Oireachtas Joint and Select Committees
Wednesday, 16 July 2014
Joint Oireachtas Committee on Education and Social Protection
Special Educational Needs Provision: National Council for Special Education and Health Service Executive
While the witnesses are getting ready, I draw their attention to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, they are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they will be entitled thereafter only to qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable. I also advise the witnesses that the opening statements they have submitted will be published on the committee's website after the meeting. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable.
I advise the witnesses and those in the Visitors Gallery that, at the request of the broadcasting service, they are asked to ensure for the duration of the meeting their mobile telephones are turned off or switched to aeroplane, safe or flight mode. The meeting is being broadcast live on UPC channel 207.
The meeting is about therapy services for children with special needs in an educational setting. The joint committee in the past considered the issue of education of children with special needs. A range of interventions for children with special education needs is possible, among which are health and personal social services such as psychological or speech and language therapy services provided by the HSE. To assist the joint committee in its consideration of this matter, I am pleased to welcome the National Council for Special Education, which is represented by Ms Teresa Griffin, Ms Mary Byrne and Mr. Sé Goulding, and the HSE, which is represented by Mr. Pat Healy and Ms Anne Melly.
We were scheduled to have another guest, a principal from St. Joseph's primary school in Fairview, but she is unavailable due to unforeseen circumstances. I invite Ms Griffin to make the presentation on behalf of the National Council for Special Education, NCSE.
Ms Teresa Griffin:
I thank the committee for its invitation to attend this afternoon. Mr. Sé Goulding is head of operations for the NCSE and Ms Mary Byrne is head of special education. The NCSE has a vision of a society where children and adults with special educational needs can achieve their potential. We all know "it takes a village to raise a child" and for a child with additional needs, the village needs to comprise a family, appropriate schooling and support, if required, from clinical and therapeutic professionals. These supports include clinical psychology, speech and language therapy, occupational therapy and psychiatric support etc. From the outset, I emphasise that the NCSE is very supportive of the approach being taken under the HSE progressing disability services for children initiative, as well as A Vision for Change. We welcome the move away from a multiplicity of therapy service providers to the development of regional multidisciplinary teams around the country. The NCSE is represented on the various national and local groups leading this initiative. In many places around the State, our special educational needs organisers work well with local HSE disability services to plan and put services in place for students with special educational needs and we work hard to ease anxieties of parents and children in transitioning to and from school.
Special education is a key Government priority and the NCSE is very appreciative that the resources we need to provide to schools have continued to be made available to us, despite the very difficult fiscal environment. We have the ability to respond to growing student enrolments by continuing to allocate additional resource teacher and special needs assistant, SNA, posts in line with need and by establishing special classes and expanding special schools. When meeting colleagues from the HSE, they advise us of their capacity issues and constraints. Groups constantly tell us the position around the availability of clinical and therapeutic service continues to be problematic for children, families and schools. When a child needs clinical or therapeutic intervention and does not receive it, we all know there can be significant repercussions for the child’s development and in terms of an ability to access education.
It is generally acknowledged that HSE-funded early intervention teams work well in certain areas of the country but I have been told by parental, school and advocacy groups that access to important health services is limited in other parts of the country, with gaps in services and long waiting lists. The main issues raised include lengthy initial waiting lists, insufficient intervention if it is provided; inadequate support in mainstream school settings; concern that only some students in special classes receive support and others in the same class with equivalent need do not receive such support because of the segregated multiple service providers and concern that some children have to be taken out of school and brought to clinical settings.
The difficulty around accessing a diagnosis of disability was one of the reasons the NCSE recommended to the Minister a change in how resource teachers are allocated to mainstream schools. We felt one cannot base access to additional teaching support on a diagnosis of disability if there is not national consistent access to such a diagnosis. Parents and schools have told us that they make difficult decisions based on the availability or absence of therapy services. For example, parents seek to send their child to a special school or a special class where he or she might get therapeutic support even if the child is capable of attending mainstream education, parents refuse to allow their child to leave a special class or special school setting because they might lose their therapy intervention and parents seek professional reports simply to access special school placement so the child can get therapeutic or clinical supports. Worryingly, mainstream and special schools are encountering severe difficulty in deciding if they can maintain the enrolment of some students who present with challenging behaviour in the absence of clinical supports. We all agree that none of these scenarios is a good outcome for the child and none is in line with the national policy of supporting inclusive settings.
As I stated at the beginning, the NCSE is broadly supportive of the progressing disability services initiative but children are only children for a period. We have recommended that, pending the full roll-out of the progressing disabilities initiative, children with special educational needs should have early and timely access to sufficient clinical services, which should be provided on a consistent, efficient and equitable basis throughout the country. This is something that the HSE is also working hard to put in place. I am very happy to any of the committee's questions.
Mr. Pat Healy:
I thank the Chairman and members for the invitation to attend today. I am joined by my colleague Ms Anne Melly, specialist in disability services. The committee requested information on the provision of therapy services for children with special needs in educational settings and I will outline the national programme under way to standardise and develop the way in which services for children with disability, including those with autism, are delivered. I will then deal specifically with issues in the Dublin north and north city area in which St. Joseph’s school is located.
