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Dáil Éireann díospóireacht -
Wednesday, 26 Feb 2025

Vol. 1063 No. 5

Ceisteanna ó Cheannairí - Leaders' Questions

Parents of children with special needs are constantly coming up against brick walls while trying to access essential services for their children. The scandal of children with scoliosis and spina bifida, left in pain while waiting for their operations, has been one of this Government's most damning failures. The heartbreaking stories of people being left behind often involve excruciating waits for assessment of needs, being forced to enter lotteries to draw a secure, suitable school place and being denied basic medical care.

I raise the case of six-year-old Tiernan Power Murphy from County Waterford. Tiernan is autistic. He has been living in severe pain since last October. He needs three teeth removed. Tiernan's parents have been told that their little boy could be waiting up to ten years for this procedure. This news was broken to them by a public dentist. Tiernan lives in such daily agony that he can barely chew food or sleep. His father Éamon has described the effect of all this on his little boy. He says:

He is usually the best in the world, usually the happiest fellow. Now to see him like this, not eating properly, afraid to eat because it hurts to chew, screaming and throwing himself to the ground, hitting himself, it is horrible for him.

No child should be left in such a terrible, traumatic situation. No parent should have to watch their child endure this agony. My colleague, Teachta David Cullinane, has contacted the HSE on Tiernan's case. A solution needs to be found for this child and it needs to be found quickly.

However, Tiernan is not alone; far from it. He is just one of thousands of children being failed by the State on dental and orthodontic waiting lists. That is thousands of children waiting for dental surgery or even to get an appointment. A mockery is being made of Sláintecare waiting targets and in the most severe cases there are more than 7,000 children waiting for more than a year for treatment that they need so badly. There are 1,100 children waiting more than four years. These children are on orthodontic lists for jaw disorders and serious teeth problems. It is very clear that pediatric dentistry is in real crisis. It is not serving children and young people generally. However, the problem is even worse when it comes to a child or a young person with special needs.

A proper solution needs to be put in place so that all these children, like Tiernan, get access to timely, specialised care. The Government needs to get to grips with the wider issue of children waiting for dental treatment. Caithfidh an Rialtas gníomh práinneach a ghlacadh maidir le leanaí atá ag fanacht is ag fanacht ar chúram agus cóir riachtanach fiaclóra. What will the Government do to address all of this? We do not have the number of dentists and dental surgeons we need. There are just 23 HSE consultants and just 250 public-only dentists. That is 25% fewer than in 2006. What action will the Government take to deal with this crisis? What action will the Taoiseach take in relation to Tiernan Power Murphy?

I thank the Deputy. Before the Taoiseach responds, by way of information for new Members and those who are not aware, as I said yesterday, when we give details of a minor and it goes on the record, we must be cognisant that I expect it is with parental consent. We have to be cognisant of that minor reaching the age of majority and not agreeing with that. I caution that when Members use private details such as a diagnosis of autism in relation to minors I ask all Members to consider that.

To be clear, that has been sought and secured. This case is on the public record.

It is not a reprimand. It is just so that everybody is aware of the consideration that needs to be given.

I agree with the Deputy that it is absolutely unacceptable that a young child in these circumstances, Tiernan Power Murphy, should be denied urgent oral healthcare and dental healthcare in terms of the extraction of teeth.

The fact that we are dealing with the condition of autism as well exacerbates the unacceptable nature of this. The Minister of State, Deputy Mary Butler, has been in touch with and spoken to the HSE. The HSE, I understand, is engaging with the family on this and a solution will be found immediately in respect of this specific case, as it should be. I believe the regional executive officer has acted on this. My understanding is the case was not elevated to the regional executive officer.

