Dáil debates
Wednesday, 6 February 2008
Leaders' Questions
10:30 am
Enda Kenny (Mayo, Fine Gael)
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I am glad to see the Taoiseach's annual mark is as clear as ever.
Few things in life are more important to a family than the birth of a child. Few things cause people more confusion than to receive a determination of something that will place that child at a disadvantage. Probably nothing causes more anger and consternation in families than when the State fails in its duty to provide for such children.
As Members meet this morning, approximately 150 cases remain backed up in the High Court involving parents who, by virtue of a no-appeals mechanism, have been forced to bring their cases to court for determination and to have their wishes regarding education for their children followed through. This issue is highly sensitive. Every year, approximately 11,000 children present with special needs nationwide. The Government and the Minister for Education and Science are implacably opposed to any extension of the applied behavioural analysis, ABA, system beyond the 12 pilot schools that were determined by the Minister's predecessor.
No one knows a child better than his or her mother. Although the Constitution purports to treat the children of the nation equally, those children who live close to the 12 ABA units at least have a chance of gaining access to them if it is determined that this constitutes the best education for them. However, this is not the case in the vast majority of other locations nationwide. This causes parents enormous consternation and anger, some of whom are before the High Court as I speak to defend their right to have the State provide the most appropriate education for their children.
Although the Taoiseach has been head of Government for ten years, it takes parents between two and seven years to get an assessment for their children. This constitutes a national scandal.
Enda Kenny (Mayo, Fine Gael)
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I refer to the anger, frustration and consternation with which people are obliged to put up. When will the Taoiseach do something about this issue? Second, why is no appeals mechanism available to parents in respect of their children, thereby forcing them to go to the High Court? A total of 150 cases remain outstanding and an entire industry has been spawned by defending the State with taxpayers' money against the interests of parents who seek an education for their children. I ask the Taoiseach to deal with these two questions.
Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny is well aware the Government does not force anyone into the High Court.
Paul Connaughton Snr (Galway East, Fine Gael)
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Where else can they go?
Pádraic McCormack (Galway West, Fine Gael)
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They have no other option.
Bertie Ahern (Dublin Central, Fianna Fail)
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When parents choose to take a case against the State and the Department or agencies involved are satisfied that what is being provided is correct, the latter must defend the action, which is what has happened in a number of cases. Obviously, to answer Deputy Kenny directly, the Government believes that as each child with autism is unique, such children should have access to a range of different approaches to meet their individual needs. While applied behavioural analysis is one such method used in special classes for children with autism, it is only one. In addition, the findings of the task force on autism, as well as international best practice, support the view that it is not the only option and that a range of approaches should be used, rather than only one. Autism societies in other countries also caution against relying on a single approach and the Government has followed this advice.
The number of special classes for children with autism has increased dramatically in recent years to the extent that, at present, there are more than 270 such classes nationwide. In the absence of the excessive network of special classes that obtained some years ago, 12 centres were approved for funding under the ABA programme. New ABA centres have not been approved in recent years because a network of special classes is now available. Consequently, it is not that the Minister is opposed to extending them but rather a range of special classes now exists.
The Government is committed to long-term funding for the existing 12 projects subject to agreement on certain standards, such as those pertaining to appropriate qualifications for the staff and to the type of educational programmes available to the children. Many ABA tutors have no formal teaching or other professional qualifications and discussions have commenced and are ongoing with Irish autism groups and a number of the pilot centres on this issue.
In addition, the National Council for Special Education, NCSE, is working extremely hard to encourage more schools to accept children with autism. It is experiencing considerable success, either in mainstream classes with resource teachers and special needs assistants, SNA, support, where appropriate, or in special classes if that is the child's parents' preference. Schools that agree to open special classes are allocated additional staff and equipment grants. Moreover, for a number of years, additional accommodation for such classes has been given priority in the building programme. A team of 80 special educational needs organisers has been put in place by the NCSE to help parents secure appropriate places for their children and children who are awaiting a place can also get home tuition paid for by the Department.
