Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 20 Feb 2019

Vol. 263 No. 15

Nithe i dtosach suíonna - Commencement Matters

Dental Services Waiting Lists

I welcome the Minister of State, Deputy Helen McEntee, to the House.

I thank the Minister of State for coming to the House to deal with this matter. I had hoped the Minister, Deputy Harris, would be here but I know he is a busy man.

I have been inundated with calls from people with serious concerns regarding dental care for children in CHO5. The HSE provides dental services to children up to aged 16. Children attending primary schools can be referred to dental treatment by a child health service or following a routine school visit. Children attending primary schools are screened in second, fourth and sixth class and, if necessary, are referred to the local dental clinic for treatment. Some children are referred to an orthodontic clinic for further treatment. This referral is from the principal dental surgeon in the health centre and orthodontic treatment is free. An individual's access to orthodontic treatment is determined by guidelines known as the "modified index of treatment need". Emergency services are also available to all schoolgoing children but mainly on a part-time, specific weekday basis. There is nothing but costly private dental care for children on weekends.

I recently heard from constituents who have a child with a baby tooth that would not fall out going for a two-second tweezer extraction on a Saturday that cost them €75, for which the tooth fairy gave them back €2. We all know who lost out. The Minister of State will be aware of the great benefits of the scheme. Many children are caught early and encouraged to ensure good dental hygiene and there is often a need to undertake only minimal work to prevent major work in the future. However, there is a serious problem with the scheme. Data published last month by the Irish Dental Association indicate that more than 80,000 children and adolescents are waiting for a public dental assessment or treatment, of which 22,900 are on the waiting list in CHO5, which takes in Carlow-Kilkenny, south Tipperary, Waterford and Wexford. In almost every area of society early intervention saves time, money and distress and produces far better outcomes.

How does the Minister propose to tackle the unacceptable delays in this scheme? It is not good enough that hard pressed parents are forced to pay for the treatment their child or children urgently need. Many of them cannot afford it. The aim of the scheme is to provide dental care for every child regardless of means. It is a wonderful idea but it is not working. According to the Irish Dental Association, the waiting list numbers are shocking. Its spokesperson, Dr. Gillian Smith, said that due to the delays around assessments children were enduring painful episodes and being treated with antibiotics and, often, surgery under general anaesthetic, which is costly to the State and easily prevented with early intervention.

The incredible waiting lists have been highlighted by hundreds of my constituents in just two counties in CHO5. I imagine hundreds more in the other counties are not complaining because they realise we are all being forced into a two-tier system, whether we like it. People feel they have to pay for everything. What is the Department of Health doing to reduce waiting lists in this area? On the modified index of treatment need, many children appear to be just outside the threshold. In 2013, the HSE commissioned an independent review of orthodontic services. Something is wrong if orthodontic services across the country are offering easy pay plans for taxpayers to have their children treated because the HSE is not getting the job done.

It was revealed late last year that there is a 12 month waiting list for orthodontic treatment in my area. That is a long time for a child suffering with a grade four diagnosis, which may mean speech difficulties or protruding displacement of teeth, or a child with a grade five diagnosis and abnormally arranged teeth, not to mention the child whose diagnosis is minimally outside of the guidelines in terms of access to treatment. Parents are forced to pay for this treatment. On 4 February last, the Minister, Deputy Harris, said on RTÉ radio that it is his job to look after the health of the children of Ireland. The delays in the dental assessment and treatment area are unacceptable. I hope the Minister of State will be able to answer my questions today.

I am taking this matter on behalf of the Minister for Health who sends his apologies for not being here. If the Senator has any follow-on questions I will, of course, raise them with him and he will respond to her directly.

