Oireachtas Joint and Select Committees
Tuesday, 23 May 2023
Joint Oireachtas Committee on Autism
Autism Policy: Discussion (Resumed)
Micheál Carrigy (Fine Gael)
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I welcome everyone to the 50th meeting of the Joint Committee on Autism and the 22nd public session over the last 12 months. Apologies have been received from Senator Ardagh and before we start today's business I will go through some formal notices. All those present in the committee room are asked to exercise personal responsibility to protect themselves and others from the risk of contracting Covid-19. I remind members of the constitutional requirement that members must be physically present within the confines of the place where Parliament has chosen to sit, namely, Leinster House, in order to participate in public meetings. I will not allow a member to participate where he or she is not adhering to this constitutional requirement. Therefore, any member who attempts to participate from outside the precincts of Leinster House will be asked to leave the meeting.
For the information of our witnesses, I wish to explain some limitations to parliamentary privilege and the practice of the Houses as regards references they may make to other persons in their evidence.
The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected, pursuant to the Constitution and statute, by absolute privilege. They are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in any such way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in respect of an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.
The arrangements for our business is that the Minister of State will make her opening statement for five minutes. Members will then have an opportunity for questions and answers and each member will have five minutes for both questions and answers. If there is time at the end of the meeting I will allow speakers to come in. We will use the speaking list that was circulated on week two. There are two sessions today. Our first session will run from now until 12.30 p.m and we will take a five-minute break. The second session will be with the Minister for Education, Deputy Foley. I will be tight on time to make sure everyone gets in and that we finish our first session at 12.30 p.m. Is that agreed? Agreed.
There are some procedural issues regarding our next private session meeting due to take place on Thursday, 25 May 2023. I ask for agreement that meeting take place at 11 a.m. rather than 12 noon if possible. Is that agreed? Agreed. Regarding the orders of reference of our committee, and as agreed at our previous meeting, we will proceed with the dissolution date set out by the Business Committee of the Houses of the Oireachtas of 1 June 2023. Is that agreed? Agreed.
The first item on the agenda is the minutes of our previous meetings. The question is to approve the minutes of 11 May and 16 May 2023. Is that agreed? Agreed.
The second item on our agenda is our consideration of autism policy. Before we hear from the Ministers I propose that we publish their opening statements. Is that agreed? Agreed.
I welcome the Minister of State at the Department of Health with special responsibility for mental health and older people, Deputy Mary Butler. I also welcome her Departmental officials, Dr. Siobhán Hargis from the Department of Health; Mr. Brian Higgins, Mr. Bernard Regan and Dr. Amir Niazi from the HSE; and Ms Clare Gray from the Department of Children, Equality, Disability, Integration and Youth. They are all very welcome.
The remit of this committee is to consider matters relating to services and supports provided by the State for autistic people. Autism is a lifelong condition and a recent study suggested that the prevalence of autism among schoolchildren in Ireland today is 3.3%. In Northern Ireland, a recent study found that 5% of the school-going population is autistic. It is important to remember that these young autistic people will grow into older autistic adults and we must ensure supports are available to them. Additionally, the committee is interested in discussing mental health services for autistic persons. Following discussions with numerous stakeholders the committee has heard of such issues as access to mental health services for autistic children, including difficulties for children with an autism diagnosis in accessing child and adolescent mental health services, CAMHS, access to mental health services for autistic adults, and access to supports in general for older people who are on the autism spectrum.
I now call on the Minister of State, Deputy Butler, to make her opening statement.
Mary Butler (Waterford, Fianna Fail)
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I am pleased to join the Leas-Chathaoirleach and members of the committee and to contribute to this important debate on services and supports provided by the State for autistic people. I thank the committee for bringing this matter to the attention of the Seanad. I particularly welcome the opportunity to discuss access to mental health services and congratulate the committee on all the work it has done to put a focus on autistic people.
The Government remains committed to the development of all aspects of mental health services nationally, including for those with a diagnosis of autism. The Government acknowledges the needs of people presenting with autism. Mental health difficulties can be complex and access to services has posed challenges. Both I and the Department of Health are actively working to improve access, signpost resources and use policy and legislative changes to drive improvement. The commitment to improving access to mental health services can be seen through increased funding provided by the Government to mental health. The total allocation for mental health services in 2023 is over €1.2 billion, which is nearly 20% higher than when this Government came into power. This funding allows for a continued focus on improving services and reducing waiting lists for both CAMHS and primary care psychology.
While I remain committed to mental health service improvement, my colleague, the Minister of State with responsibility for disability, Deputy Rabbitte, has brought the same drive and conviction to autism, and she announced the Government’s intention to develop an autism innovation strategy in 2021 to advance the programme for Government commitment to national action on autism. The strategy is in progress. There was an initial public consultation in April 2022 that sought views on the main challenges and barriers facing autistic people in Ireland. Importantly, it provided suggested actions for a future strategy. Work on this continues and a report analysing the feedback from this public consultation was published this April to mark Autism Awareness Month 2023. In addition, in late 2022, following an application process, the Department of Children, Equality, Disability, Integration and Youth also appointed the autism innovation oversight and advisory group. It is intended that, in collaboration with that group, a further public consultation will be convened later in the year before the strategy is finalised. It is the ambition of the Minister of State, Deputy Rabbitte, and the Government, that the strategy will provide the building blocks for Ireland to become a more autism-inclusive country. Equally, the programme for Government contains a commitment to improving all aspects of mental health in line with Sharing the Vision, the national mental health policy, and Connecting for Life, Ireland’s national strategy to reduce the incidence of suicide.
On mental health services for children and adults with autism, recommendation 20 of Sharing the Vision highlights the need for further development of early intervention and assessment services in the primary care sector for children with attention deficit hyperactivity disorder, ADHD, and autism to include comprehensive multidisciplinary and paediatric assessment and mental health consultation with the relevant community mental health team, CMHT, where necessary. This policy recommendation has been developed specifically to ensure services are aligned so children and their families can access the most appropriate care and supports from the correct care providers as soon as possible. The implementation of this recommendation is in process. Phase 1 of the piloting of an autism assessment and intervention protocol is complete. This programme requires integration across all services, including mental health, and work is underway to develop a pathway to address recommendations arising from phase 1 and to ensure the next two pilot sites, which will be CHOs 4 and 7, will commence. It will then be rolled out incrementally across all rest of the CHOs.
Assessment for those with autism spectrum disorder, ASD, is carried out by a multidisciplinary team that includes a speech and language therapist, an occupational therapist, a psychiatrist, a psychologist, a social worker and a paediatrician. Most clinical needs of children with a primary diagnosis of an ASD are normally best met in services such as HSE primary care or children’s disability network teams, CDNTs. The National Policy on Access to Services for Children & Young People with Disability & Developmental Delay was adopted nationally at the end of 2021. Children with complex or specialist needs requiring multidisciplinary or unidisciplinary support will be seen in primary care, where appropriate. Under the progressing disability services programme, children’s disability services have transitioned from early intervention teams and school-age teams to 0-18 CDNTs. Services are based on needs rather than diagnosis to optimise access.
HSE children’s disability services received funding for 190 posts in budget 2022. Budget 2023 provided for a further 136 posts to provide services in 104 special schools for children with complex needs. The overall funding in recent years provides for over 600 whole-time equivalent, WTE, posts. As with many other care groups, recruitment for disability network teams remains a challenge. The 2022 CDNT staff census notes an average vacancy rate of 34% across CHOs. This equates to approximately 700 WTEs. My colleague, the Minister of State, Deputy Rabbitte, in collaboration with the Department of Children, Equality, Disability, Integration and Youth and the HSE, continues to work collaborative to fully resource CDNTs to maximise capacity.
On access to mental health services for autistic people, it is important to note that mental health services are available to all children in this country regardless of whether they have a diagnosis of an ASD or any other condition. Where a child or adolescent presents with a moderate to severe mental health disorder and autism, it is the role of CAMHS to provide appropriate multidisciplinary mental health assessment and treatment for the mental disorder. This may involve joint working or shared care with other agencies. Access to CAMHS for children with ASD is specified in the CAMHS clinical operational guideline, COG, which was published in 2019 and sets out the core functions and remit of CAMHS. These guidelines are due for renewal this year. As such, any child with a moderate to severe mental health need, who also has a diagnosis of autism, can access CAMHS. However, CAMHS is not suitable for any child or adolescent where their mental health difficulties are milder. Nor is CAMHS suitable for children in need of interventions specifically regarding learning difficulties, social issues, behavioural challenges or mild to moderate mental health problems. This remains the case whether or not a child has a diagnosis of autism. Those who have a diagnosis of autism in conjunction with intellectual disability, but who do not meet the criteria for CAMHS will have their needs best met through HSE primary care and the children’s disability network teams.
The work of the Department of Health, the Department of Children, Equality, Disability, Integration, and Youth, and their agencies, is very much focused on ensuring that the needs of children and their families are met by the best services, in the correct locations and in a timely fashion. Our common goal is to improve access to care and crucial supports that are often so urgently needed for these children, who often have complicated care needs. Early assessment, early intervention and appropriate care remain central objectives. For example, the HSE is delivering targeted waiting list initiatives in both CAMHS and primary care child psychology by focusing on areas experiencing particular challenges in meeting service demand.
In the area of disability services, the HSE continues to drive a number of initiatives to reduce waiting times for children and families. These include sourcing therapy assessments and interventions externally via private service providers and the use of private providers enhancing CDNT capacity to support increased therapy interventions.
I take this opportunity to reiterate that the Government, the Department of Health, the HSE and all advocates in the sector share the committee's vision of continuous cross-sectoral service improvement for autism. I look forward to today’s discussion and to us working together to focus on the important themes on the agenda.
Micheál Carrigy (Fine Gael)
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I thank the Minister of State. We move to questions and comments from members. I remind all speakers to keep tightly to time to ensure everyone has the opportunity to come in. Deputy Buckley is first.
Pat Buckley (Cork East, Sinn Fein)
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I thank the Chair, and I thank the Minister of State for her opening statement. One of the bugbears of this committee is access. The first paragraph of the Minister of State's statement mentions access and the fact it poses a challenge. I like the line in the statement that says "Services are based on needs rather than diagnosis to optimise access". I welcome that, because we had an issue with that over the years, in that it always seemed to based more on somebody's means rather than their needs. Will the Minister of State elaborate, even briefly, on that part of phase 1 and part 2 of the pilot project. CHO 4 is my area. The Minister of State also mentioned "sourcing therapy assessments and interventions externally via private service providers". Will she tell us which providers they are or what it is costing?
It seems to come across in a lot of the health service stuff here that we have an issue with staffing and an issue with recruitment and retention, yet if you can flash the cash, you have no problem getting people in to assist, so I am just curious as to who these external private service providers are.
That is about it. Again, I thank the Minister of State for coming in today. As I said, it is nice to have her present because we have put a lot of work into this with the whole committee secretariat and everyone else, so it is nice to get that acknowledgment.
I kept it under the five minutes, definitely.
Mary Butler (Waterford, Fianna Fail)
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The Deputy certainly did.
Pat Buckley (Cork East, Sinn Fein)
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But that includes responses.
Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for his question. I give credit to him, in that when I was Chair of the Committee on Business, Enterprise and Innovation during the term of the previous Dáil, his attendance was always great. It is lovely to see him.
Pat Buckley (Cork East, Sinn Fein)
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We do not get any bonuses for it.
Mary Butler (Waterford, Fianna Fail)
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I know that.
I will ask some of my colleagues to answer some of the questions because some of them are of a clinical nature.
Over the past 18 months child and adolescent mental health services, CAMHS, have been in a spotlight. As the committee will know, we have both a review and an audit under way looking at all 74 CAMHS teams the length and breadth of the country. Between 2021 and 2022, during Covid, referrals to CAMHS increased by 33%, which was absolutely massive. The teams managed to see, in 2022, 21% more referrals than they had ever seen previously while working with the same team. Last year, in 2022, 225,000 appointments were issued to the 2% of children in Ireland who need the support of CAMHS. About 21,000 children, 2% of the child population, need the support of CAMHS.
What I am also doing, as Minister of State, is putting a focus on youth mental health because 2% of children, as I said, need the support of CAMHS. They have moderate to severe mental health difficulties and a lot of complicated issues. Going forward, we also want to talk about youth mental health in general because there is another 98% of the population of young people who would have only emotional distress or mild challenges to their mental health. We are very conscious of that as well. That is why we are partnered with so many organisations, such as MyMind, Jigsaw, SpunOut, Samaritans and Pieta, to support those people.
I will ask Dr. Niazi to speak to Deputy Buckley's question about the pilot because he is all over this. When the two pilots conclude, we will have seven other CHOs, and the next two that will be looked at will be CHO 4, Deputy Buckley's area, Cork and Kerry, and CHO 7. Then we will incrementally roll them out.
Dr. Amir Niazi:
For the past two years, mental health has worked with our primary care and disability colleagues to develop a protocol for autism assessment and intervention. It is an integrated approach of having all those working together. In mental health that is, not only for children but also for adult patients with autism, how they will be assessed and how their care plans will be worked on. We are implementing that on two pilot sites at the moment, in CHO 2 and CHO 9. That will give us a lot of learning as to how we are implementing it, what kind of resources are required and what the access or referral criteria are. We will have learning from those elements and we have already started our work on the next phase of this, which looks at CHO 4 and CHO 7, to see what our learning is from the first two pilot sites and whether we can implement that learning into the next two sites we will take on. Then we will continue to do that. That is what we have done in the past two years. Mental health has worked with colleagues in disabilities and primary care in drafting it, designing it and putting it together, and now we are in a phase of implementing it.
Mary Butler (Waterford, Fianna Fail)
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Does Mr. Higgins wish to come in there?
Mary Butler (Waterford, Fianna Fail)
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I thank Mr. Higgins for that. Might Mr. O'Regan be able to answer the specific question about disability and where the HSE outsources some of its supports?
