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Seanad Éireann díospóireacht -
Wednesday, 10 May 2017

Vol. 251 No. 10

Commencement Matters

Schools Building Projects Status

I welcome the Minister for Education and Skills to the House. Senator Richmond is first and he has four minutes to make his opening remarks.

I thank the Cathaoirleach for the opportunity to speak on this issue. I am very grateful to the Minister for coming to the House and I also thank him and his officials for their engagement with me on this and many other issues in the educational sphere in recent weeks.

I bring this matter to the floor of the House following repeated and frustrating correspondence between the local school community and departmental officials. I want to go through the background to this matter and to outline the outstanding issues that need to be addressed urgently and clearly. This goes back to initial meetings on a new school that I attended in 2010. Unfortunately, after much initial progress and enthusiasm from all parties there has been a continuous cycle of expectation, disappointment and anticipation relating to this project which is part of the Department's six-year capital programme.

In the short term, a series of questions need to be answered and I would appreciate if the Minister could provide answers today or at least send on the information to me and the school community later this week. What facilities will be made available for Ballinteer Educate Together national school in its short-term accommodation in Notre Dame? How many classrooms will be made available in that short-term accommodation? What size classrooms will be made available? How many pupils will be on campus from the other two schools at the Notre Dame site? What school start and end times are envisaged for Ballinteer Educate Together national school at the short-term site? What traffic management plans will be put in place? In light of the decision to bring all schools on campus this September, what arrangements have been made with the other two schools at the Notre Dame site? What arrangements have been or can be made to provide a school bus service to the Notre Dame campus?

As the Minister is aware from previous correspondence, it is my personal opinion that the short-term plan to move Ballinteer Educate Together national school to the site of Notre Dame in Churchtown is far from ideal, putting parents under undue hardship and diminishing the strong links already made by the school to the local community. In the context of the medium-term plan to build a permanent home for the school adjacent to St. Tiernan's community school, the school community is understandably frustrated and angered by the perceived delay and difficulty in dealing with departmental officials, in terms of getting answers. In that context, I have another series of questions that need to be answered and I would appreciate if the Minister could respond today or send on further information at a later date. First, at what stage is the purchase of the required land to allow for acceptable access to the new school? At what stage is the planning application? When will the planning application be lodged? What needs to be resolved before the application can be lodged? When will the school be built and when will the permanent school be opened?

The questions I am putting to the Minister this morning are all pretty straightforward. As we approach the end of the school year, a very large school community is deeply frustrated and angry at the severe delays in obtaining answers to legitimate questions. My office has been inundated with correspondence relating to this issue for quite some time from parents in the immediate area and from a catchment area that stretches way beyond the local environs into Bray in County Wicklow and across to Tallaght, County Dublin. I most recently attended a parent teacher association meeting at the school on Monday. The levels of confusion and uncertainty are worrying. I ask the Minister to prioritise this school and to ensure that the maximum levels of transparent information are provided regularly.

I thank Senator Richmond for raising this issue. I can understand the concerns of parents because the situation is unusual, in that temporary accommodation has to be moved to a new site. However, this does signify the success of the school.

There are nine mainstream classes which will increase to 11 in September 2017. That necessitates a move from the current site. We are fortunate in that earlier this year, as Senator Neale knows, the Department completed the purchase of the Notre Dame site, which offers a solution to the need for Ballinteer Educate Together national school to move, pending completion of its own school premises on the St. Tiernan's site. Obviously, the provisions for the school on the new site are being worked on by my Department.

A technical assessment of the campus is currently being carried out. We will need to complete that before we can answer a number of the questions the Senator raised. We will seek to accommodate, to the best of our ability, the needs of parents without there being any disruption. I took a note of the points the Senator raised specifically regarding traffic plans, co-ordination with other schools and so on. I will endeavour to get back to him with responses to those in so far as that is possible, but some of them will necessitate the completion of the technical assessment.

