I welcome the Minister of State, Deputy Chambers, to the House.
Nithe i dtosach suíonna - Commencement Matters
Energy Policy
I wish to raise an issue that has been in the news for the past number of weeks. In 2009, a Government memo was sent to Cabinet seeking the Government to approve the permanent rebalancing of network tariffs towards large energy users, and that rebalancing was to be paid by domestic household consumers. The Commission for Regulation of Utilities, CRU, made a decision, correctly, last year to unwind that, but it stopped short of rebalancing the network costs in favour of households.
We know that there was an error in the calculation of the subsidy so that the ESB is going to refund €50 to each household, but that only scratches the surface of the level of subsidy households have been paying to large energy users. We know a further €600 million was levied on households to give large energy users a dig-out. When are businesses going to be asked to repay the favour? These large energy users are highly profitable companies but we are in a cost-of-living crisis, people are in arrears and the number of households has increased, so it is time for the tables to be turned. Will the Minister direct the CRU, just like what was done in 2009, to rebalance the network tariffs permanently towards domestic users to be paid for by higher prices on large energy users?
By my maths, each household would be entitled to a refund of an additional €274.36 for the €600 million, given there are 2,186,854 domestic accounts in this country. Most people would welcome €324 instead of the €50 they are currently in line to receive. I know that is the case from my social media account and from meeting people as I walk along the street. They are asking when they will get their €50 back from the ESB Networks and why it is only €50 because they have been ripped off for the past 12 years.
The Minister of State is probably going to read from a script, mention the rebalancing of the network costs, and talk about windfall taxes and the negative public service obligation, PSO. It is welcome those measures are happening but that is not what we are here to discuss. They do not do anything to redress the unfairness of the large energy user subvention that was baked into the cost of energy. We cannot do anything about the wholesale costs of electricity but we can ensure the regulator regulates the network tariffs. The PSO levy is going into negative this year. Like the subsidy, however, households once again pay a disproportionate amount of the PSO relative to businesses because it was designed to allow businesses pay less to the PSO levy than households.
Will the Minister of State explain why the 2009 decision, if it was an emergency decision, and it is one I do not agree with, was allowed to continue for 12 years? Now, when the tables have turned and these businesses are in a profitable position but the emergency is affecting households, and knowing we are in a cost-of-living crisis and that the Government is going to announce measures to help people in the coming days, will the Minister of State rebalance the network tariffs in favour of domestic households?
I thank the Senator for raising this important topic and I am responding on behalf of the Minister for the Environment, Climate and Communications, Deputy Ryan.
In 2009, a Government decision was made to rebalance the electricity network tariffs to support large energy users with effect from October 2010. The decision was made at a time when the global financial crisis and domestic banking crisis were both starting to take effect and the competitiveness of large Irish firms, together with the employment implications, was a serious policy issue. The decision was made to help safeguard jobs in some of Ireland's most critical and export-oriented industries at a time when unemployment was rising at a fast rate.
The savings for large energy users were funded by a rebalancing of domestic network tariffs. As part of a review carried out by CRU in April 2022 into electricity price drivers, in line with the Government's national energy security framework the CRU decided to unwind the rebalancing with effect from 1 October 2022. This unwinding reduced an average domestic customer's annual bill by €40 or about €3 per month.
I will now turn to the issue of overcharging. At a recent Oireachtas joint committee hearing, the Government learned that the tariffs recouped from domestic households exceeded what was envisaged in the Government decision. The way tariffs are raised and oversight of same are matters for CRU, which is the independent regulator and which is accountable to the Oireachtas, not to the Minister. The Oireachtas joint committee is the appropriate forum through which overcharging can be dealt with and at which Deputies can raise questions for the CRU.
Departmental officials are engaging with CRU to determine if there is any action required to ensure they have the appropriate powers to ensure people are refunded and this does not happen again. The commitment that households will be repaid the overcharged sum is welcome and this money should be repaid as soon as possible.
The Senator wishes to debate network tariffs, and that is also important.