That does not take away from the broader issue of oral healthcare, dental healthcare and orthodontics more generally. This has been an issue in engagement between the Department and the Irish Dental Association for quite some time. Initiatives were taken last year in respect of endeavouring to break logjams. Over €200 million is now invested annually in the provision of oral healthcare. I believe that when such large sums of money are now allocated to various services, and I am saying this from the Government's perspective, this is not a resource issue. There are fundamental issues within dentistry - I accept that - but within services, when large-scale allocations are being made, the idea that situations such as this cannot be resolved is not acceptable. There has to be a more responsive approach. I will be talking to the chief executive officer of the HSE in respect of this. To be fair to him, he endeavours to be solutions-driven in resolving cases of this kind. Very often when children have special needs, the additional needs compound the condition and the experience for the child in terms of the particular issue he or she may have, in this case, the necessity to extract three teeth and the child being in extraordinary pain on an ongoing basis. These issues should be elevated and resolved. There are enough resources to resolve them. The broader issue also needs to be resolved.

Go bunúsach, tá an-chuid anois á caitheamh ó thaobh caiteachais ag an Rialtas ar chúrsaí oideachais, ar chúrsaí sláinte agus go háirithe i gcomhthéacs leanaí le gánna speisialta agus breise. Tá an-chuid airgid ann anois. Caithfimid agus caithfidh an córas bheith in ann cásanna den saghas seo a réiteach agus a réiteach go tapaidh.

More generally, if the Deputy looks, for example, at the education budget now, which is quite substantial, 25% of it is allocated to special education. The general situation is changing in terms of the growth as a percentage of population of people with disabilities more generally. In terms of children, the 2016 and 2022 censuses show there has been a very significant increase in the number of people presenting with disabilities or conditions that reduce capacity. It is quite an extraordinary increase in terms of the general population. It is also quite significant in terms of children. That means we have to ramp up significantly expenditure and resources, which we have. If the Deputy looks at special education alone, the number of extra classes and extra teachers is quite significant compared to two or three years ago.

I am glad the Taoiseach agrees with me that this situation is entirely unacceptable, that children are left without access to urgent dental care. I also welcome the fact that the Taoiseach will, as I understand it, make a direct intervention in respect of Tiernan, because a solution needs to be-----

It was already done.

No, sorry. I did not-----

I am putting the question to the Taoiseach, with respect, not to the Chief Whip. I asked that the Taoiseach make an intervention, and I would appreciate it if he did that. The problem is that we cannot bring all 7,000 stories of all of those children waiting for more than a year, or the 1,100 who have been waiting four years.

We would do nothing else if we were to do that. I am concerned that the Taoiseach is not recognising the problem or his part in it. The Taoiseach is not a commentator; he has been in government for a very considerable period.

Thank you, Deputy.

I said to the Taoiseach that we have 25% less public dentists-----

Thank you, Deputy. Your time is up.

-----than we had in 2006. Therein lies the root of the problem, and we need to address it.

More broadly, as I said earlier, the Minister of State, Deputy Mary Butler, has been involved in this case and has spoken to the regional executive officer. As I have already said, prior to this being raised, the HSE has acted and has advised the Minister of State. The Minister, Deputy Carroll MacNeill, has also been in touch with the HSE. The family have been advised-----

-----by the HSE that this matter will be resolved. In this specific case, the intervention has happened and the Minister of State, Deputy Butler, has been advised that it will be resolved. I will discuss the broader issue with the Minister for Health and the chief executive officer of the HSE in terms of cases involved, such as this one, and, more broadly, in terms of the broader dental situation and children with additional needs.

Every week brings yet more news of Government failure, as the housing crisis further spirals out of the Government's control. This week, we saw daft.ie report that rents have risen by a staggering 43% since the pandemic. At the weekend, right on schedule, we were treated to the latest top-of-the-head idea from the Government. First it was tax breaks, then it was beds in sheds and, this time, the housing Minister made a rare appearance to say he wants to appoint a maverick person to kick-start delivery of homes, a sort of "fixer-in-chief". In 2021, when the Government launched Housing for All, the Taoiseach described it as forming the "basis for a long-term sustainable housing system for this and future generations". We all thought the Minister for housing would be the fixer-in-chief. Is this decision now to appoint an outsider to head up the Government's new strategic housing activation office an admission that the Government's policy has failed?

