Dáil debates

Tuesday, 21 September 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Disability Services

10:55 pm

Photo of Neale RichmondNeale Richmond (Dublin Rathdown, Fine Gael)
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I know the Minister of State is familiar with this important issue. Carmona school is located in Dún Laoghaire, which is the constituency of my colleague, Deputy Carroll MacNeill. It services the entire county of Dún Laoghaire-Rathdown. Many parents in my constituency are facing an extremely difficult time because they are unable to have the proper services provided to their children in this school. I remind the Minister of State of the meeting she held with the parents and the principal of the school in May when she gave a guarantee that services would be returned to pre-Covid-19 levels in this very important school. While I understand that the HSE has returned staff to their allocated hours, it is much less than the service the school provided prior to the pandemic. It is harrowing for so many parents whose children are in the school, for the teachers, for the wider school community and for so many people involved. There has not been a speech and language therapist in the school since February. There are extremely vulnerable children at risk who are not receiving the duty of care from the State in the school. It is not good enough. I am appealing, with Deputy Carroll MacNeill, that this be remedied as quickly as possible.

Photo of Jennifer Carroll MacNeillJennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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As I know the Minister of State is deeply aware, Carmona is not a school as such. I want to thank her for her constant engagement, good faith and commitment to this issue, including coming out and meeting people. She has been exceptional on the issue. However, on behalf of the parents, I want to put on the record of the House that Carmona is not a school but a centre of excellence for children with severe to profound intellectual disability. I have spoken to parents today, with whom the Minister of State has interacted. They described how their children need constant therapeutic supports. As an example of the need for on-site clinicians, one patient is a boy of senior infants age but he is not in senior infants and never will be. He is not going into first class either. His number one learning goal this year is to bring a spoon from a bowl of food to his mouth and back down again. He has three therapy-based learning goals. They do not involve reading, writing or arithmetic. That is not on the cards. Three are four adults and five children in this room because that is what the children need. Both of that young boy's hips are dislocated. If he is uncomfortable or in pain, he has no means of shifting his position. He needs constant therapeutic oversight and support to prevent scoliosis and to help him to communicate. There is no way of deconstructing his therapy and learning needs. Another girl who is ten years of age cannot communicate at all. The speech and language therapies are not there for her. As a result, her behaviour is regressing because she cannot communicate her frustration. She cannot communicate anything to her family. She does not sleep much.

10 o’clock

Her parents are trying to look after her now without support but also trying to navigate a constant dialogue with the HSE, in which they have lost faith. I am aware that the Minister of State, Deputy Rabbitte, shares some frustration on this, and having dealt with the parents with this length of time it is understandable why. I look forward to hearing the Minister of State's response and perhaps I will come back in at a later stage.

11:05 pm

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputies for raising this important matter. As Deputy Carroll MacNeill said, it is not a school in the ordinary sense of a school and it is important for people who are looking in here to understand this. We are discussing the most vulnerable young people in society. The Deputies will be aware that I have met with parents and families of Carmona on a number of occasions, as well as visiting Carmona earlier this year with Deputies Devlin and Carroll MacNeill. I know all too well the difficulties they have faced during the roll-out of the progressing disability services model, PDS, in this area. PDS should never have been a one-size-fits-all.

I also recognise the challenges in meeting the demand for children's disability services and I am acutely aware of how this impacts on children and their families in these most difficult and challenging times. That said, I assure the House that from my perspective the HSE carried out all requests and directions made by myself when it came to pausing the removal of therapy posts from special schools. The pause button was hit so I could work with the Department and HSE on securing an additional 85 therapists for our special schools, which was successfully achieved before the summer, including the posts remaining in Carmona.

Local HSE disability services under the auspices of Community Healthcare East disability service have informed me that they have acted in good faith and in an open and transparent manner with the information received from the current service provider, St. John of God, and in communication with parents and the principal of the Carmona school. Having made inquiries with the HSE on this matter I have been informed that the pre-Covid allocation of whole-time equivalent levels based on the information given by St. John of God in April 2021 is as follows: occupational therapist at 0.4, which is equivalent to two days a week; senior physiotherapist at 0.38, which is equivalent to approximately two days a week; and speech and language therapist at 0.2, which is equivalent to approximately one day a week. This is where the issue lies. It seems that there may have been an underestimation of services delivered on the ground by the previous provider, as parents have indicated that the clinicians were present more often than this. The Deputies have clearly articulated this that we have had this discussion abroad in Carmona. I am hearing that and I am clearly understanding it. It seems that this is where the breakdown in communication stems from and why there is a perceived difference.Perhaps it was the Excel sheet and the way it was worded or delivered or interpreted. The HSE acted on the information as it was requested.

