I thank Members of the Seanad for giving me the opportunity to outline details of some of the initiatives that have been taken in recent years by this and the previous Government to enhance the level of support available to people with autism. The main areas on which I intend to speak relate to the health-funded services for people with autistic spectrum disorders and the educational services that come within the remit of the Department of Education and Science.
The philosophy underpinning the planning and delivery of services to people with disabilities, including those with autistic spectrum disorders, is that people with disabilities should be given the opportunity to live as full a life as possible and to live with their families and as part of their communities for as long as possible. Factors influencing current policy include the health strategy, Quality and Fairness, which was published in November 2001, and Government policy on the mainstreaming of services for people with disabilities.
Policy must also be underpinned by appropriate structures that facilitate access to and delivery of support services. As part of the planning structures in place, health boards have been working at regional and local level with families of people with autism and service providers to identify needs and plan responses that will meet them.
The Department of Education and Science makes educational provision for children with special needs in three ways: in special schools, special classes attached to ordinary schools, and integrated settings, in other words, integrated into mainstream classes. The main basis for provision is the assessed need of the individual child. The policy of the Department of Education and Science is to achieve as much integration as possible and also to take account of the views of parents.
Some 108 special schools and more than 500 special classes are attached to ordinary schools. Both special schools and special classes enjoy lower pupil-teacher ratios, the ratio depending on the specific disability for which the school or class caters. These schools and classes are also supported by the allocation of special needs assistants and additional capitation funding.
Since the Government decision in October 1998 that all children with special needs in the primary system should receive an automatic response to their needs, there has been significant expansion in provision for children with special needs in integrated settings in ordinary national schools. The significance of this expansion can be gauged from the increase in the number of resource teachers which, between 1998 and now, rose from about 100 to more than 2,300. Similarly, in the case of special needs assistants, numbers have risen from about 300 to almost 5,000. In recent years and in line with these developments, the Department has also increased provision for in-career training in the area of special needs.
The Department of Education and Science also provides other services for children with special needs, such as a home tuition service which is designed to cater for children who, because of their disability or illness, are unable to attend school for prolonged periods. In addition, the Department provides special equipment for children with special needs.
There has been significant investment in support services for people with physical, sensory or intellectual disabilities and those with autistic spectrum disorders. Since 1997, additional funding of about €555 million has been invested in these services, of which almost €340 million was allocated to services for persons with autism and those with an intellectual disability. Between 2000 and 2002, for example, the additional funding provided for these services was used to put in place, in addition to a range of other services, more than 900 new residential places, about 380 new respite places and about 2,000 new day places.
More than €15 million has been invested in health-related support services for children with autistic spectrum disorders and those with intellectual disability. This includes diagnostic and assessment services, early intervention, home support and outreach support to children of schoolgoing age. Some €6.35 million of this funding was specifically targeted for services for children with autistic spectrum disorders, with the balance for both the autism and intellectual disability services.
There has been an increased emphasis in the health services on in-career training, some of which is provided by staff working within the services. The Department of Health and Children and the Eastern Regional Health Authority have provided funding towards the development of an e-learning module for health professionals which is being developed by Trinity College.
The Department of Health and Children also supports the development, in partnership with the North Eastern Health Board, ERHA, Aspire, Irish Autism Alliance and the Social Communications Disorders Group, of a computerised social skills programme for adolescents with Asperger's syndrome or high functioning autism. It is intended that this training programme, when completed, will be made available to professionals and parents to assist them in working with this group. Training for families, including siblings, is also an area the health services would like to see expanded.
While this major new investment programme over recent years has undoubtedly made a significant impact on the level of service provision, it is accepted that a sustained programme of further investment is required if we are to provide the level of support identified as required to meet the needs of people with disabilities. In addition to resources, other factors must also be in place to deliver quality and effective services designed to meet individual needs, some of which I will seek to address later.
There have been a number of developments in the provision of an automatic response to children with autism. Since 1998, the Department of Education and Science has created some 115 classes for children with autism in ordinary national schools and special schools. These classes operate with a minimum staffing of one teacher and two special needs assistants for every six children. However, that level can be augmented depending on the needs of the individual children.