Mr. Bernard O'Regan:
I will send in separately a list of the organisations we are commissioning. I am mindful that we are involved in some procurement at the moment in respect of assessments, so I do not want to set the target, as the committee will understand. In general, however, we are looking at somewhere in the region of €1,600 to €1,900 per assessment. It will be influenced a little by how many clinicians need to be involved and the amount of time involved in it.
Pat Buckley (Cork East, Sinn Fein)
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I thank Mr. O'Regan for that honesty. I am just trying to paint a picture of this. It just amazes me that we cannot deliver stuff within our own health service and pay the staff appropriately but we can still outsource it at a higher cost.
Mary Butler (Waterford, Fianna Fail)
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I think the Deputy's final question was about access, that is, a child with autism trying to access a CAMHS team. Will Dr. Niazi answer that?
Dr. Amir Niazi:
If a child has a primary diagnosis relating to mental health, he or she is referred directly to CAMHS. We do the initial assessment, and if during that assessment a consultant or the team is not clear if there is comorbid autism, they even sometimes do that assessment themselves for diagnostic clarity in order that they are clear what they are dealing with. If, however, the primary diagnosis is autism, referral normally goes to our disability colleagues and primary care. That is where it starts. If there is comorbid mental ill health, we get a referral. In this protocol we are saying that if disability services have assessed somebody as having autism, whether under an in-reach model, whereby they work together and do that assessment, or after autism assessment is completed, the person is referred to CAMHS for follow-up. Both those things are being looked at on our pilot sites.
Pat Buckley (Cork East, Sinn Fein)
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Good. I welcome that because I, and probably others, see many people who fall into one remit and do not tick all the boxes and then are moved into another, and their case gets lost and time gets lost. Many of my constituents are frustrated, so I thank Dr. Niazi for that. I will follow that up later.
Micheál Carrigy (Fine Gael)
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Next on my list is Deputy Marc Ó Cathasaigh.
Marc Ó Cathasaigh (Waterford, Green Party)
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I thank the Minister of State for her opening statement. I want to sound a note of frustration from the off. This committee has been time-bound and we have been very conscious of trying to get through a substantial amount of work in a short space of time. I just want to note a frustration with the timeline. The announcement the Minister of State, Deputy Rabbitte, made on the autism innovation strategy was in 2021. We went to public consultation on that in April 2022, and then we got a report analysing feedback in April 2023. We have been dealing with families who have lost two years while we have got to a point where we are reporting and analysing feedback. It feels frustratingly slow to a member of this committee.
I have a number of specific questions I want to get into. First, I would like a little clarity about the language on phase 1 of the piloting of the autism assessment and intervention protocol. Is the pilot complete or not complete?
Marc Ó Cathasaigh (Waterford, Green Party)
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But is phase 1 of the pilot complete?
Marc Ó Cathasaigh (Waterford, Green Party)
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The report has produced recommendations, has it?
Marc Ó Cathasaigh (Waterford, Green Party)
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Will those recommendations be made public in any way? Will members of this committee, for example, have sight of the recommendations that were produced in phase 1?
Marc Ó Cathasaigh (Waterford, Green Party)
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It would be important for us to have sight of it.
Mary Butler (Waterford, Fianna Fail)
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Ms Gray can answer the Deputy's question about the timelines.
Ms Clare Gray:
As regards timelines for the autism innovation strategy, I emphasise the Minister of State's commitment that the strategy moves the dial on autism and provides the foundations for a more autism-inclusive society. As Deputy Ó Cathasaigh mentioned, the Minister of State, Deputy Rabbitte, announced the initial commitment in 2021, and work has been ongoing to drive forward development of the strategy since that date.
Deputy Ó Cathasaigh mentioned the public consultation. The Minister of State has been very clear that for the strategy to work autistic people and those around them, including families and practitioners, need to be at the forefront of the development of the strategy. The public consultation was convened before anyone put pen to paper to ensure the issues we would go after were driven by what came back from the public consultation. Last year we were involved in a process to appoint an oversight group that will provide a further mechanism for making sure the autistic community is at the forefront of this development process.
Marc Ó Cathasaigh (Waterford, Green Party)
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I apologise for interrupting but I am conscious that the Chair will shut me down after five minutes and I have a few more bits and pieces to get through. The Minister of State indicated average vacancy rates for CDNTs were 34% throughout the CHOs. Are there significant variations within this figure? Are there CHOs that are well below 34% or well above it? Within that figure, are there specific skills within CDNTs that are affected? Speaking about a 34% vacancy rate may not capture specific deficits, be it in speech and language therapy, occupational therapy or wherever the deficits are.
Mary Butler (Waterford, Fianna Fail)
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I will ask Mr. O'Regan to answer that question. If it was a mental health question specifically, I would answer it. I know it is of great frustration to the Minister of State, Deputy Rabbitte, that 700 whole-time equivalents are funded but it is proving very difficult to recruit. Regardless of whether it is public, private or voluntary, we are all dipping into the same pool, whether mental health, psychology or primary care. It is very challenging at present.
Marc Ó Cathasaigh (Waterford, Green Party)
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I will put another question to the Minister of State and while I do so perhaps Mr. O'Connor will be able to dig them out. The Minister of State has responsibility for older people as well as mental health. There is a specific difficulty in dealing with autism and the diagnosis rate of autism among older people because our awareness of autism has only developed in recent years. Has the Minister of State been doing any thinking about how we can counter this? We may not have autism diagnoses among our older people but assuming the incidence rate among older people is the same as among the general population, we could be looking at 3.5% or 4% of people in our older community who have autism. Mental health, isolation and loneliness are all issues the Minister of State is proactive about in her role. We cannot target autistic individuals because they do not have a diagnosis but have we done any specific thinking about applying a lens of autism to these strategies so that we know we are reaching these people?
Dr. Amir Niazi:
We do not have data on a first diagnosis of autism among older persons. Our protocol is divided between CAMHS and adults and we are implementing it in the adult population. It will give us a lot of information on what the needs are. Some individuals have already been diagnosed and have some level of service access. We will have a lot to learn if there is another cohort. I have discussed this with my disability colleagues in primary care. There is not a huge prevalence rate or data available on the cohort of the population that has been diagnosed when in this age group. Most people are diagnosed as young adults or before the age of 18.
Marc Ó Cathasaigh (Waterford, Green Party)
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We could be proactively autism proofing. Something that comes up over and over again at the committee is that we do not have the diagnoses. We can assume the incidence rate as it is not down to external factors and we know it is genetic. We can presumably infer the incidence rate. Presumably we should be applying a lens. Has Mr. O'Regan had a chance to find my CHO figures?
Mr. Bernard O'Regan:
Yes. Throughout the CHOs, there are averages for the CDNTs but this could be 19% in one CHO and as much as 43% in another CHO. Within this there are teams that have a vacancy rate of 60% or 65%. There are large variations among teams. Some teams have close to a 100% occupancy rate of the posts allocated to them. They may be at 90% or 95%. There are others that are way behind.
Marc Ó Cathasaigh (Waterford, Green Party)
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Are there any specialties for which we are finding it difficult to recruit?
Mr. Bernard O'Regan:
There are. Again, I will call out the averages to give Deputy Ó Cathasaigh a sense of it. If he wants more detail I can send this document to him and all of the details are in it. We are looking at an average 36% vacancy rate for speech and language therapists, 40% for occupational therapists, 39% for psychology, 38% for physiotherapy, 28% for social work, 29% for nursing and 9% for other roles, which include administration.
Marc Ó Cathasaigh (Waterford, Green Party)
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Occupational therapy jumps out.
Eileen Flynn (Independent)
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I welcome the Minister of State to the committee. This committee is cross-party and very supportive of services for people with autism. To the best of my knowledge, autism is not a mental health issue. I have heard it said that people get diagnosed with autism through mental health services. I am not a professional but to the best of my knowledge, people are going there for support.
I have a list of emails as long as my arm from people looking for access to mental health services such as CAMHS who are autistic and, unfortunately, who have been discriminated against. Does the Minister of State accept there is discrimination in our mental health services for young children who have autism? Not today or yesterday, and prior to this committee being set up, my colleagues in the Civil Engagement Group spoke about receiving emails from people who were refused access to a mental health organisation. Just last week, the committee heard from AsIAm the level of rejection that people with autism still face in Irish society and the level of rejection in our mental health services.
I have figures in front of me for the funding that has been allocated to mental health in general. Of course we welcome this and we hope for better for mental health services. We need to be specific that the committee is focusing on people who have mental health issues and are also autistic. Does the Minister of State accept that what we have in our mental health services at present is pure discrimination? Obviously this is not the case for all of them but I am thinking of CAMHS for our young people.
We have spoken about adults being diagnosed with autism. Through the hard work of organisations of people with autism, the clerk of the committee and the secretariat, we will make recommendations on mental health. How will the Minister of State ensure that she supports the committee with regard to implementing the recommendations?
Last week, Mr. Adam Harris spoke about an inclusive Bill that was brought about in 2016 in Malta. We are looking at framing a Bill to give equal access to people who are autistic. With the Minister of State support such a Bill to support people who are autistic? How can we separate the person from the mental health services and ensure it is inclusive?
Mary Butler (Waterford, Fianna Fail)
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I thank Senator Flynn. I do not accept there is discrimination against children with autism from any CAMHS team. We have to remember that we have 1 million children in Ireland under the age of 18 and only 2% of children will need the support of CAMHS. CAMHS is specifically for young children and adolescents who have a moderate to severe diagnosis of mental health challenges. Mental health services are available to all children in the country but there must be a primary diagnosis of mental health to be seen by a CAMHS team.
It is a multidisciplinary team comprising a consultant psychiatrist, a psychologist, a clinical nurse specialist and mental health nurses, among others. They will make the decision on whether a child is suitable for receiving CAMHS support. If the child has a primary diagnosis of autism and a secondary diagnosis of mental health issues, the CAMHS team will believe that the child is better served in a primary care setting. CAMHS is, first and foremost, a mental health service that supports children who are-----
Eileen Flynn (Independent)
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I am sorry for cutting across, and I do not mean to be disrespectful towards the Minister of State in any way, but a child with severe autism could be at risk of taking his or her own life. I cannot remember the figure of young autistic people with mental health issues that Mr. Adam Harris cited at our meeting last week. Why can CAMHS not see such children in an emergency when the research shows that children with autism are more likely to have suicidal thoughts and other mental health problems than children from the general population?
Mary Butler (Waterford, Fianna Fail)
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I will hand over to my colleague, Dr. Niazi, the HSE national clinical adviser and group lead for mental health. Before I do, though, I wish to revert to one point. It is the multidisciplinary team that will determine whether a child reaches the threshold to be accepted for CAMHS support. Some parents approach me to say that they believe their children should be in the care of CAMHS but have not been accepted. That decision is made by clinicians with many years of experience, not by parents or advocacy groups. It is made by professionals who are in a position to make it.
Dr. Amir Niazi:
The Senator is right about autism not being a mental health diagnosis. Anyone who has autism can have mental health issues, but autism is about people's interaction and thinking. It is a different diagnosis. Compared with the general population, though, the prevalence of mental health issues is greater among adults with autism.
If I am a parent of a six-year-old or seven-year-old and there is a possibility that he or she might have autism, the first thing I do is bring my child to a GP. We currently have a recruitment challenge in all parts of the health services, not only mental health services. If the GP knows that there is a waiting list of one or two years in primary care psychology, he or she will make a referral to CAMHS while also making a referral to the disability services because, as a parent, I want something to be done now. When a referral reaches CAMHS, a multidisciplinary team examines the issue and determines whether there is anything CAMHS can do or whether it has more to do with the child’s autism, which is managed by a team in primary care disability services. This is where the challenge lies. People say that mental health services have refused or rejected a referral-----
Eileen Flynn (Independent)
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Is Dr. Niazi saying that, when GPs find out children have autism, they refer them to CAMHS straight away even though the children do not have mental health problems?
Eileen Flynn (Independent)
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I constantly see blatant discrimination within our mental health services against young people in the Traveller community. No matter who or what we are, everything can be done better, including in our mental health services, but this is pure discrimination. There could be a 17-year-old young man who is autistic but also has mental health problems and suicidal ideas in his head and who needs CAMHS support as soon as possible, but because he is autistic, he cannot get it. I have the evidence from parents, as do other Senators and Deputies. I am not blaming the parents. I am raising the question of access for people and the different levels of autism. As soon as services hear someone is autistic, that is it.
Mary Butler (Waterford, Fianna Fail)
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CAMHS is not suitable for children who need interventions due to learning difficulties, social issues, behavioural challenges or mild-to-moderate mental health problems. CAMHS is more for children with severe mental health difficulties. The Senator is right, in that they can also have diagnoses of autism. There are children accepted into CAMHS who have severe mental health difficulties as well as secondary diagnoses of autism. They could even have other diagnoses. In the main, though, CAMHS requires a primary diagnosis of a mental health difficulty. The challenge arises where there is a primary diagnosis of autism and a secondary diagnosis of mental health issues. In that situation, a child will not get accepted by a CAMHS team.
Dr. Amir Niazi:
We do not have a perfect system. I accept that the Senator has examples, but I guarantee that, in mental health services, we do not discriminate based on diagnosis. We feel that where the needs of the patients are best met is the place where they need to start. For example, we may feel that their needs can be best met through disability primary care services that can examine their housing, education and all of their other needs. If they have mental health issues, we can intervene. This is the way we prioritise or triage our referrals. It is the need of the patient-----
Eileen Flynn (Independent)
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Mr. Harris said something that struck me. If a person with autism attended an accident and emergency department with a broken arm, he or she could get it plastered just like any other patient, but it is not the same with mental health services. Instead of arguing with the witnesses and just giving them my opinion as a public representative, the evidence I have shows that what is happening discriminates against people with autism. The NGOs would support this statement, since the evidence shows it. There are issues. How can we fix them? How can we ensure that children with autism have equal access to mental health services? Obviously, their autism should be taken into consideration, but how do we ensure that they and children without autism are treated equally? I am not attacking-----
Mary Butler (Waterford, Fianna Fail)
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We know, and we know exactly where the Senator is coming from. I am sorry that people feel that way, as that is not the intention.