There has been under-provision in this area historically. Until perhaps eight years ago, few or no resources were being put into special education in this country, or at least the amount was very small. It takes time to bring the services up to an optimum level but we have been making great improvements and are continuing to put enormous resources into this area.
I have just touched on autism but, in respect of special educational needs generally, there are now thousands of staff working in the education system whereas there used to be only a handful. There are approximately 17,000 staff in our schools working solely with children with special needs compared to a few hundred a few years ago.
Enda Kenny (Mayo, Fine Gael)
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I did not say the ABA system was the only method of providing education to autistic children. In recognising that extra moneys have been pumped into this sector, it seems that the failure of the Government to allow for an assessment system in the first place causes personal consternation and anger among parents of children with special educational needs, be it autism or another condition. That the Government has failed to deliver an assessment system within a short period is the root cause of much of this anger. Can the Taoiseach state what evaluation has been carried out on the pilot schemes in the designated ABA centres? What is the waiting list for ABA pupils in those centres? Has the Government made a definitive decision not to proceed with an expansion of the pilot scheme or are centres to be established in other locations around the country?
In general, the social experiment of putting all the children with special educational needs into mainstream schools is not working as envisaged. Teachers face difficulties due to a lack of resources in spite of increases in the number of special educational needs assistants. Speech and occupational therapists who work in special needs schools are contracted to the HSE and not the Department of Education and Science, although the problem is an educational need as distinct from a medical one. Different holiday regimes apply in the HSE and the Department. It is wrong to suggest that the State is doing all it can when it is clear that the root cause is the failure to carry out assessments. Moreover, there is no post-assessment appeals mechanism that does not require parents to borrow money from credit unions and financial institutions on the pretext of doing up their houses. The money is really intended for individual ABA tutoring, sometimes in the parents' homes.
One of the great scandals of the Governments over which the Taoiseach has presided has been the failure to deal with the root problem, that is, the inability to have an early assessment. I am quite sure that, as a public representative, the Taoiseach has met parents of children with special educational needs, be they autistic or otherwise, whose frustration is caused by the failure of the State to address their needs.
What will the Taoiseach do to enable earlier assessments? Will he introduce an appeals system so parents will not be required to fight their cases against the State in the High Court? How many are on the waiting list for ABA? I understand there are approximately 400. Will the Government extend the pilot scheme to more than 12 units, as it originally proposed? What is the Taoiseach's view on the contracting of specialists, including speech and occupational therapists, to the HSE when they should be contracted to the Department of Education and Science?
Bertie Ahern (Dublin Central, Fianna Fail)
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The commitment is for the continuation of the initiatives in the 12 pilot schools. That does not mean that, by extension, there are no new ABA places because ABA is offered in the mainstream schools. The whole point is that ABA is not just available in the pilot units or what will become mainstream schools anyway, but that one can also get that educational opportunity in a mainstream school.
Bertie Ahern (Dublin Central, Fianna Fail)
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That is what is happening and it is important that it be understood. ABA, therefore, is available.
James Reilly
Mary Hanafin (Dún Laoghaire, Fianna Fail)
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There is a range of measures.
Bertie Ahern (Dublin Central, Fianna Fail)
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Let us not mislead people. There are 12 pilot schools but the ABA service is available in mainstream schools. Therefore, one does not have to have a pilot school. I know what Deputy——
Brian Hayes (Dublin South West, Fine Gael)
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Not to the satisfaction of the parents.
Pádraic McCormack (Galway West, Fine Gael)
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The Taoiseach knows little about it.
Bertie Ahern (Dublin Central, Fianna Fail)
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Please, I am responding to Deputy Kenny. I heard Deputy Kenny state he does not believe the placing of pupils with special educational needs in mainstream schools is suitable in all cases. Eight years ago there would have been no more than a few hundred teachers fully involved with special educational needs. Subject to correction, I believe there were approximately 300 or 400. The view of all the experts and in all the reports was that if the children with special needs — there are multiple reasons for such needs — are placed in classes in mainstream schools, they can go to their local school, be with the children they grow up with in their communities, have access to fully qualified teachers and the normal curriculum and integrate with other children from an early age. That is what every report in the 1980s and 1990s suggested should be done in this country.
