Enda Kenny (Mayo, Fine Gael)
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How can the Taoiseach justify the withdrawal of medical treatment from critically ill children in Crumlin hospital?

Brian Cowen (Laois-Offaly, Fianna Fail)
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Of course that is not the case. Regarding a recent case that arose, the wish of the parents is that it would not be discussed publicly. There is no question of any emergency operations required not going ahead. There are issues on paediatrics generally and how we get greater co-operation and integration of services across the three hospital sites in this city. More than €200 million is spent on the provision of those services and it is important that there be full co-operation across the sites so we can get the service levels we would get by doing that. No emergency operations are not being proceeded with.

Enda Kenny (Mayo, Fine Gael)
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Last week this House unanimously passed a motion, part of which referred to the fact that we wanted to cherish all the children of the nation equally. The case is not as the Taoiseach says. A theatre will be closed from July to December, two theatres and 20 beds will be closed for the summer months of July and August and there will be a serious cutback of outpatient appointments by 8,500. The Taoiseach and I have both visited Crumlin hospital. It is one of the most fascinating and enthralling areas of medicine to see what can be done for very young children. The Taoiseach is aware of the sensitivity and stress this causes to parents from all over the country.

Crumlin has been deemed to be more than efficient by all standards. It has the required personnel, doctors and facilities. Consultants say children could be treated in other places in Dublin and we have evidence of children going to other hospitals out of the jurisdiction where appointments can be arranged immediately. It is a daft monetary policy that the first thing that happens in terms of the HSE and hospitals is that wards close and operations are cancelled while the lives of critically ill children are put at risk with all the stress that goes along with that. I do not believe there are not areas within the HSE that should be a greater priority for saving than this. It seems, based on evidence given to me by people working in the HSE that wastage in some areas is obscene. We have a children's hospital that measures up in terms of efficiency, standards and quality yet it will be closed down for large sections of this year because of a budgetary overrun. Is the Taoiseach prepared to call in Professor Drumm and his people to advise them that this situation is intolerable? We cannot stand by when critically ill children are not able to be treated in a hospital that has the staff and facilities to do so. The children are placed at risk as a consequence and in some cases they need to be taken to other hospitals where they can be treated. A Government Deputy has described a case from her constituency as shameful and disgraceful. It is not the kind of health system we want. In respect of standing over this decision, is the Government in a position to say that there is no other area within the HSE that should not have been cut first? At the very least if we aspire to cherish all the children of the nation equally, we should not be withdrawing medical treatment from critically ill children.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I state once again to that there is no question - we have received an assurance - of urgent cases not being dealt with in terms of surgery required or whatever. That is not the case.

Simon Coveney (Cork South Central, Fine Gael)
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That is not true I am afraid. I know a constituent of mine who is waiting.

John O'Donoghue (Kerry South, Ceann Comhairle)
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Allow the Taoiseach to reply, please.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I also want to make the case that hospitals are delivering more treatments to patients than for the same period last year. The question of wards or beds being closed during the summer is a feature of our acute hospital system. On a yearly basis that happens for various reasons. Specifically on this question of urgent or emergency cases, they are being dealt with and will be dealt with. Obviously there is a range of reasons for certain procedures not proceeding. I do not want to go into any individual case on the matter. I would respect the views of the parents in this particular case.

As I have said, the whole question is about trying to improve co-operation between these three children's hospitals so that we can reduce the administrative overhead and give more money to the front line service. Presumably that would meet with the Opposition's agreement since we have a difficult budgetary situation against which we are operating generally. Over the past five years the budget here has increased by approximately 40%. This year it is approximately 3% down on last year because of the tight budgetary situation, but in fairness to the hospital it has also increased activity levels despite that fact. It is important that we all encourage the ongoing process of engagement that would see a greater degree of that €250 million total spend going to front line services than is the case at the moment by reason of the administrative arrangement that exists in the three hospitals.

