Dáil Éireann díospóireacht -
Wednesday, 1 Mar 2023

Vol. 1034 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Hospital Overcrowding

Deputy Maurice Quinlivan

The number of people who lingered on trolleys in University Hospital Limerick, UHL, last month was 1,561. The figure for the same month last year was 1,498, so the Minister for Health is again breaking records, though not in a good way. The question I wish to put to him, which the Minister of State, Deputy Peter Burke, might relay given the Minister's absence, is a simple one. I want to know what the Minister is going to do to address the crisis in both the immediate and longer terms. I fail to understand what he has done on this issue since becoming Minister in 2020. In 2021 there were 12,106 people on trolleys waiting for care in UHL. However, by 2022 the number had grown to 18,012. The numbers have got worse and worse under the Minister's watch and he and his Government colleagues seem to have no appetite to address them with any sense of urgency. It is worth stating these figures and remembering they are not just statistics. Each of these people and their family members have had to go through the stress of presenting themselves to the hospital to be left waiting on a trolley for days at a time, in some cases. This can only compound the stress and anxiety of a hospital visit.

The Minister has spoken of more capacity to come in UHL. I welcome that construction has begun on the 96-bed unit and that more is scheduled to be done. However, that work must be speeded up. As usual, the facilities are coming too late for many patients at UHL and too late for the hardworking staff of the hospital who work in challenging and often difficult conditions, yet continue to deliver for their patients. I called on the Minister and his predecessor many times to expedite the construction of the initial 96-bed unit and many times they have failed to do that.

The January 2023 trolley figures were less than those of January 2022 because the UHL management team initiated an internal incident procedure that alleviated some of the pressure on the hospital. However, as soon as it was lifted the numbers shot back up again, as expected. The hospital presentations in the last week of December 2022 were not presentations that came out of the blue. They had been predicted, yet there were no steps taken to manage them in advance. We knew there was going to be a problem around December and January. The winter plan was announced far too late and over the course of the winter crisis of December and January we saw 45,000 hospital appointments cancelled across the State. This is an incredible number and just like the high numbers of people being treated on trolleys, it demonstrates there are massive capacity issues in our hospitals. Of the 45,000 cancellations, some 7,656 were appointments for children.

The Taoiseach, who is a former Minister for Health, visited UHL earlier this month. I appreciate him doing this because it was something I had called for many times. However, he came and left with no commitments as to how he and the current Minister will end this crisis. It is not just capacity in the hospital that is needed, though that is needed urgently. There has also been a failure to increase capacity in primary and community care. If such capacity was in place, hospital overcrowding and mass outpatient cancellations could be avoided. Capacity issues are rife across hospital services. There are children with mental health challenges who have been waiting years to be seen by child and adolescent mental health services, CAMHS. People who need elective procedures are being informed that they will be waiting years for procedures to address issues such as cataracts.

As the Minister of State is standing in, I advise him that across the State we need at least 800 additional hospital and community recovery beds to be put in place this year. The planning and procurement need to happen now and to be speeded up. The people of the mid-west need to see results now. It was only last month that 11,000 people protested in Limerick about the dire state of the health service in the mid-west region. How much longer do people in my city need to wait to see this Government supporting them and ensuring they receive safe and timely health care when they visit our local hospital?

Minister of State at the Department of Foreign Affairs (Deputy Peter Burke)

I am taking this Topical Issue matter on behalf of the Minister for Health, Deputy Stephen Donnelly, who has been concerned for some time about the congestion experienced in the emergency department at UHL, which has led to long patient experience times and patients waiting on trolleys for admission. According to the HSE’s TrolleyGAR, there were 470 patients counted on trolleys at 8 a.m. in February 2023. This represents a 25% reduction on February 2019 when it was 629 patients and a 6% reduction on February 2022 when it was 500 patients. There were just under 80,000 attendances at the emergency department in Limerick in 2022. This is up 12% compared with 2019 and is 13% higher than the average for the period 2017 to 2021. This makes UHL the second busiest emergency department nationwide.

There has been, and continues to be, substantial investment in capacity in UHL. This includes a 42% growth in workforce since the end of 2019, the opening of an additional 98 acute inpatient beds and a 19% increase in budget in 2022 compared with 2019.