The Health Service Executive has recognised the overall need to standardise the way in which services for children with disabilities, including those with autism, are delivered. We are currently engaged in a reconfiguration of our existing therapy resources to multidisciplinary geographical based teams for children as part of the national programme on Progressing Disability Services for Children and Young People between zero and 18 years. The objective of this exercise is to achieve a national unified approach to delivering disability health services so there is a clear path to services for all children, regardless of where they live, what school the go to or the nature of their disability. There is a national structure to underpin this change management programme with national, regional and local implementation groups in place. All elements of the implementation structure include multi-stakeholder involvement, including representatives from the Department of Education and Skills and its relevant service strands, including the National Educational Psychology Service and the National Council for Special Education.
The vision for service delivery is that every child and its family will have access to required services; there will be equity and consistency across the country; effective teams will work in partnership with parents; resources will be used to the optimum; and health and education will work jointly to achieve best outcomes for children. The intention is to roll out an integrated care model that will allow children, whatever the nature of their disability, to be seen as locally to their home and school as possible, at primary care level when their needs can be met there and by a network specialist interdisciplinary team if their needs are more complex. The primary and network teams will be supported as appropriate by specialist support services with a high level of expertise in particular fields.
An additional €4 million has been specifically allocated in 2014 to drive implementation of the programme, and this equates to approximately 80 therapy posts. As the programme is rolled out, it will ensure that the resources available are used to best effect in order to provide health supports and ongoing therapy to all children between zero and 18 in line with their prioritised needs. In particular and over time, it will mean that all children, regardless of where they live will have equitable access to services based on their needs.
Within the Health Service Executive, local services are delivered through integrated service areas, ISAs. Each of these is at different stages of development across the country and the 2014 plan will see developments across a number of categories. The local implementation groups in the mid west, Meath, west Cork, Cavan and Monaghan are already well developed and will consolidate implementation of the model, building on progress to date. The local implementation groups in Kerry, Mayo, Galway, north and south Lee in Cork, Wexford, Kildare and west Wicklow and the midlands are ready to move to the next phase and will begin to fully reconfigure their services in line with the model. The local implementation groups in Dublin will also see significant progress; Dublin north and Dublin north city on the north side and Dublin south, south east, south west and south central on the south side will finalise the consultation phase with all stakeholders, complete implementation plans and commence reconfiguration towards the new model of service. The local implementation groups in Donegal, Sligo, Leitrim, Roscommon, Louth, Carlow, Kilkenny, Waterford, south Tipperary, north Cork and Wicklow will progress to the consultation phase and will establish a health and education forum, reviewing and amending governance and management structures, service policies and procedures and prepare for reconfiguration in 2015.
Turning to the reconfiguration in the Dublin north area, Dublin north and Dublin north city, services to children with disabilities in this area are provided by a variety of service providers, including St. Michael’s House, Daughters of Charity, Central Remedial Clinic, St. Paul's hospital and special school, which is linked to the Mater hospital, St. Joseph’s School for the Blind, Child and Adolescent Mental Health Services, HSE early intervention services and Beechpark services for children with autism.
While many models of good practice have been developed and implemented to meet the needs of children with disabilities in Dublin north and Dublin north city, access to services and the timeliness of the response to identified needs has been largely determined by whether a child resides in an area where there is a service provider with a level of resources which enables a speedy and appropriate response. Access to ASD services for children with normal IQ or mild intellectual disability has been determined by whether the child attends a class supported by Beechpark services.
With regard to autism-specific services and complex needs, Beechpark services and St. Paul's hospital and special school are autism-specific services, but the remaining service providers are also involved in meeting the needs of children with autism when the presenting need is less complex or where the primary disability is intellectual or physical or sensory. Beechpark services are primarily targeted at providing appropriate multidisciplinary supports to children in Dublin north and Dublin north city who attend special ASD-specific classes that have been developed in special and mainstream schools.
With the multiplicity of service providers involved and the diversity of children’s needs, ranging from mild intellectual disability to much more complex needs involving multiple disabilities, issues have been identified regarding the need to have very clear identified care pathways for all children requiring health and personal social services. Evidence would suggest that there is greater clarity with regard to access where needs are clear and diagnosis is straightforward. However, the pathway for children presenting with complex needs has not been as clear, and gaps have been identified. In this context, some children diagnosed with ASD have had difficulty accessing a service and transitioning from one service to another.
In response to the many challenges emerging regarding the reconfiguration of multidisciplinary services in these areas, a dedicated senior manager has been assigned by the HSE to manage the reconfiguration programme. An implementation group comprising all stakeholders - including all service providers, representatives from the education sector and parents - is in place and work is actively progressing to attend to the realignment and reconfiguration of the service delivery system in line with the agreed policy direction. This work involves considerable system changes and it has been recognised that during the period of implementation additional resources will be required to address waiting lists and service pressures. In this context an additional five posts were approved in 2013 to enhance the service response for children with ASD, and these posts are currently being recruited. More important, a further 21 posts have been sanctioned in 2014. This additional resource will enable the commencement of an enhanced service response for those children presenting with complex needs, including ASD, in this area.
The HSE and the Department of Health jointly commissioned the NDA to carry out research into the practice of assessment of need. The findings of the report produced on the national programme for children aged 0 to 18 years highlighted that where the Health Service Executive has configured disability services for children into geographically integrated teams, the statutory assessment of need process worked better and in a more streamlined way. There was also less emphasis on using the assessment process to develop diagnoses in order to meet the specific entry requirements of individual services. Accelerating the reconfiguration into geographically integrated teams would be very important, therefore, in improving the efficiency and effectiveness of the statutory assessment of need process.
