Dáil Éireann díospóireacht -
Tuesday, 26 May 2009

Vol. 683 No. 3

Adjournment Debate.

Hospital Services.

Deputy Brian O’Shea

St. Vincent's District Hospital, Dungarvan, has long been one of the worst hospital buildings in the country. Its replacement, the 32-bed community hospital in Dungarvan, is almost complete, and as part of the project the existing St. Vincent's hospital is to be demolished. Although belated, this is to be welcomed. Unfortunately, a new obstacle has arisen. The building is about to be taken in charge by the HSE and, in line with revised procedures introduced by the Department of Finance this year, the HSE has made a formal submission to the Department of Finance seeking release of the funding to proceed with equipping the hospital. However, no decision is forthcoming.

Last Thursday I tabled a parliamentary question to the Minister for Finance which was accompanied by a letter I received from the HSE outlining the position regarding the submission made to the Department of Finance. I was seeking to find out when a decision would be reached on the release of the funding to proceed with the equipping of the hospital. The question was transferred to the Department of Health and Children, and the answer I received from the Minister of State, Deputy Áine Brady, was one line as follows: "As this is a service matter it has been referred to the Health Service Executive for direct reply."

As a long-standing Deputy I am appalled and outraged at how my question was dealt with by both the Minister for Finance and the Minister for Health and Children. The question originated from a reply I had received from the HSE. The letter was then transferred from the Department of Finance, where the answer I was seeking should have been given, to the Department of Health and Children, which in turn sent it back to the HSE. This is bureaucratic evasion at its most contemptible and I am registering the strongest possible protest in this regard. The people of Dungarvan have waited long enough for their hospital and I am demanding that a positive decision in regard to the equipping of the new hospital and the demolition of St. Vincent's District Hospital is made without delay.

The HSE has completed the equipping source list as part of the process for its submission, and it anticipates that the process from order to delivery will take six to eight weeks. I once again demand that this appalling mess be rectified as a matter of the greatest urgency and that the people of Dungarvan and west Waterford be provided without further delay with the 32-bed facility that has long been awaited and is much needed.

Minister of State at the Department of the Health and Children (Deputy Áine Brady)

I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's commitment to developing community-based services at local level.

Government policy with regard to older people is to support them in living with dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to high-quality long-term residential care where appropriate. This policy approach is renewed and developed in the current partnership agreement Towards 2016.

The Government's objective of continued development of community-based services for older persons is reflected in the funding given to the system in recent times. Since 2006, more than €200 million has been provided to develop community care services. As the Deputy is aware, the Health Act 2004 provides the HSE with responsibility for the management and delivery of health and personal social services. As a statutory body, the provision of these services, including progressing community services at local level is an operational matter for the executive.

The HSE is committed through its national service and capital plans to deliver services within its Vote provided by the Oireachtas. In Dungarvan, construction has just been completed at the community hospital and the executive has recently taken charge of the building. The facility includes a new 32-bed unit, eight of which are additional beds and 24 of which will be replacement beds, along with a 15-place day hospital.

The new building will replace the existing St. Vincent's district hospital for older people. It will provide GP access beds, convalescent, respite and terminal care, and short-term accommodation for dependent, chronically-ill young patients. Its role will be focused on providing non-acute services to complement those of the general hospital. The community day hospital will provide outpatient services for older persons, the intention being to enable older people to continue to live at home and avoid hospital admission. The overall capital cost of this development is approximately €12 million.

In light of the current financial difficulties generally, it will be a matter for the HSE to progress the equipping phase, or undertaking the demolition works, as part of the agreed HSE capital programme for 2009 or beyond. This would have to take account of priorities determined nationally by the executive, including decisions in relation to new community facilities coming on stream. Such initiatives have to be in line with agreed capital envelopes and identify any additional revenue or staffing implications arising from a particular project.

Care of the Elderly.

Deputy Seymour Crawford

I thank the Ceann Comhairle for the opportunity to raise this important issue on the Adjournment.