Fianna Fáil has held the housing brief for more than four years now. Those have been four years of failure, as acknowledged even by Government Departments. Department of Finance figures show that apartment planning permissions fell by one third in the first nine months of last year. The Department of public expenditure said this week that the Croí Cónaithe cities scheme was too small to ensure that apartment building could be viable. We are increasingly hearing from Fianna Fáil TDs the mantra that international finance will not invest in building apartments here unless they can get a higher rate of return. That is code for saying that renters will have to pay higher rents. That is what was so dishonest about Fianna Fáil's general election campaign on housing. Fianna Fáil misled us all on the figures for housing completions, continuously promising 40,000 new builds last year when the true figure was 10,000 less than that. Fianna Fáil did not make proposals for tax breaks for developers until after the election, and did not talk about rent increases or the growing crisis in apartment financing.

The truth is there are solutions which lie in a radical reset of housing policy, as the Housing Commission recommended. If the private sector and international capital are not engaged in financing the building of apartments, then the State must step in because only the State has the deep pockets necessary to underwrite the true level of risk and investment needed. The market has failed and ordinary workers and renters cannot bear the level of rents that speculators would want.

Apartments constitute vital strategic infrastructure, as well as vital homes for our communities. Alongside our plan to scale up the Land Development Agency, the Labour Party proposes several State-led solutions to the apartment financing crisis. Here is one. With €140 billion sitting on deposit in overnight and demand accounts in our banks, why are we not offering people a State-backed solidarity bond to finance housing? At the same time, the State is salting away €4 billion a year into the Future Ireland Fund. Will the Taoiseach consider deploying these funds, through the Housing Finance Agency, the strategic investment fund and other State funding vehicles, to deliver the homes and apartments that our communities so badly need?

The bottom line is that the State has intervened very strongly and assertively in the housing market. The State is the main player, I would argue, in the housing market right now in terms of the level of State investment. That is increasing and has increased over the last number of years. As I said yesterday, we are at record levels of social housing new builds compared with the last three decades. The Deputy can go back and compare and contrast. We need to get that figure of 8,000-plus to about 10,000 new builds and add about 2,000 more in terms of leasing to deal with homelessness cases and new acquisitions.

The Deputy keeps saying things we have not said. I never said that we wanted to increase rents or end the RPZs. I challenged her last week to produce a quote where I said I would end RPZs and of course she cannot find one because it does not exist.

I am struck by the degree to which the debate gets so easily distorted by commentary in the public sphere. It is interesting. There seems to be no space to tease out and discuss issues without the immediate assertion, allegation or branding of a comment into a nice box that fits the political slogans and so on but does not add any solutions to anything. The real debate in the election was how to get to 50,000 units per annum because every party accepted the figure of 50,000 that the Economic and Social Research Institute, ESRI, says we need. The Labour Party came forward with the national housing construction agency with very little detail on it. Even when I met it subsequently in the context of Government formation, there was very little detail on it. There was no paper or document. It seemed to go back to the direct labour approach. The Labour Party seemed to envisage a national construction agency that would employ thousands of people to build homes. That is not feasible in the current era. It will not happen and it would delay the process of house building even further.

The Labour Party had further ideas around the LDA, which were unspecified. It took two years to legislate for the LDA. My argument during the election debate with Deputy Bacik was quite simply that all of that would delay and disrupt the momentum of trying to get more houses built. We need more houses to be built. We need to get the existing agencies, local authorities, approved housing bodies and the LDA working and not be formulating new schemes and agencies which, by definition, all takes time. That was the Labour Party proposition.

For example, the Deputy made comments about my statement about getting private sector investment in. It is like performance arts in here. One would imagine I had said something terrible when I said we need to get private sector investment in.

Thank you, Taoiseach. Your time is up.

I can come back.

Yes. You can come back in.

I am very disappointed by the Taoiseach's response because he did not address the substantive points I raised about the need to ensure a State-led response to the crisis in apartment financing. Instead, he engaged in dismissing Labour Party proposals. At least the previous housing Minister, Deputy O'Brien, accepted that we offered constructive opposition on housing in this House.

You used to, in the past.

We supported the LDA. We put forward proposals for transforming the LDA into a genuine vehicle for delivering homes at the scale that is needed.

What does that mean?

Fianna Fáil refused to engage with us and the Taoiseach's dismissive and increasingly tetchy attitude in this House really indicates exactly why-----

He is increasingly tetchy, positively frothing with rage over some of the proposals we have made.

(Interruptions).

