Áine Collins (Cork North West, Fine Gael)
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I thank the Minister of State for attending to discuss this issue, which has been raised in my constituency and in respect of which I am finding it difficult to get clarity. I understand that personal assistance for preschool children is covered by the HSE and usually delivered in communities by service providers. Children are assessed based on their physical needs as opposed to their intellectual needs.

In September, three children in my constituency started preschool at four years of age. One has Down's syndrome and major physical disabilities and another has delayed development and is unable to use a bathroom, needs to be in a play school, etc., but neither can get a personal assistant. A third child has cystic fibrosis and, following a stroke, has no use of one arm. St. Joseph's is our service provider in Charleville and the surrounding area of Cork North-West.

I would not raise a situation in the Chamber lightly. I have been in contact with the HSE in Cork at all management levels. I have been told that it is for St. Joseph's to perform the assessment and provide care. St. Joseph's has told me that it has been instructed not to provide further personal assistants for preschool children. The HSE has asserted that it has no vehicle to do this.

While I understand the issues facing providers in terms of budget cuts and audits to ensure that they are efficient and making appropriate provisions, this support will be no good to the three children in question next year. They need it now. It is not acceptable that, if they lived in a different part of the country, they would get it.

Despite questions about who has an entitlement, it is clear from my research that physical needs are a factor in these three cases. As such, they are legally entitled to support. However, the State does not seem to be providing it. HSE management claims that this is a matter for the service provider, but the service provider has shown me information to the effect that it was told not to provide support. This is because a personal assistant is not provided where a person has an intellectual disability, only where he or she has a physical disability. The three cases clearly involve physical disabilities. This is frustrating.

We discuss child care and early child intervention a great deal. These are important issues. We should be there before three years of age, never mind four or five years of age. The parents are distraught. Any parent of a child with a disability faces challenges. It is tough enough on those parents without having to fight this bureaucratic battle or to contact me, the HSE and St. Joseph's.

It seems to depend on where one lives. There is no problem in getting this service in some places. In other places, it is a major problem.

We do not have a standardised service, so I would like to hear the Minister of State's thoughts on the matter.

Alex White (Dublin South, Labour)
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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.

Áine Collins (Cork North West, Fine Gael)
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I appreciate the Minister of State's comments and I fully understand the budgetary pressures the HSE is under. However, these service providers seem to be getting a lump sum payment, although it should be attached to the services they provide and the number of people concerned. In this case, they were providing the service but were told by the HSE that they should not do so, as it was not covered under the service level agreement. When I asked about this, I was told that they were entitled to the service based on a physical disability but not on an intellectual disability.

In one such case, the HSE originally funded the service through the Irish Wheelchair Association. Then the HSE said the person concerned was more suited to St. Joseph's, even though the HSE knew that St. Joseph's could not do anything for them. Another child has been granted three hours per week through St. Joseph's but the service cannot be provided because they are awaiting Garda clearance on somebody. It is now mid-November but if this delay continues for much longer the school year will be over. It is great that children with disabilities are integrated into mainstream schools, both for themselves, other children, the social environment and social cohesion. It is not good enough, however, that these three children to whom I referred cannot be supported when a child in a neighbouring constituency can obtain the service.

I fully accept the pressures that the HSE is under and I am also aware of all the constraints on Ministers and Ministers of State. However, the setback for these children at this early stage, due to the lack of a small amount of direction, seems to be enormous. Intervention is needed to try to resolve the issue immediately. I would appreciate the Minister of State's comments in this regard.

Alex White (Dublin South, Labour)
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I am not in a position to add much more to what I have already said. However, I will undertake to raise this matter with the Minister of State, Deputy Kathleen Lynch, at the earliest opportunity. I will certainly have an opportunity to discuss it with her next week. If Deputy Collins reverts to me or directly to the Minister of State, Deputy Kathleen Lynch, we can see how to address the issue concerning the differential in levels of service between various areas, including neighbouring counties. The Deputy is entitled to have this matter addressed and I will do everything I can to ensure that it is dealt with.