I thank the Senator for the opportunity to address the issue of dental services in CHO 5. Eligibility for dental services is provided for in the Health Act 1970. Dental treatment for adult medical card holders is provided under the dental treatment services scheme by contracted general dental practitioners. The HSE provides oral healthcare services to children and vulnerable people of all ages including people with special needs, people with disabilities and people who are medically compromised. It also includes cohorts such as refugees and asylum seekers. Services are provided on the basis of need and include four key areas, namely emergency care; targeted preventive and treatment services for children; planned care for children and adults with special care needs; and hospital services, including general anaesthetic services. Targeted preventive and treatment services for children emphasise prevention of dental disease through patient and parent oral health education, dietary advice and tooth-brushing instruction, along with preventive interventions such as the placement of fissure sealants on vulnerable tooth surfaces. Restorative treatment such as fillings is also available. Children in the targeted age groups are typically in first or second class and sixth class. Where resources allow, some children may also be seen in fourth class.

CHO 5, now known as South East Community Healthcare, provides community health and social care services within south-eastern counties of Waterford, Wexford, South Tipperary, Carlow and Kilkenny. Recent HSE figures indicate that as of 1 January 2019 there were 35,466 in second, fourth and sixth classes in the South East Community Healthcare area. A number of these children would have been seen during January and to date in February. It should be noted that the service which these children receive is a screening service - the Deputy is correct that prevention is the best measure against more serious challenges - provided for children at key ages to coincide with eruption of back teeth and once parental consent is given. This is an ongoing rolling programme for routine dental care. The emphasis is on preventive care such as fissure sealants and advice with fillings provided if necessary.

There are 2,198 awaiting treatment following screening. It should be noted that some children may be counted twice, for example where they are to be seen by a hygienist for preventive care and by a dentist for treatment following their assessment. Following a fire in the St. Dympna’s Hospital Carlow in November 2016, dental services ceased. This resulted in the cancellation of four surgeries for four months. Additional services using agency staff and additional clinics during evenings and weekends were used in 2017 to address the backlog in appointments. The dental service is still dealing with some backlogs in appointments as a result. The Minister is aware of this and is trying to deal with it. While there are ongoing difficulties in recruitment and retention of dentists in the South East Community Healthcare area, two vacancies were filled in 2018, and we hope to recruit more in the coming year. The HSE will continue to prioritise patients with greatest needs. Emergency care for the relief of pain and infection is available for all children aged up to 15 years, and patients with special needs on a same day or following day basis at HSE dental clinics across the country. Approximately 6,000 children attend for emergency treatment each month nationally.

The Minister is very much aware of concerns and the specific issues in this area. He is committed to filling the vacancies, reducing waiting lists and ensuring that the children, not only in this area but also surrounding areas, are treated in the appropriate manner and as quickly as possible.

I was aware of the fire at St. Dymphna's and the resulting backlog. The two biggest issues are the out-of-hours service where if a child has a toothache on a Saturday or Sunday the parent must pay privately. Many parents do not have the money to pay for that. There are also questions of the time delay and of qualification; a child may be told that they can qualify for a brace but then it turns out that their bite is wrong or that it is a millimetre out. Some children are well deserving but parents cannot afford the treatment. We need to have a new look at the system and there should be an appeals system. There is none now and there is no way of addressing urgent cases that do not qualify under the scheme.

The new national oral health policy will be published shortly by the Minister for Health. Its aim is to develop models of care that will emphasise preventive care and prioritise preventive approaches from childhood to old age, support the public, ensure easy access to care and enable people to have the best oral health. Issues such as out of hours, delay and qualification may be addressed. However, as with any scheme there must be a cut-off point after which access is not possible. However, as the Senator says, there can be a fine line.