On the wider issue of the building a school for Ballinteer Educate Together national school, the Senator will be aware of the planning history. A planning application was submitted to the relevant local authority but it was refused on grounds of site access. That decision was appealed to the An Bord Pleanála but subsequently withdrawn to facilitate an amended outline planning permission but that, in turn, was refused on similar grounds. I can understand the frustration that has built up. A series of attempts were evidently made in good faith but they have not been successful in meeting the needs. While an appeal was lodged on foot of the decision on the second planning permission application, it has since been withdrawn and the Department and the local authority are meeting to discuss appropriate access routes with a view to a further planning application being submitted as soon as possible.

I can understand the Deputy saying that we should be able to clearly trace details of land purchase, planning permission and then track the process out on a very clear critical path but having been twice bitten, it would make one shy on a third occasion. There is no doubt we will have to submit a planning application and secure a satisfactory site. Any land purchase is always confidential until every element of it is complete. I can understand why the Senator is seeking a clear timetable for some of these issues, and I would be looking for those myself, but I am equally aware that with respect to many of the schools with which I deal, which have submitted planning applications and designs, that hitches arise which, with the best will in the world, are unavoidable in terms of the choice of the design team and additional ideas related to the scale that are put forward during the course of the process. All these aspects can delay a process.

I do not want to nail down a critical path as that would only lead to disappointing people. I can assure the Senator, from our point of view, that this is a high priority. We want to facilitate this successful school. We want to complete these processes as quickly as possible but we have to do them in a way that meets the requirements and expectations of pupils for the long term, and that is a very important consideration. I appreciate the points made by the Senator. In so far as I can, I will provide him with answers to the queries he raised, but some of them remain in a realm where definitive answers cannot be entirely laid out at this point.

I call Deputy, sorry, Senator Richmond.

I have been upgraded twice in one go this morning.

It was a Freudian slip on both counts.

No problem. I thank the Minister for his very thorough response. I understand the many constraints in terms of his position. Some of the questions I posed were perhaps direct but they were deliberately so and that is a direct response to the deep levels of frustration among that school community. A Department official said to the principal that her role is to keep the school community positive but that is getting increasingly difficult. They mainly want to know if there is hope of the community having a permanent school. Will their most precious resources, their children, be looked after on the temporary site? Can the Minister indicate when the technical assessment, which might bring some clarity, will be completed?

I do not have a specific date in the briefing material. The decision will be made once the technical assessment is complete. I will get back to the Deputy or rather the Senator on that. I spend too much time in the other House.

The Minister is welcome here any time.

I will see if I can give some timescale for the completion of the technical assessment. Presumably that also depends on what sort of issues arise in the complexity of adapting the site. I am conscious that September 2017 is not that far away and that we need to move with due haste.

Special Educational Needs

The next Commencement matter is in the name of Senator Noone and I understand the Minister of State, Deputy Corcoran Kennedy, will take it.

I am taking Deputy or, rather, Senator Noone's matter.

There is a better chance of the man to my left as opposed to myself becoming a Deputy in the near future. The matter concerns funding for autism spectrum disorder, ASD, units. Currently, in Ireland approximately one child in 65 is diagnosed with autism, as the Minister will be aware. ASD is the name used for a specific set of behavioural and developmental problems and the challenges that go with them. As the Minister will know, a diagnosis of ASD means that children's communication, social and play skills are affected in some way, which means they have specific educational needs. Some parents are forced to drive miles to a school in another town or county to access a school with an ASD unit. I have heard of other cases of children with autism who are currently not attending school due to a lack of a suitable placement. Other children have left school early due to a lack of places.

Studies show that children who secure a place in an ASD unit can benefit greatly and make good progress. They learn at their own pace in a much smaller class size. Moreover, they get one-on-one attention in an environment tailor-made for their needs. Some units have access to a sensory room and children can also integrate with mainstream classes where possible. Children with autism have a right to an education in their own school. I ask the Minister to make funds available to provide at least one ASD class per school nationwide based on the statistics of the number of children with a diagnosis of ASD in Ireland.