Network tariffs matter because they impact all end users' electricity bills. Electricity network tariffs recover the costs of developing, operating and maintaining the networks from the users connected to the electricity networks. They are set annually by the CRU for the period October to September. The CRU has full and independent responsibility to regulate network tariffs in the interest of energy customers, with an emphasis on providing security of supply, a high-quality service and value for money. It is the Government's position not to interfere with the CRU in respect of its independent areas of responsibility, such as setting network tariffs. For this reason, it was for the CRU to determine when to remove the large energy user rebalancing subvention. The CRU holds public consultations on the setting of network tariffs and seek people's views on proposed tariffs. Should the Senator wish to do so, this is the appropriate means by which to seek a change in network tariffs.
The Government will not be directing the CRU to take a particular course of action in respect of network tariffs. The CRU is entrusted with the responsibility to regulate the electricity market and it must be allowed to do so. The Government is, however, acutely aware of the impact the recent increases in global energy prices is having on households and has acted within its remit. In 2022, the Government introduced a €2.4 billion package of supports. As part of budget 2023, it introduced a package of once-off measures worth €2.5 billion. This includes a new electricity cost emergency benefit scheme through which €600, inclusive of VAT, is to be credited to each domestic electricity account in three payments of €200 between November 2022 and April 2023.
I thank the Minister of State for his response. I know he is not from the line Department. I find the contradictions in regard to this matter bizarre. When my colleague, Deputy Carthy, raised this matter with the Minister a couple of weeks ago, the latter agreed the subvention is unfair and that the Department had instructed the CRU to unwind it. We then had the situation whereby it emerged, via freedom of information requests, that the Department of Enterprise, Trade and Employment had exceeded the scope of the CRU consultation. This rebalancing was not part of the consultation process, but the Department of Enterprise, Trade and Employment thought it was its role to tell the CRU that the Department did not agree with it. Now, the Minister of State is in the Seanad reiterating the independence of the CRU in the context of how it sets the tariffs. In 2009, the Government told the CRU what to do. Then the Government said it could not tell the CRU what to do and the Minister said the Government told it to unwind the subvention. Now, the Department of Enterprise, Trade and Employment is telling the CRU not to unwind it. Is the regulator independent or not?
I appreciate the Senator's contribution on this matter. I will pass her feedback on to the Minister. Any future rebalancing of network tariffs is a matter for the CRU to consider as part of its independent tariff-setting process. It is open to the Senator to submit proposals on the rebalancing of tariffs directly to the CRU as part of that process, a process in which the Government does not have a role.
Households have been impacted by recent energy price increases and the Government has acted within its remit to limit these impacts where possible. By April 2023, households will have received €600 credit to each domestic electricity account. This is just one part of the suite of measures introduced by the Government to help households as part of the €2.5 million in supports provided in budget 2023. Price increases have affected all aspects of our economy and employers. The Government is acutely aware of the importance of protecting jobs in order to protect families during the energy crisis. This has been key in the design of the temporary business energy support scheme, which will provide up to €10,000 per business per month until spring 2023. This scheme will also support eligible companies, covering 40% of their energy bills, in order to protect jobs and families.
Hospital Staff
I welcome the Minister of State, Deputy Rabbitte.
I raise the issue of non-consultant hospital doctor, NCHD, posts in Bantry General Hospital. First, I will give an outline of my argument. Bantry General Hospital is probably one of the most unique and wonderful complexes we have in the State. It services a really rural demographic. It covers a significant rural population that increases during the summertime. There is quite poor infrastructure in regard to the road networks in the area. The next nearest hospital is in Cork city. The latter is approximately 150 km from the peninsulas, which is a significant distance to travel. The hospital also covers seven islands, which work closely with it. The hospital is situated in a unique location.