Mr. Brian Higgins:
The fact that we have a service improvement programme for the autistic community supports what the Senator is saying about matters needing to change. There are inequities and challenges. The service improvement programme is in place to ensure that there is equitable access for anyone who requires services of an acceptable and agreed standard regardless of which services are being accessed, for example, primary care, disability or mental health. It is a challenge, which is why we are running the demonstrator. We are already gleaning a great deal from it, and there will be significant lessons from this committee that we can share and couple with that. We accept and acknowledge that it has not been an easy journey for many people with autism. We are trying to improve it.
Mary Butler (Waterford, Fianna Fail)
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As the Senator knows, the Mental Health Commission is undertaking a review of CAMHS. The HSE is performing an independent review of CAMHS as well. I have convened a series of roundtable meetings-----
Mary Butler (Waterford, Fianna Fail)
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-----to see what we can do better. At our last meeting, primary care services, disability services, the National Educational Psychological Service, NEPS, and CAMHS were all in the same room to discuss how to break down barriers. Parents in my constituency tell me that, although their children are in primary care, they feel they should be in CAMHS or getting other primary care psychology supports. If someone is in one service, it can sometimes be very difficult to get into another and people do not want to leave the first service. Everything is on the table to see how we can improve matters. It is recognised that there is considerable frustration among parents of children with autism. Even though 700 posts have been funded, we are finding it difficult to recruit for them and teams the length and breadth of the country are not fully staffed. There are difficulties in CAMHS as well. There have been 33% more referrals to CAMHS over the past two years, we have seen 21% more young people and 225,000 appointments have been allocated.
However, what I find when you receive the support of CAMHS is that you could be receiving the support of a CAMHS team for up to five or six years. You might be going there once a month. It is not a case that you will be going for one appointment and then that will be it. What we are seeing at the moment is that many more children and young people who are presenting to the service are actually leaving the service because their conditions are very complex.
Dr. Amir Niazi:
Adam Harris is a member of the improvement board my colleague, Mr. Higgins, mentioned. He sits with us and brings all the vision and focus to the table so that whatever issues come to the table, we try to address them in terms of the roll out the two pilot sites. It is with the agreement of everybody who is on that board.
Eileen Flynn (Independent)
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It is important that we have representation.
Eileen Flynn (Independent)
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I am the same. That is why I came to this committee. I am not here saying I do not want CAMHS. Yet, when I see discrimination it is important that it is called out and challenged. I just wanted to be clear that CAMHS does work for a lot of young people. It is a vital service within the communities for many young people.
Mary Butler (Waterford, Fianna Fail)
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I thank the Senator. At the start, I complimented this committee, which has done Trojan work and which has rightly put a focus on children and people with autism. I was delighted to attend an event in Waterford with Deputy Ó Cathasaigh. Waterford is trying to become the first autism-friendly city in Ireland. It is a three-year campaign. It was on a Sunday afternoon and there were more than 200 people in the room. That will tell the Senator the depth of feeling that is there in relation to supports around people and children who have autism.
Joan Collins (Dublin South Central, Independents 4 Change)
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I thank the Minister of State for her support. I agree 100% with what Senator Flynn said. Many people believe that autistic children in particular have not been able to access CAMHS or that there has been some discrimination in relation to them.
I do not know but I am trying to tease things out. A child may be diagnosed with autism, get their assessment of needs, etc. but the parents may not get the services they need to assist their child to have the best life possible with the supports they need. There is then a mental health reaction to that and anxiety could possibly arise. They will go to their GP who will assess them. There could be a two-year waiting list to go through the primary care system. They will then be referred to CAMHS, and CAMHS will say, "No, that child does not have moderate to severe mental health problems". They will then be referred back to the GP. The child will not be able to access primary care because there is a two-year waiting list. This is the frustration that many people on the ground are feeling.
It must be frustrating for the witnesses if they are trying to provide services for people in relation to their mental health and they do not have the resources to deal with that. I am not blaming them specifically for that, but we really need to try to address what we are going to do to provide services. The Minister of State said that all the different sectors, the private and the public sectors, are all working out of the same pool and are trying to attract therapists to their area. That has to be looked at more. I also raised it last week with Adam Harris.
We have to look at ways we can retain staff in our CDNTs and in our mental health services. We really need to start thinking outside the box in relation to this. There is a high level of vacancies. In occupational therapy, it is 40%. It is 39% for psychology. It is 28% for social workers. It is 29% for nursing. You cannot provide services when there is that level of vacancy. It is just impossible. Therefore, the frustration comes in relation to what CAMHS is actually for which is for moderate to severe mental health assessments.
I put it to the Minister of State that we have to look at how we attract those people who are doing their leaving certificate into therapies. We should do a recruitment campaign. The State should offer a scheme to those students that would pay for their courses. On that basis, if they accept that money from the State, they must give a commitment that they will work in those services in the public service for at least eight years. If they do not, that money will be taken back from them. Unless we ensure retention in our CDNTs, which are under pressure because of vacancy rates of between 30% to 50%, which Mr. O'Regan adverted to, we are not going to deal with this issue. We will not be able to resolve it. Could that be looked at? Could the Minister of State advocate for that in relation to retaining more people?
If the retention rate were better, there would not be so much pressure on the other therapists who are working in the CDNTs. People would not be under as much pressure and find that they want to leave. They go abroad, into private care, or whatever, because there will be less pressure on them. That is the root problem and we have not dealt with that yet. Unless we deal with that and get proper assessment of needs for children, and if mental health is an overlay on that, at least it will be clearer and mental health services will be able to diagnose children who need that care. That is what it really comes down to.
Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Joan Collins for that. Nobody will disagree with her in relation to recruitment and retention and the challenges there. Previous Governments may not have the funding, but there are 700 whole-time equivalent staff who are now funded for disability services. There are approximately 400 who are funded for mental services and who are currently going through the recruitment phase. It is very frustrating when there are teams on the ground that are not fully staffed because of the recruitment and retention issue.
Regarding the piece the Deputy raised, we train people in this country to a very high standard. I know many people decide to go abroad, which they are entitled to do. The question the Deputy has raised is a conversation we are going to have to have at some stage in relation to whether we should be encouraging people to stay for two years or four years after training. It is certainly there in the background the whole time, whether that should be done. I will allow Mr. Higgins to come in because they are doing a bit of work on this recruitment and retention piece.
Mr. Brian Higgins:
By way of update, the recruitment and retention challenge is evident to everyone. Within disability services, we approach it the other way around. We are looking at it as a retention and recruitment challenge. To that end, we convened all of the umbrella bodies for disability services, our HSE colleagues in the areas of operations, stability and sustainability and change and innovation, strategic workforce planning and HR. We will be meeting again tomorrow morning. We will be taking a half day to try to action some of the challenges that exist and that have been identified by our colleagues across the voluntary sector and within the HSE to look at how we can address that. These are around the engagement with colleges on the retention of students and bringing them into the workforce in the Irish context. This is to look at short- medium- and long-term goals in that regard. It is a major challenge.
I thank the Deputy for the comments she made last week. I read the transcript and that will be brought into the conversations tomorrow, as well as potential solutions in the medium and long term. We are very mindful of it. Mr. O'Regan and I will be engaging with our colleagues across the HSE and the voluntary sector. It will be more specifically with a disability focus in this regard. Yet, any learning we can glean can be applied across to mental health as well.
Joan Collins (Dublin South Central, Independents 4 Change)
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Will there be a report back on that? Will the meeting tomorrow morning be public?
Mr. Brian Higgins:
It is not a public meeting as such. It is just among disability services representatives. I am not sure if the information we glean and the actions we undertake can be made public, but they can certainly be shared in conversations.
Joan Collins (Dublin South Central, Independents 4 Change)
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I thank Mr. Higgins.
Mr. Bernard O'Regan:
Specifically on CDNTs, and I might also refer to CAMHS generally, as everybody is acknowledging, there is a recruitment challenge now. Within the HSE, the direction has been to prioritise recruitment for CAMHS and the CDNTs when we are looking at therapists. The message has been communicated to me, to our HR colleagues and to the various CHOs that this should be an area that should be prioritised.
Joan Collins (Dublin South Central, Independents 4 Change)
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I am sorry, I cannot hear anything. The connection seems to have gone dead.
Mary Butler (Waterford, Fianna Fail)
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We can hear the Deputy.
Joan Collins (Dublin South Central, Independents 4 Change)
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I can hear now.
Mr. Bernard O'Regan:
We are prioritising CAMHS and CDNT recruitment. Extensive work is going on in respect of recruitment and retention measures. We are undertaking substantial international recruitment now. We are working with CORU in respect of the pathways for registration. We are also working on some initiatives for the placement periods needed for some international therapists coming in who need to fulfil the registration requirements with CORU. In addition, we are leading out on some initiatives along the lines of what the Deputy has suggested in respect of sponsoring students and asking them to commit to continuing to work in the disability services or CAMHS for a certain time.
Fundamentally, there is another aspect of this endeavour that offers a longer-term solution. We are talking with various Departments and they, in turn, are engaging with the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Simon Harris, and his Department about building the supply of people in this regard because we have a growing population. There are 700 vacancies in the CDNTs now, which is based on our approved staffing level. For a population that will increase, though, we will need bigger teams. We will, therefore, need more staff coming through training. This means that there is a need to increase the pool of candidates in Ireland and internationally.
Dr. Amir Niazi:
From a mental health perspective, in the last few years we have given funding to nursing colleges to provide extra spaces for mental health nurse training, and even for doctors. I will give the committee an example. On average, a college used to train three to five CAMHS consultants, but we provided funding for extra spaces last year and 13 to 14 CAMHS consultants were trained. The issue is retention. Most of those consultants did not stay in Ireland, so retention is the challenge we have faced. On the other hand, we have not just been sitting and moaning about this. We have 74 CAMHS teams. What we learned from our experience in County Kerry is that if it is not possible to recruit a consultant for a team, which was one of the biggest reasons for what happened there, we now look at a different model of service delivery, one of a hub and spoke. I refer to combining teams into a hub and at least providing a service from there. From a clinical governance perspective, we are looking at that model now, especially for those areas where recruitment is a bigger challenge, in counties Clare, Donegal and Kerry. In those areas where recruitment is a challenge, we are looking at a different model as well.
Mary Butler (Waterford, Fianna Fail)
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I thank Dr. Niazi for that. In the context of CAMHS, it is important, as Dr. Niazi noted, to state that we are looking at the model. We have 74 CAMHS teams that are not fully staffed. The question is whether we would be better off having fewer fully-staffed teams and a hub-and-spoke model in place. We are considering everything in this regard, and no decisions have been made. This is why we had the series of round-table meetings. We are also waiting for the audit and review from the HSE, the independent aspect, and from the Mental Health Commission to determine whether people would be better off travelling an extra 20 minutes if they knew when they arrived that the young people concerned would see the consultant required, as against not being able to do so closer to home. This is something we are examining. Everything is on the table; no decisions have been made.
One thing I did this year in the context of my budget was provide €750,000 to support counselling psychologists, because their fees during college training are extremely high. Supports will be provided to those students going to college in the 2023-24 academic year, namely, the first-, second- and third-year trainees. We are still finalising the arrangements between Trinity College Dublin, TCD, and the HSE in the context of how the scheme will work. This will be the first time that trainee counselling psychologists will get supports in this regard. There are 14 places in TCD. It is not many, so we are working actively with the Ministers, Deputies Harris, and Stephen Donnelly, to see how we can expand capacity in this area. We must do so because we have a growing population. We also have more people presenting with mental health difficulties and autism, and we must have the requisite pool of professionals in place as a result.
It must be noted that all across Europe challenges are being encountered. Regarding my other portfolio in respect of older people, this is why in January this year we were able to avail of 1,000 work permits for healthcare workers coming into this area from outside the EU. This approach worked previously for nursing homes when we brought more than 2,600 employees into the country to work in that area as healthcare workers. We have now done this for home care as well. It will be interesting to see what kind of numbers that will apply during the year. We are trying to think outside the box and explore different ways of operating. We know good supports are provided to those children in the CAMHS system, but many not in the system are on waiting lists and we are concerned about this aspect.
Micheál Carrigy (Fine Gael)
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I thank the Minister of State.
Joan Collins (Dublin South Central, Independents 4 Change)
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Can I just come back in briefly? I can see that the Minister of State and her officials are trying to do a lot to try to provide services to people.
Micheál Carrigy (Fine Gael)
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I am sorry Deputy, but I am going to let in the next speaker. We are going to be tight on time and I wish to let in the four other speakers. If I get an opportunity, I will come back to the Deputy. I am sorry about this. I call Deputy Pádraig O'Sullivan. He does not seem to be with us. I call Deputy Tully.
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I welcome the Minister of State and her team. I echo what other speakers have said about CAMHS. The frustration I am hearing expressed by families regarding situations where children are sent to a service, and they may have been referred by a CDNT, only to be refused admission and sent back to the CDNT. These children are falling between two stools. The Minister of State spoke about this aspect. She also spoke about increased collaboration between the CDNTs. I welcome this because it is what is needed. The fact remains that these teams are understaffed anyway, so this is a major issue. The Minister of State has also been addressing this aspect. Until we fully staff all our CDNTs, however, children will not be able to get the services they require. I wonder how many autistic children would need to access CAMHS if they received the services they require through primary care or the CDNTs. I say this because many mental health issues are born out of these children not getting services such as speech and language or occupational therapy or psychology sessions in the CDNTs. The Minister of State spoke about this earlier. We must increase the size of our teams and collaboration between all our teams as well.
I wish to raise an issue concerning autistic adults and mental health issues. I will give an example, and similar cases have been raised with me by several people. A 19-year-old young lad, as his mother described to me, had distress-response behaviour. Again, he was not receiving the services he required within the community and he became quite irate, violent and a danger to himself and others. His mother reached out for help. The next thing that happened was that this young man was admitted to an adult mental health unit. The latter is not an appropriate setting for this young man. Even the team there has said this is the case. Yet he is still there eight months later. He will not be discharged to go home, which is what he wishes and what his family want. This is because the team in the adult mental health unit say it is necessary to wait until the service becomes available and they will be able to refer him on. It has not been made clear what this service is. His mother maintains this young man only needs speech and language therapy and perhaps some personal assistance. The adult mental health unit, however, will not allow him to go home.
