Dáil debates

Tuesday, 12 March 2013

Topical Issue Debate

Services for People with Disabilities

6:40 pm

Photo of Aodhán Ó RíordáinAodhán Ó Ríordáin (Dublin North Central, Labour)
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I thank the Ceann Comhairle for allowing me to raise this important issue of the restrictions announced by the Health Service Executive, HSE, Beechpark services for autistic children in north Dublin and the Minister for Health, Deputy James Reilly, for being here in person to discuss it with me. When I previously raised it several months ago, I was told there was an ongoing review with which I should engage. However, that has not been successful from my end.

There are a number of autistic units in a number of Dublin northside schools with which I deal frequently, including Scoil Chiaráin CBS and Our Lady of Consolation in Donnycarney and Scoil Bhríde and Scoil Naomh Colmcille in Donaghmede. Beechpark services provide several services for children in these units such as speech and language services, occupational and play therapies and psychological services. These are vulnerable children and the staff are doing their best to serve their needs. There are varying viewpoints as to what Beechpark services can do for a school. Many schools state once they receive the services, they are delighted with them, while others say it is difficult to even access them in the first place. I have also been informed some private diagnostic assessments are not being recognised by the HSE for referrals to Beechpark services, which is an added problem.

Schools are now being told that new children will not receive these services. All children will be played off against each other, as the HSE will assess their needs and allocate resources on the basis of the needs various children have. One child may have more needs than another. I do not know how anyone can assess the difference between one autistic child and another. I accept that there are various degrees on the spectrum, but I would have thought any child admitted to a unit needed all the supports he or she could possibly get. School principals will be looking at older children in their units continuing to receive services, while new entrants - younger children - will not receive the same level of service or allocation of resources.

Has the review of Beechpark services being completed? Can a communication which brings clarity to the issue be brought to all schools that depend on these services? There is significant uncertainty and trauma associated with this issue. Last Friday the Autism Bill 2012 was introduced to the House and it was graciously accepted by the Minister for Health. Several speeches were made on all sides of the House on how Ireland had grown up on this issue. However, when curtailment of services happens, parents who care deeply about their children and feel strongly about their advancement in life begin to wonder what will happen next. They had a sense of certainty that their child would receive these services but now that is gone.

I know budgets are tight and difficult, but it is the haziness, lack of clarity and total uncertainty surrounding this entire issue that need to be cleared up. The schools need to be dealt with in a more professional and compassionate manner. We need to ensure schools and the children's parents know where they stand. We cannot have a dichotomy of services in any autistic unit in which older children receive services younger children do not.

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I thank the Deputy for raising this matter. The Government is committed to protecting front-line services, including services for children with disabilities and autism, to the greatest possible extent by seeking to maximise the provision of services within available resources. Beechpark is a regional HSE service which provides clinical supports for children with a specific diagnosis of autistic spectrum disorder up to 18 years of age who attend designated special schools, outreach preschools and outreach classes in Dublin, Kildare and Wicklow. The service has to operate within the financial and other parameters applying.

Importantly, the Beechpark service is working with local implementation groups to progress disability services for children and young people across the HSE's Dublin north-east and Dublin-mid-Leinster areas to focus on the current service model and service delivery structure provided by all service providers in the area with a view to addressing the realignment of resources in the context of the report of the national reference group, the national review of autism services report and the progressing disability services programme. This issue is also being examined by the Dublin Beechpark service review group.

Specifically on the issue of speech and language therapy services, the HSE aims to ensure the resources available are used to best effect in order to provide an assessment and ongoing therapy for children and adults in line with their prioritised needs. With the significant investment in the area of speech and language therapists employed in recent years, a range of new approaches has been developed and is used in many speech and language therapy services across the country. These include providing structures, training and support for parents and carers in order that they can work to help to improve the individual's speech and language. In addition, therapy is delivered in group settings, where appropriate.

These changes to speech and language therapy services aim to ensure services are provided based on the level of need in an equitable manner and in line with evidenced-based practice. It also facilitates access to services where vacancies arise having regard to the employment control parameters which apply. In that context, the Beechpark speech and language therapy service in north Dublin has been moved to a rotation system in the school-based model in an attempt to meet the needs of children across the entire service. The speech and language therapy service is due to rotate schools in April. The individual needs of the children will be kept under review. The speech and language therapist service will also continue to be available on a consultation basis for ongoing programmes.

While the current economic position presents challenges in how best to maximise the provision of services with available resources, I am committed to protecting front-line services, including children's disability and autism services to the greatest extent possible. I am less than happy with this situation or the level of service delivered. I am acutely aware of schools which do not have a service, even though they have special needs assistants. I have asked for a review in the Department. Today I spoke to Mr. Tony O'Brien, the HSE director general designate, about how staff were rotated and how the public sector recruitment moratorium impacted on front-line staff, especially therapists. For parents of a child with autism, each week without a service is a serious concern as the opportunity for the child to reach his or her full potential is compromised.

The position in the Beechpark service is unacceptable and I will take up the matter with the Minister of State responsible, Deputy Kathleen Lynch. I have always agreed with her approach that the service must be in place to ensure early diagnosis. Equally, once a diagnosis is made, the more specialist services required must be made available. I know the Minister of State will not be one bit happy about this either. I will revert to the Deputy on the matter.

Photo of Aodhán Ó RíordáinAodhán Ó Ríordáin (Dublin North Central, Labour)
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I am impressed not just by the Minister's attendance in the Chamber but also his willingness to move off script to give an impressive and impassioned defence of the services the children in question need. I take it at face value that he will communicate with the Minister of State, Deputy Kathleen Lynch, on this issue and revert to me in due course. We are agreed on the need for the children in question to access the services they require. We must also acknowledge, however, that there is significant disconnect between schools, parents and the service providers. This is not good for the relationships that need to be built up over time. This issue needs to be ironed out. The very least the schools and parents should expect is clarity. I thank the Minister for his commitment to deal with this issue and appreciate his offer to revert to me on it. I hope we will have positive news for the parents involved.

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I appreciate the Deputy's comments. Many years ago I was involved in the setting up of the Beechpark service when I was a member of the then health board.

The service was based on the south side but was to serve the entire area I referred to, including Dublin, Kildare and Wicklow. I am not happy that we have unequal distribution of services and I have asked for this to be addressed. I have allocated €1 million per annum for three years to the area of autism and I await more complete reports on how that money is being spent and how it is impacting on the service. In all areas of patient care we need to focus not on inputs but outcomes and we need to measure outcomes. Having said that, if there is no therapist available to support special needs assistants then children will not receive the optimum care that they should receive.

Earlier Deputy Áodhan Ó Ríordáin referred to the review and I did not respond on that point. The review is not complete. However, we are the first Government to put in place at principal officer level an individual across the Departments with responsibility for health, education and children to deal with intellectual disability and autism. We have done the same thing to address childhood obesity as well. Certainly, I will come back to the Deputy. I believe this is a serious situation and one I will address aggressively with the Minister of State, Deputy Lynch. I believe she is as committed as I am to seeing the situation corrected. We are keen to see the type of flexibility applied to the moratorium on recruitment that will not prevent people taking up posts in this specific area because of its significant importance to the future of children.