I am happy to answer any questions from members of the committee.
I thank Mr. Healy and Ms Griffin for their opening remarks. I thank Teresa in particular for being very up-front in her presentation about the impact of this lack of services on children. It is totally unacceptable that whether a child receives a vital service is dependent on where he or she lives. This is very unfair to the children concerned. We know that children with special needs need to receive appropriate interventions as early as possible, yet in some parts of the country this early intervention is non-existent. In my area of Dublin bay north and in the broader north Dublin area, the waiting list for early intervention - the list to get on a list to be considered for a service - closed in November 2012. No matter how serious the child's need, he or she cannot even get on a waiting list. This is a really shocking and very unfair situation.
The HSE presentation referred in detail to reconfiguration of services, and we all share its vision as to what services should be provided in an ideal world, but in the meantime, the HSE has been talking about this since 2011. I have tabled this issue a number of times in the Seanad over the past three years and my colleagues in the Dáil have also raised the issue in that House. Every time I have raised the issue I have heard the same reply as today - that services are being reconfigured. That is cold comfort to the children who have been unable to get any service in the meantime. I support Ms Griffin, who is representing the National Council for Special Education, in her call that in the interim something needs to be done. I agree that reconfiguration of services should be pursued, but in the meantime the resources need to be available. It sounds as if this talk of reconfiguration is being used as an excuse for not providing resources and in my view this is very unfair.
The principal of St. Joseph's in Fairview planned to speak to the committee today but she is unable to attend due to illness. I will make some of the points she intended to present. St. Joseph's is a mainstream school with a number of special classes which were provided on the promise of appropriate health and educational resources. The educational resources are in place. Originally, all the children in the special classes were being provided with speech and language and occupational therapy services from Beechpark, but because of cuts imposed in recent years, Beechpark has not taken on any new children. The current situation was referred to by the National Council for Special Education in that only half the children in the class are receiving a health service, based on an arbitrary decision depending on when they joined the school. This is very unfair to the children concerned and it has also caused health and safety risks for other students and for the staff because the behaviour of some of these children who are not getting the services they need has deteriorated to the point where a number of serious incidents have occurred when children have become out of control in the classroom and attacked teachers. The principal rang me one day in tears as a result of the latest incident. She said she did not want to be forced to expel primary schoolchildren because she wants to be able to look after them and to provide them with the service they need, but she is unable to do so. She is at the end of her tether as a result of the impact of the lack of services on her children.
When will the reconfiguration of services be completed? In north Dublin, three years on, we are still talking about a consultation process. In the meantime, children who started three years ago have now missed out during a vital part of their young lives which they will never get back. I ask the HSE to provide the resources for a service which can then be reconfigured later as needs be to provide a consistent service in all geographical areas in the country. The ideal situation would be for the health services to be provided on the same basis as educational provision. The Department of Education and Skills made an arrangement years ago with the Department of Finance to ensure that teachers and special needs assistants would be provided when a special class was initiated. The Department does not need to renegotiate with the Department of Finance for every new class because that agreement is in place. This should be the case in the provision of the health service but it is not. Has the HSE requested it in budget discussions? Will it look for it? Does the HSE agree that this would be a better solution to these problems?
I welcome Mr. Healy and Ms Griffin to the meeting and I thank them for their presentations. I have two questions, which are both directed to Mr. Healy. He referred in his presentation to the 80 new therapy posts approved for funding in 2014. I understand there has been a delay in advertising those positions and they have not been filled as of today. I ask Mr. Healy to clarify the position. I ask him to explain the basis for the allocation of these posts around the State. Has the HSE made any attempt to ascertain the number of therapy posts needed to ensure that the disability network teams will be fully staffed?
What body, if any, measures the outcomes or consequences for children who are not getting the necessary level of therapeutic interventions in an educational context? Apart from the impact on the individual, there is a long-term economic cost of failing to assist children at an early age to reach their potentials.
I welcome the NCSE and HSE guests. Which existing therapy services are included in the new reconfiguration? Can the HSE give us an overview of the pressures in different parts of the country? There are different operations in various regions. What are the waiting lists for the various therapy services? Are they much longer in some areas than others? Are young people being seen earlier in some areas, and do the waiting lists extend to more than a year in other areas? Are there caps on the number of psychological assessments and other services a school can get? My information is that the number of children a school can send forward to see an educational psychologist is limited. As a result, schools must choose between children, which is not a position in which any school should be. Is this case across the country?
Could both guests elaborate on the distinction between services available to special schools and mainstream schools? Parents have told me they felt they had to send their children to special schools because it was the only way they could access support services although the children were capable of being in the mainstream school system. What services are affected by the distinction between special and mainstream schools? Could the NCSE elaborate on its experience of the allocation of resource hours? Its presentation has outlined that it very much depends on when a child is assessed and follows on from assessment. Could the NCSE give more details on the number of students affected and whether it is different in various parts of the country?