I thank the Senator for raising this matter. It is an issue of particular concern to many Members of both Houses. We have made huge changes in this area in recent years. For example, since 2011, the number of resource teachers has increased by 41%, the number of special needs assistants has increased by 23% and the number of ASD units has increased by more than 100%.

As the Senator will note from the reply, the position regarding the provision of ASD units is that 18,000 students have been diagnosed on the autism spectrum and approximately 63% attend mainstream schools, 26% attend special classes in mainstream primary and post-primary schools, and 11% are in special schools.

The policy of the National Council for Special Education, NCSE, on enrolment is that, where possible, a child on the ASD spectrum should be accommodated in a mainstream setting with the appropriate supports. However, where it is demonstrated that students require the support of a special class, that should be because they are unable to learn effectively in a mainstream setting. That is identified by the NCSE as a need for a particular child. Currently, 26% of such students attend special classes. As I stated in the reply, the rate at which we have been expanding these is very rapid and we are responding to need as and when it arises. The number of special classes in 2011 was 549. That number has increased progressively to 1,153 this year and we will be adding 162 special classes for children on the ASD spectrum. I do not have the number but there is probably an additional figure for those outside the ASD spectrum. There will be another increase of 18% this coming year for children in that area.

To go from a figure of approximately 1,300 by next September and say that the need would be 4,000, which would be one for every school in the country, would be a very radical transformation and is not in accord with the NCSE's assessment of the need.

It recognised that many students on the ASD spectrum did well in mainstream schools without the requirement for special classes. The NCSE sees that the approach being taken in meeting this demand on a needs basis and expanding the category in accordance with identified need is proceeding satisfactorily. In general, the council is satisfied that we are providing special classes to meet demand as it evolves. We will continue to respond to need on that basis.

When it comes to providing classes, we have to consider which schools are best placed and can provide the most effective facilities. Therefore, classes are not provided automatically in every school. The NCSE examines schools to match the profile of need with those that can offer the best delivery of ASD units. The approach to accommodate a larger proportion of children in ASD classes is continuing and there will be a significant increase next September. We are responding based on the assessed needs of each child and that is the right approach to take. In an ideal world, if we had plenty of capital and were not trying to address population pressures in other areas, we might consider building ahead of need, but the NCSE's view - it is the expert in this field - is that we need to examine the needs of children. Mainstreaming is the ideal, unless it does not work for the child and then we should opt for a setting that allows the child's progress to be ideally fulfilled. The approach adopted by the Department is, therefore, correct. In 2015 the NCSE provided my Department with policy advice on supporting students with ASD in schools. The advice set out a range of recommendations for future provision in the area, including recommendations on teacher education and qualifications, appropriate special class provision and so on. That is the policy backdrop against which we are implementing on the capital side.

I appreciate the Minister's response and the efforts being made by him and his Department. Clearly he is on top of what is happening in this area. I was contacted by a number of parents engaged in a campaign for this provision, of which I am sure he will be aware. The progress being made is heartening. I am not an expert on ASD, but if one in 65 children is on the spectrum, the chances of there being an ASD unit in a larger school must be significantly increased. I hope the NCSE will take account of areas where parents have to travel a great distance on a case by case basis. We are moving towards what these parents wish for and in that sense I am satisfied with the Minister's response. Perhaps it might be a little too much to move towards a scenario where there will be an ASD unit in each school. That may be over the top, but I am keen to ensure parents and children will not suffer because of their lack of proximity to a school with an ASD unit. Will the Minister clarify that this is at the forefront of the Department's mind when it comes to assessing individual cases?

I thank the Senator for her comments. The NCSE's advice is that it has not identified a need to provide an ASD special class in every school, which would mean 4,000 classes. It is interesting to examine the numbers. For example, at post-primary level, demand and provision are increasing much more rapidly, although it is starting from a lower base. There were only 100 such classes in 2011, but that number has trebled in the intervening period. There is a pattern of identified need in passing through primary level and increasing pressure at post-primary level. The Department is considering the provision of a map of ASD units across the country for parents in order that they can see where such units are available. That would be helpful as they would be better able to plan their child's education by having that support.