The Department has also funded a number of stand-alone units that are not integrated into ordinary national schools. Support for these units was committed on a pilot basis. The first was established in Cork in 1999 and is known as CABAS Cork. Since then, further projects have been established in Kill, County Kildare, and Kilbarrack in Dublin. The Department's inspectorate has undertaken an inspection of these units as well as of other autism specific provision in the system to inform development of future policy and to assist in the development of best practice.
The report of the task force on autism, published by the Minister for Education and Science in late 2001, contains many recommendations which, when fully implemented, will further improve provision for both children with autism, high functioning autism and Asperger's syndrome and their parents. The principles associated with the task force recommendations would also apply to children with other special needs and their parents. It has been widely acknowledged that until the automatic response decision in 1998, the level of resources applied to special needs was not what it should have been. However, as in the case of the health services, the issue is not just resources. There have been weaknesses in the structures for the delivery of special education services and also in the wider legislative framework within which such services are delivered.
As already stated, the provision of additional resources, while extremely important in the context of delivering an enhanced level of support to people with autistic spectrum disorders and other people with disabilities, is not the only response required. There is also a need to look at the structures which underpin the delivery of those supports.
It is essential that my Department can access data at national level in respect of people with disabilities who are accessing health services or may have a need to do so in the future. A national database can inform planning, service development, the prioritisation of service needs and resource allocation at national, regional and local level. The information from the national intellectual disability database played a key role in accessing the additional funding which has been made available in recent years. My Department, in conjunction with the health boards and the voluntary sector, is currently implementing a national physical and sensory disability database. While some persons with autism who also have an intellectual disability are included on the national intellectual disability database, it does not contain information on this group as a whole. While the database provides information in respect of the level of services being provided and current and future needs, it does not identify persons with specific disabilities such as Down's syndrome or autism. Its principal role is as a planning and monitoring instrument.
Initial work was carried out during 2002 on the development of an information system which would give a level of information on the needs of persons with autism similar to that already available from the national intellectual disability database. This work is being continued during 2003 and consultation will take place with the health boards, service providers and persons with autism and their families.
My Department will work closely with the Department of Education and Science on the information requirements of the new National Special Education Council. There has been, as I have already stated, a significant programme of new investment in services, including early services. The health boards are in the process of developing regional autism diagnostic, assessment and support teams. These are at different stages of development. The availability of these teams, together with input from other areas of expertise, will facilitate the move towards more uniformity regarding diagnostic and assessment services in general.
One of the major difficulties facing the health service in delivering support services to people with disabilities and those in other areas of the service is the shortage of certain professionals such as speech and language therapists, occupational therapists, physiotherapists and psychologists. Progress has been made in this area and also in implementing the recommendation made in the Bacon report on manpower planning. Significant progress has been achieved in boosting the number of therapy training places in line with the recommendations of the report, Current and Future Supply and Demand Conditions in the Labour Market for Certain Professional Therapists, prepared by Dr. Peter Bacon and Associates and published in June 2001. The report concluded that a major expansion was essential in the numbers of therapy professionals over the next 15 years, comprising an increase of over 150% in occupational therapists and a fourfold increase in speech and language therapists.
On 29 May 2002, the Ministers for Education and Science and Health and Children announced some additional therapy training places in speech and language therapy and occupational therapists. The University of Limerick is to offer 25 places on a Master of Science programme in occupational therapy and 25 places in speech and language therapy. NUI Cork is to offer 25 places on a Bachelor of Science programme in occupational therapy and 25 places in speech and language therapy. NUI Galway is to offer 25 places on its programme leading to a BSc in occupational therapy and 25 places in speech and language therapy. The colleges have been working intensively to plan the provision of the speech and language and occupational therapy courses. Efforts have been made to recruit services and personnel and the recruitment of staff is well advanced. There has also been communication with the relevant professional bodies to ensure that the proposed programmes are accredited.
Following the joint announcement in May 2002, the Bachelor of Science in physiotherapy in the University of Limerick commenced in the 2002-03 academic year with an intake of 28 students. It is envisaged that the masters programmes in speech and language therapy and occupational therapy at the University of Limerick will commence in June 2003 with an intake of 25 into both courses. These courses are accelerated conversion courses, the first graduates of which will be produced in two years. NUI Cork has made provision for a CAO entry in September, 2003 for both the Bachelor of Science course in occupational therapy, which has 25 places, and the Bachelor of Science course in speech and language therapy, which has 25 places. The option of a programme to allow students with suitable backgrounds to enter into the second year of a degree programme in October 2003 is currently being considered.