I acknowledge the amount of work that has been done in Bantry General Hospital, in particular during the past six years. We have seen the refurbishment of the medical assessment unit, costing €1.5 million. St. Joseph's unit was extended to include a theatre and recovery room. This came at a cost €2.5 million. The radiation suite was upgraded at a cost of €500,000. The laboratories and administration buildings were extended. A CT scanner was put into the hospital in 2019, costing €850,000. There is now a massive redevelopment taking place in the building of a new stroke and rehabilitation centre and endoscopy unit, which will cost €17.6 million. There has been significant investment in Bantry. It also has, for the first time ever, six full-time consultants, in addition to 300 members of staff and 17 NCHDs. Due to the success of the hospital and the capital that has gone into it, the number of NCHDs needs to be increased to 21.
Bantry General Hospital is a good-news story. It is an example of what we need to have in rural Ireland: a hospital that is well-invested in, well-maintained and well-run with consultants on the ground. The fact that there are six full-time consultants there - the first time in the history of the State that this has been the case - is a credit to the amount of work that has gone into the hospital. Due to this success and to the amount of work done and capital invested in the hospital over the past six to seven years, we now need to see an increase in the number of NCHDs to 21.
Unfortunately, the political reality is that Bantry General Hospital becomes a political football every time an issue arises, there is an election or someone wants to get media coverage. We need to talk up this hospital, particularly in the context of the management and the staff. The latter are being driven demented because the hospital is being talked down. It covers a huge geographical area, including parts of south Kerry and all of west and north Cork. It really is the focal point for medical services in that entire geographical area. It is also a major financial driver for the area. It is one of the biggest employers there. As already stated, 300 people work at the hospital. The fact that it becomes a political football, particularly at election time, is bizarre. The knock-on impact is that we find it hard to get people to come to this remote location to work. If one were to Google "Bantry General Hospital", one occasionally gets the impression that it is closing. It is anything but closing. In fact, it is going from strength to strength. It is because of the hospital's success and the developments that have taken place there that we need an in the number of NCHDs to 21. We also need to take politics out of it and support the staff and management, who do such a great job. Will a programme be put in place to enable us to increase the number of NCHDs from 17 to 21? This would have a knock-on impact in allowing this good-news story to continue and to become a great-news story.
I thank the Senator for raising this matter, which I am taking on behalf of the Minister for Health, Deputy Stephen Donnelly. I will stick to the script.
First, I acknowledge the hard work and commitment of all the staff in Bantry General Hospital. The hospital serves a unique, large, rural geographical area, from the peninsulas in the south west, to Clonakilty and Timoleague in the east.
Although the hospital serves a population of approximately 60,000 people, during the summer months this figure can increase by 80% to 100%. This also covers the islands, as the Senator has said. Under the reconfiguration of services in Cork and Kerry, Bantry General Hospital has been designated the only model 2R hospital - remote and rural - in the country. This means, that unlike other model 2 hospitals, Bantry General Hospital continues to receive undifferentiated medical presentations 24-7. Services like the medical assessment unit are experiencing a notable increase in demand, up by 7% in 2021 and an additional 13% in 2022. Bantry General Hospital has received a significant level of investment in recent years, with funding increased by 11% since 2020. The hospital's workforce has also grown considerably. As of 2022, the hospital employed 1,165 WTEs, an increase of 10% on the same period in 2020. That sounds to me like a vibrant hospital. The Senator is right to say we should be talking, because all I have ever heard about Bantry General Hospital is negative. The Senator's contributions are therefore welcome this morning. I acknowledge that recruitment of relevant and appropriately skilled staff in rural areas continues to pose a particular challenge to the HSE. Hospitals like Bantry General Hospital are particularly affected by this trend. I have been advised that the hospital is currently relying on short-term and long-term locum non-consultant hospital doctors, NCHD, with differing levels of experience to maintain the very busy twenty-four hour, seven-day per week rota at the hospital. The cost of funding agency spend on NCHDs in Bantry was just under €170,000 for 2022. With the support of these locum doctors the hospital must also meet the 24-hour European working time directive key performance indicator, KPI. Recruitment and retention of healthcare workers generally, including NCHDs, remains a top priority for this Government. As recently as September the Minister announced that he is establishing a national taskforce to focus on the NCHD workforce. The purpose of the taskforce is to put in place sustainable workforce planning strategies and policies to improve the NCHD experience, and support and grow a sustainable NCHD workforce. Central to achieving this will be the promotion of a culture of education and training at clinical site level to support present and future retention of NCHDs in all hospitals, including Bantry General Hospital. Perhaps that will address the Senator's question about expanding the number of NCHDs at that location.
