Michelle Mulherin (Mayo, Fine Gael)
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I appreciate the opportunity to speak on this serious and unsatisfactory situation prevailing in some special needs schools which need to provide nursing care for pupils. A total of 127 special schools cater for the education of children and young adults with mild to moderate and severe learning disability. Many of these children have serious medical needs and life-limiting conditions which means they need nursing care while at school. However, there is a disparity in the provision of nursing care in the schools. Some nurses in some schools are funded by umbrella organisations while others are funded by a HSE grant and-or by the school board of management. In a small number of cases, nurses are directly employed by the HSE. Some schools have no nursing care for pupils but are trying to get it. Some schools in receipt of the HSE block grant must stretch their funding to cover not only a nurse, but also to provide for medical equipment and supplies, anything from medical gloves and syringes to thermometers and everything in between. In some cases if nurses are not in a position to attend school then students with severe medical conditions are unable to attend school on those days. This is a very unsatisfactory situation.

The manner in which the nurse has to work in the school environment is not satisfactory and that is the reason I have raised this issue. These nurses, for the most part, are working in isolation without the support of a professional medical body. There is no medical model set out for these nurses working in a school environment. There are no prescribed best practice and procedure or policies to which such a nurse can refer. This is contrary to the situation prevailing in the United Kingdom.

The board of management of a school is presiding over the work of a nurse but without any medical expertise or guidelines I question how the board of management can do so. While the board of management can provide management accountability for the operation of the school and the employment of staff, I ask how can it ensure that professional accountability and support is in place for the nurse. There is no professional accountability.

The situation needs proper funding to allow nurses to be permanently employed. A medical model needs to be put in place to ensure best practice and policy and professional accountability in order to support these nurses. There is a need for a nurse to be directly employed and funded by the HSE in co-operation with the Department of Education and Skills. The right to education for children with severe learning difficulties must be supported by nursing care in the case of some children and young adults. However, the gap in the service has not been addressed. I ask for support and some form of framework for those nurses. The current situation is neither desirable for themselves, the boards of management nor the children and the families.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Mulherin for raising this matter which reaches into every corner of Ireland. 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. It has been a topic for discussion over many weeks. Deputy Kelleher has been actively engaged in that discussion. Notwithstanding these financial pressures, I assure Deputy Mulherin 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 past number of years the health sector has invested significant resources in services for children with disabilities. For the first time we have discovered that the budget for all disability services is now more than €6 billion. Disability services for children have a long history and many organisations provide excellent support and interventions for children and their families. However, there is a wide variation in the services available in different parts of the country and for different categories of disability. The HSE is working on reconfiguring existing therapy resources into geographic-based teams for children aged from birth to 18 years of age. The HSE's national programme on progressing disability services for children and young people aged from birth to 18 years, aims to achieve a national, unified approach to the delivery of disability services so that there is a clear pathway for all children to the services they need, regardless of where they live, what school they go to or the nature of their disability or developmental delay.

The Deputy raises the issue of professional accountability of nursing staff and their adherence to proper and standardised clinical procedures in special schools. I am not certain this is what the Deputy meant in her Topical Issue matter but I will deal with it. I do not want us to misunderstand each other.

It should be noted that all nurses are legally required to be registered with the Nursing and Midwifery Board of Ireland and are accountable to the public though the board. They must adhere to a code of professional conduct and a scope of practice guidance document. The scope of practice sets out the range of roles, functions, responsibilities and activities for which a registered nurse or registered midwife is educated, is competent and has the authority to perform. This is the case for all nurses, regardless of their employment setting, including a hospital or a special school. The provision of supports in special schools is an issue which involves both the health and education sectors. These special schools are mainly attached to non-statutory disability service-providers which are funded by the HSE. Many of these service-providers will have support staff, including nursing staff, in place. Special schools provide for those children with the most complex special educational needs, beyond what can be provided by mainstream education. Teaching supports are allocated on the basis of very small class sizes. The Department of Education and Skills also provides over 2,100 special needs assistants to special schools to assist in providing for the care needs of pupils attending those schools.

As a result of the considerable medical advances that have taken place in recent years, a small number of children survive premature births or serious illnesses. They continue to have chronic needs that require ongoing medical intervention to ensure their survival. Some special schools catering for children with severe or profound general learning disabilities now have a small cohort of these children enrolled.

The National Council for Special Education, in policy advice to the Minister for Education and Skills earlier this year, recommended a more consistent approach to accessing nursing support for children with high medical needs in special schools through dedicated health service funding,. This recommendation raises significant issues for the health and education sectors. The stakeholders involved, including the HSE, the Department of Education and Skills and the Department of Health, will need to examine this issue fully, including the resource and overall policy implications.

I thank the Deputy for raising this matter.

Michelle Mulherin (Mayo, Fine Gael)
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I thank the Minister of State for her reply. To be clear, the issue is not about the qualifications of nurses or the care they provide, rather it is to have a system of professional accountability and support. I know that these nurses working in special schools feel very isolated because there are no prescribed rules, practices and procedures for them to follow.

At the very least that is a framework they require and that should be under the auspices of the Health Service Executive. We inspect various aspects of medical care from nursing homes to whatever, and I am aware that is the responsibility of the Health Information and Quality Authority. As the Minister rightly pointed out, we are talking about only a small number of cases but they are important because if nursing care is not provided for these children and young adults, they will not be able to attend school. It is beholding on the Minister that a proper system of support and accountability is put in place, in whatever form it takes. We must take into account the reality of financial constraints but these people cannot be left out on a limb as they are at the moment.

I urge that the recommendations of the National Council for Special Education would be taken on board and that ways are found to address the current shortcomings in the education system but which are the responsibility of the Department of Health.

Kathleen Lynch (Cork North Central, Labour)
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I take on board everything the Deputy said and would disagree with very little of it other than to say I am always reluctant to move back to the medical model when it comes to disability because most people within the disability sector, and I am talking about the people who have a disability rather than those who would speak on their behalf, tell me clearly that they do not want a medical model of care and that it is more that. I understand fully the point the Deputy is making but there are major difficulties in regard to funding. However, I am sure our circumstances will improve and the recommendations from the National Council for Special Education will be taken into account.