NUI Galway plans to commence its intake of students into both programmes – the Bachelor of Science course in occupational therapy, with 25 places, and the Bachelor of Science course in speech and language therapy, with 25 places – in September 2003. NUIG is also investigating the possibility of accepting suitable students into the second years of the programmes in September 2003. In addition, the universities which are already offering degree courses in these specialities have increased the number of places being offered in the past number of years. The occupational therapy course in Trinity College increased its intake from 30 to 35 students in the 2000-01 academic year and further increased its intake in the 2001-02 academic year to 41 students. A total of 40 students were accepted in 2002-03. The speech and language therapy course in TCD enrolled 26 students in 2000, this increased to 32 in 2001 and 29 were accepted in 2002.
Intensive efforts have been undertaken to improve staffing levels in speech and language therapy and occupational therapy, both at local and national level. One development has been the continued implementation of the recommendations of the report of the expert group on various health professions – developments to date include the introduction of common pay scales for the therapy professions and pay structures. There have also been changes to the career structure, including the introduction of the post of clinical specialist, and many other posts have been upgraded from basic to senior level in line with the recommendations of the expert group. Management grades have been restructured and the focus on broader management issues has increased.
Other developments have been the undertaking of a concerted overseas recruitment drive on behalf of all health boards, the introduction of a fast track working visa scheme for health and social care professionals, the streamlining of procedures for the validation of overseas qualifications and the planned significant expansion in the number of training places in speech and language therapy and occupational therapy referred to above. The success of these measures is reflected in the increase in the numbers of speech and language therapists and occupational therapists employed in the public health service over the three-year period to the end of 2002.
In 1999, for example, 371 occupational therapists were employed by the health services, but three years later in 2002 there were 642 occupational therapists. This represents a percentage increase of 73% over three years. In 1999 there were 345 speech and language therapists; three years later, in 2002, there were 460 employed by the health boards, which represents an increase of 33%. A concerted recruitment drive for the therapy grades is currently being conducted on behalf of all the health boards by the Northern Area Health Board. This has resulted, to date, in the recruitment of 20 occupational therapists and eight speech and language therapists.
Following the publication of the report of the joint review group on psychological services in the health services in March 2002, a major priority for the Department was to promote an integrated and co-ordinated approach by the health boards to its implementation over time. This applied, in particular, to the major recommendations of the report relating to the organisation and management of psychology services, entailing substantial increases in the number of principal and director level psychologist posts.
Given the key role of the Health Boards Executive in fostering collective working and progressing organisational change and development in the health service, the Department secured the agreement of the executive to work with the directors of human resources in the health boards towards the implementation of the recommendations in the report. The current position is that the directors of human resources are in the process of giving individual consideration to the recommendations contained in the report and to how their boards might propose to proceed with the implementation process over a period.
My Department, together with the directors of human resources in the health boards, is prioritising support for the implementation of a key recommendation of the joint review report relating to human resource planning through the provision of a substantial number of additional postgraduate training places in clinical psychology. This has resulted in a threefold increase from the end of 1999 to the end of 2002 – from 26 to 83 – in the number of trainee clinical psychologists employed in the health services. This development in enhancing graduate output will help maintain an improved balance between demand and supply in human resource and service provision.
The Department remains committed to working on an ongoing basis with health agencies, educational providers and the education authorities to ensure adequate provision of training places in clinical psychology, consistent with the medium-term human resource requirements of the health services as detailed in the joint review group's report and the important recommendations on investment in training and education detailed in the action plan for people management published in November 2002. A particular priority is to ensure the best return, in terms of graduate output, on the significant financial resources currently being invested in the health services to support post-graduate clinical psychology training. Consequently, the Department, together with the health boards' directors of human resources, is examining the current model for post-graduate psychology training, with the objective of supporting training provision on a planned and sustainable medium-term basis.
