Alex White (Dublin South, Labour) | Oireachtas source

I thank Deputy Collins for raising this matter, which I am dealing with on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch.

I have no doubt that everyone in the House is aware of the pressures on the health system to maintain services within the parameters of its budget. Notwithstanding these financial pressures, I would like to assure the Deputy at the outset that the Government is fully committed to the ongoing delivery of vital services and supports to children with disabilities to the greatest extent possible within available resources.

Over the last years the health sector has invested significant resources in services for children with disabilities. Within the preschool sector specifically, the Health Service Executive provides some limited grant aid to community preschools, as well as funding some special preschools that cater specifically for preschool children with disabilities. In certain parts of the country, the HSE funds a preschool support service. This service provides a support worker to enable a child to participate and integrate into a preschool setting. The HSE has no statutory obligation to provide this kind of service. There is no standardised scheme in the HSE for funding these preschool support services, which have been developed at local level. One such service supported by the HSE is provided by St. Joseph's Foundation in Charleville, where 23 children are supported to access mainstream preschool. It is important to note that this is not a personal assistant service. Personal assistant services are generally provided to adults with a physical or sensory disability with support needs, who then self-direct their own services.

Significantly, the HSE is also currently engaged in a national programme of reconfiguring therapy resources for children with disabilities from birth to 18 years. This programme aims to achieve a national unified approach to delivering disability health services, so that there is greater equity of access to services based on need, clearer referral pathways to these services and improved intersectoral collaboration. The nub of the issue the Deputy has raised is the necessity for a standardised system across the country. It is not an area with which I am directly familiar but this matter has arisen in other areas of the health service where there are differential levels of service in various parts of the country. It is perhaps a legacy of the earlier organisation of the health services but it is very frustrating.

The Deputy makes the point eloquently that first, there should be clarity about what services are available and what the entitlements are. It seems that many of the services are not provided statutorily but have grown up over the years based on what people have tried to do locally, albeit in good faith. The Deputy is correct to say that an entitlement to access these services should be standard across the country. I can only agree with her that access should be uniform where possible.

The participation of children with a disability in preschool is a cross-cutting issue involving a number of stakeholders. These include the Department of Children and Youth Affairs, the Department of Health, the Department of Education and Skills, and the HSE. The health, education and children and youth affairs sectors co-operate on a regular basis concerning children's disability issues. To strengthen this co-operation the children, adolescents and young people with complex disabilities unit in the Department of Health, led by a principal officer, has been established. This important development aims to foster greater collaboration between the Department of Health, the Department of Education and Skills, and the Department of Children and Youth Affairs on children's disability issues and to build on the cross-sectoral working arrangements that are in place. A dedicated cross-sectoral team, comprising representatives of the Department of Health, the HSE, the Department of Education and Skills, and the Department of Children and Youth Affairs plays a key role in this regard.

A subgroup of this team has been set up to examine the issues around integration of children with disabilities into mainstream preschool settings, building on previous analysis in this area. Representatives of the various Departments I have mentioned, as well as the HSE and the city and county child care committees, are members of this group which is chaired by the Department of Health. It is envisaged the work of this subgroup will be completed by the end of this year, at which point it will report to the cross-sectoral team.

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