Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 14 May 2013

Vol. 803 No. 1

Other Questions

Cancer Screening Programme

Seán Fleming


81. Deputy Sean Fleming asked the Minister for Health his plans to expand the BreastCheck programme; and if he will make a statement on the matter. [22595/13]

The BreastCheck programme provides free mammograms to all women aged 50 to 64. The programme for Government includes the extension of BreastCheck to women in the 65 to 69 age group, in keeping with EU guidelines on effective screening for breast cancer. The main priority for the HSE's national cancer screening service, NCSS, at present is to maximise national uptake in the 50 to 64 age cohort, and it aims to extend the upper age range from 65 to 69 in 2014. In the meantime, women of any age who have concerns about breast cancer should seek the advice of their GPs, who will, if appropriate, refer them to the symptomatic breast services in one of the eight designated specialist cancer centres. I am sure Deputy Kelleher will agree that any woman who is concerned about changes in her breasts should consult her GP.

An efficiency review of the BreastCheck screening programme in order to prepare for the age extension of the programme to women up to 69 was published recently. The review, which was commissioned by my Department, makes a number of recommendations on how the screening process could be enhanced to increase the number screened. The NCSS has set up an internal working group to begin the planning and costing process for the extension of the age range. The group is reviewing all aspects, including population growth, the impact of the higher rate of breast cancers in the older age range, resource requirements and implementation options. My Department will continue to work with the HSE to ensure that national priorities and programme for Government commitments are met.

Any extension to the service is welcome. Planning is critical in this regard. There were regional disparities when the original national breast screening programme was rolled out and these gave rise to a great deal of anxiety in particular geographical areas. Would be it possible to obtain a commitment to the effect that instead of being based on geographical areas, the roll-out will take place on a simultaneous national basis? The Minister referred to planning and a review by the NCSS. In that context, it is extremely important that the target for 2014 be hit at the beginning of that year rather than at the end. The recruitment embargo must be lifted in advance in order that the HSE might recruit this year in respect of the roll-out in 2014.

The issue of genetic predisposition is obviously high on the agenda as a result of a book published recently which was written by Angelina Jolie and which outlines her experience in this regard. Is it possible to obtain a commitment that people who are concerned about genetic predisposition and who visit their GPs will be able to obtain screenings?

I will give credit where it is due. This programme, which is a good initiative, was rolled out under a previous Government. As per our programme for Government, we want to extend it. The recruitment of radiographers is ongoing and 15 whole-time equivalent posts were advertised. Of these, 8.3 positions have been filled and a further five candidates have completed successful interviews and are involved in the final clearance process. A further 1.8 posts remain vacant. There is an issue with regard to radiographers who specialise in mammography. The facility used to train such radiographers in the past was closed by you-know-who. We are, however, considering reopening it because of the difficulty we are experiencing in attracting radiographers. We want to have radiographers in place in order that we can continue to deliver the service. In addition, we want to improve breast cancer survival rates. An independent breast screening review undertaken in the UK was published in 2012. The independent panel charged with carrying out this review assessed the benefits and harms associated with population screening and discovered that breast screening programmes in the UK are saving lives. I have no doubt that the same will prove true here.

What of the promised mammography services in Sligo Regional Hospital? The equipment there has been lying idle for the past two years. Both Fine Gael and the Labour Party made commitments in their pre-election manifestos and the programme for Government that full breast cancer services would be restored to Sligo.

We are very keen to see the mammography service restored to Sligo. As I have already indicated to Deputy Kelleher, however, we are experiencing great difficulty in attracting mammographers. We have been obliged, therefore, to consider recruiting from abroad and, in final frustration, we are going to begin retraining people here. We have already appointed two people to training posts in order that they will be available to work either at the end of this year or the beginning of next year.

Will one be assigned to Sligo?

That is my intention. This matter is under the remit of the Galway group, which is constantly under pressure.

I have made it clear to Mr. Bill Maher, who is keen to have this mammography service restored, that these people should be available to the Sligo service. I do not want women travelling from Sligo to Galway unnecessarily. I have made it clear many times that I want to end the days of 30 people travelling to see a specialist. Instead, a specialist should travel to see them, in this case for mammograms.