I thank the Minister of State for her response. It is about trying to make sure we can get that number from 17 up to 20 or 21. We all realise the geographical issues with Bantry's location. It is about making sure that we talk up the complex, the management and staff, and what they achieve on the ground. If we can tell the good news story, the ability to get the doctors required on the ground will come. It is a global market now. It is not about the Irish national market, or even Europe. This is a global market, so when someone Googles Bantry General Hospital they need to hear the good news story. They need to hear that Bantry is vibrant, and it produces a lot of good work on the ground. It serves a rural community with seven islands, but it does what it does and attains. It actually delivers. We need to make sure that story is out there. I welcome the review. I think it will be positive. Off the back of that we can hopefully get the extra doctors required to ensure we can keep telling the good news story about Bantry General Hospital.
I would like to reiterate that the Government, along with the Department of Health is committed to addressing workforce challenges across the health services to meet the growing needs of the population. We also need to make sure that sustainability model is in place when we look at rural areas. Since the beginning of the Covid pandemic, this Government has overseen the largest ever expansion of our healthcare workforce. At present, there are almost 18,000 additional whole-time equivalents working in our health service than there were at the beginning of 2020. This is a significant increase of 15%. The number of NCHDs employed has also increased by 18% in the same period. This ongoing growth has supported service delivery and delivered reductions in the overall working time of the NCHDs. It is recognised that in order to make sites like Bantry more attractive, training opportunities need to be enhanced, and the HSE is committed to increasing the overall number of training posts and to providing enhanced training to the NCHDs who are not occupying recognised training posts in sites such as Bantry. The Minister and the Department of Health remain committed to addressing these challenges and delivering the best possible care for the people of the south-west. That is a priority for this Government.
Medical Cards
I thank the Minister of State for taking this Commencement matter. The Minister of State is in a neighbouring constituency quite similar to mine. She was with us recently and I thank her for that positive visit to Cashel. I have raised this because of the frustration in my office, and I am sure in hers and others across the country, of people who are not getting medical cards, even though when we deal with them we know they deserve them. I will speak to a couple of examples, and then about how it particularly falls back on the self-employed and farmers. They have an asset that obviously costs a lot, but they will never sell it. They are losing out regardless of how low their income is from that asset or of the outgoings they have. People are missing out on medical cards who genuinely deserve them.
I have a couple or examples I want to put on record. I have been dealing with these for the past number of months. There are two ladies in Tipperary who have both had a leg amputated. These women are both married to farmers. I and Councillor Mark Fitzgerald have been working for months to get these medical cards over the line, but to no avail. The single farm payment appears to be putting them at a distinct disadvantage in attaining the medical card. One of these ladies needs a new prosthesis, but she cannot afford it so needs to get a medical card. However, she cannot get one because her husband is a farmer. I have had this issue a number of times with self-employed people, but particularly with farmers. I suggest, that particularly for these ladies who will live the remainder of their lives with a severe disability, a medical card be automatically granted on medical grounds without the need for financial assessment. I know there are cases where medical cards are granted for severe medical conditions, where they meet certain criteria, but I believe these criteria need to be examined and expanded to include amputees and those living with life-altering illnesses. There have been dramatic changes in the Department of Health in terms of opening up GP care, free GP care and visit cards. I welcome that. The availability of these services is under strain but these people really deserve medical cards.
There is another person in Tipperary who has been living with diabetes for decades. He has a good job and a good wage, but three out of his four children are now in college. The family is struggling significantly. His wife recently returned to work to supplement their income. He is under significant pressure as he is on a strict diet to control his sugar levels. His application has been refused numerous times. I know that man is making financial decisions to make sure he can pay for his children to go to college instead of paying for medicine and looking after himself. That is not the situation we should be in. These are genuine cases where people need to be assessed on the basis of common sense. If somebody is an amputee it is common sense that they should have a medical card based on medical need, and nothing to do with their financial circumstances. I have spoken to others and everyone has these frustrations. I assume the Minister of State has had the same experience. These are genuine people who need support. If we cannot support them, well what are we doing?