We started out on that road and there are now approximately 17,000 staff in our schools working solely with children with special educational needs. The Government has made improvements in the area of special education and has made it a major priority. Some €900 million is now being spent on education for students with special needs. Last year or the year before, there was a 40% increase in funding. We have continued to provide resources.
Brian Hayes (Dublin South West, Fine Gael)
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People are still going to the courts.
Bertie Ahern (Dublin Central, Fianna Fail)
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One of the fundamental reasons is to give children an opportunity to get into school.
I accept that there was a poor approach to assessments in the past and that it will take time for us to have assessments for everybody — I am not arguing about that. However, when we held the discussions on the Disability Act 2005, with which I was deeply involved, we proposed a new entitlement in the legislation for assessments for children under five. It came into effect in June 2007 and will ensure children are assessed at an early age. The parents, medics and paramedics say the way to get it right is to make the assessment at a very young age. Deputy Kenny said this himself.
Improvements are also on the way in respect of access to health therapies. The programme's commitment is to use the National Treatment Purchase Fund to provide therapies for children under five who have been waiting for three months. I do not know the precise figure but Deputy Kenny stated there are 400 on the waiting list.
Schools that agree to open special classes get extra staff. Extra accommodation is being made available. I stated 80 special educational needs organisers have been in place to help parents get the appropriate place for their child. If one believes everything is not perfect, one should realise we have made an enormous attempt to deal with the matter.
On co-ordination, Deputy Kenny made the point that both the Health Service Executive and the Department of Education and Science are involved with special educational needs in schools. It is for that reason that I asked the Minister of State at the Departments of Health and Children and Education and Science, Deputy Devins, to assume a co-ordinating role between both Departments in respect of both policy and implementation.
Eamon Gilmore (Dún Laoghaire, Labour)
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The Irish Cancer Society told us yesterday that up to 30,000 cancer cases are being diagnosed in the State each year. This is a significant number in a country of just over 4 million. The society tells us that the numbers are increasing and that, in the next 12 years, we may face a cancer epidemic. On several occasions before Christmas we had exchanges in this House about cancer treatment and things that went wrong in cancer treatment. There was the sad and tragic case of Susie Long, known to radio listeners as Rosie, as well as the case of the women in Portlaoise who were given the all-clear for breast cancer and then were called back for re-examination. There were several other cases of misdiagnosis.
On each occasion that we raised these issues with the Taoiseach and the absent Minister for Health and Children, the answer we were given was that investigations were under way, reports would be presented and that we could not get answers to what went wrong in these cases until we had the reports. Five such investigations are still under way. These are the Dr. Ann O'Doherty report into the cases of suspected breast cancer misdiagnosis in Portlaoise, which was to have been completed by the end of November but is still not published; the review by John Fitzgerald into the circumstances surrounding the release of information on the misdiagnosis of breast cancer in Portlaoise, which is still not completed; the report by the Health Information and Quality Authority, HIQA, on the circumstances surrounding the misdiagnosis in the case of Rebecca O'Malley, which was due to be published in December but has not yet been produced; the report by HIQA of a review of pathology services at University College Hospital, Galway, in the wake of another breast cancer misdiagnosis where a woman was twice wrongly given the all-clear, which is still not completed; and the internal report by Cork University Hospital regarding the appointment of a pathologist despite the fact that his work was subject to two reviews in Finland.
These five reports are still ongoing and have not been produced. There have been no answers for the patients concerned, their families and the wider public. When will these reports be produced and published and answers provided to the questions we first raised last October and November?
Bertie Ahern (Dublin Central, Fianna Fail)
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To the best of my knowledge, the report by Cork University Hospital was acted upon. The individual involved is now out of the jurisdiction and there has been contact between consultants in Cork and the international medical organisations. I am not sure whether there was to be a written report in that case.