The Minister met with the hospital group management and elected Oireachtas Members from the mid-west on 11 January this year to discuss the emergency department situation in the hospital and future developments. The hospital crisis management team was convened in January to de-escalate UHL and took various actions. Extra staff, including nurses and doctors, were asked to present for duty, with additional consultant and support staff working over the weekends to effect discharges. A medical assessment unit, MAU, at Nenagh hospital has been operating seven days a week as a temporary measure since 7 January and will continue over the coming weeks. Additional surge beds opened in Ennis, Nenagh and St. John’s hospitals. Outpatient appointments for UHL were cancelled during the first week of response. Sanction was given for the use of bed capacity in private hospitals in the region and outside the region. These actions brought about a significant reduction in trolley numbers.

The medical assessment pathway for 112 and 999 patients has commenced at both Ennis and Nenagh hospitals. The new pathway allows stable medical patients meeting agreed clinical criteria to be treated in model 2 hospitals. A key element is a telephone referral from a treating paramedic to the receiving MAU doctor, which ensures that the right patient is brought to the MAU. This pathway facilitates patients receiving medical treatment in a hospital closer to their home, assists in reducing patient presentations to emergency departments and helps to release ambulances more quickly to respond to other emergency calls. Those 112 and 999 patients who do not meet these clinical criteria will continue to be transported to the emergency department for assessment and treatment. The medical assessment units in Ennis and Nenagh hospitals treat patients referred by GPs, Shannondoc and now National Ambulance Service paramedics. It is envisaged that similar measures will be introduced at St. John’s Hospital in the near future.

In addition to the national winter plan, there are bespoke site-level plans, including for Limerick. The local plans focus on local needs and build on integration between the community and acute hospital services. UHL’s plan includes measures such as the recruitment of extra staff, including but not limited to two whole-time equivalent emergency medicine consultants, additional emergency department registrars and discharge co-ordinators to target patient flow; improving access to diagnosis for both urgent and emergency attendances in the emergency department and for GPs; the enhancement of GP out-of-hours supports; the recruitment of administrative staff; and the creation of a performance management office to drive the ongoing service improvements in the University of Limerick Hospitals Group.

The Minister, Deputy Stephen Donnelly, has asked the HSE to prepare longer-term unscheduled care performance improvement plans for all our emergency departments, including that at UHL. The Department of Health is working with the HSE to ensure winter plan initiatives continue to be implemented.

Deputy Maurice Quinlivan

I thank the Minister of State for his response. After what I have heard, I am not convinced that the situation will improve anytime soon, unfortunately. I assume the figures were supplied by the Minister or the Department of Health. I notice he is using different figures from those he used when he sat on this side of the House. I will use the same figures we have all used over the years, which are the Irish Nurses and Midwives Organisation, INMO, figures. The trolley figures in Limerick have not reduced at all, unfortunately. I wish they had. We know they are not just figures; these are people we know. They are often family members, relatives or neighbours. They are often elderly people and are often in distress.

The knock-on effects of the capacity challenges can have a real impact on patients. At UHL, this is most profoundly seen in the outpatient waiting lists. As of 26 January this year, there were 29,027 adults on waiting lists, of whom 5,787 had been waiting for 18 months or longer. Heartbreakingly, there are 4,055 children on outpatient waiting lists at the hospital, of whom 668 have been waiting for 18 months or longer for their appointments. These are children. The time is long past for this crisis to be solved. The reports of last year - the HIQA inspection, which was a damning inspection of the hospital, and the Deloitte report - showed an array of issues and problems that need to be addressed at the hospital as a matter of urgency. However, I see nothing in the response this morning.

The emergency department does not have the capacity to cater for the current volume of presentations. We all agree on that. However, this was predicted when we closed down the accident and emergency departments in Ennis, Nenagh and St. John's hospitals. The powerful letter signed by 87 consultants in relation to inpatient care in UHL noted that there are, on average, 240 presentations a day at the emergency department, which is designed to facilitate a maximum of 190 presentations. That is the problem. What message does the Minister of State have for the people of Limerick and the mid-west region who desperately want to have an emergency department at their local hospital that is fit for purpose and to get the respect and treatment they deserve?