I thank the Senator for raising this Commencement matter, which I am taking on behalf of the Minister, Deputy Donnelly, whose script I will read. If I have time I will also give my own opinion, which I would like to on this one.
Person-centred care is an existing core value of the health service, where everyone living in Ireland and considered by the HSE to be ordinarily resident here is entitled to either full or limited eligibility for health services. Persons with full eligibility, those who hold medical cards, can generally access a wide range of health services without charge.
As of January this year, there are over 1.5 million medical card holders and over 530,000 GP visit card holders. Eligibility for medical cards is provided on a statutory basis under the Health Act 1970 and based primarily on means. The Act obliges the HSE to assess whether a person is able, without undue hardship, to arrange GP services, having regard to his or her overall financial position and reasonable expenditure. The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual's own financial circumstances.
The Minister for Health's focus continues to be on ensuring the continued operation of an appropriate and effective medical card system which aims to provide support and access to health services when needed. If an applicant's income is over the limit for a medical card or GP visit card, he or she may still qualify for a discretionary card. The HSE may, and I use the word advisedly, exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where he or she faces difficult financial circumstances, such as costs arising from the illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.
I can advise the Senator that since 1 December 2018, the medical card earnings disregard for persons in receipt of a disability allowance has increased from €120 to €427 per week and applies to the assessment processes for both single persons and families. This measure gave effect to one of the key recommendations of the Make Work Pay for persons with disabilities report and enables persons in receipt of the disability allowance to have a higher level of earnings and still retain their medical card. I can assure the Senator that the Minister for Health endeavours to ensure the medical card system is responsive and sensitive to people's needs. The Department of Health keeps medical card issues, including the current medical card income thresholds, under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements.
Last Friday morning I met a farmer of 72 years of age and his wife who is not yet 70. This is his third time applying for a medical card. He is over the threshold by X number of euro but at the same time his wife suffers from a serious underlying health condition. In cases like this there is need for flexibility, particularly with the self employed and in the farming sector. The Senator referred to prosthetics. The price of a prosthetic can be up to €20,000. Many people cannot afford that. Even if one has private health insurance, it is not covered. There are certain needs, such as the example I have just given where people do need a medical card. People of that age have a life-altering experience. They were probably hale and hearty and all of a sudden things have changed dramatically. After having an amputation it can be up to a year later that a person needs to be fitted for a prosthetic. That is not taken into consideration. That is why those people need flexibility. We need to look at a budgetary piece where VAT is removed on the income that people are paying who find themselves in this situation.
Out of the many of the responses I have heard in this Chamber, the last minute was one of the most frank and honest responses I have had on a Commencement matter. I thank the Minister of State for that. If we could keep her in the Department of Health for a couple of years she could sort out all of the problems there. On a serious note and as the Minister of State herself said, people in this situation have enough to be worrying about and they have experienced tragedy. To then feel as though the State is not supporting them is difficult. They come to us genuinely thinking that we can support and help them. It seems such an obvious thing where the State would look to support a person financially to get a prosthesis. However, we cannot and it is incredibly frustrating. When people are using the limited amount of money on other things and not on their own medical well-being, we really have a problem. In her response, the Minister of State mentioned that the HSE may use discretion. I have never seen the HSE move from what the rules are to having any sort of discretion or common sense. It is infuriating from our perspective. One gets to talk to someone in the HSE and they agree that the point is valid but still, nothing changes.
I thank the Minister of State for her honest response.