This young man is not a ward of court. I know of another similar instance where someone was made a ward of court in the same circumstances. This was done against the wishes of that person and the family concerned, and even without their knowledge or understanding of what was happening. In the case I am referring to, section 26 of the Mental Health Act 2001 has been cited in the context of why this young man cannot go home. The team in the adult mental health unit has admitted he is not a mental health patient; this young man is autistic and needs supports. He is not getting these and this is having a very traumatic impact on him. His mother is extremely worried that if he is sent to another strange place, where he knows nobody, after the traumatic experience he has had in recent months in the adult mental health unit, it will only make things worse.
Can the Minister of State please address these issues? I believe this is happening on quite a regular basis. Young autistic adults are being sent into inappropriate settings and maintained there against their and their families’ will because a small number of services are not being provided for them in the community.
Mary Butler (Waterford, Fianna Fail)
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Obviously, I cannot comment on individual cases. If the Deputy wants to send on the details of that case, my two colleagues here will certainly look at it. Perhaps the broader picture is the issue whereby some young people are receiving supports up to age 18 and then age out. The Deputy referred to this young person as being 19. We are looking at that issue in respect of mental health. The Deputy knows, for example, that Jigsaw provides supports for those aged 12 to 25. There is now a subcommittee in place under the national implementation and monitoring committee specifically looking at whether a young person should age out at 18 or whether it should be 21, 23 or 25. In many countries it is 25. Perhaps that is part of the issue. As I said, it is difficult to discuss individual cases.
I am not aware - I will let Dr. Niazi in on this - of many adults in departments of psychiatry in our approved centres with a diagnosis of autism. They would have to be retained under the Mental Health Act under a diagnosis of mental health.
Dr. Amir Niazi:
This is the other side of it. Normally, people complain about having lack of access and that kind of thing. If somebody is in the acute unit and we detain involuntarily against their will, we must have solid reasons. There is very strict scrutiny by the Mental Health Commission on every admission to our approved centres. We have to answer back to a solicitor, an independent person and a consultant, who comes and challenges the team that is admitting somebody. There is a robust process when we admit somebody against their will. I cannot specify about this case but the team that is holding this child will have valid reasons to do so. It would be a multidisciplinary assessment and they probably would have made that decision on the basis of risk assessment.
On the other side, this is the reason sometimes our bar is a little bit high. If the needs of this 19-year-old or any child are better met in primary care or disability services, we do not want to admit them to mental health because instead of helping them, we might be going the other way around and not helping them. We might be admitting them in an environment that will be more stressful and all of that. If the Deputy provides me with more details, I will be happy to look into it.
Mary Butler (Waterford, Fianna Fail)
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For everybody who is involuntarily detained in a mental health facility in our approved centres, of which we have 56 all over the country, the Mental Health Commission has a huge role to play. As Dr. Niazi said, each person is entitled to a tribunal with a solicitor and an advocate who is a consultant psychiatrist. The Mental Health Commission is in charge of these tribunals for every single person’s care, especially those who are involuntarily detained. I do not know the details but it would be very unusual for someone to be involuntarily detained for that length of time if the medical diagnosis was not there to back it up. Certainly, if the Deputy passes on the details, we will have that looked at for her.
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I was informed that the mental health team in the adult unit said this person should not be there and they are inappropriately placed there. They have actually said this. The problem is they will not allow this person to go home even though it is their and their family’s wish. They are insisting that a service be provided that is not there.
Mary Butler (Waterford, Fianna Fail)
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It can be sent through me.
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Okay. I thank Dr. Niazi and the Minister of State.
Ruairi Ó Murchú (Louth, Sinn Fein)
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I welcome the Minister of State and all the witnesses. It is good to see Dr. Niazi again. In fairness, Deputy Tully has dealt with much of it. We have all had the conversations about silo operations. I think we would all agree that if people got the service they wanted for their autistic kid, whether in primary care or disability services, nobody would be looking to be in CAMHS. The problem is the CDNT or whoever else is saying people need to go to CAMHS for this service but CAMHS then says that as a person is autistic, he or she does not fall into this category. It is over and back and it is a complete farce. Of course, we cannot call anyone about this. It is not as if anyone will take my clinical diagnosis; rightfully so. We have a system that does not work at all, however.
Mr. O'Regan got into it. We are talking about the CDNTs and post occupancy. What did he say in respect of the worst case at times? Was it 19% or 43%?
Ruairi Ó Murchú (Louth, Sinn Fein)
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There are spectacular gaping holes. Regarding that, we had the Irish Association of Speech and Language Therapists, IASLT, the Association of Occupational Therapists of Ireland, AOTI, the Psychological Society of Ireland, PSI, and others in here. We have been told for ages that workforce planning has been sorted. When I listen to Mr. Higgins and others, I am not quite sure we are there. Ministers will say they will have this problem sorted in four or five years' time but we all know the retention issues. I want a real answer around where workforce planning is at this point in time.
We had those groups in. We all accept we have missing gaps. I accept what was said about looking at hub solutions and so on. That is the sort of stuff we need to do but we cannot have everyone operating in their own silo, where they may be under-resourced. I understand how there can be pushback. That will happen naturally. For example, “I have space. I can deal with ten people” or “I have 15 people on my books therefore I can’t deal with anyone else”. Nobody will ever admit to that but human nature and reality will tell you that is what happens. Those groupings said that nobody had a conversation with them on what the best that can be offered. That is on everything from assessments right through. We all know the element of how you do not need an assessment to get a therapy but you may need it if dealing with schools and all the rest of it.
The Minister of State talked about best services, about cross-sectorial services - we all love talking about multidisciplinary services - and putting the services where they would have the most impact. We need to look at schools because there will be bespoke solutions. We need to look at assistive technologies to back up therapists and whoever else. In most cases, we deal with disaster cases where we have missed early intervention. What is the plan to deal with that? Can we have a real conversation on what we can offer in the short term in order that we can then ensure we have workforce planning? Eventually, we will get down to dealing with people and a plan for life. I acknowledge I have given the Minister of State limited time.
Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Ó Murchú, who I acknowledge to be passionate about this area. In respect of primary care psychology, we have run a waiting list initiative for the past three years to get anyone waiting longer than 52 weeks off that list and seen. However, the referrals into primary care psychology from 2020 to 2022 saw an increase of 48%.
Ruairi Ó Murchú (Louth, Sinn Fein)
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I accept that. Can we accept that we are in a bad situation regarding how many have come to us in the past while looking for service?
Mary Butler (Waterford, Fianna Fail)
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I can.
Ruairi Ó Murchú (Louth, Sinn Fein)
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Can we accept we have a bad situation, in that we do not have the people in play? We have what we have. We need a plan to sort out the workforce planning in order that we will have enough in the future. What can we offer at this point in time? The silo system does not work. People just want an answer to the problem.
Mary Butler (Waterford, Fianna Fail)
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With all due respect, I was trying to answer the question. The Deputy asked what plan we have. At the moment, we have an intervention to try to reduce long-waiters off the waiting list for primary care psychology. This is after there have been 48% more referrals in the space of two years. Any system is going to be under pressure. We also have a waiting list initiative running across six of the CHOs in respect of CAMHS. It was a waiting list initiative in 2018 that led to the discovery of the challenges in Kerry CAMHS, which led to the Maskey report and all these reviews we are doing.
I agree with my colleague. It is not so much that recruitment is the issue now, rather, it is retention. It has to be stated that people working with persons with profound disabilities and the most vulnerable people with very severe mental health difficulties – acute and enduring mental health difficulties – have tough jobs. We have people who are so dedicated and do their utmost. Many of these people need supports 24-7. There are people working on a Saturday night and a Sunday night, at weekends and on bank holidays.
The HSE now has 140,000 staff and it has a lot of partners. On recruitment and especially retention, when some of us are out on, say, a Saturday evening, going out for a meal or going to the cinema or doing something with our families, there are a lot of people who work in services and it is challenging to retain them. It has to be acknowledged that people work in very difficult circumstances who are doing their absolute best.
Ruairi Ó Murchú (Louth, Sinn Fein)
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A huge number of people do that. An awful lot of these jobs are a hard station and the Minister of State is also dealing with people's frustration, which is not necessarily right but that is what happens.
Mary Butler (Waterford, Fianna Fail)
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I welcome the engagement that Mr. Higgins and his team will have tomorrow on retention per se. We will soon need to have an unpopular conversation about whether we should retain graduates for "X" number of years.
Ruairi Ó Murchú (Louth, Sinn Fein)
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Yes. What about the silo issue and game of ping-pong that happens?
Mary Butler (Waterford, Fianna Fail)
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We tried to discuss the issue at the roundtable series of discussions, which comprised NEPS, disability and CAMHS. Mr. Higgins is the assistant national director for change planning and delivery for disability and mental health services and, therefore, there is a real focus on the area and he will comment. Many families experience great frustration due to the silo nature of the supports that are made available.
Mr. Brian Higgins:
Part of the challenge with the improvement programme for autism is whatever the mechanism is used, whether it is primary care, disabilities or mental health, that effectively it is the right one and that within that process a person can be brought to the correct thing. Ultimately, there should be a single door and that is the right door.
Ruairi Ó Murchú (Louth, Sinn Fein)
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But no wrong door.
Mr. Brian Higgins:
We then move a person through a door. We are working to that principle and demonstrating that in our current programme.
The Deputy spoke to the fact that part of the retention issue is about the continuity of a relationship between the people with a disability or with autism and the people who look after them and provide services to them. That is critical. There is a dignity piece with that that we must retain as well as the person. The other problem with the risk of losing more people is an enormous amount of learning goes with the individual who goes so retention is critical. We are in a difficult position. Our colleagues in the voluntary sector would say that there is a movement where somebody might move within and from the voluntary sector to the statutory sector. We are trying to address that. There are a number of initiatives between the Departments and the professional bodies that are looking at that but fall outside of my own engagement in the HSE. What we are trying to look at tomorrow, and in the process of conversations we have had, is what can we do to respond on the ground today and how do we build that up. We are conscious that what we are doing will feed into a larger piece. We are very happy for that to be shared but we are certainly not a panacea.
Mr. Bernard O'Regan:
We are trying to a range of things on the disability services side, which is exactly as the Deputy framed it, What can we do today while still looking at what can be done tomorrow?
There is a piece of work going on at the moment led by the chief operating officer of the HSE to bring key people together at CHO level, national operations across primary care, mental health and disabilities and clinical programmes that take a look at what are we doing in support of children regardless of disability, mental health or whatever. It is trying to say we have lots of pathways around integrated working, where we are at with them and what we can do to improve the experience for children and adolescents.
Mary Butler (Waterford, Fianna Fail)
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The Deputy made the point that there should be no wrong door and that has to be the approach because, regardless of whether it mental health, disability, autism or whatever, when a child is referred, it is done for a reason and where one door does not open, there has to be some door.
Ruairi Ó Murchú (Louth, Sinn Fein)
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Once the person is dealt with, yes.
Mary Butler (Waterford, Fianna Fail)
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Ensuring that there is a door was part of our roundtable discussion with the stakeholders. We spend €80 million each year on mental health services and work with various NGOs whether that is Jigsaw, MyMind, Turn2Me or the text line 50808. For some people, a referral to one of these organisations might be sufficient at that stage. The issue is to find the right door but there has to be a referral. People get frustrated when they are on a waiting list for 18 months or two years and the situation gets worse but then they might need CAMHS whereas it would have been better to have an early intervention. We are acutely conscious of the matter. I know that everybody here is only trying to do the very best they can for the young people who need support.
Joan Collins (Dublin South Central, Independents 4 Change)
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I thank everyone for their replies. I know of a woman from Brazil who has a degree from the midwestern state university of São Paulo who can only work here after she successfully completes a course that gives her a Quality and Qualifications Ireland accreditation even though she is qualified. How can we make it easier for qualified people from abroad to work here because many of these aspiring workers do not have €1,500 or €1,600 to pay for a QQI course? Can the State intervene and help these workers join the public health system? I am sure that there are many more people like this woman in a similar situation.
Mr. Bernard O'Regan:
We are actively working with CORU on making entry pathways as smooth as possible. However, one of the challenges is that the standard of education from one institute to another can vary greatly. The thresholds are set in our own regulations, which must be complied with. I am not discrediting any institution but if it does not reach the standard within which CORU must operate, that is where the gap can arise. Sometimes that can be addressed through a supervised placement but at other times people, at their own cost unfortunately, have to pursue further training.
On the one hand, the situation is challenging and can be frustrating. On the other, we have had, as was broadcast recently, the experience of somebody operating without a well-recognised qualification and having some consequences attaching to that as well. On balance, it is better that we err on the safe side but the situation is challenging, and it can be time-consuming and expensive for people.
Joan Collins (Dublin South Central, Independents 4 Change)
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Can the State examine ways to support potential workers to work in public healthcare? Perhaps the State could pay the cost of a certain course for a person and then he or she could commit to work in the public health system for three years, four years or whatever period. This has to be investigated.
Mary Butler (Waterford, Fianna Fail)
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Under the social care model, the HSE will now employ, as a healthcare worker, a person who has completed two modules of a QQI 5 course and commits to study the remaining modules while working or earn and learn. I always say that we cannot compromise on standards.
Joan Collins (Dublin South Central, Independents 4 Change)
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I agree.
Mary Butler (Waterford, Fianna Fail)
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The Deputy has not asked us to do that but I will take away her point that it is very costly, and can cost as much as €1,500, for a person to secure further accreditation to ensure an appropriate placement. Having to pay €1,500 may mean that a person does not get an opportunity to offer his or her skills.
Micheál Carrigy (Fine Gael)
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The Minister of State has responsibility for older persons and I ask that plans are future proofed for persons on the autism spectrum.