Deputy Peter Burke

As I mentioned in my opening statement, significant resources have been invested in UHL over recent years. The workforce at UHL has increased by 42%, or 1,161 whole-time equivalents, since the end of 2019. It is accepted that a key part of the solution for Limerick is additional beds. Work on a new inpatient block at UHL has commenced, with the Minister, Deputy Stephen Donnelly, breaking ground on this development. The project consists of a four-storey, 96-bed acute inpatient ward and renal dialysis unit. It involves a total capital investment of just over €90 million. In addition, 98 new inpatient beds have been opened in UHL since the start of 2020. This includes a 60-bed modular ward block, which was established to provide a rapid-build interim solution to begin to address the bed capacity issues at UHL.

The Department regularly seeks assurance regarding the appropriate escalation measures for emergency department overcrowding. The HSE performance management and improvement unit continues to lead an intensive engagement with hospital in response to the Minister's concerns about the hospital. The engagement with the University of Limerick Hospitals Group and the local community healthcare organisation in the mid-west supports and oversees the implementation of rapid improvements and services in the region. These measures include a renewed focus on hospital avoidance, patient flow and discharge planning, and regular and frequent assessments of patients with long stays in hospital.

Reform of service delivery, as outlined in Sláintecare, is vital to deal with the demand. This includes the expansion of community care and other measures, providing people with the care they need outside the emergency department, and improving patient flow and discharge from hospital with more home support packages and nursing home supports. The matter of emergency department performance is under constant review by the Department of Health through ongoing engagement with the HSE. I assure Members that the Government and the Minister for Health are committed to improving emergency department performance.

Covid-19 Pandemic

Deputy Neasa Hourigan

In some ways, the matter I want to talk about - the ongoing issue of long Covid and how it affects healthcare workers - is related to the pressure that we see in emergency departments and hospitals because it speaks to the staffing issue we are experiencing in the health service. By "healthcare workers", I do not just mean nurses and doctors. I also mean healthcare assistants, cleaners, housekeeping staff, catering staff, porters and every person who was expected to go to work when we were all told to stay at home, mind ourselves and cut down on our contacts. They did not just "go to work" during the middle of a global pandemic - they went into the epicentre of that pandemic. They went into places where we knew people had Covid and sometimes did so in the knowledge that the protective equipment we had given them was not adequate.

When we talk about long Covid, we are not talking about people who experience Covid and then take six, eight or 12 weeks to recover. We are talking about people who are still experiencing very severe symptoms after two or three years. We do not have a particularly good track record in this country of dealing with post-viral illness. Even though it can be nebulous to diagnose, it is very real for many people. People experience things like debilitating fatigue, difficulty getting out of bed or getting through the day, brain fog, joint pain, muscle pain, insomnia, which seems to be an issue I hear about repeatedly, and vertigo. Those are probably symptoms that all of us have experienced to some degree at some stage in our lives. However, if a person is experiencing that all day, every day, it impairs his or her ability to work.

We know that a disproportionate number of healthcare workers are experiencing long Covid. Certainly, their unions would be well able to speak about how many people are experiencing it. These people have acquired long Covid in conducting their duties as healthcare workers. In minding and looking after us, they have contracted a long-term illness that is affecting their ability to live their lives and do their work. On top of that, it is now affecting their financial security, the security of their long-term employment and their general well-being.

We recognise in this country that when you contract an illness or a condition through your work, the State should support you. We have a system of recognising prescribed diseases or illnesses, as set out in the Social Welfare Consolidation Act 2005. In section 87, it sets out two criteria. The first criterion is that the illness has been contracted as a risk during their occupation, not as a risk that is common to all.

We all accept that those who were working in emergency departments, in wards, in hospitals or in primary care, and were dealing with people who were suffering from Covid-19, were at more risk than the rest of us who got to stay at home.