Mr. Pat Healy:
The reconfiguration of services is a major change programme and we wanted to get it right. We set out four categories of locations. The first category is the mid west, where much work has already been done and the model is working well. It is not getting additional resources this year but is moving on. We will give some funding to support education and training and to keep the good work going. The third category is Dublin, where there was clear recognition of the necessity to prioritise and address the challenges. Category two includes a range of locations across the country where all the preparatory work in terms of consultation with families, schools and educators has been done, the care pathways are ready and we are ready to implement. The final category is those that have work to do this year but will be ready next year.
The prioritisation of the posts is related to need but also to the capacity to implement the reconfigured programme in a sensible and organised way. We are targeting 21 posts to the north side of Dublin, which will make a significant difference. The posts are cleared and will be filled on a permanent basis during the rest of the year. We recognise we need to use the resources we have to target waiting lists. We will not wait until the posts are there permanently but will use the resource at local level to use capacity between public, private and voluntary in order to address the waiting lists. We do not want to lose the benefit of the reconfigured model. The key aspect of it is that, as we roll out the model and apply more resources over time, we will eliminate the non-standardised issue whereby the service depends on the service provider to which one is aligned or whether a special school has resources attached to it, or issues such as the Beechpark issue in Dublin. The new model will address the needs of the children, irrespective of the school or provider they attend. This is important.
Mr. Pat Healy:
Absolutely, and while this is happening we will use the resources to provide some resource to services I mentioned such as the mid west, which has already made significant progress, to support education, training and other initiatives. Every local implementation group involved in the consultation and in rolling this out will also receive education and training capacity, because it is an important part of getting the model right. The intention is to fully utilise the resource in the current year.
Mr. Pat Healy:
One of the posts we will put in place is specifically focused on the development of outcomes, which is very important and will be developmental. There is work ongoing examining how many posts we will require into the future and a workforce planning piece has been done. The additional resource we have this year is €4 million and we cannot move beyond that. Our maximum capacity is to implement the 80 posts. Including the posts that were approved last year and this year, it will be a 20% increase in the north Dublin area, which is significant. I take the point made by education colleagues that we are not in the same position as them in that we do not have to get approval to proceed every time a special class is developed. This is not how the funding of the health service has progressed.
I have outlined how funding is being allocated this year.
The areas where we target funding take into account significant pressures and the capacity to roll out the model in the current year because we need to do it appropriately. The model does not envisage placing caps on schools. With regard to making a distinction between mainstream and special schools, the purpose of the new model we are rolling out is to remove all of this inconsistency.
Mr. Pat Healy:
There are gaps in the existing model, some of which are associated with the historical way we have developed services. The point has been made in the feedback through education that those associated with a particular service provider or class may get a very good service, but the issue for us is that we must develop a more consistent approach. The inconsistency which arises by targeting particular special schools or specific providers, as has been done in the past, is not the way to continue. I referenced the work and research done by the National Disability Authority which supports this. Where the model is implemented it makes a difference. I take the point made by members that one must pay attention to today as well as roll out the model, and we are trying to strike a balance, but we do not want to lose the implementation of the model.
Mr. Pat Healy:
We must address the issues in the north Dublin area. It is recognised there are significant gaps in early intervention in north Dublin and in autism spectrum disorder services in the north of Dublin city. We will allocate 21 posts, which will make a significant difference. These 21 posts, together with the five posts approved last year and other replacement posts, will mean a 20% increase in the resources available.
The point made by my education colleagues is correct. The health system does not have approval to proceed as special classes are developed. We do not have the resources to match education in the same fashion. There was acknowledgement that to roll out a reconfiguration of the services additional resources are required, and €4 million was secured by the Minister to give effect to this. This will go a long way. We will implement a post specifically focused on developing outcomes associated with the model, which will help to demonstrate the benefit and measure how we progress.
Mr. Pat Healy:
Categories 2 and 3, which include Dublin, are progressing and moving beyond the consultation phase. As we have rolled this out in various locations we have learned that consultation, particularly with parents, schools and local communities, is very important and we must ensure it happens. The programme will be fully rolled out in all locations by the end of next year. What will remain as an issue then will be matching needs as they increase, and our capacity to respond and match the number of special classes and services if they are expanded by the Department of Education and Skills.
Mr. Pat Healy:
I do not have the figure for 2011 but I believe the figure was static from 2011 to 2012. The figure in 2013 was 142. I can find the previous figures and give the Senator the comparators. At a meeting with the Oireachtas Joint Committee on Health and Children I provided analysis of all therapy posts in the system. Notwithstanding the fact there has been a significant reduction in health service numbers of more than 12,500, we increased therapy posts because we prioritised them. I can provide the Senator with this information.
The area I know best is north Dublin. A member of staff there went on maternity leave and was not replaced, and children were left without a service. This was entirely predictable and there should have automatically been a replacement but this did not happen. From raising this issue in the Seanad over the past three years I have learned there seems to be a difference between how many people are recruited and how many people are providing a service. Where do we stand in respect of this? Mr. Healy stated 21 extra posts have been allocated. I have been raising this issue for a long time. For the past two years the Minister has stated a total of €4 million has been allocated, but we have not seen it being spent or seen people in positions. What is the actual situation?
