Enda Kenny (Mayo, Fine Gael) | Oireachtas source

That is a question to be raised as a Topical Issue when I am quite sure the Minister would give the Deputy a detailed response. This morning, on the recommendation of the Minister for Education and Skills, the Government approved a further allocation of over 800 special needs assistants, bringing the number to 12,900, the highest number ever. There will, I believe, be a need for a further 115 next year. However, it is not just a case of making appointments of special needs assistants, whose job it is to look after the physical needs of children; it is also a case of dealing with the intervention process and meeting the needs of children at a much earlier stage. These requirements could be related to speech and language therapy services or psychological services. There could be a range of other needs. In making provision for what is a very extensive number of special needs assistants the Minister has commissioned, through the National Council for Special Education, an analysis of the outcome of expenditure and the numbers employed in this area. In other words, can more be done? Should there be a different intervention at an earlier time, or has it just become a call that the special needs assistant is a very important entity, which is the case? Should something be done at an earlier date? I do not know the details of the case the Deputy mentioned, but I am quite sure the Minister would respond to him.

The priority is to focus on universal health care and have it provided through home care packages, community facilities and primary care centres and to keep people out of hospital when they do not have to be there.

The Minister has set out his stall on waiting lists and trolleys in emergency departments. I do not see why we cannot have in the public health sector diagnostic centres that would be the match of anything provided in the private sector. Some time ago I opened a privately run unit that is open from 7 a.m. until midnight, with two facilities operating in parallel all day, every day. The number of scans that can be carried out is enormous. There is no reason, in endoscopy units and the public health system, we cannot have really effective diagnostic capacity and centres that do not close at 5 p.m. If we are serious about having an impact on waiting lists of individuals awaiting scans, we should be able to achieve this in the public sector also. There is spare capacity in many hospitals where consultants and doctors could see patients not on their own waiting lists in order to make progress.

Deputy Micheál Martin made a point about drugs. This is important. The Minister has made it perfectly clear that the trend has been to leave the decision, or the perception of it, to the Minister for Health of the day. Some weeks ago I listened to Dr. Barry talking on the radio about the reasons clinicians turned down a drug based on its effectiveness. It is at the clinical level that the discussion needs to take place. The clinical discussions on the effect on quality of life, at the cost level set by the companies, have to be dealt with in the first place by those who know what they are talking about in terms of the clinical outcomes and clinical analysis of the drug in question. The Government decides afterwards whether it can provide the funding for many of them. We know that in the next ten years there will be a range of as yet unpatented drugs to treat particularly challenging conditions. They will be very expensive. The Minister is clear that the discussions should, in the first instance, be between those who can carry out a clinical analysis of the impact of drug X or Y on the quality of life of a patient. If that is determined, the Department and the Minister can, on behalf of the Government, decide to act. Deputy MIcheál Martin's point is valid, but I have outlined where the discussion should occur in the first instance.

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