Health Strategies

Michael Colreavy


82. Deputy Michael Colreavy asked the Minister for Health the measures he will undertake to expedite the implementation of the national asthma programme; and if he will make a statement on the matter. [22575/13]

The national asthma programme, which commenced in 2011, is one of a number of chronic disease programmes established in the HSE's clinical care directorate aimed at bringing a systematic approach to changes in how services for patients are delivered. The overarching aim of the programme is to reduce the morbidity and mortality associated with asthma and to improve clinical outcomes and quality of life for all patients with asthma. A key component is improved management of people with asthma in primary care, thereby avoiding emergency attendance at general practitioner, GP, out-of-hours services, hospital emergency departments and inpatient admission services.

The initial focus of the work of the programme has been primarily on the development and implementation of national asthma guidelines based on international best practice for acute and ongoing asthma management and national asthma education initiatives for patients and health care professionals; and the organisation and better integration of national asthma services at primary and secondary care levels through the development of a national model of care. Acute adult and paediatric asthma guidelines and associated care pathways, treatment protocols and care bundles have been developed for use in primary and secondary care settings. The acute adult asthma guidelines, which are available online at www.hse.ie, are being revised.

The programme is working on developing a national model of care for asthma. The proposed implementation plan will detail how physicians, nurses and other health care professionals will work with engaged patients to make the clinical decisions most appropriate to the patients' circumstances while collaborating with specialist colleagues in providing a safe, seamless patient experience within the health system. This is a key deliverable of the national asthma programme for 2013.

As 85% of asthma is managed in primary care without the requirement for hospital specialist services, the programme is undertaking work to consider providing a yearly programme of assessment for asthma in primary care called Chronic Disease Watch - Asthma, also referred to as Asthma Check. The development of Asthma Check is being done in conjunction with the Irish College of General Practitioners, ICGP.

Additional information not given on the floor of the House

Asthma Check outlines the step-by-step process for implementation of guideline-based asthma management in primary care to deliver optimal outcomes for patients, the aim being to facilitate the implementation of best practice asthma guidelines in primary care in order to improve asthma control. This will reduce acute exacerbations and, thus, their associated overall costs, with fewer hospital bed days and less time off school or work for patients. It will also ensure that patients with asthma maximise their quality of life. I am satisfied that good progress can be made in the ongoing development of the programme.

With the details of free GP care yet to expose themselves, is consideration being given to rolling out access to the long-term illness scheme for people suffering from chronic asthma, of whom I have known a few in my lifetime? Thirteen percent of respondents to a survey by the Asthma Society of Ireland reported that they suffered asthma. I am unsure of the national statistics, but asthma is more prevalent than people realise.

While I am not making the case for asthma across the board, would the Minister of State give consideration to the inclusion of chronic asthma on the list of illnesses under the long-term illness scheme? Will he advise of what other measures he is considering in respect of this very serious condition?

I can provide the House with the asthma statistics now or at another time. I take the Deputy's points about the importance of addressing this issue. However, the question was on the national asthma programme, which was the basis for my reply. In a previous debate, we discussed the GP card and the emerging difficulties associated with their allocation on the basis of medical illnesses. The plan for rolling out the GP card will be ready before the summer.

In terms of the national asthma programme, I have set out the policy for asthma care. The programme is the basis of the HSE's approach to clinical care and forms the basis on which I would like us to address this undoubtedly troubling condition.

I note that the Minister for the Environment, Community and Local Government proposes to roll out a ban on smoky coal across the State, a measure that was implemented in the city of Dublin many years ago. That is something to be welcomed. However, we are all aware of the health circumstances relating to fuel poverty. Many of those who are chronic asthma sufferers are in circumstances where they are dependent on solid fuel for heating. Is there any contact between the Department of Health and the Department of the Environment, Community and Local Government on the matter, and will consideration be given to any downside of the introduction of a further ban?

The Deputy is correct that the curtailment of smoky coal is a progressive move. However, at the risk of irritating the Deputy any further than has already occurred, I say with respect to him that I am not sure there is any evidence to support a connection between the use of coal and other solid fuels in the home and the contraction of asthma. I accept his point. We are all in general agreement on the need for this condition to be addressed. It is important to note that the condition is a recurring one. Its diagnosis and care are not as straightforward as perhaps with other conditions.