Special Educational Needs Service Provision

Cuirim fáilte roimh an Aire Stáit. Teastaíonn uaim ceist a ardú ar luaigh mé ar an Ord Gnó sa Teach seo ar 6 Feabhra. I raise an issue which I mentioned briefly during the Order of Business on 6 February. It is estimated that approximately 25% of students have special educational needs of one kind or another. Legislation envisages the provision of individual educational plans, IEPs, for many of these children. These are written plans prepared for a student specifying the learning goals to be achieved over a set period, as well as teaching strategies, support and resources necessary to achieve those goals. The value of these plans is accepted and they are implemented across the world including in the UK, Australia, Canada and New Zealand. The Education for Persons with Special Needs Act 2004, or EPSEN Act, includes a requirement for schools to provide an individualised education plan for students with special needs. However, this section of the Act has not been commenced 14 years after it was passed by these Houses. The National Council for Special Education developed guidelines on the provision of individual education plans in 2006, which is now 12 years ago.

In response to a Parliamentary Question on 4 December, the Minister for Education and Skills, Deputy McHugh, told the Dáil:

There is currently not a statutory requirement for schools to provide a mandatory Individual Education Plan for children with special needs. [...]

However, all schools are encouraged to use some form of educational planning for the delivery of additional teaching, or care supports, for children with special educational needs [...]

My Department's Inspectorate's advice is that the majority of schools are now using some form of education planning for children with special educational needs.

Despite the Oireachtas passing a law requiring schools to implement these plans 14 years ago, this remains to be commenced or brought into force. The position, as the Minister told the Dáil, is that we are relying on the goodwill of teachers and the ability of individual schools to implement individual education plans from their own resources. This state of affairs changed before Christmas when the Association of Secondary Teachers in Ireland, ASTI, issued advice to its members not to implement IEPs due to a lack of adequate resourcing. A circular to its members on 18 December 2018:

In view of the fact that IEPs have not commenced under the EPSEN Act, ASTI members are advised not to implement IEPs or equivalents [...].

The ASTI is extremely concerned that in the context of insufficient resourcing and the lack of a sustainable model for the delivery of all aspects of the EPSEN Act [...]

The ASTI rejects the imposition of a special education needs model which takes no account of the time, workload and practical implications for teachers and schools.

I understand that the Teachers Union of Ireland, TUI, has given similar advice to its members. While the ASTI made clear that this would not affect any existing plans in place, this is nonetheless very worrying. How is it defensible that 14 years after the passage of the 2004 Act that IEPs have not been given force of law? How can it be acceptable that the teachers themselves feel that they cannot provide these plans due to a lack of resources? We are all aware of the seeming inability of some Departments to manage public finances in a prudent way, causing massive potential waste of Exchequer resources. It would be horrible to think that this would be one area that would suffer the downstream consequences of such mismanagement. I would be grateful if the Minister of State could give me any assurance today that that is not the case. I would be grateful if she could give me a response that goes further and offers more than the Minister's response in the Dáil some months ago.

I thank the Senator for raising this issue as it gives me an opportunity to outline the position on educational planning in schools on behalf of the Minister for Education and Skills.

The Department of Education and Skills recently wrote to the Teachers Union of Ireland and the Association of Secondary Teachers Ireland to reiterate to them the importance of planning for pupils with special educational needs in schools and to note that provision has been made for such planning. Under the Education Act, schools have a legal duty to provide an appropriate education to all students. The Senator is correct to state there is no statutory requirement for schools to provide a particular form of individual educational plans but there is a statutory obligation to provide education appropriate to the abilities and needs of students. This includes people with special educational needs and, obviously, schools need to plan to ensure this happens.

Planning is a normal part of a teacher's work and planning tools, such as the student support file, have been created as a resource to help schools provide for their students. The Government has invested heavily in recent years in supporting our children with special educational needs, with €1.8 billion spent annually, which is approximately €1 in every €5 of the education budget. This is 20%, which is close enough to the figure the Senator mentioned with regard to those needing special support in our schools. I assure the Senator there is no mismanagement of funding and the €1.8 billion is being spent very much appropriately.

All mainstream schools are provided with special education teachers, based on the profiled needs of the school, to provide extra teaching support for pupils who have additional learning needs in schools. At present, there are almost 14,000 special education teachers in schools, an increase of more than 37% since 2011. This has greatly increased the number of special education teachers who have been allocated to schools throughout the country.