We know from our discussion the numbers are increasing, that is, younger persons on the autism spectrum are going to be older persons. There is always that fear, especially from parents, because suddenly all these supports end at 18 years of age and the Minister of State has made a comment on that. Any policies must be future-proofed to ensure the supports are available and all parents - including me, as the parent of an autistic son - know they will be available for the whole of life. That is extremely important.
What Ms Gray said about the strategy was alarming. Am I correct in saying there were only 51 submissions made to the strategy? A lot of recommendations are going to come from those proposals, but there was a very limited number of submissions. I looked at details only in the last couple of days. Even the Isle of Man, which is a small island, received 350-odd submissions to its policy from a population of less than 100,000. I am wary. We need to have a focused second look at some of the recommendations to ensure they are not skewed in a certain direction. One aspect of the discussion is the issue of applied behavioural analysis, ABA. Everyone was talking about ABA and it being removed, yet it is suitable for some children. A support or therapy that is beneficial to children should not be withdrawn. It may not be beneficial to all children but it is to some. We should look at this issue because I was extremely surprised to see the figure of 51 submissions. Why that was the case I do not know, but the figure is too low for us to be focusing on developing a strategy based on that alone.
On the vacancies, at one stage last year, my local CDNT had 3.8 positions covering the whole area, which has a population of over 45,000. We had over 700 children on the waiting list for therapies and 245 waiting on an assessment of need. We are all conscious of the challenges ahead, but what about the places in colleges? I had this discussion with my local CHO 12 to 18 months ago. There was talk of scholarships and the HSE and State funding those positions in college in return for a minimum number of years working in the system, within primary care or the CDNT. We have been talking about it a long time and we need to know now. By September 2023, extra courses should be in place to bring professionals into the system. I am aware that will take four years. Have we looked at graduate programmes where those in the teaching profession, social care or the medical profession would be able to do a 12-month degree to top up and go into speech and language? I know significant numbers of people who would be more than qualified to give that therapy and support, yet we are limited to those who get high points getting into a small number of places in colleges. We are probably causing the problem ourselves by not increasing the number of courses.
Mary Butler (Waterford, Fianna Fail)
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There are discussions between the Minister, Deputy Donnelly, and the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, on higher education and trying to put more posts in train. As the Cathaoirleach said, it will take four years for some of them to come through the system. It takes even longer for other definitions. There are certainly many conversations being had there because we have to start someplace. We have to start training up more people, such as psychologists. I welcome Dr. Niazi's statement that the executive increased the number of consultant psychiatrists because we are dependent on them. It is very challenging and we are seeing issues right across Europe with recruitment and retention. We have a growing and ageing population. We have the highest life expectancy in Europe according to the WHO. I try to say that every single day. We are therefore doing many things well but I take on board the Cathaoirleach's point.
I met Alone only two weeks ago to discuss loneliness and I will also speak on the loneliness task force. We are doing an awful lot of work with people with dementia, but it is important people with autism are included in strategies, going forward. I will certainly take that on board.
Micheál Carrigy (Fine Gael)
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I think it was Dr. Niazi who mentioned mental health services being more appropriate than primary care or vice versa. If a child is referred to the local CDNT, who makes the final decision as to which service is the best? Is it a full clinical team that decides the child would be better off within the CAMHS or staying within the CDNT?
Dr. Amir Niazi:
It depends upon the diagnosis we are dealing with. If it is a diagnosis of depression, anxiety or psychosis, we are the people to deal with that. If it is about communication and behavioural issues, then the child's primary needs are met at the CDNT level in disability and if he or she develops any comorbid mental health issues we work with our colleagues there.
Micheál Carrigy (Fine Gael)
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Dr. Niazi is saying he fits in with and works with the CDNT-----
Micheál Carrigy (Fine Gael)
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-----but he will not go into the CAMHS. The CAMHS basically means a professional comes into the-----
Ms Clare Gray:
On the 51 submissions, it is fair to say it is a bit of an underrepresentation. In hindsight, we could have portrayed that figure better because some of the submissions were coming from umbrella organisations that might have collated the views of tens or hundreds of people. I emphasise that this is not the end of consultation on the strategy. There will be another consultation in quarter 3 of this year, we hope. We will take forward lessons learned from that first consultation to make the second one as robust as it can be.
Micheál Carrigy (Fine Gael)
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That is perfect. I thank the Minister of State and the officials for attending. It has been a beneficial discussion for everybody and very informative. I thank the witnesses for their work. It has been a difficult number of years and as has been said, the number of referrals has increased, which places a strain on the system, as I think everyone accepts.
Mary Butler (Waterford, Fianna Fail)
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I thank Dr. Niazi.
Micheál Carrigy (Fine Gael)
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I welcome everybody back to the second part of our public meeting today. In particular I welcome the Minister for Education, Deputy Foley. I also welcome from the Department of education, Ms Martina Mannion, Mr. Frank Hanlon, Mr. Martin McLoughlin and Ms Jill Fannin.
The remit of the committee is to consider matters relating to services and supports provided by the State to autistic people. Autism is a lifelong condition. The educational system can help autistic people to go on to lead full lives in Irish society. Today we will further consider the opportunities the educational system provides to autistic people. The committee has published a report on the summer programme 2023 and is running a survey of special schools to gauge their interest in taking part in the programme in 2023. We would like to discuss this further today. The committee is also interested in discussing various issues affecting education for those on the autism spectrum. I have a list here, but I know they will come up in the conversation.
I ask the Minister to make her opening statement.
Norma Foley (Kerry, Fianna Fail)
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I thank you, a Chathaoirligh, and the committee members for the invitation to be here today. I look forward to engaging with them on issues they might wish to draw to our attention. I am accompanied today by a number of officials from the Department of Education: Martina Mannion, assistant secretary with responsibility for special education and inclusion; Frank Hanlon and Martin McLoughlin who work as principal officers in the special education section; and Jill Fannin who is a principal officer in the teacher education section.
I sincerely acknowledge the work of the committee in bringing an increased focus on the needs and experiences of children, young people and adults with autism. Although this committee was not established too long ago, I know that it has had many meetings and engagements with stakeholders and I hope that this work has been beneficial for the committee.
In the area of education, I thank committee members for their interest in special education matters and in particular for the report on the summer programme 2023 published by the committee in November of last year. I acknowledge the work the committee put into delivering this report and I also acknowledge the people and groups who have contributed to this report and its recommendations, including parents’ advocacy groups.
The Department has also been preparing intensively for the summer provision for 2023. I am delighted that the recommendations align with and support how we have further developed the programme. I am happy to say that these efforts are bearing fruit, with more schools than ever having signed up to run a summer programme this year. This year, we have introduced several new initiatives aimed at increasing the number of children and schools that avail of the programme, including the appointment of a national co-ordinator, a new portal for staff recruitment, increased resourcing for schools running the programme as appropriate and allowing group tuition arrangements under the home programme. We continue to work towards the successful roll-out of the programme this summer and we have already seen positive developments. In particular, we have seen a 50% increase in the number of special schools running a programme this summer.
However, I continue to be ambitious, as I know committee members are, for the programme for the years ahead. I want to continue to ensure we get more schools offering the programme each year. I know that is also a clear aspiration of the committee. I am happy to provide further updates on the summer programme during our discussions today.
I know that the committee is interested in the issue of teacher education. I fully accept the importance of providing strong initial teacher education and professional learning opportunities for our teachers. First, however, it is important that we continue to provide sufficient teaching and special needs assistant supports for our students with additional needs. I am determined to ensure that our newly qualified teachers are better prepared to teach all of our students, including those with special educational needs. In March, I published an initial teacher education policy statement which sets out a vision for initial teacher education to the end of this decade.
Through the actions in this policy statement, I have asked that the Teaching Council and my Department work towards requiring that all student teachers spend at least one placement in a special education setting. This target will require significant engagement with higher education institutions and schools. It is very important and will have a significant beneficial impact for our students into the future.
Regarding the continuing professional development of our school staff, I note that the committee has rightly referred to the important and significant role being played by the Middletown Centre for Autism. The centre was established to support the promotion of excellence throughout the island of Ireland in the education of children and young people with autism. The centre’s role is to complement and build on existing first-level services, such as those available through the National Council for Special Education, NCSE. The centre offers a wide range of specialist research, information and resources on evidence-informed approaches and practice-based professional learning. Both the Department and the NCSE have been provided with additional funding to recruit more advisers. We are committed to continuing to work closely with the centre and looking to expand the range of supports and services it can offer.
Committee members will be aware that the assessment of need process is provided for under the Disability Act and that responsibility for the process lies with the HSE. Schools are now required to assist in the completion of an assessment of needs by providing existing school-based information contained in a student support plan. Assessment is a fundamental element of teaching and learning. In finalising the assessment of need process, we have had extensive consultation with the education partners and with individual schools. I am very grateful to all those who contributed to this process. The Department of Education and the NCSE have put in place comprehensive supports to assist schools in completing the educational component of the HSE’s assessment of need process.
Turning to the NCSE policy advice on special classes and special schools, it is important to highlight that the Department of Education’s policy in respect of supporting children and young people with special educational needs remains very clear. Based on a child-centred approach to the provision of education, we want to ensure that all children and young people with special educational needs can be provided with an education appropriate to their needs.
I am happy that the vast majority of children with special educational needs are educated in mainstream classes. In recent years, there has been a very significant increase in the number of children and young people being diagnosed with special educational needs, particularly in the area of autism.
We have responded to that by providing additional supports in mainstream classes, as well as the special classes and special school places necessary to meet the emerging needs of those children and young people. The Department received policy advice from the NCSE on special classes and special schools in recent months. That policy advice will need to be considered fully so that, long-term, a more inclusive education system can be delivered while also ensuring current demand from parents for special classes and special schools can be supported and met.
It is the Government's position to see therapists reinstated to all special schools. Their value within the special school setting cannot be highlighted enough. However, I understand the committee has heard first-hand from the HSE at a previous meeting, there is a lack of supply for these professionals, not only in Ireland but in mainland Europe. My Department is working with the HSE and the Department of Children, Equality, Disability, Integration and Youth, which has the lead responsibility on this matter, to ensure this critical service is returned. We are all working on increasing supply in this field.
We have come a long way in ensuring that children and young people with autism can access an appropriate education. There is strong evidence to support this. I provided some of this earlier. However, we are collectively ambitious that we should continue to do more for our students. There continues to be so much to learn in relation to how we support children and young people with autism and it is important that my Department, relevant agencies and support services continue to review and adapt our policies, programmes and supports as required.
I look forward to engaging with committee members during today’s meeting and addressing any questions that they might have.
Pat Buckley (Cork East, Sinn Fein)
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I thank the Minister for being here. I want to make a couple of observations first. This committee has engaged with a lot of different stakeholders and has learned that investment in teacher training is absolutely vital. The Minister mentioned the reinstatement of therapists in special schools but at present we are having difficulties with retaining and even finding therapists. Is it time to think outside the box and take a different approach to recruiting these specialists? That said, even in the short time that this committee has been operating, a lot of work has been done on this issue, with some positive results.
As the Minister said, the numbers are rising. The Minister and the Department have put a lot of investment into new schools. I will always give credit where it is due and that has to be acknowledged. These facilities were needed and it is great to see them. One of the big bugbears of this committee is school transport, which is a major issue for children with autism. There is a particular difficulty for children transitioning from primary to secondary school. To give an example, Cobh in east Cork has 30 to 35 students going to Carrigtwohill but there is no bus available because the school is outside the catchment area. There are two schools in Cobh but the students cannot get into them because they are full. I just wanted to flag that with the Minister.
This committee has done an awful lot of work on summer provision. We are not here to put people's back against the wall in relation to the summer programme but to highlight the fact that the summer programmes are absolutely vital to everyone involved, including service users and their families.. I saw first-hand how beneficial the programmes can be for service providers too when my own children volunteered a few years ago to work with people with autism. They got a better understanding of autism. Investing locally in the people who need support is so important. We are duty bound to do our utmost to support the summer programmes. I appeal to the Minister to work with us so that there is full buy-in, with support from the Department in terms of assisting the teachers and other staff involved in summer programmes.
Norma Foley (Kerry, Fianna Fail)
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I am happy to follow up on the case that the Deputy raised in terms of two schools in an area being full and children trying to access a third school outside of their area. It is an issue that has been raised with me by a number of Deputies. We are very clear that if the two schools within the immediate vicinity are full and if the students have applied to both and been told they are full, then they are eligible to go to the third school. They must receive confirmation from the two schools that they are full but I can talk to the Deputy about this later.
Pat Buckley (Cork East, Sinn Fein)
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I will forward the details to the Minister
Norma Foley (Kerry, Fianna Fail)
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If they provide the confirmation, then they are eligible to attend the third school.
As already stated, I acknowledge the enormous body of work that this committee has done to try to push forward with the summer programme, with the aim of maximising the uptake. The Government has invested €40 million in order to be able to facilitate a maximum uptake of the programme. We are seeing success this year and I appreciate the committee's input into that success. We are seeing a 50% increase in special schools involving themselves in the summer programme and a 20% increase overall in terms of the number of schools taking part. That is significant. In 2019, we had 13,000 young people participating in the programme. Last year, had 42,000 participants and we are already seeing an increase on that this year.
This year, in terms of the special schools, we have made a very concerted effort. A national co-ordinator for the special schools has been employed and within the schools there is both a programme manager and a school organiser. The aim there is to lift the burden of organisation from any one individual within a school.
The Deputy make reference to thinking outside the box, and I appreciate everyone having an input into determining how we can do things better. This year we did think outside the box. We set up a portal for those who might have an interest in working on the summer programme and more than 1,500 people registered on that portal. That is separate from those who did not have to register at all because their own schools were doing it. Those 1,500 who registered included student teachers, therapists, SNAs, people coming from a care background and so on. The idea was that if there was a school that was unable to run the summer programme, we would have staff available and there might be an opportunity for a private group or provider to set up a programme for the summer. A considerable body of work has been done on that and Mr. Hanlon, in particular, has engaged on it.