At present, there are approximately 105 clinical psychologists undertaking postgraduate training in the State. Over 60 students are enrolled on the Psychological Society of Ireland's clinical psychologist postgraduate training diploma. A total of 24 are enrolled on the doctoral programme in clinical psychology at Trinity College – 12 in first year and 12 in second year – and 19 are enrolled on the doctoral programme in clinical psychology at UCD – ten in second year and nine in third year. It is understood that both the National University of Ireland, Galway, and the University of Limerick have plans to introduce doctoral programmes in clinical psychology in 2003, with an intake of a further 20 students in total. There has been a significant increase in excess of 40% – an increase of 121 to 412 over the three years to the end of 2002 – in the numbers of fully qualified psychologists working in the health service. This has contributed to a significant increase in the volume of psychological services provided.
In addition to measures to increase the supply of psychologists through the implementation of the recommendations of the joint review report, other efforts have been undertaken to improve staffing levels in the psychological services, both at local and national level. Relevant developments include the recruitment of psychologists from overseas by the health boards, the introduction of a fast-track working visa scheme for health and social care professionals, the streamlining of procedures for the validation of overseas qualifications and the devolution of responsibility for recruitment of basic grade psychologist posts to health boards from the Local Appointments Commission. Ongoing pay enhancements through the implementation of the recommendations of the public service benchmarking body will make a further contribution to reducing current vacancy levels by increasing the attractiveness of employment as a clinical psychologist in the health services.
The Department of Education and Science has been aware that its capacity to respond administratively to demands for special education services has been limited in some respects. For this reason, as Senators will be aware, the Department has decided to establish a national council for special education. The intention is that the council will fulfil a number of functions. First, it will provide advice to the Minister on responses and provision for children with special education needs. In addition, it will provide a local presence on the ground in the form of special education needs organisers who will be charged with drawing together provision for children with educational needs. The council will also provide a vehicle for dissemination of information and guidance on best practice in relation to responses to special needs. It is intended that, associated with the council, there will be an appellate structure to enable parents to appeal in relation to responses to the special educational needs of their children. It is also intended that the council will be established initially by an order under the Education Act 1998. The council will subsequently be catered for in primary legislation when the new education for persons with disabilities Bill is enacted.
The Education for Persons with Disabilities Bill 2002 which, in the lifetime of the previous Government, had been passed by the Seanad, was not reintroduced by the current Minister, Deputy Noel Dempsey, who was anxious that a further period of consultation would be facilitated to allow interested groups and parties to make submissions on the legislation. That process was completed and the new Bill is now at an advanced stage of interdepartmental consultation with a view to early approval by Government and publication.
The Government regards these more fundamental structural and legislative reforms as the key to enabling improvement in delivery of services for children with special needs and their parents. It is intended the new education for persons with disabilities Bill will cover the range of issues including assessment, responsibility for provision, appeal processes, individual education plans and so on. In drafting the Bill, the Department of Education and Science is attempting to clarify how the needs of individual children should be met, both by the education and health services. Clearly the Departments of Health and Children and Education and Science need to work together at the macro level with a view to ensuring that we have "joined-up Government" in terms of development of policy in respect of responses and the resourcing of services for children with special needs. Equally, at local level, there are issues whereby health boards, service providers and education services can operate in an integrated way. Clearly, the Department of Education and Science's capacity to work in an integrated way on the ground locally is very limited at present. For this reason, the national council for special education will be particularly critical in enabling integrated responses to be pulled together at local level.
In this regard, the National Educational Psychological Service, NEPS, has been doing a significant amount of work in terms of producing procedures and structures which will enable close co-operation to take place between NEPS and the health boards. In establishing new structures and putting in place agreed operational protocols, particular regard will be given to information dissemination so that parents of children with autism will not have the additional burden of not knowing where to turn for particular services.
I emphasise that while many advances have been made in recent years, much still remains to be achieved. However, progress can best be made through partnership, whether this is at national, regional or local level. While both the health services and the educational services have worked together over the years to deliver appropriate support to children with special needs, these efforts will undoubtedly be greatly assisted by the new legislation, the establishment of the National Council for Special Education and the increased availability of allied health professionals. These measures will also assist families to access the support which they require.
The availability of improved information, together with the ability to specifically target resources at agreed priority needs, will enable both children and adults with autism to receive the support which they require as they move through the various stages of life. It is in this spirit that the Department of Health and Children looks forward to the many changes – legislative, structural and service related – which will undoubtedly take place over the coming months and years.