Mr. Pat Healy:
Approval has been cleared for 80 posts, which will be made on a permanent basis. There is a commitment to utilise the resource to provide education and training to support the local implementation group process and to target local waiting lists while the permanent posts are being put in place using capacity in public, private or voluntary sectors. We have the challenge of dealing with the employment control framework which operates in the system. We are funded for a level of resource. We are covered for a percentage of maternity leave but we do not have approval to go beyond this. We try to prioritise therapy posts in particular. We have set out in our operational plan for social care for the year the importance of maintaining therapy services, particularly for children. In acknowledgement and recognition of the challenges in Dublin, such as Beechpark and autism spectrum disorder services, we prioritised the totality of Dublin during 2014 and we will continue to try to develop this, which is why we have specifically assigned 21 posts to the north of Dublin city.
I accept that Mr. Healy is working within resources but I have been asking the same questions for the past three years and getting exactly the same answers. We keep being told a process is under way, money has been allocated and people are being recruited. When will there actually be extra staff in north Dublin providing a service for the children who since November 2012 have not been able to get on a list?
Mr. Pat Healy:
Whatever about previous responses, I took up this post towards the end of last year. We included the €4 million funding in our service plan and have approval for it this year. In January and February this year we announced the intention to spend the money. We have gone through the process of settling on the allocation of the resource, approval to fill the posts is in place and we will fill them. An important and positive part of this is we will be able to benefit from the graduates in September. It is very positive to have the posts ready for them. We will also target the use of the resource in the current year on waiting lists and on education and training with regard to local implementation groups.
It is important to support the consultation and engagement with families.
Not really. I do not think we have progressed any further on this than when we started and I find that depressing, given the nature of the issue. Services have not improved and all we keep hearing is talk of process, though I mean no disrespect to the witnesses. If the 21 people referred to are recruited by the end of the year I will be the first to congratulate the witnesses. I am sceptical because I have been told of recruitment for the past three years. I have with me today replies to questions from different Deputies of various parties that raised the issue in the Dáil and they were all told there is a process in place and people are being recruited. I am sure Mr. Healy is trying to be helpful and I mean no disrespect to individual witnesses when I say I am sceptical but I get phone calls from school principals who are in tears because of what the children in their schools are enduring. All I hear is talk of process and this does not give me faith in the system.
Mr. Pat Healy:
I can confirm, whatever of the past, the only thing that could delay the filling of these posts would be the inability to find staff to take them on a permanent basis. The filling of these posts has been approved, it has priority and it will proceed. There were no such additional posts available last year.
Ms Teresa Griffin:
Deputy Jonathan O'Brien raised issues relating to deficits in resources and the monitoring of outcomes for children. The issue of the cap on psychological assessments was also raised and I understand the National Educational Psychological Service, NEPS, has a limit of two assessments for every 100 children in a school. Its approach tends to look at the whole school and put structures in place on that basis. I think NEPS assessments are limited as outlined but I will come back to the committee later if I am mistaken.
On the different services in mainstream schools and special schools, from an educational point of view, we allocate teaching and special needs assistant, SNA, resources to schools in line with pupil-teacher ratios that are set down for special classes, whether in mainstream schools or special schools. For example, the standard pupil-teacher ratio in a special class for children with autism is one teacher and two SNAs for every six children but this can increase depending on the children and many special classes have three SNAs. In other words, staffing of one teacher and two SNAs for every six children is the baseline and individual care needs are also taken into account.
It is difficult to measure deficits in the monitoring of outcomes for children because, as our policy advice has said, outcomes are not routinely measured. We recommend that where additional resources are applied outcomes must be measured because we would like such information. Through additional services implemented by the Health Service Executive, HSE, in conjunction with voluntary organisations like Atlantic Philanthropies in Limerick and an initiative in Tallaght, we have become aware that where services are put in place 18% of children that need early intervention speech and language therapy will be discharged from the service. In other words, the service that was put in place saved those children from multiple disadvantages later in life because the early acquisition of language is very important and children who do not acquire language early will be at a significant disadvantage when they start school.
The last time we examined the matter of waiting lists was in preparation of our policy advice paper last year. I think 23% of applications under the assessment of need process were met in the timeframe set down by the HSE, but perhaps the HSE witnesses here can confirm that. This led to significant delays in children accessing resource teaching hours. The impact on our services can be seen in the understandable frustration of parents who know they must have a disability diagnosed before additional teaching supports can be accessed. We allocate resources twice a year and huge frustration builds as deadlines for our assessment and allocation process approach. The frustration stems from the fact parents are on a waiting list and know if they miss the deadline they must wait another six months for the allocation of resource teachers.
The lack of therapeutic services in certain parts of the country sometimes means a recommendation for an SNA service is made where speech therapy is required but the resources are not available. When we turn down an SNA this also leads to frustration. If parents are unwilling to allow a child to leave a specialist setting when he or she is suitable for a mainstream setting because of a fear of losing therapy services we must open more special classes. This is counterproductive in terms of the inclusion setting and it affects our services.
I apologise for missing the presentation but I had to speak in the Dáil. This is an area of particular interest to me as there are gaps in services in classrooms in north County Dublin and parents are angry. I hope I heard correctly from Mr. Healy that recruitment of staff will address some of this. I will not repeat what has already been said but I hope the issue of the lack of services in classrooms sees improvement.
I too apologise as I had to speak in the Dáil and missed much of the presentation. I am sorry if I repeat what was said earlier. Early intervention is of interest to me and we are fortunate in west Cork to have West Cork Child Development Services, which provides superb services that may not be available elsewhere. I have had reason to use its services and it is an excellent organisation that works with children around two and a half years of age. What is the overall policy to roll out such services across the country?
