is happening. Is the Minister aware that diabetic eye disease is present in up to 50% of persons with type two diabetes by the time they present for diagnosis?

Did the Minister see the "Prime Time" programme during the week which detailed how a young girl has lost one eye as a consequence of diabetes? The lack of screening of diabetes in this country — it is estimated to affect 250,000 people, 100,000 of whom do not know they have it — costs the State a fortune in terms of complications that arise because of a lack of action that would prevent complications of eye, renal and cardiac disease.

If there was ever a case for preventing an illness or detecting it early, this is it. The Minister will be aware I called for a national body test in the past but there was no mention in the programme for Government of age-appropriate annual check-ups. Nothing has happened.

Now we have another report compiled by a group of experts making recommendations but nothing has happened and it is being left on the shelf. The funding which was there previously, put up by a drug company in Beaumont to initiate an excellent outpatient operation in conjunction with GP service, was withdrawn and the State would not take it over. Will the Minister confirm when the expert advisory group's report that was completed in 2007 will be published and its recommendations implemented? I am more interested in when its recommendations will be implemented than when it will be published.

Can the Minister explain why the mobile retinopathy screening service in the north west has not been expanded, despite the fact that funding was set aside for its expansion in 2007 and 2008? I cannot let this matter pass. Additional money — €750,000 — was given this year but it still has not been used.

I wish to raise the issue of the allocation of funds for specific policy objectives that are highjacked by the HSE for its own ends. This matter is important because it is the key to how things stand and it was not addressed by the Minister earlier — it got the Taoiseach so exercised recently that he threatened to silence the Opposition. Will the Minister address this?

Deputy Jan O’Sullivan

Are there plans for a national diabetes screening programme?

Deputy Mary Wallace

We would like the retinopathy screening service in the north west to continue and our officials have contacted the HSE in this regard. We hope to see progress in the near future.

Regarding the report, the Deputy suggested nothing has happened but timing is important. He referred to September 2007 but the report went to HSE management one month ago. We are discussing what has happened in the past four weeks and we should get the timing right. HSE management is considering the report and is doing its best to implement the recommendations it contains. The clinical guidelines the Minister is to launch on 16 June, which I referred to in the reply, are of practical value for people because there has been agreement between GPs and consultants on who does what, when they do it and where. This is important for patients presenting with diabetes and the continuum of care and clinical management was covered in the agreement for the guidelines. The guidelines will be very good and may be used for other specialties because it is good that those involved know what each person will do, how it will be done and so on. This is important for some of the clients referred to.

Deputy James Reilly

My understanding is that the report was completed last September. Is the Minister of State saying that is not the case or is she saying that, despite being completed last September, the HSE has only received it now? Perhaps she will correct the record of the House for me. I understood the report was completed last September.

I agree it will be an excellent model of care but "will" is an unfortunate word. When will it come into use? We have known for some time about diabetes. The issues around models of care have been tried in other countries and on a pilot basis in this country, but we are still waiting for yet another report. This is like reinventing the wheel; the knowledge exists and the outcomes have been proven. The basis for going ahead with a national programme for diabetic care under a chronic illness model is to be welcomed. When will this happen and why are funds that were put aside in specific cases not being used? As I asked the Minister earlier, what will the Government do about this situation in which its policy objectives can be usurped by the HSE? For one reason or other budgets are not spent and are used for other purposes. This is a serious question that the Minister for Health and Children, Deputy Harney, should answer.

Deputy Mary Harney

The money is used for services, drugs, medical cards and hospital care. People are not putting the money in their pockets.

Deputy James Reilly

It is clear that Government policy, as promised, is meaningless. The bureaucrats in the HSE are left to determine how health policy is enacted and that is why we are in the mess in which we find ourselves. Frankenstein's monster is out of control and its creator has walked away from it.

Deputy Mary Harney

The Deputy is ranting again.

Deputy Mary Wallace

The management of chronic illnesses, including diabetes, is a priority in the new contract with GPs. The clinical guidelines will be launched on 16 June.

Regarding the report's timeframe, it was not finalised in September 2007. The first report of the diabetes expert group was drafted in October 2007. On 17 December 2007 the expert group met HSE regional and sectoral representatives and decided a gap analysis report should be conducted. That report was completed on 13 February and a summary document was then created. The report did not reach HSE management until April 2008 and it has been there for the past few weeks.

Deputy James Reilly

When will the report be implemented?

Deputy Mary Wallace

I outlined the outcome of some of the elements relating to it. The report has only been with HSE management for four weeks. It is a very good report with many good recommendations and there are suggestions relating to models and standards of care and clinical guidelines that can be implemented.

Deputy James Reilly

There is no timeline.

Deputy Mary Wallace

I stress again that implementation of the report relating to areas that can be addressed, within the resources of the HSE, has commenced.

Written Answers follow Adjournment Debate.