It is true. The Taoiseach may laugh, but it is increasingly-----

The tetchy Taoiseach.

A Deputy

It is performance politics.

A few people tried that.

It is increasingly evident.

It is called political debate.

The Taoiseach knows that in the Labour Party manifesto we put forward-----

Deputy, your time is up. I ask the Taoiseach to respond.

-----careful proposals to transform-----

Thank you, Deputy.

-----the building of homes in this country. He would not engage and he continues to dismiss our ideas.

Actually the State is involved in the apartment building area at huge cost and a genuine debate would ask whether there are better ways of doing it. I do not know what the Deputy means by turning the LDA into a genuine vehicle, as though it is not genuine now. However, when I indicated last week, as everyone outside agrees, that we need private sector investment-----

We are proposing a better idea.

Most economic people and experts in housing are saying it.

I never disagreed with that

The Deputy attacks people for mentioning it. She moves straight to tax breaks. She might benefit from looking at the history of her party on this. I quote:

We are creating this process for bringing in private investment. I hope to launch a new scheme in relation to investment in social housing in the near future, a new process for bringing in investors.

Can we guess who said that when he was Minister for housing? It was Deputy Bacik's current colleague and former party leader, Deputy Kelly-----

We have no issue with that.

-----back in the day when AK47 was firing on all cylinders.

You created the mess in the first place.

When I mentioned it last week-----

You crashed the whole country.

-----there was outrage and hyperbole.

The Taoiseach was part of the Government that crashed the country. It crashed the country and he is still spouting off.

No, this was before the 2016 election.

The Taoiseach's time is up. I call Deputy Cian O'Callaghan of the Social Democrats.

Do not get tetchy, Alan.

You are the tetchy one. It is you, not me. I have already got my nickname, sorry.

(Interruptions).

Radie Peat of Lankum and Dan Lambert, manager of Kneecap, recently spoke about their experiences as parents of a child with additional needs. Speaking with Oliver Callan on RTÉ radio, they described the challenges that they, and thousands of families like them, face in battling to get supports for their child. Since their child was 17 months old, Radie and Dan realised she was autistic and non-verbal. Despite this, she will not get the supports she urgently needs until she is six and a half years old. The story Radie and Dan have shared mirrors the experience of thousands of other families. After looking for help, their belief that they would get the necessary supports was quickly shattered. From the outset, they were told their child would not get what she needed in a timely manner. They were advised to leave Dublin. They were told their child would get better support in any other European country and that they would be better off leaving Ireland. They were told they would have to battle continuously to get access to basic supports and that nothing would happen at the appropriate time. All this resulted in them feeling completely overwhelmed.

Radie spoke of how she had to cry and beg as she navigated a grossly under-resourced system and how trying to figure out how the systems work is like a full-time job. She spoke about fighting and battling to get to the next step in the process, only to realise when she got there that there is nothing there and about how doing all this while working and supporting a child is completely and utterly exhausting. Radie and Dan were speaking not only about their experience but about the experience of thousands of children and families in similar situations.

Some 14,221 children are overdue for an assessment of needs and a further 12,920 children are on waiting lists for children's disability network teams, CDNTs. The Taoiseach is aware that early intervention is key and that there is no time to lose. Children with additional needs are being left behind while their parents jump through hoops to try to access basic services and supports. Last May, I asked him about the 700 vacancies in CDNTs, with some areas experiencing staff shortages as high as 60% and even 70%. How many of these vacant posts have been filled? When will children with additional needs get the access to basic supports and services they urgently need?

I thank the Deputy for raising this issue. I accept fully that the journey of parents of children with special needs is an extremely challenging, difficult and traumatic one. They simply have to fight too hard and too long for access to services and in some cases, though not all, for education and access to school places. It is my objective as Taoiseach to change this story and it is a key priority of mine, along with housing and child poverty. They are the key priorities of my term as Taoiseach and of the wider Government.