The second criterion is that the illness can be reasonably attributed to their occupation. I do not think we can argue with that. People who looked after us during Covid got Covid themselves. We know that other countries have an occupational injury scheme for healthcare workers who are disproportionately affected by long Covid. France, Italy, Denmark and Sweden are doing it. It is being introduced in countries throughout Europe. The EU Strategic Framework on Health and Safety at Work 2021-2027 highlights long Covid and states that it is something we should be looking at. It does affect healthcare workers. It is a real thing. It is very easy to dismiss and it is hard to diagnose, but that does not mean that people should be put at financial risk and insecurity and employment risk in the long term for minding the rest of us.

Deputy Peter Burke

I wish to respond on behalf of the Minister for Health, Deputy Stephen Donnelly. I thank Deputy Hourigan for raising this issue.

The Department of Public Expenditure, National Development Plan Delivery and Reform introduced special Covid leave with pay for all Civil Service and public sector employees at the start of the pandemic to assist in preventing the onward spread of Covid in work premises. Currently, special Covid leave with pay applies for all cases for the duration of the self-isolation period only. Any periods of Covid-related illness which extend beyond the isolation period are treated as ordinary sick leave. A temporary 12-month scheme, specific to the public health service, was introduced to provide for paid leave for certain public health service employees who were unfit for work following a Covid infection. Employees who met the eligibility criteria for the scheme will have transferred to the scheme in July 2022. This temporary scheme, specific only to the public health sector, was introduced in recognition of the higher risk faced by certain public health service staff who were required to work on site through the most challenging phases of the pandemic in clinically exposed Covid-19 environments.

It is our understanding that an epidemiological survey is planned by the HSE and will provide much needed insight into long Covid, which is not yet fully understood from a clinical perspective. The HSE has also commissioned a review by the Health Information and Quality Authority to assess the latest international evidence on long Covid. The EU Advisory Committee on Safety and Health at Work has recommended the recognition of Covid as an occupational illness in health and social care. However, member states vary in respect of their treatment of Covid in this regard. Officials from the Department of Health have met with officials from the Department of Social Protection who operate the national occupational injuries benefit scheme. The Department has indicated that Covid does not currently constitute a prescribed disease or illness as set out in the Social Welfare Consolidation Act 2005. I understand that the Department of Social Protection has committed to reviewing the EU committee recommendation in respect of the occupational recognition of Covid and to reporting back to the Select Committee on Social Protection, Community and Rural Development and the Islands on the matter.

As part of the Department's review, the Minister, Deputy Humphreys, has sought input from the Minister for Health in respect of the matter. The Minister, Deputy Stephen Donnelly, has asked officials from the Department of Health to examine the options in respect of the recognition of Covid as an occupational illness in the public health service, with the intention of replying to the Minister for Social Protection on the matter without delay. The matter is currently under consideration.

Deputy Neasa Hourigan

As the Minister of State can see, the State has already recognised that healthcare workers were at higher risk through the creation of the temporary 12-month scheme and that therefore they must be treated in a certain way.

I am sure the Minister of State is aware that when people are put on standard sick pay, it essentially means they are on a pathway to medical retirement. We are talking about people who are in their 30s, 40s and 50s. Not only do they have financial burdens such as kids in school and all the rest of it, but they are also very young to be put on medical retirement. It might be that we could manage the process in a better way.

I am pleased to hear the Department of Social Protection is doing a review. I will follow up on that. I hope the Departments of Social Protection and Health are engaging with the unions on this issue because I am aware that in certain community healthcare organisations, occupational health departments are putting pressure on workers to trial a return on reduced hours and then they move off the 12-month scheme. The scheme is about to run out. While we are dilly-dallying over whether it is an occupational injury, those people are experiencing great insecurity about what the future looks like for them. It is not fair to people who have given their all in supporting us and minding us.

There are two further points that the Minister of State, Deputy Peter Burke, could pass on to the Minister, Deputy Stephen Donnelly. The first is that there seems to be a disconnect in terms of recognising long Covid. We could communicate very quickly with GPs by means of a one-page circular outlining the symptoms of long Covid and what it looks like. We know it is difficult to diagnose. It is a nebulous series of symptoms, but it is a very real thing. We could support GPs to be able to recognise it sooner and give people the security that their illness is being taken seriously. Second, we could do a number of things to provide support, such as making melatonin available without a prescription. That is the case in many European countries but not in Ireland.