As the Senator said, an ASD unit is designed to accommodate six children. It is geared up with 1 and 1.5 teachers per child at primary and post-primary level, respectively. The units have SNA support and provide facilities that allow children to progress. While still in a social environment, they progress well. The NCSE's approach to identifying a child's needs is at heart of the policy we are implementing. There will be continuing growth in the number of ASD units as need is identified and we respond to it.

Health Services Provision

I thank the Minister of State for coming into the House to take this matter. I am hopeful she will be able to allay the fears of the communities of Elphin and Strokestown who are hearing reports of the potential closure of one or both of their health centres once the new primary care centre opens in Boyle, County Roscommon. The opening of the new centre is warmly welcomed. Providing dental services, occupational therapy, physiotherapy, speech and language therapy and public health nursing services all under the one roof will be of fantastic benefit to the community. I know this because of my experience in general practice in Belmullet, County Mayo, but I am also aware of how destitute my patients would be without these services and the hardship it would cause if they were forced to travel 50 miles to Castlebar to avail of them.

Shortly before the Easter break, the Minister of State at the Department of Health, Deputy Helen McEntee, reiterated in the House that one of the Government's key priorities was to implement a decisive shift in health services towards primary care. She stated: "Our ultimate goal and, as Minister of State with responsibility for older people, my goal is to make sure that people get the care they need as close to home as possible and have access to a greater range of health and social care services within their community." Will the Minister of State, Deputy Corcoran Kennedy, advise what "as close to home" and "within their community" mean in this context? Does it mean within walking distance or the county boundary? Whatever way we look at it, a healthy person would have no problem in travelling a distance to a primary care centre for treatment, but, as I have said previously, we need to remember that most people visiting GPs and care centres are not in the whole of their health. They are in need of medical attention and we can assume in pain or distress. The fact that they cannot visit a doctor in their own locality, in close proximity to their home, only adds to their distress.

The journey from the health centre in Strokestown to the new primary care centre in Boyle is at least a half an hour's drive. The smaller care centres around the country are vital in so far as they act as a filter to the larger centres and the wider hospital network, thus preventing an additional workload at these highly pressurised sites. In response to a parliamentary question submitted by Deputy Billy Kelleher on the future of services in Elphin and Strokestown health centres, Mr. Frank Murphy, head of primary care services, stated the services being provided from existing health centres would be reviewed in the context of whether they would be more appropriately delivered from a primary care centre. I am referring to two small health centres in two small villages facilitating older people in rural communities. Will the Minister of State provide further clarity on the future of these centres which cater for a large ageing population in great need of them?

I thank Senator Swanick for raising this issue. I know his experience as a GP in addition to being in the House is a motivating factor.

Enhancing and expanding capacity in the primary care sector is crucial to ensuring delivery of a preventive, joined-up approach to the management of the nation's health and the modernisation of primary care delivery. In a fully developed primary care system, 90% to 95% of people's day-to-day health and social care needs can be met in the primary care setting.

The development of primary care centres to accommodate primary care teams and, where possible, GPs in the one location is a key enabler for the delivery of primary care services. Primary care centres facilitate the shift from acute care towards primary care because of the range of multi-disciplinary services they can provide and the role they can play in keeping people who do not need to be in an acute setting out of hospital.

Significant investment has been made in the development of primary care centres and continues to be put in place. These additional primary care facilities across the country will be provided through a combination of direct build, through public private partnership and by way of the Health Service Executive’s primary care operational lease mechanism. Boyle primary care centre is one of the 14 facilities being developed under the public private partnership model and is expected to open in the third quarter of 2017.

The Health Service Executive has advised that the Elphin health centre provides a range of services to the local community delivered by two GPs, one public health nurse and one visiting speech and language therapist while the Strokestown health centre provides the service of one GP. The HSE has advised that no decision has been made to close any health centres located in close proximity to the development of new primary care centres. This is the position for Elphin and Strokestown health centres. Once newly opened primary care centres become operational, the services being provided from existing health centres will be reviewed in the context of whether these services would be more appropriately delivered from a primary care centre. A decision will then be made on the future of some health centres, with the HSE advising that many of the health centres will remain where GPs are in situ and not relocate to a primary care centre.