A number of cases have recently been brought to my attention. In one case, the carer for a 93 year old woman who is almost blind had to go into hospital. Initially, it was not certain how long the hospital stay would last and an application was made for the provision of care to the woman in the meantime. It was refused. Fortunately, her carer only had to go on two individual days so the situation was not as serious as it might have been. This 93 year old woman has to have her food liquidised three times a day and the only support she was given while her carer was absent was one visit in the morning. This person has no living relatives. Her sister in law, who is in her 70s, lives eight miles away. She visited at lunch time and another neighbour helped in the evening. This is a typical situation where no cover is provided by the HSE and it is unacceptable.

Another case was that of an 86 year old woman who has had two strokes and is confined to a wheelchair. Her daughter, who lives with her and cares for her with the help of other carers, has been seriously ill following a difficult child birth. She wants to go for a week's holiday in June and when she asked for that, she was told it was not possible and that the family would have to look after her mother.

This is not acceptable. Money can be found for all sorts of issues but those are two cases from many. Another lady on the far side of Cavan is unable to walk. She was checked a year ago but has not been reviewed since. When she was checked, it was estimated that she did not need too much help. She must use a walking aid and she cannot get to the toilet in time. We all know the result of that. Any female would have an understanding of the dire needs of that person but she cannot get a carer when her own carer is absent.

I spoke to someone in charge of an outside agency. She spelled out the difficulties that occur in Cavan-Monaghan. She no longer wants to do business there because regulations are so lacking in understanding, sympathy or care for the elderly. She works in other counties where the situation is totally different.

This comes down to one thing. In the north-eastern area, which consists of four counties, there has been a massive increase in population. The budget for the region, however, was never increased and, as a result, there is penny pinching everywhere. I beg that this not be taken out on the elderly, the most vulnerable in the country. When millions can be found for other issues, as happened in the past few days in our own area, the few euro it would take to employ a carer or an agency worker to carry on for the few days in question must be provided. It is not so bad if there is a family who can help out but some of these people have no living relatives and it is desperately unfair on them. I spoke to this lady on the phone and she is a lovely person who does not deserve such treatment.

I urge the Minister to ensure, no matter what it takes, that people like her get the care they deserve in their later years. These people are saving the country a mint by staying at home but they are being penny-pinched.

Deputy Áine Brady

I thank the Deputy for raising this issue as it provides me with an opportunity to reaffirm the Government's continued commitment to services for older people generally and, in particular, to the important area of home care services.

The development of these services nationally reflects the prioritisation and significant investment by the Government in recent years with, for example, just over €200 million in additional funding provided to develop or expand such services over the period 2006-08. This additional funding related to a range of services such as home care packages, home help, meals-on-wheels, and day and respite care.

Home care services are delivered either directly by the Health Service Executive or on behalf of the executive in partnership as appropriate with the voluntary sector or through private providers. The position in the home help programme shows, for example, expected expenditure this year by the HSE of around €210 million, including just over €55 million development funding provided since 2006; an increase from 10.8 million home help hours in 2006 to nearly 12 million hours this year; and an increase in the number of clients benefiting from around 41,500 in 2006 to 54,500 this year.

Home care packages are a relatively new initiative introduced by the HSE in 2006 and developed nationally in the meantime through phased investment of €120 million new funding made available by the Government. A package comprises a variety of community-based services and supports, including a significant home help element in many cases, to best meet the needs of an older person. Clients may have significant medical, nursing and-or therapy requirements and may be recently discharged from hospital, or at risk of admission to hospital, if such needs are not met in a planned way. The HSE service plan envisages around 8,700 people benefiting from packages at any one time, or over 11,000 people benefiting over the course of this year.

I wish to highlight that, notwithstanding the current financial pressures generally across the health system, the Government has made every effort to protect home-care services for older people. This year, the HSE aims to deliver the same quantity and quality of home help and home care packages nationally in line with 2008. If the Deputy can supply details of the individual cases raised today to the HSE, or to me personally, the executive will arrange to urgently review these and report back direct to the Deputy.

The capacity of the HSE to provide approved levels of home help services continues to be reviewed in the context of overall available resources. It is incumbent on each local health manager to ensure home help services are delivered within allocated budgets. This requires a stringent ongoing review of the application of the resources.