Deputy Peter Burke

I thank Deputy Hourigan for the very important points she has raised. I will pass them on to the Minister for Health. The Government recognises the significant role of public healthcare workers throughout the pandemic. They have gone beyond the call of duty, working at the front line, in clinically exposed environments treating Covid-positive patients in extremely difficult circumstances. Their efforts continue to be very much appreciated by the Government. Unfortunately, many front-line public health workers contracted Covid in the workplace and, as Deputy Hourigan has pointed out, some still suffer from the symptoms of long Covid. While the temporary scheme of paid leave for certain eligible health sector staff suffering with long Covid remains in place, the Minister, Deputy Stephen Donnelly, is acutely aware that this scheme concludes in three months' time. He is also mindful that the criteria for the temporary scheme meant that not all staff who contracted Covid while working in clinically exposed environments were able to access the scheme. It is noted that many of our EU member state counterparts have adopted the EU Advisory Committee on Safety and Health at Work recommendation that recognises Covid as being occupational in nature in the health sector in their respective countries and have introduced the recognition of same. However, the recognition of same varies in the approach. The Minister for Health has asked his officials to consider the matter further in light of the treatment of the issue by his EU counterparts. He has also committed to providing support to impacted staff, as appropriate, in this regard.

School Accommodation

Deputy Jennifer Whitmore

This morning I would like to discuss Blessington Community College and its accommodation needs, not just for the upcoming school year but also in the future. Blessington Community College is the only secondary school in Blessington. It has 627 students currently enrolled. The number has doubled in the past nine years. It is an incredibly popular and successful school. Its projected intake for 2023 is 709 students, which is an increase of 82 students on the current intake. The enrolment of the school is predicted to be 900 by September 2027. The growth is based on actual figures from the 11 feeder schools in the area. The principal has gone around to each of the feeder schools and found out how many children are there and forward-planned on that basis. This is a school that has experienced incredible growth in student numbers and that will continue to be the case.

Currently, the school is a labyrinth of Portakabins that have been added on over the years as the school has grown. The canteen was decommissioned in 2022 due to health and safety reasons and there is currently no canteen. There is no sports hall. The sports area has been reduced, as have the areas for science laboratories and home economics.

The school itself, despite being very popular and successful, is finding it difficult to meet the needs of the students. The thing is, a new school build was announced in 2018. Obviously, everyone in the school community, including the parents, students, teachers and principals were delighted to hear that announcement, but there has been no progress on it since 2018. There has not been a single movement towards turning the sod on that school. There are two issues I would like the Minister of State to address. The first is the very short-term immediate problems that are facing the school. What is the school going to do in 2023 with the students who have been enrolled, because it does not have capacity for them at the moment? I understand that the Department has granted an additional school accommodation, ASA, allowance for an additional six Portakabins to go onto the site. Unfortunately, the school has no timeline as to when that will happen. It is now March, and as the Minister of State is aware, these projects can take considerable time. The school is starting to get concerned, as are the parents, that those buildings will not be in place for August in order to have that intake coming in. If the Minister of State could provide a timeline on the delivery of the temporary emergency accommodation that is required for the school, that would be very useful.

The second issue is the build itself. First we have to deal with the emergency situation, but the school does need a new building. The Department initially said that it was looking at a 650-student school building, which would not even meet the current needs. The school wants a 1,000-student school building. My understanding is that the Department is considering that and a review is under way. I ask the Minister of State to give me some indication as to where that review is at, when the school will be notified of the outcomes of that review and a tangible timeline for when the school will see those buildings actually put in place to enable the school to plan for the future.

Minister of State at the Department of Education (Deputy Josepha Madigan)

I thank the Deputy for raising this matter. I am taking it on behalf of the Minister for Education. It provides me with the opportunity to clarify the current position in relation to the accommodation needs of Blessington Community College.