Kathleen Lynch (Cork North Central, Labour)
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The individual concerned left of his own initiative. There should be a report on his appointment.
Bertie Ahern (Dublin Central, Fianna Fail)
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Following concerns raised by staff in the breast service, the HSE set up a clinical review last autumn of all breast radiology diagnoses in the Midland Regional Hospital from November 2003 to August 2007. That review was led by Dr. Ann O'Doherty, a consultant radiologist at St. Vincent's University Hospital and with BreastCheck. The HSE has advised that this review is complete. Nine women were identified as having a diagnosis of cancer and all nine have been offered appropriate treatment. A clinical review of ultrasounds at Portlaoise is also complete and no cancers were detected in this review.
The HSE has advised the Department of Health and Children that a report on the reviews will be published by the HSE when the necessary legal requirements have been completed. A target date of the end of this month has been set for publication. The legal issues relate to the necessity to give an opportunity to those who are mentioned in the report to make their defence or their statements. The suspension of mammography services at Portlaoise continues pending publication of these reports.
The Minister for Health and Children has asked the chief executive officer of the HSE for a report on the circumstances that led to the decisions of the executive to suspend the breast radiology services at the hospital, place a consultant radiologist on administrative leave and initiate a clinical review of the services. That report, which was led by Dr. Ann O'Doherty, has been completed and will be submitted to the chief executive officer of the HSE. The Minister also asked for a report from the board of the HSE on the management of all events starting from and subsequent to these decisions. That report is being undertaken by Mr. John Fitzgerald. It is not finished but is being drafted.
Eamon Gilmore (Dún Laoghaire, Labour)
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As I understand it, the pathologist in Cork had left before the investigation began. What we want to establish is how he was engaged in the first place given that his work had been subject to review in Finland. I ask again for an answer in this regard. There is an issue of public accountability, it is not enough just to say he is gone and let us forget about it. We must find out what happened.
I am somewhat confused by the Taoiseach's reply on the O'Doherty report. On the one hand, he tells me it will be published in the next month——
Bertie Ahern (Dublin Central, Fianna Fail)
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It will be published by the end of February.
Eamon Gilmore (Dún Laoghaire, Labour)
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He also said it will be submitted to the chief executive officer of the HSE. Have I the Taoiseach's assurance that the report will be published?
Bertie Ahern (Dublin Central, Fianna Fail)
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As I understand it, it will be published.
Eamon Gilmore (Dún Laoghaire, Labour)
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The other reports to which I referred are the two HIQA reports, one in the case of Rebecca O'Malley and the other in the case of University College Hospital, Galway. The Taoiseach did not refer to those in his response. When does he expect them to be published?
Bertie Ahern (Dublin Central, Fianna Fail)
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I will check the position on the Cork case. As I understand, the report on that was prepared. The clinician involved was only in Cork for a short period before he was suspended and then left the jurisdiction. I understand Deputy Gilmore's question relates to how this person was appointed in the first place. I will raise that point.
The HSE has informed me that there are two aspects to the Dr. Ann O'Doherty report. First, there are the nine women who were identified as having a diagnosis of cancer and, second, there is the clinical review of the ultrasounds, which is also complete and no cancers were detected in that review. The HSE has informed the Department of Health and Children that the report on the reviews will be published by the executive as soon as the necessary legal requirements have been completed. Its target date, as I said, is the end of the month.
The third part of the review is that the Minister for Health and Children asked the chief executive officer of the HSE for a report on the circumstances that led to the decision of the HSE to suspend the breast radiology services in the hospital. That report, which was done by a review group led by Dr. O'Doherty, has been completed and submitted to the chief executive officer of the HSE. It does not say in my information that this report will be published. The fourth element is the Minister's request for a report from the board of the HSE on the management of all events starting from and subsequent to these decisions. This report, which is being undertaken by John Fitzgerald, is not complete.
I will ask the Department about the Deputy's query regarding Galway. I have received no information on that.