As with every service, a limitless resource is not available for the provision of home help services and while the resources available are substantial, they are finite. Levels of services provided are reviewed regularly and, as a result, this in individual cases may increase, decrease or remain constant based on the assessed need in each case. Professional staff on the front line, who are aware of local circumstances, undertake the individual client assessments. Services are targeted at clients with a high level of dependency, and in accordance with their assessed need.

An example would be a person discharged from an acute hospital who may require home help assistance for a period following discharge, until he or she has regained independence. In this case, the level of service provided on discharge would be kept under review. When the person is in a position to live more independently, the home help hours may be reduced or withdrawn in line with the re-assessed care needs.

The Government has made considerable improvements in recent years to enhance home care provision throughout the country. Demand can at times exceed service resources, especially in cases involving the need for temporary cover. I am satisfied, however, that the HSE will continue to deliver the home help service in the best manner possible, taking account of evolving circumstances at national and local level.

Deputy Seymour Crawford

I gave the names and addresses of the people concerned so the Department knew the exact situation.

Acting Chairman (Deputy Johnny Brady)

I cannot let Deputy Crawford speak again.

Foetal Alcohol Spectrum Disorders.

Deputy David Stanton

Foetal alcohol syndrome is the biggest cause of non-genetic mental disability in the western world. It is 100% preventable and is caused only when a mother drinks during pregnancy. In addition to foetal alcohol syndrome, there is a range of other alcohol related problems such as alcohol related birth defects and neurological disorders. Maternal risk factors for children developing any of these are advanced maternal age, low socioeconomic status, frequent binge drinking, family and friends with drinking problems and poor social and psychological indicators. Symptoms are babies who are small, underweight, and have poor muscle control and different facial characteristics. Other symptoms are permanent brain damage, speech impediments, hyperactivity, heart and eye disorders, genetic deformities and behavioural problems such as autism, aggressiveness and impaired social skills. Prevalence rates in the US have been estimated to be between 0.5 and two per 1,000 births, but other estimates of mild foetal alcohol syndrome have been much higher, at almost one in every 100 births.

I questioned the Minister for Health and Children on this recently and was told that the incidence in Ireland is unknown but that the Health Service Executive is developing proposals for a research project to be carried out in a large maternity hospital to evaluate the prevalence of alcohol in pregnancy. Can the Minister of State tell me where this will happen and when this study will begin? We should take account of the research carried out in the US, other countries in Europe and the UK where lifestyles, culture and attitudes to alcohol are similar to here. It would be safe to assume the estimates for Germany and, perhaps, the UK would apply here as we have cultures where alcohol is consumed in large amounts and is heavily connected to special occasions and social life.

Last week the Minister agreed that symptoms can range from mild attention deficit problems to lifelong problems such as neurological, cognitive and behavioural problems, growth retardation and developmental delay. I am concerned about this when one sees the rise in issues such as these in our schools with children with hyperactivity and other problems. There is possibly a link. The Minister advised at the time that the promotion of healthy behaviour in alcohol intake is a national priority, but we need to do more. We must advise and inform people much more than we have been doing about the dangers of this alcohol syndrome.

I am pleased to note that the Health (Miscellaneous Provisions) Bill will provide for a mandatory labelling of alcohol to advise of risk of drinking during pregnancy. Such labelling is in place in a number of countries such as Canada and will go some way to raising without delay the necessary awareness in this country of the dangers to children. Other awareness raising measures will be included. It is clear from international research that more people need to be aware of the dangers of drinking even a small amount of alcohol when pregnant to stop the needless suffering of many children affected by foetal alcohol syndrome. I urge the Minister of State to develop as a matter of urgency a national policy on the issue and begin initiatives to improve awareness of the risk and dangers as soon as possible. I look forward to the Minister of State's response to this very important matter which is not known to many people. The awareness levels in this country are very low.

Deputy Áine Brady

I thank the Deputy for raising this matter on the Adjournment which I am taking on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. Pre-natal exposure to alcohol can produce a range of effects known as foetal alcohol spectrum disorders, FASD. Depending on factors such as the amount of alcohol consumed during pregnancy, the stage of pregnancy at exposure and the duration of alcohol exposure, FASD can range from mild attention deficit problems to full foetal alcohol syndrome with its lifelong problems such as neurological, cognitive and behavioural problems, growth retardation and developmental delay. FASD is often difficult to diagnose and can be diagnosed as another disorder with clinically similar features. Thus, in many countries, FASD in particular is under-diagnosed.