Vaccination Programme

Willie O'Dea


83. Deputy Willie O'Dea asked the Minister for Health the supports he plans to put in place for persons suffering from narcolepsy and other medical complications following vaccination with pandemrix; and if he will make a statement on the matter. [22619/13]

Michael Moynihan


118. Deputy Michael Moynihan asked the Minister for Health when he will meet with members of SOUND to discuss their concerns and the commitments he has previously made to them; and if he will make a statement on the matter. [22608/13]

Caoimhghín Ó Caoláin


135. Deputy Caoimhghín Ó Caoláin asked the Minister for Health when the package of supports for children and young persons diagnosed with narcolepsy as a result of vaccination with pandemrix will be delivered as promised; if he will meet with the parent representatives; and if he will make a statement on the matter. [22554/13]

I propose to take Questions Nos. 83, 118 and 135 together.

I am pleased to inform the Deputies that a number of supports are in place for persons diagnosed with narcolepsy following pandemic vaccination. My priority is to ensure those affected by narcolepsy, with symptom onset post-pandemic vaccination, are provided with a range of services and supports to meet their health needs. My colleague, the Minister for Education and Skills, Deputy Quinn, wishes to ensure their educational needs are also supported. The Health Service Executive has responsibility for health service delivery and, at my request, the HSE developed a range of appropriate services and supports to address the needs of this group.

Together, the HSE and the Department of Education and Skills provide a very comprehensive range of services and supports to those affected. These supports and services include access to rapid diagnosis, clear treatment pathways, temporary medical cards and reimbursement of expenses incurred. This includes expenses for counselling services for individuals and also for families of children affected by narcolepsy following pandemic vaccination in cases where such services are not already available through the HSE. Multidisciplinary assessments which allow for appropriate individualised health and educational supports to be put in place are ongoing. The National Educational Psychological Service, NEPS, is also engaging with the HSE and with the individual schools and parents of children concerned to identify and provide educational supports for the children and adolescents affected.

The HSE's advocacy unit is in regular contact with the support group, SOUND, and last met representatives of the group on 28 February 2013. Through regional co-ordinators, the HSE also has frequent contact with individual members of SOUND to assist them in service access and reimbursement of expenses. On 22 March, the HSE held an information day to ensure those affected were fully aware of all the services available. My Department is considering all possible supports which may need to be put in place for those affected by narcolepsy following pandemic vaccination. I assure the Deputies that this matter continues to be a priority for my Department. A further meeting with SOUND will be arranged when the matter has concluded. It is important we support those who have adverse events following vaccination because they are administered in good faith and taken in good faith with benefit not just to the individual but also to the wider community.

The national narcolepsy steering committee reported more than a year ago.

Commitments were made and while I acknowledge that there have been meetings with the HSE and other agencies of the State, what the representatives of children afflicted with narcolepsy on foot of the Pandemrix vaccine want is a clear pathway outlined on access to health and education services and some form of redress. With all due respect, this issue was to be addressed last September. A paper was due to go to Government in October but we are now in May 2013. While some individuals may have access to the various agencies of the State in terms of assistance and assessment, what they want is a guaranteed mechanism to be put in place vis-à-vis health, education and redress in order that they can get on with their lives. That is critical, especially if we are to have confidence in vaccination schemes on a broader level. Clearly, if something goes wrong with a vaccination programme, it should be addressed because people have their children vaccinated in good faith and for the right reasons. The current situation whereby 30 children or more are now afflicted with narcolepsy and are effectively left to campaign on an individual basis is not good enough.

As I outlined earlier and for the record, by 10 May the Irish Medicines Board had received 48 reports confirming a diagnosis of narcolepsy with symptom onset following the Pandemrix vaccination. The majority of these reports relate to children and adolescents. Further possible cases have been investigated by the HSE and the Irish Medicines Board. As I have pointed out, a range of services are being provided through the Department of Education and Skills and the HSE. The development of a national centre for narcolepsy treatment is under active consideration by the HSE and money has been set aside for the development of such a centre in 2013. There has been active engagement between the Department of Health, the HSE and the Department of Education and Skills to meet the needs of those affected. There has also been active engagement with representatives of Sufferers of Unique Narcolepsy Disorder, SOUND, the advocacy group for those affected. The HSE's advocacy unit acts as liaison with service and support providers and other Departments to facilitate access to required services. The HSE has established a network of liaison officers countrywide to allow a single point of service contact for those affected by narcolepsy. The HSE has also provided a range of services to those affected, including access to rapid diagnosis, clear care pathways and temporary medical cards, and expenses incurred by parents are being met by the HSE. The total amount expended since the reimbursement scheme began in 2011 is approximately €60,000.