I did emphasise the word "may" and the reason I did so is that I have yet to see the word come into operation myself. The HSE also uses the word "discretion". I have yet to see the word in operation. When it comes to medical cards, they are two words that are held in the dictionary but not in operational circumstances. There should be a review for the self-employed within the medical card section. This will enable us to see how we can put into effect the idea of discretion within the medical card section for people who find themselves in life-altering conditions or where their circumstances change. For example, they might have an income but they have family going to college. In the crisis we are going through at the moment we need to be open to all suggestions that are brought forward.
Special Educational Needs
I will start by painting a picture of two of the many cases I want to speak about. The first case if that of the family of a young man from Newbridge. The family speaks of a loving son whose preschool teachers first raised concerns about him. The boy was granted the access and inclusion model, AIM, programme. He was due to have an assessment by teachers at the end of junior infants' class to see if there were any additional needs. When the pandemic hit, the school was closed and this assessment was delayed until senior infants' class. When it was carried out, his teacher pinpointed a number of things that needed to be investigated. The family submitted the initial assessment of need application in November 2021. The family then spent the next 14 months ringing and emailing. Some dates very given but those dates came and went. Then his mother stated it came to light about the High Court ruling at the end of March 2022 that required the Department to change the process of the assessment of needs, AON. More calls were made and only yesterday the family were told by someone in the assessment of needs office that there was no timeframe and their son remains on the waitlist. However, they were told every child that had previously been assessed, prior to the High Court ruling, is entitled to a re-assessment first, resulting in longer delays. That person in the AON office also informed the Newbridge family that extra assessments require qualified staff that it does not have but it is doing a recruitment drive. The reply from the exhausted mother to me was that it had been the first transparent response she had received.
The second family I want to talk about are from Athy. Their son had an assessment of needs in 2012. He received a letter from the appeals office in November 2021 after years of calls and no answers. The letter stated that his review had commenced and he would be offered a preliminary team assessment, PTA, given the length of time involved since the last one and the change in his presentation. Roll on to September 2022 and a reply I received on behalf of the family stating that this young man was highlighted as requiring a review of his assessment of needs in August 2020. A plan was in place in late 2021 to review his case using the PTA, but due to the High Court ruling referenced earlier, this method had been invalidated. The team now has no alternative for this young man and his case will be highlighted as one of a number of past assessment of needs where requests for reviews have been made
Both families tell stories of their young loved ones finding life so difficult, drifting through each day, looking to their parents for help. Both sets of parents say they are at their wits' end, not knowing how to help them and not getting answers despite numerous calls and emails. This is just a small example of the many representations I get in Kildare. I am dealing with them day in and day out. I am also a member of the Joint Committee on Autism, which the Minister of State has appeared before. Recently we had some senior officials from the HSE in and they were at pains to point out that an assessment of needs was not required to access services. Time and again, they told us that was the case. Unfortunately, time and again, and since that discussion, parents tell me the exact opposite. They tell me they cannot access services without an assessment of needs. They tell me those offering the services, if they can get through to them that is, demand an assessment of needs before they will engage.
I hope the Minister of State is bringing some positive news to these families today. The families want certainty. They want routine. Their children are years without this. We need clarity on the assessment of need and whether it is needed for access. How is the recruitment going that was mentioned in previous replies I have received? Most important, when will these families, particularly their loved ones, see the services they need, which, as I have said, they have been without for years?
I thank the Senator for raising this topic and for giving me the opportunity to engage with him on it. To put it in context, we are talking specifically of community healthcare organisation, CHO, 7, which covers the Senator's Kildare-Athy region, the surrounds of Maynooth and reaches as far as areas of Dublin.
It is important for me to be honest and transparent with the Senator. I thank him for raising the issues of the two families. The Senator is after getting a script but I need to correct something on it. It states "CHO 7 currently reports 1,320". Thankfully, Noel in my office kept digging until we got the actual figure so that I could give the Senator real openness and transparency on it. The figure is 2,665. That is the number of families in CHO 7 awaiting an assessment of need. That is Groundhog Day. That is as bad as it can get. To be honest, the HSE has not kept pace with the growth in population as shown in the census returns. Funding has not kept pace with disability sector and the growing population. It is important to say that.