The Department's circulars 0013 and 0014 of 2017, which set out the basis for the allocation of special education teachers to schools, note the importance of educational planning. This is to ensure that children with the greatest level of need receive the greatest level of support. The circulars note that educational planning is an essential element of a whole-school approach to meeting pupils' needs. The circulars also note that in making allocations for special education teachers to schools, provision is made within the total allocation for planning and co-ordination activities.

Circular 0014 of 2017 for post-primary schools states the allocation for special education teaching support being provided for schools includes provision for planning and co-ordination activities required to ensure the most effective use of the special educational needs hours provided to schools for children. The extent of co-ordination time required to be used by schools will vary depending on the number of students requiring additional teaching support and the number of teachers proving this support. It is noted, however, that planning for the provision of additional teaching support for pupils in schools is an important part of the process, and that co-ordination and planning time for this has been acknowledged in the allocation. Schools, therefore, should be resourced to carry out planning.

Support and guidance for schools on how best to carry out educational planning is available from the National Council for Special Education support service and the National Educational Psychological Service. The Department's advice is that the majority of schools do carry out some form of educational planning for pupils with special educational needs. This is an appropriate use of the significant levels of additional special education teaching resources that have been provided for schools. The ongoing provision of planning should represent a continuation of the good practice that is already occurring in the majority of schools throughout the country.

I reiterate that no projects or investment in education, including in special needs, will be amended or reduced in the coming months or years because of another project.

I thank the Minister of State for her response. I reassure her that in talking about the potential downstream consequences of mismanagement I do not suggest mismanagement of the existing budgetary allocation to the area of special needs in education, I am talking about the wider mismanagement of public money in the economy and, therefore, the lack of necessary extra and additional resourcing. The Minister of State made the point she estimates the approximately 20% of the budget, at approximately €1.8 billion, going to special educational needs is not far off the quota of students with special educational needs of one type or another. Surely, when we speak about children with special educational needs, we imagine there would be a greater percentage of resources and not a slightly lesser percentage of resources dedicated to their needs. Why are individual education plans in the legislation if they have not been provided? I am involved in the management of a primary school in receipt of resources under the special needs heading and I do not dispute there has been much investment in the area but why, if the legislation envisages individual educational plans, has it not been implemented 14 years on?

I reiterate that when we look at the figures we see that in the past seven or eight years there has been an increase of more than 37%. Although we still have more work to do, the Senator will agree this is a significant increase. We have the significant number of 14,000 special education teachers in our schools providing support to students on a daily basis. A total of €1.8 billion is spent annually and this is having a significant impact throughout the country.

There is no statutory requirement to provide a particular form of individual education but there is a statutory obligation to provide education to students appropriate to their abilities and needs. The Minister has already outlined that the vast majority of schools provide these plans. They are focusing on where there are clear measurable learning targets, specifying the resources and interventions used to address student needs. This is in line with the continuum of support process. While subject teachers retain overall responsibility for the provision of education to students, in most instances special education teachers will develop the student support plans. Teachers are working with their students and with parents, families and the school to ensure the plans are in place. The Department informs me the supports and resources are there but if the Senator has information to the contrary I will pass it on to the Minister, who will continue to engage with the TUI and ASTI to ensure children receive the adequate support they require.

Coastal Protection

Cuirim fáilte roimh an Aire Stáit go dtí an Teach. I am absolutely delighted the Minister of State, Deputy Moran, has come to the House to deal with this Commencement matter. The history of the issue goes back to 2014, when practically all of the west coast of Ireland was battered on 4 and 6 January and significant coastal damage was done by the Atlantic Ocean. The houses of many people were flooded and businesses were damaged. I am delighted to say much work has been done on coastal protection, certainly in County Clare, since this happened. A total of €5 million has already been spent on rock armour and essential coastal protection works in Lahinch. Another €2 million or €3 million is being spent as we speak and the contracts were signed last week. This is a significant investment in Lahinch. Other parts of County Clare have also had significant coastal protection works carried out. The international hotel in Doonbeg has made a planning application that is with An Bord Pleanála to invest millions of euro in rock armour.