When will the Minister meet the representatives, that is, the parents of the children affected? I understand that 54 affected persons are represented by SOUND. It is important that the Minister would meet the representatives as soon as possible. When will the Minister deliver the promised supports for these children? It must be borne in mind that what they are asking for is very reasonable indeed. They want an awareness campaign for medical professionals and the public, which would be very sensible. They also want access to rapid diagnosis, a special services medical card, continuing educational supports, access to new drugs and treatments and compensation. This is a matter that deserves cross-departmental address but the Department of Health has to be the lead Department. Finally, the advocacy group is also calling for the official recognition of narcolepsy as a disability. That is very important because these children will grow up into young adults and future adult life and their condition may very well affect their employment prospects. Only by designating narcolepsy as a disability will they be able to access disability allowance if their work life is interrupted in any way.

The Deputy asked when I will meet the representatives and the answer is "shortly". I have absolutely no hesitation in meeting them. They sent a letter to the Department outlining some of the things they would like to see happen and most of them have, in fact, already happened. The Deputy mentioned rapid access to diagnosis, which is already available.

They asked for a special medical card and they have been given that.

In the area of compensation we have already been notified that eight cases are going to court. On behalf of the State and as the Minister for Health, I have received six letters of notification of an intent to proceed legally in claims against the Minister, the HSE and the manufacturers, GSK, regarding damages suffered as a result of vaccination with Pandemrix. As yet no proceedings have been issued. It is our hope that we could avoid all that by perhaps going through the State Claims Agency, which is eminently suited to deal with this. I would prefer that any moneys available go to compensating those who have suffered pain and loss as opposed to the legal profession - I mean no disrespect to my honoured colleague beside me.

There are two things to say about calling for it to be named a disability. There are many conditions that result in disability but that are not labelled as a disability. The second point is a matter of some hope. I have been told unofficially - I am open to correction - that there appears to be some evidence abroad that some of those who have suffered narcolepsy as a consequence of this vaccination are beginning to recover. This may not, and, I hope, will not be a lifelong disability, but that is not to diminish in any way the huge distress that it has caused those it has befallen.

I refer to the issue of global information. There may be some evidence coming from abroad, including areas outside Europe, relating to people who have been affected with narcolepsy because of Pandemrix vaccination. If there is such information or if treatment becomes available that assists or benefits these people, will the Government examine the peer-reviewed material and other documentation to ensure that patients get the best advice, information, clinical assessment and treatment available in the world? We have several people that have been affected with narcolepsy because of this vaccination but there may be others throughout the world. By pooling information and sourcing elsewhere we may come up with solutions to these difficulties.

There is a broader issue and I hope these people meet the Minister in this regard. The idea that people are serving notice on the State in the courts for compensation is a clear indication that the State is not looking favourably on redress. If it were, then the first engagement or port of call would be the State, as opposed to having to force the State into a confrontation.

With regard to the last point, no proceedings have been commenced but it is a statement of intent borne by the sense of hurt and loss that parents believe their children have suffered. We have to take that on board.

The other points raised by Deputy Kelleher are well made. Of course we should always look at best practice not only here but abroad and we should seek to pool information. We opened the e-health conference yesterday. More than 2,000 delegates are attending the Convention Centre, Dublin, at the moment to consider the subject of exchanging information and trying to accelerate change within our health services in the European Union and beyond. Three European Union Commissioners will be present during the conference. The President of the Senate of Massachusetts, Therese Murray, was present yesterday and we look forward to the presence of Deval Patrick, the Governor of Massachusetts, tomorrow. This is very much an EU-US initiative but it involves other people throughout the world feeding into an information process that will help us improve practice not only in the area of the treatment of narcolepsy but in many other aspects of health care.

The report prepared and published by the national narcolepsy study steering committee was produced more than one year ago. In the Minister's response at the time of publication he stated that a package of supports would be in place before the summer recess. That was in 2012. We are now almost at the summer recess of 2013 and there is no permanent package of supports in place. There is no across-the-board package of supports which the parents have identified as a requirement for them and their children to cope with the condition, which must be most upsetting to deal with given all the situations that it can entail. Why has it taken the Minister so long to meet them?

Will the Minister be particular and give an indication of a date? He talks about shortly but that is non-specific. I do not understand why he has not met them already.