As for what I will do as Minister of State to address that, because 2,665 families are waiting for an assessment of need which will open many chapters, be it in education, domiciliary supports or whatever, in working with the HSE I am looking at putting in place a number of regional teams. At a local level, I have to complement Ms Deborah Jacob, and I complement my leads in that area, namely, Stewarts Care and the Central Remedial Clinic. They work very hard with Ms Jacob in ensuring what can be delivered under the Progressing Disability Services for Children and Young People, PDS, programme and the assessment of needs can be done.
However, there is a legacy piece to do with the preliminary team assessment, PTAs. It also requires us to address the High Court ruling. I have received the report on it from the HSE. I have sent it to the legal department in the HSE for its independent advice on it before we make a final decision because what was in the past did not work. The PTA, which was there when we came into office, did not work and we need to be not unsure about the next step.
When I have the final report back within a number of days, my suggestion is to put in place six regional teams to match the regional health areas, RHAs. I was fortunate in the recent budget to secure €11.5 million to address this backlog in assessment of needs. Those six regional teams will cover the various areas, so we will have a complementary team in each RHA that will specifically address assessments of needs and we will get through them. When those assessments are done, the children who need whatever supports are required will, depending on the need, either find themselves back with a primary care team or back with the children's disability network teams, CDNTs. They will have the results they can present to the Department of Education to get their educational supports.
There are three different levels to this. While it might sound complex, the flow of this will be quite seamless and it will be dependent on the staff. As opposed to putting the pressure on each single team, because we have neither the staff on the team nor the clinical governance piece to assess the risk of it, by doing six teams, each CHO manager lead, that is, the head of community health, needs to support the disability manager and work with primary care. We also need education on those RHA teams. It is the whole of the child, the child at the centre and what the child needs. That is the ambition, and sooner rather than later.
I thank the Minister of State. Once again, she gave an honest answer. That is the message I have got from the families I deal with. It is like what that woman said to me yesterday, that it was the first transparent answer she got after almost three years of asking. The Minister of State has given that today, albeit with the disturbing figure of 2,665 children that she has also given us. The Minister of State mentioned that is a crossroads we have to come back from urgently.
I appreciate the Minister of State will put in place the six regional teams but we also need to address that statement by the HSE that an assessment of need is not needed, because it is. That is huge. The HSE representatives were at pains to point out at the committee that it is not needed, but the first question every clinician visited by families I have dealt with ask is where is the child's report or assessment of need. They will not talk to the families unless they produce those. The Minister of State said her short-term goal is to address that and put those six regional teams in place, but we need to address something else. There is communication lacking somewhere when the HSE comes to the Committee on Autism and states an assessment of need is not required when the facts on the ground are completely different.
I thank the Minister of State for her honesty.
I will focus on that point because the Senator is correct. There are two different trains of thought on this. To be fair to the HSE, if a child is in need, for example, for occupational therapy, physiotherapy or speech and language therapy, the health needs will be met within the teams. If a child is P1 or P2, that priority listing of behavioural needs, he or she will be seen to because of that need and should not need a diagnosis to access it. However, a diagnosis is needed for education and for social welfare. Three different Departments have two different understandings of what is the need. At all times, we are saying we are a health model and, therefore, we meet the needs of the individual. I totally understand that. Unfortunately, the Department of Social Protection and the Department of Education say two different things. If a person does not have that piece of paper, his or her child cannot access a special class, a special unit, domiciliary allowance or carer's allowance. That is a piece that needs to be sorted out. However, the HSE is correct in what it is saying to the Senator, but it is unjust not to acknowledge that, without a diagnosis, a person cannot access the other services. I am trying to break down that barrier of understanding.
In terms of trying to get answers from Ministers, it would be great if all Commencement matters were addressed in such an honest way.
Absolutely.
I thank the Minister of State for coming in and speaking in such a manner.
Cuireadh an Seanad ar fionraí ar 10.17 a.m. agus cuireadh tús leis arís ar 10.30 a.m.
Sitting suspended at 10.17 a.m. and resumed at 10.30 a.m.