It is very important to stress that from the point of view of people using the wide range of services provided by the HSE at community level, the objective is to ensure services are responsive to people’s needs and enable them to receive a joined-up service that results in the most favourable health outcomes for patients. These primary centres will, when completed, significantly enhance and expand capacity in the primary care sector to deliver on this. This is very much in line with the policy of Government that people access the great majority of their health care needs in the community and, as far as possible, in one location.

I thank the Minister of State. I welcome that the HSE has advised no decision has been made to close the health centres in Elphin and Strokestown. While the Minister of State has said some services may be relocated, she acknowledged that where a GP remains in a health centre, it will remain open. It is a very important point. Once a health centre is staffed by a GP, the health centre cannot be closed. It is one message I want to send out today.

While I welcome the development of primary care centres, it is not all about bricks and mortar and building fancy new buildings; it is about the activity that happens in the primary care centre. Often where care is delivered close to communities and where people have easy access to care it is the best form of care and it leads to fewer referrals to hospitals and earlier discharges. I welcome that no health centre will be closed as long as a GP remains in situ.

Hospital Closures

Gabhaim buíochas leis an Chathaoirleach. Cuirim fáilte roimh an Aire Stáit go dtí an Teach seo inniu. The Minister of State is very welcome to the House and I thank her for her attendance. I will address the issue of the closure of the Sacred Heart unit in Dungarvan Community Hospital. The unit provides vital rehabilitation for patients suffering as a result of strokes or other serious accidents. It is regrettable the decision was taken on a Friday of a bank holiday weekend. It was underhanded and mean. It placed the patients and families affected in a very stressful situation of not knowing where they were going to go and when they were going to go. The reason given was the HSE is finding it difficult to recruit nursing staff. Surely the Minister of State will agree somebody in the HSE should have seen this particular problem coming down the tracks so it would not have had to take such a knee-jerk decision on a Friday of a bank holiday weekend. It is very clear the terms and conditions of nurses are not good enough. My colleague, Senator Swanick, with whom I will share my time, with the permission of the Acting Chairman, will go into more detail on that. It is having a serious effect on the health service. A bigger effort needs to be made to try to give better terms and conditions to nurses. We are educating our nurses and as soon as they are qualified they are going abroad because there are better terms and conditions on offer to them.

I will ask two questions before I let my colleague in. The HSE has made a commitment to reopen this particular unit when it recruits sufficient staff to do so. Is there a timeframe for that? I have spoken to a number of people who were thinking about coming home from the UK to take up a post in Ireland but they have to go through a procedure of applying for a PIN. We understand they could be waiting six months in order to get that PIN, which seems crazy. Will the Minister of State look into that?

I will be very brief. I thank my colleague, Senator Gallagher, for allowing me to share his time on this very important issue. The closure of the Sacred Heart unit in Dungarvan is absolutely devastating to the community and will send shivers down the spines of other community hospitals which are experiencing the same issues with recruitment. Most hospitals are only a couple of staff away from ward closures. As a director of Belmullet hospital, I am too aware of it. I also concur with my colleague's sentiments that the closure was underhanded in the manner in which it was executed over a bank holiday weekend in an attempt to bury the story. At the very end of last year, the Minister for Health said he had no magic wand to recruit more nurses into the health service. He also said he was satisfied with the package on offer to graduate nurses and that many nurses are returning here to be closer to family and friends. This is in direct contrast to what the INMO reported only a few weeks ago. The organisation undertook surveys of all nursing and midwifery students on the final leg of their degree to examine whether they would seek employment upon qualification in September 2017. It found that 78% of respondents are considering emigrating and 70% have already been approached by overseas recruitment agencies. That is compared to 29% who had been offered permanent positions in the Irish public health service at that time. Surely all of the students who are in their final 36-week placement should be offered competitive, permanent contracts to be entered into following successful graduation of their course. The people of Dungarvan are now without 16 vital beds, which provided much needed rehabilitation, respite and step-down care and undoubtedly alleviated some of the pressure on the struggling University Hospital Waterford.