I am told that the level of support as indicated by the previous provider is being provided by the children's disability network team, CDNT, assigned to the school. The new lead agency, Enable Ireland, which under the PDS has replaced St. John of God, is actively recruiting to fill these vacancies to ensure on-site support in the school for the future.I gave a commitment for on-site support. The CDNT is undertaking a thorough due diligence exercise in respect of the children who attend Carmona to ensure safe and appropriate services will continue to be provided under the PDS model of service delivery over the next two weeks. They will review the transfer reports to identify if a number of specific supports need to be scheduled for the children. They will also ascertain the needs of the children and resources required from the CDNT going forward, and the above information will assist in this analysis. It is a complete review of the Excel from April 2021.

Photo of Neale RichmondNeale Richmond (Dublin Rathdown, Fine Gael)
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I sincerely thank the Minister of State, not just for her reply but also for her continuing efforts in this regard. We are grateful, particularly for her frankness. We talk about points on a scale and spreadsheets, but the fact is that much of this is beyond stressful and it is down to a breakdown in communication. It is no criticism of the Minister of State, but we all share the feeling that it is simply not good enough. It is not good enough for the children who attend the service and who are at constant choke risk. It is not good enough with regard to the position in which they find themselves. It is not good enough for their parents and guardians who lie awake sleepless at night wondering if their children are safe to going to Carmona the next day. I genuinely thank the Minister of State for her frankness and her response. I stress that time is of the essence. While a stopgap has been put in place it is important, to give the peace of mind and security for this entire community, that the recruitment is done in a timely and efficient manner.

Photo of Jennifer Carroll MacNeillJennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Minister of State for her response. I have a list of our back and forth, which shows quite how engaged she is. I acknowledge what she said about the assessment of services. She will also understand that at this stage the parents do not care why it was assessed wrongly. They do not have the therapists they need. They will not care about Excel. I have dealt with the HSE and I have heard about Excel spreadsheets previously. My question back to the HSE is why this did not raise questions for them. Why is it such an under-provision given that we know how serious this is and we know how the Minister of State has made directions on this? In the parents' words, we are talking about the most disabled children in the State. It is mind-numbing that the HSE would not have reacted more forcefully to challenge an assessment of that kind. There should be no need for the parents to have to be as engaged as they are on this issue. They should not have to contact people like me, the Minister of State or anybody else. It was anticipated and well flagged. There was no handover by the HSE when the social work services were removed. I know one woman whose 11-year-old son has extreme behavioural problems, and she has had no social worker since June. There was no handover. If I was going on holiday I would do a handover in order that somebody could cover my work. The HSE did not anticipate a handover for the social work need of this kind. This mother has had no behavioural therapy and no respite. The family is considering bringing the child to the emergency department because they have no place else to go at this stage.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputies. Since yesterday, and to complete this work in a timely and safe manner, I have been informed by the HSE that the CDNT manager has increased the clinical resource in addition to the original allocation on a temporary basis from the existing team. I am also happy to confirm that the CEO of Enable Ireland, the HSE chief officer for the area, the disability head of services, and the CDNT, will schedule a meeting with the children's families separately to the meetings with the principal of Carmona in the coming weeks - within the next two weeks - to get the clear understanding, as articulated here this evening by the Deputies - and to see the parents in front of them. While they may not need to be made to understand perhaps they need to be re-informed and retold that this situation is not like everyone else. It is a little different. These are the most vulnerable. For a child to be in discomfort, he or she needs that additional help and assistance. They are dependent on more speech and language, physio and occupational therapies.

To be honest, I was fortunate that the Taoiseach supported me and the Minister Deputy Donnelly, in acquiring, mid-season, 85 additional therapist posts. I will not be found wanting for what is required to fill the gap in Carmona. Whatever the outcome, I just want an outcome from the HSE which is to tell me what the shortfall is so we can ensure delivery of services in Carmona and get on with delivering services and rolling out the PDS model.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Is the Minister of State also dealing with Topical Issue No. 4?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I am. This is a new one for me now.