We have been very keen to maximise the number of young people that have access to the summer programme. We have introduced a number of innovations that build on those introduced last year, including provision for online payment. The latter means that staff will be paid more quickly. We have built on all of the initiatives that are required and are confident that we will see growth in the summer programme again this year. I accept what Deputy Buckley said and agree that we need to get to a point where we have 100% availability to all students. We are working towards that.
Marc Ó Cathasaigh (Waterford, Green Party)
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I thank the Minister for her opening statement and for being with us. I welcome many of the improvements that have been made to the summer programme. It is an issue that this committee has spent a great deal of time on.
I want to ask about the planning of special classes in particular. The 900 new special classes are very welcome and much needed. However, in terms of the planning of same, my sense - and I hope I am misguided in this - is that it is a little haphazard. We are placing special classes in schools that are open to providing special classes as opposed to planning a geographical spread. I know the Minister is aware of the context in my own home town of Tramore because she has met me a couple of times on related issues. We only have 12 places in a town whose population is heading towards 12,000 at primary school level. That does not include the hinterland. How are we planning for these special classes in particular? Are we making sure that we are forward-planning in terms of population spread?
Norma Foley (Kerry, Fianna Fail)
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I thank the Deputy for his question. To be clear, we are working hand in hand with schools. The Deputy is aware that we have the power to compel schools to open special classes. In the first instance, however, we try to work hand in hand with schools.
We have significantly increased the resources that are going into the National Council for Special Education, NCSE. An additional €30 million has been provided to it this year to increase, for example, the number of special educational needs organisers, SENOs, who are on the ground so we can do a body of work that pre-empts the requirement within an area.
It is not a question of a school just putting up its hand and saying “We will do it.” There obviously has to be a need in the area and where there is a need, we work with the school. Where the school does not put up its hand, we engage very strongly with the school and we speak to the supports that we are willing to provide in terms of training, for example, the four days of training provided for the staff who are working on the programme, as well as supports for the whole school and supports that are provided for the principal.
In our engagement with the schools, we have listened with regard to where they believe there have been difficulties. Reference was made to the number of special classes we have and so on. We were coming from a low base and there have been almost 1,000 new places in the last three years. I acknowledge that many staff feel they were not sufficiently trained initially, all those years ago, before the arrival of these classes. It is important that we provide CPD and intensive training for those working in that area and we will continue to do that.
Marc Ó Cathasaigh (Waterford, Green Party)
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My question is whether we are seeing uniformity of provision or are some geographic areas being left behind. Do we have an analysis on that?
Norma Foley (Kerry, Fianna Fail)
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Ms Mannion might like to come in on that. I think we are seeing quite a spread and I visit schools across the country. We are seeing enormous growth and there is no focus on any one area, unless it is an area that has been identified as requiring particular provision.
Ms Martina Mannion:
I want to give reassurance that we have had a very intensive process over the last two years within the Department of Education, working closely with the National Council for Special Education and, within the Department, with the special education area and also the planning and building unit. We have looked at it much more holistically than we would have done previously. We have gone back and examined, for example, where children in post-primary special classes might have come from. Initially, we might have thought they were all just coming from primary special classes but, in fact, we see at post-primary that about one third of children are coming from primary special classes, one third from mainstream primary and the last third from within the post-primary schools themselves.
We have been very clear. We wrote to all post-primary schools last October to say that we expect that every post-primary school in the country will be opening special classes. For example, over the next three years, in the Deputy’s area of Waterford, we envisage that we will have 17 new primary special classes and 15 new post-primary classes and that is in addition to the classes that we have already opened in the last year. For example, we have opened four new special classes for this school year at primary and four at post-primary.
Each year, we are going to build on what we have done before. We are looking at it in terms of ensuring we have a good geographical spread across counties and across areas. The Deputy can envisage that if every post-primary school has special classes, we are going to have a very big spread. At primary level, we are conscious of children having to travel a distance so we are trying to make sure that we are opening them in areas where there are no other special classes.
We are working with schools that have physical accommodation available to us because one of the key things to get a class open as quickly as possible is to try to target schools that have existing space. We are working with the planning and building unit to make sure that the schools we are looking at in the first instance have space and where schools do not have space we have moved to doing reconfiguration works.
Just so the Deputy will know, we have engaged with the planning and building unit and, in effect, we have introduced a number of new arrangements to facilitate that. Previously, schools would have had to undertake that work themselves but we now have a new framework that schools can draw down that allows the reconfiguration works to be done by people provided by the Department, instead of the schools having to do that themselves. We introduced that last year and it has been hugely successful and it gets the classes open and available more quickly. All of these kinds of initiatives are helping to get the classes open as quickly as possible.
The other thing that we are doing which has worked well is that where schools have agreed to take a class, and where we were either working on the reconfiguration or on modular accommodation, we are making sure that the NCSE has sanction for the teachers and SNAs in advance. This means teachers and SNAs are working with the children, they are reaching out and they are transitioning them from their existing placement into the new placement and they can also make sure that the range of NCSE training and supports is available to the class. We are approaching it holistically and we are looking at it across all of the geographic information system, GIS, areas with the planning and building unit. We are satisfied that we will get to the point where we will have a very wide spread of special class provision across all of our primary and post-primary schools.
Norma Foley (Kerry, Fianna Fail)
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All of our new builds will also have dedicated special education provision. Considering we have a considerable number of new builds, with 180 new builds last year and additional accommodation at 300 locations at various stages of development this year, it is positive going forward that this is an intrinsic part of new developments when planning and building.
Marc Ó Cathasaigh (Waterford, Green Party)
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With regard to the NCSE policy advice, the Minister said it was received in recent months. Can the Minister be a bit more specific about that? I also want to ask about the response. Presumably, the advice is being considered. Is that response going to be public, do we have a timeline for it and will there be a point at which that NCSE advice is made public?
Norma Foley (Kerry, Fianna Fail)
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Yes, it has been received by the Department and the Minister of State, Deputy Madigan, and I are currently considering it, but we have also invited the consideration of officials within the Department, especially the National Educational Psychological Service, NEPS, and the inspectorate, so there would be a wide embrace of the views expressed in the report. It is our intention to publish it imminently.
Marc Ó Cathasaigh (Waterford, Green Party)
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Would the Minister have a timeline on “imminently”?
Norma Foley (Kerry, Fianna Fail)
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My plan is that it will be before we fall into recess, most certainly. That is the current plan anyway.
Mark Wall (Labour)
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I welcome the Minister and her officials to the committee and thank them for making themselves available. It is very important to this committee that they do that and that we get the chance to talk to them on a number of issues in regard to education.
The first part I want to speak on is the summer programme. The Minister mentioned the €40 million and the 20% increase overall, and she also mentioned the national co-ordinator. Can we hear more about the national co-ordinator and what its function is? I have raised at this committee the issue of major towns where there are still no summer programmes available, and the Chair has supported that and contacted the Department. Is the national co-ordinator going to co-ordinate that to ensure that a town like Newbridge, for example, will have a summer programme? The Minister and her officials are aware, as we are from our meetings, of the routine that is needed by parents. When there is a break in that routine and there is no summer programme available, it is difficult for families to re-engage with that and to get back into the education system. It is an issue that has been brought up with us at many of the 50 meetings we have had so far. I ask for a comment on the co-ordinator and whether we can look at those major towns to ensure the routine that is essential for parents is maintained.
With regard to special education places, I have contacted the Department in regard to Kildare and a number of people have come to me to say they have contacted not just one or two but up to ten schools in their area. What they seem to be getting is a list from their SENO through the NCSE of schools. Can we handle that better? Can we ask the SENO to work with the family to ensure that they identify a school rather than parents contacting me and my colleagues, crying on the phone and saying that they have rung ten schools, eight schools, two schools or one school - whatever it is - and they are basically being rejected? Is there a better way of doing it? I believe there is. The Minister might comment.
On teacher education, I first thank all of our teachers as I believe it is important to thank them when we get an opportunity like this. I am aware that they have a difficult job. The special people we are talking about today can be very difficult in terms of teaching, and there is physical assault and so on, which we are aware of. What is the Minister doing in regard to the advancement of teacher training? We have had a number of witnesses who have gone out of their way and paid for their own education and their own training and the Minister will get examples of that through all of our committee meetings. The Minister mentioned the report in March. What are we doing in regard to teacher training to advance the skills that are there, particularly for those who are in teaching for a long time, which the Minister mentioned, rather than those who are coming new to it and may be getting that training?
I want to mention the SNAs, which was an issue referred to by the Minister. I thank the Minister for bringing back the announcement in regard to SNA allocations to April. A number of schools did not get that announcement until the middle of May and there are probably still one or two schools waiting. Is it the Minister's intention to keep it in May or even to bring it a bit earlier in the year?
We are all aware that these people are hanging onto the coat tails of the Department to know if they will have a job in September or not. Will it be April next year, given the great work that SNAs do in supporting our teachers and in ensuring these special people get the education they deserve? Will the Minister commit to having that in April or can we even get it earlier so those SNAs can know they will have a job come September?
Deputy Buckley mentioned school transport and we have been back on forth with the Minister on this in the Seanad. Because of the lack of special school places, some people have to drive and I know the Minister has been given examples of this by other Deputies and Senators. Parents are driving an hour to get to a school in some cases. Is the Department examining the school transport model to see if we can co-ordinate a little bit better? It can be difficult because of the distance involved but I ask that the co-ordination be looked at.
Norma Foley (Kerry, Fianna Fail)
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On the national co-ordinator for special schools, we are placing particular emphasis this year on supporting special schools to run the programme. As I said, we have seen a 50% increase in that, which is positive, and we hope to build on that. The function of the national co-ordinator is to take the overall view and support and engage where there might be challenges. We have deliberately resourced the programme managers and the schools organisers into the schools. For example, I referenced that we had the online portal as well for people who might be interested in registering, whether they are teachers, SNAs, therapists or whatever. We have 1,500 of them, distinct from those who are already registered in their schools. The purpose of that is to support the national co-ordinator where there might be, as the Senator identified, an area where a school is not in a position to run it. Separate to that, a great body of work is being done to work with other providers that might be in a position to come in and take over the running of the summer provision programme. That is not necessarily the schools themselves.
On the Senator's area, 53 schools in Kildare are running the summer provision programme and three are special schools. If there is a particular query or anything he wants to raise, I have no issue with that and I will look at it afterwards. That is a-----
Norma Foley (Kerry, Fianna Fail)
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Yes, it is positive but we are working towards it being better and I want to acknowledge that.
I also want to acknowledge the role of the SNAs. Our schools could not function without the support that is given by them. The Senator is correct that we worked hard this year to have an earlier announcement. It is my ambition, to the best of my ability, to be able to deliver it on an ongoing basis and as early as possible. We have done significant work with SNAs and we have set up a unit within the Department for workforce planning. There are seven regional meetings to take place around the country to engage directly with SNAs on the issues they identify, whether it is training, supports or whatever. It is the first time we have done that and the Senator will also be aware of the qualification at level 6 that is being provided for SNAs. I recognise the value of SNAs and we will do all we can to work collaboratively with them. Workforce planning is the first step in that direction in terms of the unit within the Department.
With regard to school transport and parents driving their children to special classes and schools, this is taking its time. We will ultimately achieve the local provision of these services but it is not happening quickly enough. Our goal is that in everyone's local school there will be local provision for the young person who needs to avail of special education. We are seeing it improve and we can say that by the end of this year we will have almost 3,000 special classes available. We have seven special schools and the most recent two that were announced were in Cork and Dublin. We are building up resources all the time to make special education more accessible and to make it easier for people to access supports more readily in their communities.
There are two aspects to teacher training. There is the initial teacher education aspect, which is important because they are our teachers into the future. We have done a body of work on that and all the higher education institutes must have programmes that are registered with the Teaching Council. In 2020, the Teaching Council announced a new standard, céim, and within that there must be an inclusive approach to education across all of the experiences in initial teacher education. All of the 68 programmes across 14 institutes are working to achieve that accreditation. It has been achieved at first year for all of them and by the end of this year, in 2023, it will have been achieved by all of them. That means that all of our teachers coming out will have experience across the curricula they study of inclusive education, which is positive. I am not so sure about siloing it off into particular experiences; rather it is a good thing that it would be across all elements.
I will go a step further and say that in March I launched a policy statement for initial teacher education, which is the vision of my Department for the next ten years. In that I have clearly expressed that it is my determination that we will ultimately achieve a scenario where every student teacher will have had a placement in some type of special education setting. I accept that heretofore that might not have been possible because we did not have sufficient classes, special schools or whatever, and I am not saying we have that capacity but I am saying that is the clear direction of travel. No teacher should come out of training without having had experience in a special school setting and that is a clear objective in the policy statement.
For those who have been teaching for a long time, significant CPD is being provided, specifically for those who are setting up special classes. There are four days of intensive training, there is the whole-school visit with two days of training, there is support for the principal and there is an investment of an additional €13 million that has been provided to the NCSE. That speaks to the issue the Senator raised of parents having to do the work of going from this school to that and another school looking for places. That is not acceptable and it is not the way I would want it to be. Feeding into that has been the fact that we have not had enough special educational needs organisers, SENOs, on the ground. We will increase the number of staff within the NCSE by 50% and the objective is to build up that resource of staff to ensure there is a sufficiency of SENOs on the ground who are linking in with the parents all of the time.
Did I miss something else from the Senator's questions?
Mark Wall (Labour)
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That is fine. Colleagues are anxious to get in so I will let them have the time. I thank the Minister for those replies.
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I wish the Minister a good afternoon. On the summer provision, she indicated that if a school in an area where there is a demand for summer provision is not providing that, an organisation other than a school can do so. Are supports being given to that organisation? It would be quite difficult if it is a charitable organisation, a parent's group or whatever. A point that some parents made is that the summer provision may be offered in some areas but that it is not being offered for the full four weeks in many cases. Is the Minister aware of that? There are also reduced hours over the four weeks and it is just that the full course is unfortunately not being offered.