I am concerned about a particular part of the coastline at Spanish Point. It is a particularly vulnerable area where rock armour and coastal protection works are not adequate. The residents have done a significant amount of work on the streetscape and amenities near the beach with regard to making it visibly attractive for people who live there all year round and, equally importantly, for the people who visit. There is concern about the ongoing delays in approval of the minor works programme necessary for the local authority to get on with the work that must be done to put in place the necessary coastal protections.

I am raising the issue in the hope the response from the Minister of State will allay these concerns and we might get a specific timeline on when the work will start and, equally importantly, when the work will be completed.

I thank the Senator for raising the matter and I am pleased to provide an update. The Department of Housing, Planning and Local Government has overall responsibility for Government policy on coastal strategy.

Local authorities lead on identifying works to protect the coast in their respective areas. The primary objective of Government policy on coastal protection is to ensure that, in areas identified as being at greatest risk of damage or loss of economic assets through coastal flooding, appropriate and sustainable measures are identified by local authorities to protect those assets. Where defence measures are economically justified and compatible with all required environmental and other statutory requirements, they can be implemented subject to the availability of resources.

The Government decided, on 11 February 2014, to make available up to €69.5 million, based on estimates provided by the local authorities concerned, for a programme of repair and remediation works to roads, coastal protection and flood defence and other public infrastructure damaged in the storms from 13 December 2013 to 6 January 2014. Of the total amount made available, up to €19.6 million was provided via the Office of Public Works for the repair of damaged coastal protection and flood defence infrastructure. Based on the estimates submitted by local authorities to the then Department of the Environment, Community and Local Government, that Department contacted all affected local authorities indicating the amounts being made available to the councils to undertake the necessary repairs works. This included the amounts available via the OPW in respect of the cost of repairs to damaged coastal protection and flood defence infrastructure in the country.

The amount made available to Clare County Council for coastal protection repair works was €9,712,385. Clare County Council submitted to the OPW a programme of works based on its allocation of €9,712,385, and this included repair works at Spanish Point, County Clare. Further to that, my office, through the minor flood mitigation works and coastal protection scheme, provides a funding mechanism to support works to protect coastal communities, particularly those at risk from flooding. In this regard, the OPW minor flood mitigation works and coastal protection scheme provides funding to local authorities to undertake minor flood mitigation, coastal protection works or studies costing less than €750,000 each to address localised flooding and coastal protection problems within their administrative areas. In 2015, Clare County Council received funding of €65,000 from the OPW under this scheme for a coastal erosion and risk management study from Quilty to Miltown Malbay, which produced recommendations for works at Spanish Point, County Clare. In September 2018, on foot of those recommendations, Clare County Council made an application to the OPW for funding for the provision of rock armour to protect against cliff erosion caused by waves and tides at Spanish Point. This application is currently under consideration. As soon as a decision is made on this application, this will issue to the council.

I thank the Minister of State for a comprehensive reply. The key question is when a decision on the application will be made. I have no doubt that it will be positive but I would like a timeline for the decision, because it has been with the Department since well before Christmas. I am not sure how long these things take but I would like the Minister of State to give us an idea.

The Senator has raised this with matter me a number of times and I have given it considerable attention in order to deliver the project. I know what Spanish Point means, not just for tourism but for people who live there and who need to be protected in their homes and villages. I assure the Senator that everything is being done by my office and the local authorities to deliver on this as soon as we can. Things need to happen to meet the criteria and we are accelerating our work to get delivery as quickly as possible.

Sitting suspended at 11.05 a.m. and resumed at 11.30 a.m.