I apologise as I had to meet Inland Fisheries Ireland while three other meetings went on and missed the presentation. I want to refer to a case that has arisen in the mid-Kerry area, where services are being reconfigured.
St. Francis special school in Beaufort has encountered huge difficulties since last autumn in providing occupational therapy, speech and language therapy and physiotherapy to its students. The experience of the 52 children attending that school has been appalling and very upsetting for their parents. Many of the children have regressed because of the inadequate level of services.
I very much welcome the provision of 80 additional posts nationwide, four of which have been allocated to Kerry in recognition of the reconfiguration process that has taken place there. The fact remains, however, that the reconfiguration has left huge gaps in the service and children have suffered immensely because of it. Will the delegates indicate whether similar problems have arisen in other counties? When will we see the full allocation of those 80 posts and what guarantees can be given to children and their families that they will receive the services they require? Nobody is looking for a luxury service here. I recently visited a mother whose son struggles to swallow and cough. The lack of services available to him has led to his regressing so far that he developed a chest infection because he was not able to cough. That is how fundamental these services are; it is basic stuff, not anything fancy.
Mr. Pat Healy:
Deputy Daly referred to west Cork, which is one of the exemplar areas under the new model. I mentioned in my presentation the categorisation we devised, with category one comprising those locations in the mid-west, Meath, west Cork and Cavan-Monaghan where a great deal of progress has been made. The mid-west is often cited as one of the exemplar sites around which the model was developed, with west Cork being another very early adopter. The collaboration between schools, service providers and the Department in those areas is excellent. When we talk about rolling out the naught to 18 model, that is what we are talking about. Part of the learning from west Cork and other locations in the mid-west and elsewhere was the necessity of having that type of framework in place, with local implementation groups, good consultation with parents and so on.
To address Deputy Griffin's question, a similar process to what happened in west Cork was undertaken in Kerry. The general feedback I have had is that it has worked well, people understood what was being done, there was a great deal of engagement and consultation with the various providers and good linking into schools. I will look into the situation at St. Francis special school in Beaufort, which I know well from my past role as director of disability services in the south. I was not aware of any particularly significant problems there, but I will investigate the matter. The general feedback on the changes has been good. Indeed, the work done by the National Disability Authority shows that where the new model has been rolled out, it is working better overall. I take the point, however, that the changes must be handled appropriately and in proper consultation with families. There is obviously a resource issue at play here in the context of increased levels of need. I am confident, however, that the model we are rolling out is the best one. We must address the resource issues as we go on. I will get back to the Deputy regarding St. Francis special school.
I thank Mr. Healy for his response. He might not have got around to reading the detailed e-mail I sent him last week setting out the problems at this particular school and elsewhere in mid-Kerry. The previous Minister, Deputy James Reilly, met with parents and HSE officials in May and was well aware of the problems. Students at St. Francis special school have had an appalling experience. My concern is to ensure the HSE is fully aware of the terrible impact on the children in question and to seek assurance that the same thing will not happen elsewhere. While I appreciate the need for reform and to do more with less, we cannot have that amount of damage being inflicted on the children who depend on these services. While the objective is to move to a better system in the long term, this type of thing cannot be allowed to happen in the transition period. I ask that the HSE be vigilant in identifying these types of problems and, where they arise, to rectify them as quickly as possible.
Ms Teresa Griffin:
Thank you, Chairman. I said in my opening statement that the National Council for Special Education is very appreciative of the fact that we still can respond to need. This year we have opened 21 further early intervention classes for children with autism aged from two and a half upward. While that is separate from the therapy issues, it does indicated that the education system has the capacity to respond.
I have two questions for the delegates before handing back over to members. Ms Griffin referred to a recent report by the NCSE which examined the way resources are allocated. Will its recommendations be adopted?
Second, there is an issue in my constituency where schools in Lucan are finding it difficult to recruit somebody to perform the psychological assessments. Has there been any progress in that regard or is there a continuing issue with finding suitably qualified people for posts? Delays in assessments are causing particular problems for students who are transitioning from primary to second level. Is anything being done to ensure necessary resources are in place to address that issue?
Chairman: Second, there was an issue in my own local area in Lucan there was a problem with recruiting of somebody to do the psychological assessments.
Following on from the Chairman's question, we are told that 21 people are being recruited this year. If the delegates had carte blanche to recruit as many people as they need to satisfy the demand that is there, what would that number be? I am trying to get some perspective on the figure of 21 new appointments.
I concur with what Ms Griffin said in regard to National Educational Psychological Service and there being a cap on individual schools. I know from experience that there are huge difficulties for teaching staff in having to decide which students will be assessed. In the particular school I have in mind, there was a class with five students all requiring an assessment and all in receipt of some level of resource hours. Some were simply being taken out of the class and given whatever additional hours they could be given even though those hours were not necessarily allocated to the individual student. One student was assessed and diagnosed as having severe dyslexia and dysgraphia and the recommendation in the NEPS report was that the child have an occupational therapy assessment in light of the issues identified with fine motor skills. The parents discovered, however, that there was an 18-month waiting list for that assessment. They had the NEPS assessment confirming the child's diagnosis but they were faced with a delay of 18 months before obtaining an additional diagnosis of what they suspected was an underlying condition. That created huge difficulties for the school because although management knew what needed to be done for this particular child, it could not secure the resources to do it. Will the new allocation model be able to address those types of scenarios?