A major capital project for Blessington Community College is being addressed through the Department’s construction programme. As the Deputy is aware, this project is currently at stage 2B of the architectural planning process. That is where the detailed design takes place, planning permission and other statutory approvals are secured and tender documents are prepared. It is fair to say that to increase the total capacity of the school to 650 pupils, plus two special classes, is a major extension. That is obviously of interest to me in my capacity as Minister of State with responsibility for special education. The school and the patron have requested an increase in the proposed size of the school to 1,000 pupils. My understanding is that that is under active consideration by the Department and would include an associated increase in special class provision. I hear what the Deputy is saying when she outlines the anticipated figures into the future. The school had around 479 pupils in 2018, and as the Deputy said, there are now 627 pupils. I note the projections she is making into the future.

In order to plan for school provision and analyse the relevant demographic data, the Department divides the country into 314 school planning areas and uses a geographical information system, GIS, using data from a range of sources, including child benefit and school enrolment data, to identify where the pressure for school places across the country will arise and where additional school accommodation is needed at primary and post-primary level. Current and planned residential development activity, as well as Project Ireland 2040 population and housing targets, additionally inform the Department’s forecasts of school place needs. In its planning ahead for 2023, the Department is engaging with the Department of Public Expenditure, National Development Plan Delivery and Reform in relation to capital funding in order to support the operation of the school system with the roll-out of school building projects to construction in 2023. Blessington Community College is among the many school accommodation needs across the country being considered as part of the process. I understand that the Department will be in further contact with Kildare Wicklow Education and Training Board, KWETB, in relation to the college itself. The Department is currently considering the long-term capacity requirements in the Blessington area, taking existing demographics into account, as well as future and current residential developments. Schools that are being built need to take into account the longer-term needs of an area and the immediate school requirements. I understand that the officials will continue to engage with KWETB in this regard. A solution to address the school's accommodation needs is also being progressed. The Department has been working with KWETB to ensure that there is sufficient accommodation in place to meet the interim needs of the school, pending the delivery of the main project.

Specifically on the Deputy's query around temporary accommodation, I understand that additional modular accommodation was approved. However, concerns were raised by the patron, the board of management and the architects that as the site is restricted, the installation of additional accommodation would hinder the permanent school build. Following a meeting with the Department, the school reviewed its requirements and confirmed that the four refurbished existing prefabs and the two prefabs from another patron-owned site would be sufficient until the delivery of the first phase of the permanent accommodation.

Deputy Jennifer Whitmore

Unfortunately, I did not hear any new information from the Minister of State there. It is true that the school has completely pared back its requirements for temporary accommodation to the point where it is just refurbishing four Portakabins and putting in two new ones. Despite that, there is still no indication that this will be in place for September 2023 when it is needed. The school and parents are getting worried. It is getting to the point where the school may have to reconsider offering parents those places because it cannot guarantee that the building will be in place.

The Minister of State mentioned the special education needs rooms, and there are two of them in the school. They were finalised last October and have been sitting empty since then. The two Portakabins are ready to go and need some sort of certificate finalised, but that has still not happened. The buildings are there and four months later they have not been handed over to the school and opened. The school is understandably very worried about the lack of timelines and actual information as to when these Portakabins will be finished and whether or not they will be in place for August this year.

The Minister of State has also not provided any timelines in relation to the new build. That is of a concern. Four years ago, in 2018, there was a big announcement and all the Government Deputies were out congratulating themselves and patting themselves on the back that this was being done, and there has not been anything done since. In fact, the Department has delayed so long that the school build that was previously designed is no longer going to be suitable. It is looking at increasing the capacity of it. The school and the parents need information. I really hope the Minister of State asks the Minister to start putting things down on paper for them. I know that all the Deputies from Wicklow have written to the Department. We would like to meet with the Department in relation to this because we need to see movement on it.

Deputy Josepha Madigan

In terms of the Deputy's request, I am sure the Department is listening in to this debate. I will certainly bring the Deputy's request back to the Department. On the issue of temporary accommodation, as the Deputy is probably aware, funding of €556,150 was recently approved for temporary accommodation. Talking specifically about timelines, I do not have the information here. That is something that the planning and building unit will have. The Deputy will appreciate that, notwithstanding the wider construction environment of high inflation, labour shortages and supply chain issues, the Department has still a strong track record of delivery. It delivered 180 school building projects during 2022, and 273 still remained under construction coming into 2023. Most of those will be completed this year. I know that the planning and building unit within the Department is currently assessing its work programme and its priorities for 2023 in the context of available funding. I can understand the concerns that the Deputy has in relation to this school building project, the fact that there is an increasing demographic and that there are projections that there are children who will need accommodation in a school in their locality, notwithstanding the special education part of this and the fact that there are two rooms there that are currently not being utilised.