Olivia Mitchell (Dublin South, Fine Gael)
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Closing beds and theatres will not improve administration.

Eamon Gilmore (Dún Laoghaire, Labour)
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Last February the Minister for Education and Science decided to close down 118 special needs classes in various primary schools. These are classes where children with mild learning difficulties are taken out of the mainstream classes and are then educated in classes with small numbers. It enables them to progress their education and allows the children in the mainstream classes to progress their education at their own pace. Some 40 of the schools concerned appealed the decision to the Minister for Education and Science and yesterday he made a decision which will allow for only ten of those special needs classes to be restored.

This is a cause of major concern and anxiety, particularly to the parents of the children in the special needs classes. I met many of them during the campaign for the recent local and European Parliament elections. I visited some of the schools, including some of the classes concerned. I met parents who were able to demonstrate to me the progress their children were making in the special needs classes. They also told me that in many cases they had enrolled their children in those schools because they had the special needs classes to accommodate their needs. They are now faced with their children going back into mainstream classes from September, which is causing anxiety to the parents and children concerned.

The Minister for Education and Science has sought to dress this up as something that is being done for the educational benefit of the children. It is not, of course. It is a cost-saving measure. The amount of money that will be saved is in the overall scale of things relatively small. The issue is now urgent because if it is not resolved before the primary schools close down in a week or ten days time for the summer holidays, it will not be resolved at all. Will the Taoiseach ask the Minister for Education and Science to reverse the decision to close down these special needs classes? While I appreciate the country has financial difficulties, inflicting this kind of additional educational disadvantage on children who, in many cases are also socially disadvantaged and many of the schools concerned are in disadvantaged areas, is unfair and should be reversed. I ask the Taoiseach to have this decision reversed in order to allow these special needs classes to proceed. The amount of money involved is not huge and, I am sure, could be quite readily found from other parts of the education budget or elsewhere.

Brian Cowen (Laois-Offaly, Fianna Fail)
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Looking at the overall economic situation, we are borrowing €70 million a day to maintain present levels of services against a background in which we are trying to bring about financial stability and this is a process that will be ongoing. It is an argument that can be made all the time, but it is important to point out that in this specific issue the Minister contacted the schools affected by the decision to end 128 special classes for pupils with mild general learning disability of below a certain number of students. That rule had been in place for some time. He invited people affected by the decision to make a submission setting out their case on educational grounds to retain their special classes even though they had dropped below the required number of pupils to retain such classes. I understand in 14 of the 49 schools the decision on appeal has been changed. In 35 of the 49 schools the decision to end special classes remains.

It should be noted that having the children in the mainstream classes is the desire of the vast majority of parents. Thankfully we have seen and are seeing in the more than 3,000 primary schools children with a mild learning disability included in ordinary classes supported by their friends, class teacher and learning support teacher, who can work with particular children on a one to one basis. The curriculum is flexible so that teachers can cater for the needs of children of different abilities. Specifically regarding this position on the numbers of pupils - fewer than nine pupils were in these special classes - the question of a teaching post being available is something that has not been available since 1999. This obviously built up over a long period of time. The Minister has reviewed it and in 14 of the cases he has accepted on educational grounds the case that has been made. The other cases will integrate as with the other 3,000 primary schools.

Eamon Gilmore (Dún Laoghaire, Labour)
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I am very disappointed with that reply. I did not seek to raise this issue in a particularly political way. The matter needs to be resolved. There is no educational justification for closing down the special needs classes. The justification at the time was financial. It was announced in February in the aftermath of budgetary decisions that were made. The saving at the time was estimated to be approximately €7 million. It is probably considerably less than that now given that some of the schools have made some arrangements and we are down largely to the number of schools that have appealed the decision. What strikes me about the list of schools that have been refused is where they are located. They are virtually all located in disadvantaged areas, including parts of Tallaght, Ballyfermot and Edenmore.

Olwyn Enright (Laois-Offaly, Fine Gael)
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Birr.