To establish the levels of alcohol, smoking, and illicit drug use during pregnancy, a research team reviewed maternal records spanning 1988 to 2005 held by the Coombe Women's Hospital. The study revealed that there has been a change in drinking behaviour in women presenting for antenatal care over the past two decades. In the main, alcohol consumption has increased. The study revealed that one in ten women report drinking more than six units of alcohol per week in pregnancy and two thirds of all pregnant women under 18 years old reported drinking alcohol during pregnancy. The promotion of healthy behaviour in one's alcohol intake is a national priority, not least among women who are planning or embarking upon pregnancy.

To create greater awareness of the risks associated with alcohol consumption, the Health Service Executive has published a booklet entitled Women and Alcohol. This includes advice for women to avoid alcohol in pregnancy.

The Department is devising legislation to provide for mandatory labelling of alcohol containers advising of the risk of consuming alcohol during pregnancy. The legislation is part of a miscellaneous public health Bill being prepared.

The Health Service Executive is developing proposals for a new research project in a large maternity hospital which aims to evaluate the prevalence of alcohol exposure in pregnancy, the patterns of behaviour, such as social drinking, binge drinking and sustained heavy drinking, and the factors that influence whether a woman drinks alcohol before conception and during each trimester of pregnancy. The research project aims to follow a cohort of women who drink alcohol during pregnancy to evaluate the impact on the infant's condition at birth and subsequent development.

The diagnosis and management of foetal alcohol syndrome is a clinical issue requiring contact with general practitioners and specialists as appropriate. The Health Service Executive also provides a range of child and adolescent services at local and community level to support children and families. If appropriate in particular cases, a child under five may have an assessment which covers the full range of a child's health and education needs.

The Government is committed to ensuring all pupils, including those with special educational needs, can have access to an education appropriate to their needs, preferably in school settings through the primary and post-primary school network. This facilitates access to individualised education programmes, fully qualified professional teachers, special needs assistants and the appropriate school curriculum. The Department of Education and Science provides for the education of children with special educational needs through a number of support mechanisms depending on the child's assessed special educational need.

I am concerned about the harm caused by alcohol misuse in Ireland. FASDs are one of the many consequences of our alcohol culture and especially our binge drinking culture. As my responsibilities as Minister of State include health promotion, I intend to identify and seek implementation of the necessary policy measures and actions required to reduce the overall level of alcohol related harm in society.

Special Educational Needs.

Deputy Olwyn Enright

I thank the Ceann Comhairle for the opportunity to raise this issue. While I am delighted to have the Minister of State, Deputy Áine Brady, here in her new position, I would have liked to have had the Minister with responsibility at the Department of Education and Science taking this, as it is a serious issue. The forthcoming closure of the special classes at St. Brendan's boys primary school and the Mercy primary school in Birr has caused great upset and concern in the area, especially for the children and families affected.

We debated this issue in the House a number of weeks ago and at the time, I outlined the plight of the children who I know are affected. When the Minister first made this announcement to close 128 classes last February, it caused consternation in the schools and among the families affected. There was rightly and understandably outrage at the decision.

At the time, the Minister committed that local arrangements could be made where numbers allowed them, and I believe the numbers allow them here. Indeed, during the debate in Private Members' time, many Deputies from the Minister's side of the House looked for special arrangements to be made in the areas they represent.

I raise this issue because I want to know exactly what local arrangements can be made in regard to the two primary schools in Birr. There are 13 children between the two primary schools in the special classes. There have always been special classes in both these schools. The key issue appears to be a push towards total integration, regardless of whether it suits the child.

Some 12 of the 13 children in Birr — children from all over south and west Offaly — already tried mainstream class but it did not work. These 12 children were already in mainstream classes in their local primary schools. Mainstream class is where every parent hopes their child will be. These 12 families made the very difficult decision with professional advice and guidance that the mainstream class was not helping their children. They made the decision to move their children to one of these two schools because of what was best for them. They have told me of their delight and joy in watching their children finally begin to blossom, develop and make friends in a way which did not seem possible before.