I welcome what she said about teacher training and new teachers coming out. As she pointed out, 98% of students with additional educational needs are in mainstream schools. I know that when I was training there was no special education component; it was voluntary. The CPD is important and it should not be voluntary but compulsory for teachers who have been teaching for a longer time. Some teachers will make every effort to have an inclusive classroom and will differentiate the work but a small number do not do that. I want to ensure that everybody is educated on all aspects of disability and autism. The Minister referenced the Middletown Centre for Autism. It was established in 2007 and 16 years later, it is still a pilot programme in the South.
This is a pity, because it does absolutely brilliant work. It only deals with 12 students here in the South and 60 in the North, so it is five times the number, even though it is a much smaller geographical area. Could much more be done to ensure that is actually reviewed and expanded, because they offer great supports?
The Minister also referenced that there are to be comprehensive supports to assist schools in completing the educational component of the HSE assessment. Could the Minister expand on that? There was a nervousness among a lot of schools and unions over what was involved there, and they want to ensure that the supports are put in.
On inclusive education, I welcome the fact that the Minister said that the Department will be publishing a response to the NCSE's policy advice very soon. Will the social inclusion model be a big part of that? Is it time to look at combining the social inclusion model with the children's disability network teams, CDNTs, to reach out to as many pupils as possible? It is the same pool of staff which the Department is looking for. They are all therapists. There is a shortage, and I know there may be efforts to increase the number available. However, at the moment, we do not seem to have enough, and where that is piloted, and where the social inclusion model is working, I believe the demand for supports from the CDNT reduces. More integration and co-operation between disability and education is warranted there.
I am glad the Minister said that there is going to be an increase in the number of SENOs. I worked with SENOs who were excellent, who knew every student within their catchment area who had an additional need, and who would be in regular contact with families. Now I have parents coming to me asking who the SENO is. The SENO has not reached out to them and is not doing their job. I welcome that, because a lot more needs to be done there.
Norma Foley (Kerry, Fianna Fail)
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I thank the Deputy. On the last point, I agree with her that we need a stronger representation of SENOs on the ground. They are the local connection to the parents, and their role is an invaluable one. We recognise that, and provision has been made in the budget to increase that. If we have to do more, we will continue to do more in that space. Deputy Tully is right, and Senator Wall has referenced it, when that link is not there, it is all the more frustrating for parents, and I understand that.
Regarding the summer provision, I want to be clear that a body of work has been done. Significant supports are in place now for the running of these courses, if they are to be run by those who are, say, not within the school setting. Mr. Frank Hanlon can come in afterwards to give further details, but we are engaging. This is a new sphere and space for some of these organisations to take up. Even if we can get a few of them on board this year, it will give confidence to grow it even more next year. We are working hard with a number of organisations to get it off the ground this year, and Mr. Hanlon will come in and give a bit more detail on that.
Deputy Tully referenced the reduced hours, and the two weeks or whatever. I am conscious that some of the schools coming on board this year are doing so for the first time. They are taking the two weeks, and that is what they feel they can manage this year. However, the potential is there to grow it going forward. Equally, we have made a huge effort around the special schools, and we have offered them particular flexibility, for example, flexibilities around the week they would choose, or flexibilities around the school day. I understand that it might not suit everybody, but I would rather a school runs it for a certain number of hours than not run it at all. It is being run between the hours of 10 a.m. and 2 p.m. I am great believer in the idea that if one does something once and garners experience, one has more confidence doing it the second time, and we are really in a space where we want to maximise the number of special schools in particular which are doing it. We want them to see that it can be done, and that they will be well supported by the Department. For that reason, I have already referenced the national co-ordinator, the programme manager within the schools, and the schools' organiser. There is additional grant funding for special schools as well. For example, if they run a two-week programme, there is an additional €4,000 being made available to the schools, on top of what has been given. We are really pushing the boat out this year. I am not saying we have everything absolutely smack perfect this year, but we are learning from what has gone previously. We are acknowledging that there are not enough numbers taking it up, so we are doing more and more. We will learn again from how this has worked this year, if we need to do more next year.
Deputy Tully mentioned the Middletown Centre for Autism. As she is aware, and I know she would be well placed to know it, that is a shared endeavour, North and South. We have the National Council for Special Education here. We rely on it for the training here. That equivalency is not in the North, so much of our work is led out by the NCSE. Deputy Tully is correct that, currently, we have 12. Next year, 2024, that will grow to 14. However, there is also a new package coming on stream in 2024 which Middletown will be launching. It is a particular body of work on additional supports around the three areas, which is working with the schools and teachers, parents, and the young person. There is an enhancement of that package of supports to be provided from 2024, and we will have more details on that in time. That is being worked on by Middletown, and I want to acknowledge the excellent supports that are provided. However, I think the wraparound service in 2024 has great potential going forward as well.
Regarding the assessment of need, I understand that there was a certain amount of trepidation there in view of the assessment of need. However, we have to be clear that this is a legal obligation, and it is since 21 October. Our role in education is to assist the HSE. We come in as an assistant. It is not a diagnostic-based assessment from our point of view in education; it is a needs-based assessment. Much of that work is already done within the schools and the portfolio of learning which they have. We want to be clear that before any of this was introduced, there was significant consultation with all of the partners. There were 80 schools involved in trialling it. It was trialled last summer and again last October. There is a significant body of work in it, and we are also saying that for the ongoing work which is there, we will continue to support the schools. There are advisers available to the schools, and the entire process will be reviewed by the end of this year, so that where there needs to be learning or things done differently going forward, we will do that. We gave that absolute commitment. I would like to say as well that 90% of the assessments are taking place at primary school level, rather than post-primary school, but we will do the full review.
Regarding the school inclusion model, I want to be honest about that. It was interrupted as a consequence of Covid-19, but it is back up and running in community health organisation, CHO 7. It is an ideal model, where there is a therapist based in schools. I want to recognise that the role of the therapist does not fall within our gift. It has now moved to the Department of Children, Equality, Disability, Integration and Youth. However, wherever it falls, the important thing is that it falls right for the schools. There is a huge body of work there, and we are engaging, particularly with higher education institutions. We are trying to build up the provision of therapists from different disciplines coming into the schools. I take the Deputy's point about those based in the community who are coming into the schools. We are open to looking at any model which will increase and maximise the number of therapists at work in our schools. They are a fundamental part of the provision for young people. We can control the education side of it; we are dependent on others regarding the therapy side of it. However, we are very happy to engage and have engaged with the HSE. We will have ongoing engagements, but there is also a collaborative engagement with regard to increasing the number of therapists which, from a higher education point of view, can be brought on stream as well.
I cannot remember what the last question was. I should have responded to the Deputy - and Ms Mannion might come in on this as well - about the summer programme in her own area. There are 29 schools in Cavan and 33 in Monaghan. Again, we are working to build that up. Ms Mannion might come in on that.
Ms Martina Mannion:
To assist the Deputy, I might add something regarding that piece on the assessment of need. In the Department, we were really conscious that this was something we were asking schools to do in co-operation with the NCSE. The Minister talked about the trialling which we did in June, and then the further trialling in October. We learned a lot from working very collaboratively with schools during Covid-19, with regard to the kind of resources and supports which they needed. With the unions, management bodies and the parents, we worked through what schools would need to be supported to go through this. For example, we did a guidance document with step-by-step procedures on how to complete the process. We did a short video, because people felt that video was a very snappy way to be able to engage with it.
There is a dedicated email within the National Council For Special Education, NCSE, that is monitored and responded to. There is a dedicated telephone line with people trained to answer the assessment of need, AON, queries. We have aFAQdocument that we update regularly on foot of the feedback from the schools. We have completed exemplars of where schools did it and how they did it. We have that up again on our website. Then, we have the in-person support visit. The key piece on this is when we are asking schools to engage, and the Minister talked about engaging with the information that is already in the school on the student and in the student's support plan, this is very much in line with what schools do already. It is part of the continuum of the education process. It is part of the initial teacher training whereby teachers assess and understand the needs of the children in the class and modify the curriculum to meet those needs. That is built upon at every stage including the initial teacher training and continuing professional development, CPD. When we introduced the special education teacher allocation in 2017, we produced significant training and guidance as to how we go about identifying need. Members may recall that at that point, we moved away from requiring a diagnosis to get resources. In 2017, we trained and supported teachers to be able to identify accurately a need within the classroom and then apply their skills and competencies to meet the need of that child. We have built upon that again in the new autism guidelines we issued last year. In effect, in the AON, we are asking schools to take the information and skills they have and the information that is held on the student's support file and transfer that to the NCSE, which will then quality assure it and it send it over to the HSE. We have given that commitment, which the Minister referenced, to meet the stakeholders; I meet them regularly. We have committed to doing a review of this before the end of the school year and we are absolutely going to do that with both the primary and post-primary stakeholders.
Micheál Carrigy (Fine Gael)
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Mr. Hanlon indicated that he wants to comment on the summer programme.
Mr. Frank Hanlon:
It was really about the point that Deputy Tully made around what we call the private group provider scheme. We knew not every special school would be in our programme this year, although I am delighted we have had that increase. However, we have opened it out to other groups now, as the Deputy said, maybe voluntary groups or local charities and they can step in. We will support them in terms of what is required. It pretty much mirrors what is in the school-based system in terms of the teacher set-up. We have had a couple of inquiries and we are working with a couple of different groups I know are going to do it in a couple of areas where the need is there. We are continuing to do that with a couple of other groups as well. I would like to see this as possibly the start of something because it is about having access for the children who need it most. I know that is what this committee is about and we totally agree with that. Like the Minister said, we are seeing the start of something really positive this year. As she also said, the role of the national co-ordinator has been really important in that because he has gone out and met school representatives. He is a peer. He can show them the benefits around the programme. He is bringing on schools that will act in a really positive way to show other schools. What we want is for schools to follow other schools on this. We have organised for the first time ever separate training in person for the special schools in Athlone, which I think is happening tomorrow, so that special schools are actually coming together and collaborating and looking at best practice and at ways to do this in the best way possible. There is more work to do but we are trying to put it out there that there is something for everybody.
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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If an organisation or majority in an area wants to run it, can they use a school? Will a school be made available in an area? It does not necessarily have to be a special school. Can any school be used?
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Or the premises.
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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Yes, I know.
Mr. Frank Hanlon:
-----but we have one place where that is going to happen. In that case, the collaboration is there with the school, which is important. There are other way of doing it, however. We will work with each group individually to look at their individual needs. Some people have premises already or have access to a premises. It does not have to be a school if they have somewhere else to do it, but we will work with them on it.
Norma Foley (Kerry, Fianna Fail)
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It is an ideal situation to have the premises, but where there is not a premises available or we have a premises but for a variety of reasons it might not suit or whatever, it will be at the discretion of the board of management. Going back to what I said earlier, however, we will be able to showcase maybe after the summer a few different models. Mr. Hanlon said there is maybe one school that would do it. If schools are not doing it themselves, we have the outside provider or maybe there is another that will have a premises. In other words, we would be able almost to have a template for others next year which may like to follow. This is kind of a learning curve for us as well. It is a new departure but it has the potential to grow itself going forward.
Micheál Carrigy (Fine Gael)
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I am sorry for jumping in with a question. The Minister said it is at the discretion of the board of management. Ultimately, however, all schools belong to the State.
Micheál Carrigy (Fine Gael)
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If there is a need in an area, I do not think a board of management making a decision that we are not doing a summer programme or that it is not available should be superseded by the need of the kids. I will mention one of the replies we got to our survey. We emailed all 128-odd schools. One school actually came back and said it was not going to run a summer programme because it is leasing out the school to a private provider to run summer classes.
Micheál Carrigy (Fine Gael)
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That is not acceptable. I feel strongly about it. It is the property of the State. The Government has put significant funding into this. They belong to the taxpayers and to the State. They should be made available as a priority. I am sorry; I jumped in there.
Norma Foley (Kerry, Fianna Fail)
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That is fine. I hear what the Cathaoirleach is saying.
Micheál Carrigy (Fine Gael)
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I call Deputy Ó Murchú.
Ruairi Ó Murchú (Louth, Sinn Fein)
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I thank the Minister and her officials. I welcome an awful lot of what has been said, particularly when the Minister spoke about flexibility. Am I right with regard to summer provision that the Department is engaging across the board and has opened it up to any group that may want to operate within reason, obviously, and even if they do not have a premises, there is the possibility of school premises being used?
Ruairi Ó Murchú (Louth, Sinn Fein)
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I am just making sure.
Norma Foley (Kerry, Fianna Fail)
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That is it. That would have to be a local solution at the moment, however.
Ruairi Ó Murchú (Louth, Sinn Fein)
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I accept that and I know there can be particular issues in that regard.
Norma Foley (Kerry, Fianna Fail)
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That is the idea.
Ruairi Ó Murchú (Louth, Sinn Fein)
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That is all vital. In fairness, I welcome the fact that the Minister spoke about learnings. We all talk about learnings being made, which they have been and will continue to be. We will not get this perfectly in one go. It is about delivering this to as many children and families as possible who require it.
When we talk about provision of autistic spectrum disorder, ASD, units, I have seen a huge amount of interaction between the special educational needs officers, SENO, and individual schools. At times, there are particular issues around building work and space and constraints. I have spoken to the Minister and the Minister of State, Deputy Madigan, in this regard. I welcome the fact that we are talking about an expansion to the number of SENOs and whatever. We need to make sure all this is done to an optimum level from a point of view of delivery. The bit that did not make sense was the fact that there were so many kids going through primary school and while we might not have had all the data we needed, we had enough data to know we were going to have a difficulty and that we did not have the provision.
I will ask a question that was put to me by the Irish Primary Principals Network, IPPN and others. Would it make sense with regard to disability provision that there could be an allowance, let us say, where parents would be able to apply to a school two years beforehand? Therefore, the school would also be aware of the input they may have and the requirements that would be necessary. I am never sure we will ever get down to a point where we will have enough special educational needs, SEN, teachers or special needs assistants, SNAs. I am aware of the great work that has been done. I have spoken about my wee lad being in St. Joseph's National School in Dundalk and the work done by teaching staff and also SNAs, and I talk about what is happening with him in Ó Fiaich College at the minute. He is in mainstream and the school does not have an ASD unit. My point is that we have been talking in this committee about silos as well. It is the idea that there are kids who may need to be in an ASD unit but then possibly move and whatever else. My term for today is going to be "flexibility" but we do need to see that.