In this child's case serious consideration was given to whether he should move from mainstream to special school because the resources were there to deal with dyslexia. The parent wanted to keep him in mainstream school.
It is an awful predicament for any school or teacher to be in, to be told what is wrong with one’s son and that he needs additional tests which are 18 months down the line. Eventually that parent had the tests done privately. I believe if one has tests done privately, there is a problem with recognition of the report. The school said the parent was better off staying in the public system because, although it would take longer, it would carry more weight. I do not believe that is the case but that was the impression given. Some parents weigh up whether to get it done privately or to hang on to do it in the public system if that will carry more weight. This causes huge problems.
Ms Teresa Griffin:
We published our proposed new model in the past month and the Minister undertook to engage in consultation with the teaching unions immediately. We recommended that time be taken to ensure further consultation. We consulted quite widely and went back to various groups about our model. It is a change and that is difficult to manage. We did not want a model that would send a shock through the system and cause a great deal of upset and concern. We recommended that the Minister take time to consult further with the various educational partners to make sure that when or if the model was introduced, there would be broad consensus behind it. The last thing anybody wants, especially parents, and the children, is deficiency in the resourcing model. For our model to work it is important that everybody work together to ensure it is put into place as quickly and smoothly as possible, which would reduce anxiety among parents and students.
That is one of the reasons for recommending change, to ensure that resources would be available in the school, based on the educational profile of each school to help a child who everybody knew had difficulties. We are not saying that children do not need to be assessed. We believe absolutely that it is appropriate for children to be assessed but that is to inform the teaching and learning rather than just to drive the diagnosis of disability. We accept recommendations from appropriately qualified people for the allocation of resources. If one has a private diagnosis and it meets the appropriate criteria, for example, for autism, we accept that and allocate resources.
That is important because some parents feel that staying in the public system carries more weight. That is obviously not the case but it is the perception that there will be questions about the qualifications of the private assessor and whether that report will be accepted. All of those issues can be addressed easily by relaying information.
Some people also get it done privately in order to jump the queue and pay to have the resources allocated. The diagnosis is the least important part. The schools should focus on the strategies to develop language skills and contribute to the individual education plan, IEP, as opposed to having a label and allocation and assuming that it is a case of happy days afterwards.
Mr. Pat Healy:
All the stakeholders, providers, the school system and parents. There are examples of this in west Cork, which Deputy Daly spoke about, and in the mid-west. Each group ensures that it has engagement with parents who pick a representative. There are usually several parent representatives in the local implementation groups. Where it works well it seems to have a very beneficial impact. It overcomes the type of difficulties Deputy Griffin spoke about. That is why we are trying to develop it. Equally, it is a good feedback process. If we start to roll it out and it does not work as well as we thought it would, we can get feedback and respond. We want to make sure we do that right.
Ms Griffin mentioned the cap of two assessments per 100 students in a school. Will the number of recruits to the National Educational Psychological Service, NEPS, be sufficient for there not to be a cap?
Ms Teresa Griffin:
One of the reasons for changing the system for allocating resource teaching hours at post-primary level a couple of years ago was to try to address the delays in assessment at the transition from primary level. Historically, at primary level, children who had dyslexia or a mild or borderline general learning disability had the supports within the school. The children did not need assessments, which was causing a bottleneck in the transition from primary to post-primary. The Department changed the way of allocating services at post-primary level to mirror what was happening at primary level. That should address the bottleneck. There is still a requirement for an-up-to-date assessment of behaviour but it might not be necessary for a child with autism.
I thank the witnesses for their patience with us today. I was very impressed with the proposed new model. I attended the briefing by the NCSC at the Department of Education and Skills. It is a very positive step. I spent several years dealing with those challenges in the classroom from the parents’, the administrative and the teaching points of view. It is very welcome and I look forward to its adoption.
The collaboration between the HSE and CoAction in west Cork leads to the good work there. One of my children uses that service and we are blown away by the level of service and the therapies available, especially speech and language, occupational, and all the four main therapies. I do not want to make my colleagues jealous by boasting about this wonderful service.
To give credit where credit is due, it is exceptional and parents are very appreciative. I do not believe they realise how lucky they are in west Cork. They believe the standard there is the standard across the board.
What are we doing to measure outcomes in the area of early intervention? The amount of therapy my little two and a half year old girl is receiving is impressive. My hope is that when she goes to primary school, there will not be the same draw on resources. How far have we proceeded in measuring the outcomes? I would like to know the NCSE perspective. Perhaps the HSE is measuring also.
Kerry had a consultation process also. There was widespread consultation with parents of the children involved. Everyone was happy to move forward with the reconfiguration process but, unfortunately, what people got was certainly not what they were told they would get during the consultation process. Obviously, there is no point in having a consultation process and informing parents of the proposed outcome if it is not going to be followed through.
When the problems first arose in Kerry, there was not a good system of feedback and parents did not feel empowered to highlight the problems and try to work through them. I am thankful that in the past two months, there has been a process in place to allow for a regular meeting with representatives of the HSE to address the problems that arise.