Community hospitals facilitate discharges from university hospitals and prevent admissions to university hospitals. Another important aspect of the community hospital is that it acts as an interface between the fair deal system and the university hospital. If a loved one is waiting for the fair deal scheme in a university hospital, he or she can be transferred to a community hospital for the intervening period before being transferred to a nursing home. This is another vital element. I ask the Minister of State to review these closures as a matter of priority.

I thank Senator Gallagher for raising this important matter and I thank Senator Swanick for his contribution. The overarching policy of the Government is to support older people to live in dignity and independence in their homes and communities for as long as possible. This is clearly what older people want but we also have patients who are in genuine need of residential care either on a long-stay or short-stay basis.

The Health Service Executive is responsible for the delivery of health and personal social services, including those at facilities such as Dungarvan Community Hospital. The hospital provides long-stay residential, respite, palliative care and rehabilitation services for older people.

As with the health service in general, Dungarvan Community Hospital is experiencing significant challenges with recruiting and retaining nursing staff, which the Senator acknowledged. Dungarvan has 16 whole-time equivalent vacancies, eight of which are required for the Sacred Heart ward.

While there have been several national recruitment campaigns for nurses, unfortunately, a serious challenge has arisen in recruiting nurses to fill vacancies in Dungarvan. As a result, to maintain the delivery of safe and high-quality services, the Health Service Executive, HSE, has decided to move residents internally from the Sacred Heart ward to alternative accommodation in the hospital. This is a temporary measure and staff will be re-organised to optimise patient safety. Long-stay and short-stay care, including palliative and dementia care, all continue to be provided.

I understand, as does the HSE, that this decision has caused a great deal of upset for residents, families and the local community. I hope further clarity has been and will continue to be brought to the situation by the HSE. The HSE has assured me patient welfare is a priority for staff and management and expressed its deep appreciation of the support the hospital receives from families, as well as the wider community.

The HSE acknowledges the concerns expressed on this subject in recent days and apologises to residents and their families for any inconvenience. It will work to ensure minimum disruption to normal services during this interim arrangement. It is important to note there is no negative impact on existing staffing numbers while this interim safety arrangement is in place.

The HSE has ongoing opportunities for nurses. Advertisements remain live on the HSE website. In recent days, the HSE issued an appeal for any registered nurses available for work, whether on a full or part-time basis, to contact it. Specifically for Dungarvan, all inquiries, including from nurses who are retired or not currently serving, may be directed to the HSE’s manager for older person services for Waterford. The HSE has given an assurance all applications will be processed without delay.

Representatives of hospital management continue to be available at all times to residents and their families to discuss any matter of concern to them. They will work closely with staff representatives to bring the hospital back to full operating capacity. The HSE met families on 3 May and a further meeting is scheduled for June. The Department will monitor this situation carefully. I have asked the HSE to keep me updated on progress. I will bring the specific points made about recruitment to the attention of the relevant people.

I acknowledge the temporary measure of this arrangement. However, as the Minister of State will accept from my experience working in medicine, when hospital beds are closed temporarily, they tend not to open again. I also acknowledge the measure was introduced for patient safety arrangements.

Can the Minister of State put a timeline on this? How long will it take for these beds to re-open? Will she suggest to the HSE to conduct monthly reviews of the administration in the hospital and staff recruitment? Local public representatives and patients are concerned about the current situation there.

The HSE has advised me that it is its intention to re-open the ward. To give a timeline would be difficult, however, because it depends on the recruitment of nurses. As soon as the recruitment process is concluded, we can look forward to it being re-opened.

I will bring the Senator’s suggestion about monthly reviews to the attention of the relevant people.

Sitting suspended at 11.15 a.m. and resumed at 11.30 a.m.
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