I am establishing a disability unit in the Department of the Taoiseach. We had our first meeting with about eight Ministers earlier this week and a disability Cabinet subcommittee will follow. All Ministers are clear that there must be a whole-of-government response to the issue of disability more generally - it is wide - with a particular focus on children in education and then on assessment of needs and, more critically, access to therapy services. In the first instance, we must deal with the assessment of needs issue. The 2022 High Court judgment of Ms Justice Phelan in the case of C.T.M. (a minor) v HSE has created a situation where there are huge resources and backlog in the area of assessment of needs. The Deputy is correct that the number is 14,000. That is not tenable. Legislation has to be brought in to deal with this. That will happen and there will be engagement with the House on it.

We have to get the right balance of existing resources to the services and the provision of services. You do not have to get an assessment of need to avail of services. You should have an entitlement to services even when awaiting the assessment of need. The Minister for Education is developing proposals for a school-based therapy service beginning in special schools. This was a commitment we made in the programme for Government which we are going to see through. The CDNTs and HSE are continuing to recruit across the 93 CDNTs. The current recruitment campaign has issued about 145 job offers across key therapy roles. Progress is slow. There was a 17% increase in staff from 2023 to 2024 and another 111 are expected to join soon. The vacancy rate has dropped by 7.9% to 21%, but none of that is enough. It is not adequate.

I thank the Taoiseach. You can come back in.

There will be a relentless focus on this for the lifetime of this Government.

There continues to be a huge level of vacancies that need to be filled. The Taoiseach keeps on blaming the 2022 High Court judgment which found the Government to be in breach of legislation. When will the Government get children the access to what they urgently require rather than blaming that judgment? This Friday, a group of 50 parents will hold a sleep-out outside the Department of Education because their children cannot get the school places they need. Parents should not have to sleep out in order to assert the rights of their children to access an education they desperately need. When is this going to change? When will there be enough school places for children with additional needs? When is the Government going to stop failing children with additional needs? When will the vacant and empty posts be filled on the children's disability network teams?

I will come back on the situation on the CDNTs. That recruitment continues.

On education, it should be acknowledged that there has been a huge increase in public expenditure, and rightly so, on special education. It now constitutes 25% of the overall education budget, or about €3 billion now. Money, however, does not mean a whole lot to people if they are waiting for school places. We have some 23,000 special needs assistants now in our schools. We have 20,800 special education teachers. The number of special classes has doubled in the last five years to 3,336, serving 20,000 students, and 11 new special schools have been established, with five more planned for this school year 2025-26. With regard to the September deadline, the Minister for Education is clear that we want to ensure all children get a place by September. Working with the NCSE, we will focus very strongly on that.

On the education side, there has been significant progress over the last number of years. We just have to make sure that the system is almost automatic in that children or their parents should not have to be under pressure in trying to secure a place for their child.

The Taoiseach's time is up.

The last decade has seen a big shift in public policy towards childcare in this country. The State now recognises that the first five years are a critical developmental time for young children and has built a range of supports for parents and children so they can give their children the best start in life. As part of those supports, the State now seeks to make early learning and care accessible and affordable. There has been real progress in recent years, including the doubling of investment in early years education, the halving of childcare costs and the huge increase in the number of parents using the national childcare scheme. All those numbers are going in the right direction. The progress is only as good as the political will behind it, however. Much of the sector and many parents are looking at the new programme for Government and asking where that political went.

The new programme for Government makes no commitment to and absolutely no mention of creating a legal right to the two early childhood care and education, ECCE, years. This is despite that commitment being in both of the manifestos of Fianna Fáil and Fine Gael. Where did the commitment go? Did the Independents ask the Government to drop it, did the Department of Public Expenditure, NDP Delivery and Reform get involved or did the Government just forget all about it? At a time when the loss of childcare professionals from the sector is a key threat to increasing capacity, the programme for Government merely commits to a business-as-usual approach to pay increases for staff.

When it comes to the development of a public model of childcare, a policy change that was absolutely central to the general election debates only four months ago, the programme for Government could not be more vague. There is a promise of an action plan but no timeline and no specific numbers. It is a long way from Fine Gael's commitment to 30,000 public childcare places by the end of 2030.

I am not fully clear what the Taoiseach's own position is on the concept of the public model of childcare. That is at the heart of this. We have made a lot of progress but we have still to take that most important step and recognise that only the State can guarantee access to childcare in areas where private or community services have not been established. A public model of early learning and care is the final step that brings together the various reforms that have been undertaken over the last number of years. It is this which the new programme for Government fails to recognise.