Eamon Gilmore (Dún Laoghaire, Labour)
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The child of somebody who is well off will have the money to hire a speech therapist and additional teachers to get extra help, including grinds. Maybe if they are well off enough they will be sent to a private school. Other children, however, will not get the educational leg-up they need unless it is provided through the State school system. This is their chance. These children are having difficulty in learning. They are getting a higher degree of attention in these circumstances than they would if they were put into very large primary school classes. We all know the difficulty that imposes on them. These children will be left behind largely because they are poor and their parents are not in a position to pay for private tuition like better off parents who live elsewhere.

The amount of money that is being saved is not huge. I suggest that in the long term the State will end up paying a lot more to pick these children up later on. This is at the primary school stage where they learn to read. If they cannot read they cannot learn. They get the opportunity now but if they fall through the cracks at this stage it will cost more for them to pick up at a later stage. In the long run it will cost the State a lot more also. It is something that can be addressed and it does not involve a huge amount of money. I appreciate what the Taoiseach has had to say about the amount of borrowing but it should not be placed at the door of these children who now require this educational assistance. They should not be left behind.

I ask the Taoiseach to have this issue revisited by the Minister for Education and Science. There is no disgrace or discredit in changing the position on this matter. It is needed and is in the children's interests. It is not going to break the bank, so it should be done.

Brian Cowen (Laois-Offaly, Fianna Fail)
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I do not lay the question of our public finances at the door of these children or any of our children. It is a question of finding a way forward that will be sustainable in future. It comes against a background of much development in this area. I will come back to the specific points the Deputy raised, but I need to make the general point that over 11% of our total education budget, over €1 billion, is being spent in the special needs area, and rightly so. That level of investment particularly in the last ten or 12 years has been very significant. In total, we had 300 special needs assistants in our schools ten years ago, while there are now 19,000 staff in our schools working solely with children with special needs. Some 10,000 of those are special needs assistants. As I said, the figure has risen from 300 just ten years ago. We have quadrupled the number of resource and learning support teachers in our schools, and rightly so. We have brought the question of entitlements for those who are disabled and have difficulties to the centre of how we deliver an education system. Part of that philosophy is about mainstreaming children with disability in our schools. If one looks at the UN conventions in this area in terms of general policy it is all about ensuring that we give effective individualised support measures, providing environments that maximise academic and social development consistent with the goal of education.

The specific issue the Deputy raised concerns a legacy that has built up over time. For educational reasons, the educationalists say that at least nine places should be provided before one provides special classes in schools outside the mainstream environment. There were 128 such classes. The proof of educational grounds being the criterion is that when the Minister invited people to make a further appeal on their particular cases in any particular school, 14 of them were successful. Therefore they were able to make that case on educational grounds and it was acceded to.

With regard to the general policy, people with mild learning disability are mainstreamed in 3,000 schools. However, the Deputy is suggesting that the 35 here should be retained when in fact the whole policy direction is towards mainsteaming into the general class and providing individual supports within that environment. Generally speaking, the vast majority of parents go along with the idea that there is a wider social environment for the development of social skills by doing it that way. That is the context if one looks specifically at the schools mentioned by the Deputy, although I am aware of the point he is making. Of the 119 schools affected, 80 have reduced class sizes either under DÉIS or other previous disadvantaged schemes. Of the 80 schools, 17 will be due an extra post when the pupils in questions are divided among mainstream classes. So the loss of a teacher in respect of the special classes is compensated for in moving them into the mainstream class, increasing the pupils in that class and therefore - under the rules that apply - getting an extra teacher in 17 of those schools. The loss of the teaching post in the mild class will be offset by the additional post required to maintain the lower class sizes because of their disadvantaged categorisation. That is the full picture. In this respect, the Minister's response in inviting people to revisit those issues has seen a proportionate response where the educational grounds are established. In the other cases, because of the way the disadvantaged categorisation works, there is the prospect of an extra teacher in the main class environment because of the changeover.