We need much interaction with regard to two things, one of which is the assessment of needs. We all accept that is a right but it is finding the solution that works for every kid and being able to deliver as soon as possible an actual educational plan to facilitate kids' transition, particularly between the bit of responsibility that falls within the Minister's Department, which is primary to secondary. That is accepting that every plan will change as time goes on. This point has been brought up multiple times and I get that it does not fall completely within the Minister's gift.
There needs to be interaction from a point of view of providing the services. Everyone is talking about best practice. We all know we do not have enough of any type of therapist at this time. It is about putting the service where the need is. In a lot of cases, school is the perfect place for that. I have seen the advantages that can be provided by teachers and SNAs. I am not saying they can fill that gap but we know they try to employ best practice. If there is a crossover and an interaction with therapists, psychologists and whoever necessary, that will be a benefit to everybody. We really need to look at assistive technologies. The wider issue is that if we are talking about assistive technologies, we need to look at augmentative and alternative communication, AAC, in the round. We all know about Fiacre Ryan and the use of the rapid prompting method, RPM, and whatever else. While I am not talking about one specific technology, we need to look at whatever works on a bespoke basis for each kid. In fairness, I have left the Minister with ten seconds to answer about 16 questions.
Norma Foley (Kerry, Fianna Fail)
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I acknowledge the Deputy's personal engagement with me on an ongoing basis on this whole area. In the first instance, I should say that we are now at a point where we have almost 40,000 professionals who are working in the area of special education. That is something that we had not achieved before. There is almost an even breakdown of 20,000 special education teachers and in and around 20,000 SNAs, give or take. That is a significant improvement from where we were at. However, I absolutely accept what the Deputy has said - it has already been mentioned by previous speakers, including Deputy Tully and others - about the SENOs. They are the key link on the ground. There has been a 50% increase in staffing levels in the NCSE on foot of the €13 million in additional funding provided. That will include not just SENOs but also advisers, who are important. For example, the Deputy referenced the assessment of need. Those advisers are important in providing any additional supports that might be required in the schools. On the assessment of need, Ms Mannion has articulated very well the supports that have been given to the schools. The Deputy talked about primary and post-primary levels. In terms of the assessment of need, 90% of applications are actually coming in at primary level. We will do absolutely everything we can to support the schools to find the process less daunting and challenging. That is why we are so clear that ultimate responsibility lies with the HSE. It will come from the NCSE to the school and there will be a single form to complete. That was another thing that caused problems initially. There was so much paperwork flying left, right and centre. Now, there will be one form to be filled out. Ms Mannion has referenced the supports that are available. If additional supports are required, the adviser is there as well. We will review the process in its entirety at the very end.
The Deputy has articulated very well - and it is my own vision - that where there is a special class, there has to be movement between the special class and mainstream. Movement between the special class and the mainstream should be encouraged. That is the absolute ideal. That is why special classes are set and located within the mainstream, so there is that continuity there. It is also my ambition that as we develop a variety of campuses going forward in education provision, there will be cases where there are special schools on the same campus as mainstream schools. There should be integration and familiarity there as well. That is the ideal. That is the world that we live in and the world that we want to promote. Going forward, I would like to see the special schools are located alongside the mainstream schools, with a crossover where possible between the-----
Ruairi Ó Murchú (Louth, Sinn Fein)
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Built-in universal design.
Norma Foley (Kerry, Fianna Fail)
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Basically, yes. The Deputy mentioned assistive technology and if it will assist in the area. I share the Deputy's view. If technology will improve the education and life experience of an individual, that young person should be getting the technology, full stop. If we need to make changes and do things differently, then we will do so. I am clear in my own mind that if technology is going to be the answer for a young person, then that technology should be provided for. The Deputy mentioned something else. In terms of the transitions between the school and leaving-----
Ruairi Ó Murchú (Louth, Sinn Fein)
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Also, the notion of a two-year run-in for parents of those with disabilities to apply.
Norma Foley (Kerry, Fianna Fail)
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Okay. I will respond on transitions in the first instance, as I have it in my head. We are running a couple of pilots on transitions at the moment. They are being run in Dublin and Galway. We are moving into the post-primary schools, working with the students to inform them of the opportunities that they will have in further education or whatever other options they might choose to take up. It is not that the facilities or opportunities - and there is always a need for more - are not there, in the main. One of the real stumbling blocks is that people do not know that they are there. Two different types of pilot are being run out in order that we can garner enough information to see how best we can support lifelong learning and transition from one stage to the next. They are very good pilots. As I have said, they are bring run in Galway and Dublin.
On assistive technology, I should mention that in the last budget we provided more than €2 million in additional funding for that sphere. We are continuously building it up. There is a very strong body of work on the provision for parents to apply for that earlier. Ms Mannion has referenced the fact that we have engaged directly with the post-primary schools, telling them what their obligation is in terms of making special provision. We also have the GIS in place and the SENOs on the ground, who are forward-thinking and engaging in advance. I am very happy to look at any other model. If it is a model where there is an application, I am happy to look at it, proof it out, discuss it and see what way we could implement it. I am happy to look at anything that we might be able to do in that regard.
The other thing is that the new legislation that has come into force provides for a specific function to ensure there is co-ordination between the NCSE, via the SENOs, and co-operation with the parents on the ground. That is an obligation. That is why have increased, and will continue to increase, the provision of SENOs on the ground. We are open to looking at everything. I think the increase of SENOs on the ground will be a substantial boost to us going forward.
Ruairi Ó Murchú (Louth, Sinn Fein)
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In fairness, it is an issue on which I have engaged with the Minister before. It is just that we sometimes hear of a fear in schools around provision. For example, if things break well for a school in relation to the SNA allocation and it gets double, it will be only too delighted like anybody else, but sometimes schools are afraid to make an appeal in case there is row-back and they might actually lose SNAs. I did not mention specific schools.
Norma Foley (Kerry, Fianna Fail)
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I will refer to Mr. Hanlon there. I would not want that to be the premise on which a school operates at all.
Norma Foley (Kerry, Fianna Fail)
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Our job is to ensure that where there is a need for SNA support, that SNA support is provided. I want to be very clear about that. It is not about giving with one hand and taking away with the other. I really do not want the schools to operate in that way. Perhaps Mr. Hanlon wants to come in there in terms of the figures.
Mr. Frank Hanlon:
Even without the exact figures, I do not think any of the reviews done by the NCSE on the SNA allocations have resulted in a drop in or a loss of SNAs. There were some that stayed the same, but the majority of the reviews resulted in an increase in SNA allocation. The NCSE is continuing to work on streamline the process for schools and to make it a bit easier. If schools feel that they require additional SNAs, they should definitely contact the NCSE without fear of falling foul.
Ruairi Ó Murchú (Louth, Sinn Fein)
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That is what I was hoping the answer would be. I hope that can allay some of the fears.
Micheál Carrigy (Fine Gael)
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There are ten minutes left before we finish. I have a few comments. Deputy Ó Murchú raised the issue of AAC. I know that the Minister of State, Deputy Rabbitte, allocated €1 million to provide devices, but it is not enough to ensure that every child will have a device that is capable of supporting them, particularly those who are non-verbal or minimally verbal. That is the world we live in now. There is a company based in Northern Ireland that won the EY award for developing assistive technology. It is something that every child should automatically be given once they come into the school system. They should be given an iPad with that technology or an app on it that is developed or supported by the State to give them that opportunity to communicate.
A bugbear of mine is the word "unit". I do not like the word and I would love to see it removed from all terminology and Departments. One even sees it written on the screen during questions or Topical Issue matters in Leinster House, with reference to the "provision of a unit" in such and such a location. They are classrooms. We use the word in daily life, because the terminology is there. Could we look at removing the word from websites, paperwork, etc.?
Pauline Tully (Cavan-Monaghan, Sinn Fein)
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What about autism spectrum disorder, ASD?
Micheál Carrigy (Fine Gael)
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The word "disorder" is part of a different portfolio, but it is an issue. It is a question of the terminology being used and I would love to see the word "unit" removed.
I acknowledge the significant investment and support for schools from the Minister's office, whether it is school-building or staff. It has to be acknowledged that considerable investment is being made by the State in special education. It has to be put on the record.
The summer programme has been referenced a number of times today. I thank Mr. Hanlon for his engagement over the past 12 months. Numerous conversations have been had on this subject. We are both of a similar mindset to make sure improvements were made. I look at my own geographical area, which we call the "Shannonside Northern Sound area", that is, counties Longford, Westmeath, Cavan, Monaghan, Roscommon and Leitrim. Two schools, with the capacity for 14% of the pupils who are in the special schools within those six counties, have come forward for a summer programme this year. That is the one of the gaping geographical areas. I would fully support any initiative put in place to make sure of provision for parents. I have anecdotally heard stories of special schools that do not provide a summer programme, but that ring the principal of a national school half a mile down the road to ask whether the school would have a place for some of its kids. I know those principals are fairly frustrated. They are putting on a four-week programme, because it is their duty to provide the programme for the kids within their school. It really annoys me, to be quite honest. We need to take a stronger hand on it.
We put out an olive branch this year and made substantial changes. I know we have 20 extra schools and we are up to roughly 45% of schools in the country, but we need to go a little bit further. Those schools are funded and wages paid by the State. I have been told of a school saying no other staff would be able to look after the kids and yet, they would make a call to the primary school for a completely new set of staff to look after the kids, rather than doing so in the environment where the children are the rest of the year. I have strong feelings on it, as the witnesses can hear. I acknowledge the considerable work that was done, led by Mr. Hanlon. I fully support any measures put in place for geographical areas. We should look at that.
The Middletown Centre for Autism, whose committee was here with us, is under-utilised by us, as a State. We are funding half of it. I would like to see Middletown, which is recognised throughout Europe as using best practice, provide training programmes for our special needs assistants, SNAs, and teachers within our schools, to provide a model of training going forward. It could be linked in with a reduction in Croke Park hours, based on having undertaken that training, or a model could be created for SNA or teachers to do autism training in the summertime with the Middletown centre. It would be extremely beneficial. I know we had the Teaching Council and the Irish Primary Principals Network, IPPN, before the committee. The Teaching Council was positive about changes to teaching training.
I welcome comments the Ministers has made that by 2024, all teachers coming out will have had significant engagement in all parts of education, in order that we have a fully inclusive education system. Would it be worthwhile, as part of that, to have teacher training and a placement within the summer programme, with student teachers being obliged to work at least one summer on the programme, to help with the numbers? The Minister mentioned 1,500 people have put themselves forward on the portal. Will we be able to employ all of them, to make sure we have a fully resourced programme for this year? I apologise for asking a load of questions.
Norma Foley (Kerry, Fianna Fail)
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No, that is perfect. In case time runs out and I do not get the opportunity to do so at the end, I wish to acknowledge the vast body of work of this committee. It has only been up and running for a number of months but has been very helpful to the Department. We have a shared objective and agenda, that is, to enhance the experience of education for children and young people with autism. From my point of view and on behalf of the officials, it has been a positive engagement and we have benefited considerably from what the committee has brought to the table.
While I am not saying going for outside providers is the ideal model - we would like to think our schools would be in a position to provide - I recognise there may be extenuating circumstances in a school doing so. We will learn a great deal from what is being progressed this year. We will have templates of good practice for how to do it going forward. I hear what the Cathaoirleach is saying about student teachers having an opportunity to participate in the summer programme. It is my vision that within the next ten years, we will ensure they will have had a placement in a special education setting. To be clear, we have a very good uptake of student teachers on the summer programme. The uptake has been really good. If I were a young teacher, I would think it was an ideal setting. I am very familiar with young teachers who are doing so. Whether it is SNAs, therapists or others, it is a very positive experience for them. Making it mandatory could be difficult. At any given time, there are approximately 3,000 people in teacher training. It might be difficult but when we get to full provision, there may be an opportunity to look at it.
I acknowledge the great asset Middletown is to us. As the Cathaoirleach has said, it is a joint venture. We are looking at a new enhanced delivery from Middletown in 2024. It is my understanding that Middletown does not work in the areas of SNAs at present. That is why I referenced the SNA workforce development unit and the work we are doing with it in seven different regions. Middletown has worked with more than 7,000 parents and teachers on our behalf, with regard to supports provided. However, we are very much still working with Middletown to see what the opportunities are going forward to enhance that work. It is an ongoing job. I also acknowledge the work of many of our staff who are upskilling, whether it is in terms of postgraduate studies in special education, or specifically in the area of arts and special education. These are postgraduate studies fully funded by the Department.
With regard to technology, we are currently reviewing the assistive technology scheme to make it more streamlined for applicants and, more importantly, needs based. That is the most important aspect. We have seen a considerable uplift in funding. There has been a 60% increase, with an additional €2 million provided to technology in our schools, on the back of €100 million already provided. We are working on that area, but a review is important, to make it needs-focused going forward.
Micheál Carrigy (Fine Gael)
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What about terminology and the word "unit"?
Norma Foley (Kerry, Fianna Fail)
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I 100% agree with the Cathaoirleach that language is important. You can see how our language in the area of special education provision has evolved over time, which is right and proper.
The EPSEN review was a public consultation that involved more than 28,000 people and a very large number of them specifically referenced language. As part of what will come out of the review, we will certainly look at any changes that are required in language.
I personally do not believe that it is ever acceptable to refer to something as a "unit." They are classrooms and that is the way we talk about them in our new builds. There will be the classroom base, the SEN base or whatever it will be in the same way that you will have other classrooms. I agree with the Cathaoirleach on that. The fact that this issue has been quite prominent in EPSEN speaks for itself as well.
Micheál Carrigy (Fine Gael)
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It is 2 o'clock on the dot. I thank the Minister and all her Department officials for coming here today. I thank them all for their good work. I believe we are going in the right direction and we just need to train more professionals in the therapies to assist with a lot of the programmes and plans that are in place, which will make a huge difference.
We now adjourn until Thursday, 25 May when we will resume in private session.