There are children who will need accommodation in a school in their locality, notwithstanding the special education aspect and the fact there are two rooms that are not currently being utilised. I am not sure whether the school has received the sanction it needs from the National Council for Special Education, NCSE. The Deputy may follow up with me on that if she so wishes. I do not want to see a situation in which rooms in schools that offer capacity for children with additional needs are not being used. The sooner we can progress this matter, the better. The project is at stage 2B of the architectural planning process and I hope it will progress further in early course.

Special Educational Needs

Deputy Martin Browne

On numerous occasions, I have raised the availability of autism spectrum disorder, ASD, classes and the challenges faced by parents in accessing those classes for their children. In my county of Tipperary, Carrick-on-Suir is one of the areas that has been the focus of my concern since I was elected to this House. For many years, parents have been faced with uncertainty at the start of each school year. I have no doubt the Minister of State, Deputy Madigan, is faced with this issue in her office, as is every Deputy in the Chamber. There is great uncertainty for parents of children with special needs, who are given only a couple of months to organise something for the coming year.

We see the exact same thing every year. Each year, we are faced with claims that there is no issue with the resourcing of ASD classes. We are given the old line that the current demand appears to be met by the currently established classes in surrounding areas. I assure the Minister of State that Carrick-on-Suir is not the only area in which people face these concerns. Parents are tearing the hair out of their head with worry about whether their children will get a place and, if they do, where it will be. Some have been told to keep their child back for another year in preschool. I know of a family in Tipperary town facing similar problems. The parents in that case have contacted school after school but have not been successful in finding a place for their child.

There is a serious issue with how the provision of ASD classes is organised and rolled out. For parents of neurotypical children, they know years in advance where their child will go to school. For the families of children with special and exceptional needs, however, no such plans can be made. Many such parents are left without any certainty only a matter of months before a place is needed. This issue needs to be addressed at this stage. I appreciate there is increased demand on the Department and planning is needed. However, planning for provision for children with special and exceptional needs should not involve the level of uncertainty being experienced by families. Clarity should be provided to them way in advance, not just a couple of months before the start of the school year.

I am often told I should contact the NCSE regarding the provision of classes for children with special needs. It is my duty to let the Minister of State know that the NCSE can be difficult to contact at times. Sometimes the council will point parents to classes that do not even exist. People rarely find themselves speaking to the same person twice, which is part of the problem. As I said, I appreciate the Department is under pressure. However, that is nothing compared with the pressure these parents are under every year. I urge the Minister of State to review the way in which this matter is approached and to design a system that has children and their parents at its centre, rather than inflicting panic on families every year.

As I said, I have been pursuing the issue of the provision of spaces in Carrick-on-Suir. Last week, I received a reply to a parliamentary question informing me that the Gaelscoil in the town is scheduled to open a new ASD class. I am told this class is planned to open for the 2023-24 school year and is expected to provide an additional six places in the area. This is great news for Carrick-on-Suir and Tipperary. Will the Minister of State confirm this will be done? Will she tell the parents in the area who need these spaces what arrangements they must now make and when applications will be taken?

Deputy Josepha Madigan

I thank the Deputy for raising this issue, which is of significant importance to me as Minister of State with responsibility for special education. Enabling students with additional needs to find appropriate placements in the education system is an absolute priority for me and for the Government. When talking about children with additional needs, it is important to stress that 97% of them attend mainstream classes, with the remainder attending special classes or special schools.