Deputy Ó Caoláin has the right to ask as many questions as he can, but when he does, it is difficult to answer all of them. He asked why I will not meet them. I have already said I will meet them and will do so shortly on the basis of fully understanding and being able to respond to the more recent communication we had in April around their requirements. We have put in place virtually all the educational and medical supports required at this point. We have held information days, and consultants in sleep medicine from the Mater Hospital, such as Dr. Catherine Crowe, Dr. Elaine Purcell, and Dr. Brian Lynch, consultant paediatric neurologist in Temple Street children's hospital, have made presentations and answered questions.

Every possible measures is in place to ensure rapid diagnosis, with the Mater Hospital sleep clinic providing a six-day service, including Saturdays, to facilitate those where a possibility of diagnosis of narcolepsy exists. The Department has been assured by the HSE that anyone who has a confirmed diagnosis of narcolepsy is fast-tracked through the system to ensure required services are provided at the earliest possible time.

We should all use this opportunity today to highlight the issue and the services that are in place. If people find themselves unable to access them, I would like to know in order that I can offer them the opportunity to avail of what is being provided. More will be required in the longer term in terms of compensation and redress, and we are open to that.

Universal Health Insurance White Paper

Pádraig MacLochlainn


84. Deputy Pádraig Mac Lochlainn asked the Minister for Health the process for drafting the White Paper on universal health insurance including membership of teams; the timeframe for same; and if he will make a statement on the matter. [22559/13]

The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance, where access is based on need, not on income. Under UHI, everyone will be insured and will have equal access to a standard package of primary and acute hospital services, including acute mental health services. A new insurance fund will subsidise or pay insurance premiums for those who qualify for a subsidy.

The Department is preparing a White Paper on universal health insurance which will provide further detail on the UHI model for Ireland in addition to the estimated costs and financing mechanisms associated with the introduction of universal health insurance. Broadly, this involves the development of detailed policy proposals covering issues such as the design of the UHI model, the scope and composition of the UHI basket of services and funding and financial support mechanisms for UHI. More detail in relation to the overall process for producing the White Paper, including the projects, studies and policy appraisals that need to be undertaken, is set out in the preliminary paper on UHI, The Path to Universal Healthcare, published by the Department in February 2013 and available on its website, www.doh.gov.ie.

A special UHI design team has recently been set up to oversee and support the work involved in the design of the UHI model and the preparation of the White Paper on universal health insurance. The membership of the UHI design team comprises officials of the Department of Health, Department of Public Expenditure and Reform, the HSE, the Health Research Board and the implementation group on universal health insurance.

The work involved in UHI design is both complex and technical and demands a wide range of legal and financial expertise. Accordingly, it is envisaged that the design team will be supported by specialised expertise at appropriate junctures. To this end, the Department has recently engaged legal expertise to support deliberations in relation to the design of the UHI model. Work on the development of detailed policy proposals is proceeding with a view to publishing the White Paper as early as possible.

There has clearly been little or no meaningful progress on the White Paper on universal health insurance. Without this we have no clear indication of the anticipated relationship between hospitals and insurers and the crucial purchaser-provider relationship. That has consequences for all hospitals when it comes to services.

Would the Minister accept that the future role of hospitals will be determined not by Professor Higgins but by these competing private insurers? At the end of the day, they will be the determinants of the level of service provided at any of the hospital sites.

There is no evidence for - and in fact, there is growing concern about - the Minister's preferred model of multiple competing insurers. There is no proper debate on alternative models. The model to which, by all accounts, the Minister is married will drive costs up rather than down. Greater efficiencies would be gained through the single insurer approach. Is it well past time for the Minister to draw a breath on this and consider all of the possible alternatives? His approach, I fear, will not succeed.

On the one hand, we do not seem to be going fast enough, but on the other hand Deputy Ó Caoláin wishes us to draw a breath. I had to point out to him that a paper was produced by the universal health insurance group in February.

Where is the White Paper?

The White Paper is under-----

A Ladybird book would have more information than that.

When it comes to Ladybird books, and Tweedledum and Tweedledee, we all know to whom we should refer.

The reality here is that we are undertaking a sea change in the way we provide care and how we fund it. It is a fundamental shift, moving from hospital-based care to a primary care model and from a tax-based system to an insurance-based system under which those who cannot afford all of the cost are subsidised and those who cannot afford it at all will be paid for by the State, but everybody will be treated equally. There are some who would like to see a continuation of the old ways, with a virtual health service for those who cannot afford to pay for it and the ability to queue-jump and have the service one wants if one can afford it. That is not the way to run an egalitarian society or one in which everyone is equally cherished regardless of his or her income.