From the Kerry experience, one of the main problems is that when somebody goes out sick, nobody replaces him. It is a huge problem. If the driver of a train to Kerry is sick, somebody else replaces him and drives the train. However, if one member of staff is not able to provide a therapy service for a child with special needs who desperately needs it, that child must go without. That is not acceptable at all. Will it be addressed? Will we actually see flexibility in the system so that, rather than shutting off services, a replacement member of staff will be able to do the job that is necessary at the front line?
Mr. Pat Healy:
On Deputy Daly's question on outcomes, we are providing for a specific professional post as part of the reconfiguration. We are going to do it at national level this year. It will be assigned specifically with a role in the development of outcomes for the programme for those between zero and 18. Obviously, we will be working with colleagues on the wider agenda concerning outcomes overall but we want to focus specifically on the rolling out of the aforementioned programme.
Deputy Griffin and Senator Power referred to leave. Within the health service, we are limited by the employment control framework. We have some flexibility, which is limited by resources. There is a certain amount of cover possible, which often relates to maternity leave or sick leave, but if one goes beyond what is resourced, there is just no funding to cover. There have been gaps in some of our services when there was a high proportion of leave, for whatever reason. We have tried to come up with innovative ways of trying to deal with the problem locally, including through using clinics and reorganising how we operate. However, the employment control framework and the necessity to live within fixed resources bring challenges.
As I said to Senator Power, we have absolutely prioritised the therapy posts for filling, particularly those being talked about at this meeting. Given the importance of therapy posts, we are trying to maximise the resources we have for the very reasons suggested by the Deputy and in recognition of trying to roll out the programme. At the same time, however, there is a significant challenge in terms of health resources. The employment control framework applies and we must live within it.
Mr. Pat Healy:
We are doing work on that, and we have not got a definitive position worked out yet. Specifically on the Deputy's area of interest, I mentioned earlier that with the additional 21 posts we are putting in, the five we approved last year, and the 2.5 replacement posts, there is an increase of 20%. That will certainly have an impact. We are doing work on what the overall requirement would be over time. Part of what we have to do in this regard is examine how we roll out the new model as we reconfigure it. We will develop this analysis for ourselves over time.
Mr. Pat Healy:
The Government invested considerably in the university system to develop posts. That is working well. I was mentioning earlier that we are trying to time implementation to coincide with the emergence of graduates. That should assist. There can be particular pockets in the country. I know from a previous role as a regional director in the south that we always experienced difficulty in recruiting psychologists. This was because of the scale of numbers and the fact that other parts of the country were regarded as more attractive. These areas had more candidates. Once one went below a particular threshold, it was more difficult to encourage people to come in one's direction. We try to develop creative ways to attract staff. Challenges can arise, but, broadly, we are training, through the universities, etc. The important thing is to have the posts into which to put the graduates.
It is 80 in total, of which 21 are in north Dublin. Why have there been such different rates of progress in the reconfiguration around the country? Have there been particular problems? It is stated the plans of the local implementation group are already well developed and are being consolidated in the mid-west, Meath and some parts of Cork. Deputy Daly pointed out that the services are working very well in some parts of Cork. I look forward to similar circumstances in north Dublin. In some areas, staff are just finishing the consultation. This is not only in north Dublin, but also in Dublin's north inner city and in south, south east, south west and south central Dublin. The same applies in Donegal and Roscommon. Do particular local issues arise? Are there difficulties getting people to the table and reaching an agreement? Why are some places already delivering services while others are still at the talking phase?
Mr. Pat Healy:
There is a variety of reasons; there has been diversity across the system. An important benefit of having a post like my own, as national director of social care, is that it brings a specific focus to the area of disability in the elderly. What we are now able to do, and what we have done in the social care operational plan for the year, is bring a specific focus to this, give it the priority it requires and start to roll it out in a consistent, measured way. Of course there are resource issues, which we have talked about. It is necessary to put in place the appropriate process. We need to put in place the appropriate policy procedures and guidance. One needs to have consultation locally. The type of discussion we have had needs to be engaged in, and that is what we are now doing. I regard this as very positive. I am positive about the future in regard to rolling out a consistent model across the country.
There will, of course, be an issue of resources. The positive aspect of this is that there has been an allocation of €4 million this year. We are saying clearly we are going to drive that out and ensure we do the recruitment. As I stated, we must target waiting list initiatives and so forth in the meantime. We do not have the benefit of the kind of arrangement the education sector has whereby once a need for a class has been identified, a dedicated and agreed resource can be obtained. We are not in that space.
Mr. Pat Healy:
We have prioritised the therapies.
To be fair to the Minister, she prioritised this in the current year and resources were provided in recognition of the challenges encountered. There was a coming together of the capacity to implement a new model and providing resources for it. We were able to demonstrate that by making this push, we would get a result. It is important for us to successfully do this, demonstrate that we can do it well and then seek more resources.
Ms Teresa Griffin:
I do not think I dealt with the question about NEPS recruitment and removing the cap. The NEPS is not part of the NCSE, but I am aware that it was involved in a recruitment process. I will ask if somebody in the Department can refer back to the committee directly.
I thank the committee for its good wishes regarding our new model. We have our fingers crossed that it will be accepted, but it always nice to hear good feedback, for which I thank the committee.
We have had a very good, thorough discussion. I thank the officials from the NCSE and the HSE and all members for their participation. Obviously, the matter is ongoing and if any issue arises, we will refer back to the delegates.