Will the Taoiseach commit to legislating to ensure that every child has a legal right to the two years of the ECCE programme? Does he believe that the work childcare professionals do is as important as that of teachers and that the State needs to pay them in a way that recognises this? Does he agree that a public model of childcare, working alongside private and community providers, is the best way of ensuring that all children and parents have access to affordable and accessible childcare wherever they live in our country?

I will start by acknowledging the work the Deputy did when he was the Minister responsible for this area in the last Government for close to five years. I hope he acknowledges the commitment of the Fianna Fáil and Fine Gael parties, with the Green Party, to the issue of childcare during the last Government when it dealt substantially with pay and conditions and money was allocated to successive Ministers for public expenditure in respect of the agreement with the trade unions on pay and conditions. The unions acknowledged that at the time. There was the freeze on increases in the cost of childcare and there was very significant investment in childcare itself.

It struck me that when Members are in opposition they talk very nobly and are principled about the public childcare system, but I do not see great models. I remember talking to the Social Democrats about this in our preliminary meeting. There was no detail. I remember people saying to me that it would be done gradually, on a phased basis, and that an inventory or audit must be done first. The problem is that it is a bit more complex than that. We can all commit to a public model but if one is committing to that, there is an obligation to outline it. What would we do with community play groups? Would the State take them over? Would the State take over the private sector provision? It could be done in a different way. It could be done with special needs first and children with additional needs. There have been Green Papers as far back as the late 1990s suggesting that the State and the Department of Education should be more involved in the provision of early-based education for children with special needs. The Department did get involved in the syllabus, the curriculum, Síolta and all of that, as well as other aspects.

There is an onus. It is great to make the great announcement but, with respect, the Deputy was in government for the last four and a half years. No model came forward to me about a public model for childcare because the Deputy had to deal with the realities - the fiscal reality and budget realities. As Minister, he made a lot of progress in respect of childcare, as we all did collectively, but we need to do an awful lot more. A fundamental call needs to be made. How do we deal with the existing structures? Fianna Fáil created the ECCE scheme at the time and it has been expanded. The childcare model has evolved from when it was originally in the Department of Justice through the NOW programme. It has been expanded dramatically through childcare county committees and through different iterations. It is now in the Department of children. To be frank, the answer as regards increased resources, increased expansion of places and more resources to try to decrease the cost to parents is "Yes".

I thank the Taoiseach. From my experience over the past four years, I am well aware of those complexities but I am also of the strong belief that if we just continue to pump money into the existing system and continue our reliance on the existing system, we are not going to be able to deliver the sea change we need to ensure every child has access to the quality early learning and care he or she needs.

There seemed to have been an agreement across political parties during the general election, but the desire and opportunity to provide leadership at the start of a new Government's term is not apparent in the programme for Government.

Yesterday, in response to a question from Deputy McDonald on special education, the Taoiseach cited the constitutional right to primary education. However, there is no right in the Constitution or in legislation to the two years of the early childhood care and education, ECCE, programme. The Taoiseach's party promised that in its manifesto and Fine Gael promised it in its manifesto but there is no reference to it in the programme for Government. That is part of the State taking parental involvement in the delivery of-----.

Thank you, Deputy. Time is up. Just before the Taoiseach begins his response, I will mention that we will have a minute's silence after Leader's Questions to mark the anniversary of the invasion of Ukraine.

The immediate issue is primarily the allocation of resources and also working through what we mean by public health model and how we integrate it with the school-based model for children from the age of four and a half or four years upwards. That is the big question. We then have to ask about the funding implications of that and identify how much would it cost and how we would plan, in terms of the overall allocation of resources, to give effect to it. That is work that can be done. It could usefully be done by an Oireachtas committee in respect of childcare, just like we did in terms of healthcare and other areas in the past. It needs a fairly detailed analysis and engagement with all of the stakeholders in the area of childcare.

We can create legal rights and constitutional rights, but, fundamentally, the real meat is in the provision of resources, with structures and systems that give the desired outcome of access to childcare places for everybody who requires it.

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