St. Brendan's has had four full-time special needs assistants for children designated as being in need of this help. This school should be at DEIS band 1 like its sister school but it is stuck at band 2 with no opportunity for review until after 2010. Along with Mercy primary school, it will now lose its special class. However, in addition, St. Brendan's is expecting to lose two thirds of a special needs assistant post. It has not been officially notified yet. It has been told by its special educational needs organiser that she has made this finding but is submitting it to a higher authority for approval. Not only are these children being forcibly reintegrated into mainstream classes, which have proved not to suit them, with the withdrawal of the special classes, they are also set to see a reduction in special needs assistant support. They will have less than they had before they went into the special class.

This is wrong. The original decision was wrong and these extra cuts reinforce the error being made. Instead of compensating these children for the loss of these classes, the Minister is taking more away from them.

The Minister stated in a letter to me last week that the decision to take away special classes is not being done for economic reasons so he should use that money being saved to help those children. He promised there would be a solution. Those representing his party promised a solution and Fianna Fáil Deputies looked for one in the debate last week.

I would like an outline of exactly what will be done. Both schools are willing to enter into any arrangement where they could still have a special class, whether sharing a teacher or whatever, because anything is better than the total loss they expect. I hope the issue of the possible withdrawal of special needs assistant support from St. Brendan's will also be addressed because these children cannot afford to be in a worse off position than they were before they entered the school.

Deputy Áine Brady

I am taking this Adjournment matter on behalf of my colleague, the Minister for Education and Science, Deputy Batt O'Keeffe. I am pleased have the opportunity to clarify the position in regard to the matter raised by Deputy Enright.

The Deputy will be aware that allocations to schools typically increase or decrease depending on pupil enrolment. In the case of special classes for pupils with a mild general learning disability, the normal pupil-teacher ratio that applies is 11:1. The Department, however, allows for a small reduction in this number and permits schools to retain a teaching post where it has a minimum of nine pupils in the class. The minimum was not fulfilled in the schools in question and, therefore, the schools no longer qualify to retain the special classes for mild general learning disability.

In the case of 128 classes in 119 schools, the number of pupils dropped below this minimum. These schools, therefore, are no longer entitled to retain the teaching posts in these classes. All of the 119 schools from which the teaching posts are now being removed are in receipt of additional teaching resources under the general allocation model of teaching support to enable them support pupils with high incidence special educational needs, including mild general learning disability. These schools, therefore, have been resourced to cater for the categories of pupils in question.

It is also important to note that the 3,000 schools which do not have special classes for pupils with mild general learning disability meet the needs of these children through mainstream classes and the use of their general allocation teaching resources. Furthermore, some schools in recent years voluntarily disbanded their special classes and mainstreamed the pupils with the associated loss of the mild special class post.

The pupils from the 128 classes will now be placed in mainstream classes and will receive support from their class teacher and all will benefit from the support available to them through the schools' general allocation model. As I stated, other primary schools which do not have classes for children with mild general learning disability cater for these pupils from within the general allocation model.

The Minister for Education and Science has previously stated that he is open to listening to proposals from schools where they can demonstrate that it is educationally more beneficial for the pupils involved to be in a special class of their own rather than to be integrated with their peers and supported by the mainstream classroom teacher and the learning support-resource teacher. I understand that correspondence has been received by the Department from both of the schools in question in this regard and it is currently being considered by the Department. This process is well advanced and it is expected that a decision will be conveyed to the schools shortly.

There has been unprecedented investment in providing supports for children with special needs in recent years. There are now approximately 19,000 adults in our schools working solely with children with special needs. There are over 8,000 resource and learning support teachers in our schools compared to 2,000 in 1998. More than 1,000 other teachers support children in our special schools. Some 76 classes for children with mild general learning disability are being retained where there are nine children or more in these classes.

The Minister would like to emphasise that priority will continue to be given to provision for children with special educational needs. As stated, the establishment of these classes for mild general learning disability pre-date many of the developments in special education policy in recent years and we now have a system for providing schools with supports for children with high incidence special needs through the general allocation model.

I again thank the Deputy for giving me the opportunity to clarify the position in regard to this matter.

The Dáil adjourned at 10.50 p.m. until 10.30 a.m. on Wednesday, 27 May 2009.