An egalitarian society-----

The Minister is turning left.

Has there been a major change?

Deputy Ó Caoláin has 20 seconds.

The Progressive Democrats health policy.

Deputy Reilly is going socialist.

I have got 20 minutes; is that correct?

Deputy Alex White must have written the answers.

Deputy Reilly is the funniest socialist I ever saw.

He has the beard and moustache, although that is about as far as it goes.

The Deputies should calm down.

On the national children's hospital, that is a product my party supports. That is why we want to see it expedited.

On the national insurance approach, my party wants to see such a universal process in place, but not under the model the Minister is proposing, because we do not have faith in it. It is a reasonable position for us to take. We are not convinced. Does the Minister recognise that there is growing international evidence that discounts the claims he has made about the approach he has championed here over these past couple of years? It is not only that the Minister does not have a White Paper but that at the end of the day he does not even have a good idea.

May I respond? There are two minutes left.

The Minister has ten seconds.

Deputy Reilly should go back to the day job.

Deputy Ó Caoláin talks about not having faith in the Government's system. His leader does not appear to have faith in the system on this side of the Border or that in Northern Ireland when he chooses to use the free travel provided to him by a benefactor to avail of whatever the insurance sector seems to provide in the United States for his own treatment. Deputy Ó Caoláin's words ring a little hollow.

What has that got to do with the question I posed to the Minister on universal health insurance? Is that the best he can do?

There is still one little gem left - Question No. 85.

Make no mistake; there is no gem in dealing with the Minister, Deputy Reilly.

Disability Support Services Provision

Micheál Martin


85. Deputy Micheál Martin asked the Minister for Health the action he will take to ensure that children with suspected disabilities have a needs assessment within the legal time limit; and if he will make a statement on the matter. [22598/13]

Here comes the lefty Minister.

I am sorry; I thought we were all done. I beg the Acting Chairman's pardon.

The lefties are in now.

The egalitarian.

Part 2 of the Disability Act 2005 was commenced on 1 June 2007 in respect of children aged under five. In 2008, the then Government decided, in the light of financial circumstances which the Deputies will recall, to defer further implementation of the Disability Act 2005 and the Education for Persons with Special Educational Needs Act 2004.

Part 2 of the Disability Act, inter alia, provides for an assessment of the needs of eligible applicants occasioned by their disability to be commenced within three months of receipt of an application and completed within a further three months.

There has been a very significant rise in overall activity around the assessment process in recent years in respect of the children now encompassed by the process. The number of assessment reports received in 2012 was 3,505, which is at least 400 more than in 2010. It is worth noting that in the period 2010 to 2012 more than 8,200 reports were completed. While the HSE recognises that it faces significant challenges in respect of meeting the statutory timeframes that apply to the assessment of need process, given the number and complexity of cases, it is endeavouring to address the issue from available resources.

While a delay in assessment or intervention for any child is not desirable, the assessment process under the Disability Act can take place in parallel with any intervention that is identified as being necessary. The HSE has issued guidance to its staff that where there is a delay in the assessment process, this should not affect the delivery of necessary and appropriate interventions identified for a particular child. In addition, targeted action plans have been in place since early 2011. Measures have included prioritising assessments, holding additional clinics, contracting the private sector to conduct assessments and reconfiguring resources to target areas of greatest need. These plans are monitored on a monthly basis by the HSE centrally.

Following the publication of a report commissioned from the National Disability Authority, NDA, by the Department of Health and the HSE, a major emphasis is being placed on reconfiguring disability services for children into geographically-based early-intervention and school-age teams as part of the progressing disability services for children and young people programme, which is under way. The NDA report indicated that where integrated teams were operating, the assessment of need process ran more smoothly. It found that there was no single solution to remove all the challenges to operating statutory assessments of need. A meeting involving the Department, the HSE and the NDA has been arranged for early June to discuss the report further.

We will pause there. I thank the Deputies for their questions.

I did not get an answer to the question.

I know that, but we are moving on to the next item of business.

That answer is completely at variance with the reality on the ground.

Like the rest of them.

There are 760 children waiting over six months.

It is Deputy Martin's question.

Deputy Alex White is the Minister of State.

Deputy White is in the hot seat.

I thank Deputy Kelleher. We are moving on to the next item of business. I thank the Deputies for their questions and the Minister and Minister of State for their answers.

Ten years ago, my party had a Minister for health.

It was Deputy Martin's question.