The Deputy asked specifically about the provision of ASD classes. Before addressing the situation in County Tipperary, I will refer to the issue more generally. We have a budget of €2.6 billion this year solely dedicated to special education. This accounts for almost 27% of the entire education budget, which is up 10% on last year. The budget also made provision for the appointment of 686 extra special education teachers and 1,194 additional special needs assistants, SNAs. This means we now have 19,000 special education teachers and 20,000 SNAs. That amounts to 40,000 qualified and committed staff who are wholly and exclusively dedicated to supporting children with additional needs. This resourcing aspect is the first point to make. There is not and should not be an issue with resourcing and funding special classes. We have opened 2,537 special classes this year, comprising 1,798 at primary level and 739 at post-primary level. In addition, the NCSE has sanctioned 386 new special classes for this year. There is a significant increase in provision, which is clear when we recall that the total provision in 2011 was only 548.

Regarding ASD classes, it is important to put the issue in context. There was a prevalence rate of 1.55% in respect of the provision of classes. That has now increased to 3.11%, which means it has grown exponentially in the past few years. There must be provision for children with additional needs, particularly those with autism, which is the substance of the Deputy's question. In County Tipperary, there are 106 special classes, of which 71 are at primary level and 35 at post-primary level. Over the past three years, we have opened 21 new special classes in the county at primary level and 11 at post-primary level. The Deputy is correct that parents need some succour and comfort in knowing when their child will be eligible for a special class and when he or she has secured an appropriate placement in such a class.

We expect the NCSE will confirm where the new special classes at primary and post-primary level, including in County Tipperary, will be sanctioned over the coming weeks. This is in keeping with timelines in previous years. The issue the Deputy raised is timely in that we expect those decisions to be made in the coming weeks, at which point parents will be made aware of whether and where their children will get a place. If the Deputy is aware of a child who has not secured an appropriate placement, he can contact me directly on the matter.

Deputy Martin Browne

Gabhaim buíochas leis an Aire Stáit. As I said, I appreciate the Department is under pressure on this issue, which arises every year. Every Deputy will have met the same problem. However, I do not get a sense that the Minister of State realises how serious this issue is for some families in certain places. When there are no special needs, parents can make plans from the time their child is in preschool for what primary school he or she will attend. For children who need an ASD class, parents have only a couple of months' notice on a yearly basis.

The process must be reviewed and it must be done in a much better way. I make no apologies for raising the situation in Carrick-on-Suir. However, it is not the only area in which parents are scrambling for spaces. I appreciate the Minister of State's indication that there will be extra classes in County Tipperary. She did not answer my question as to whether a class will be provided in the new Gaelscoil in Carrick-on-Suir, as indicated in the reply to my parliamentary question. Will she confirm whether the Gaelscoil will get the new class for the six students? Will she ensure the system is reviewed for the provision of the new places that are coming online to ensure it will not involve parents having to scramble for places in the middle of the summer, with September on their mind for their children getting an education?

That is the biggest worry for many people. I will forward the case in Tipperary town that I mentioned to the Minister of State. I appreciate what has been done and what has been spent in the budget but it is still not enough for families that are struggling to find places for their children. Will she confirm that the Gaelscoil in Carrick-on-Suir will get the extra ASD class?

Deputy Josepha Madigan

There are 106 special classes in Tipperary at present. It is expected that the NCSE will announce and confirm over the coming weeks where new special classes will be created in the county. I am not at liberty to say whether it is the Gaelscoil or not because there are still ongoing negotiations and engagement with various schools, not just in Tipperary, but in other counties as well. I would not like to in any way influence the outcome of any ongoing conversations. The Deputy made an important point on forward planning and in his initial contribution he pointed to the fact that neurotypical children have perhaps been catered for in a way that neurodivergent children have not been by the education system as a whole. I do not disagree with that but that has radically changed, particularly over the past three years. The fact that we have been able to create more than 600 primary special classes, 300 at post-primary and five special schools over the past three years shows the level of engagement and that the initiatives we have brought forward are bearing fruit. We have a detailed review of statistical data that is ongoing. We also have improved data-sharing arrangements. There is always an analysis of the accommodation capacity going on. A geographical information system from the planning and building unit now shares with the NCSE in real time where there is capacity and where there is not in a way that was not done in previous years. We now have future-proofing at post-primary level where all new 1,000-pupil capacity schools will automatically have four special classes, which is important. We have the modular accommodation framework and we also have a good deal of ongoing work with the fee charging sector as well.