Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I thank the Ceann Comhairle for selecting this matter and I thank the Minister for Children, Equality, Disability, Integration and Youth for coming to the Chamber to deal with it.

I understand that St. Christopher's special school in Longford town has formally applied to appoint a new school nurse on an increased weekly contract of 32 hours. At the moment, the role is contracted for just 14 hours per week, meaning that the school only has access to a nurse for three hours a day from Monday to Wednesday, and for two and a half hours on Thursday and Friday. It is very evident that this is a high-risk situation and has clear health and safety implications for some of our most vulnerable school-going children, while also putting extreme and unnecessary pressure on the staff.

A total of 14 hours simply is not adequate to meet the complex medical needs of the pupils attending this school. There are currently seven classes in the school and pupils have varying degrees of complex medical needs. Indeed, the profile of the pupils attending St. Christopher's has changed significantly in recent years. More than half the pupils at the school now have complex medical and care needs. At present, there are 12 pupils attending the school with a diagnosis of epilepsy who are prescribed emergency rescue medication. Two pupils have refractory epilepsy and may continue to seize on and off throughout the day. They require close monitoring and recording of vital signs. One pupil has a PEG in situ and requires bolus feeds throughout the school day. This is a time-consuming procedure that can take up to 45 minutes per day. This particular pupil, with whom I am very familiar, is a very lovable young child who is also a wheelchair user, is non-verbal and has a profound intellectual disability. The pupil has limited head, neck and body control and must be seated in a correct, upright position and remain in same for one hour, post feed, to ensure there is no risk of aspiration. A second pupil is due to have a PEG inserted in the near future, due to difficulties administering medication. Four pupils have severe allergies and are prescribed emergency medication in the event of a reaction. A further three pupils have asthma, one of whom requires a daily inhaler in school. There is always a risk that this pupil could have an asthma attack at any time during the day. Due to swallowing difficulties, there is a serious risk of choking among some pupils. Two pupils have very specific cardiac issues. Care plans are required for all students in recognition of their complex medical needs. Most pupils also have mobility issues and visual impairment and are at constant risk of falls. There are currently seven wheelchair users attending the school and up to ten pupils are hoisted in the school three to four times per day. Manual handling assessments are required for each pupil and this task is carried out by the nurse.

I am sure the Minister will agree that a nurse is best placed to decide if emergency medication needs to be administered and is also best qualified to monitor a pupil following a seizure or an allergic reaction. Due to the number of pupils with medical needs a large volume of paperwork, including emergency care plans and risk assessments, needs to be updated on a regular basis. Due to the demands on the school nurse while on the school grounds, it is simply impossible to get all of this administrative work done in a timely and efficient manner. I would go so far as to say that all of the nurses who were in this post previously voiced concerns about the role and the stress and pressure they were under. At the moment, the school is actually without a nurse, as the most recent incumbent resigned her position and has taken up a new post. We wish her well but it is an extremely high-risk situation for the school. The school wants to fill the post as soon as possible, but more importantly, it wants to fill it at 32 hours. I am particularly worried by the delay in approving the 32-hour role. It has gone to senior management in CHO 8 for a decision and I urge the Minister to take a hands-on role and ensure that this situation is remedied. The high-risk situation must be alleviated in this school, which is extremely close to the hearts of the people of Longford.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Deputy for raising this very important matter and I thank the Minister for being here to deal with it.

Roderic O'Gorman (Dublin West, Green Party)
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I join the Ceann Comhairle in thanking Deputy Flaherty for raising this important issue. He has given us a real sense of the great work done at St. Christopher's and the real challenges that the staff there face in dealing with very vulnerable students with complex needs.

Both myself and the Minister of State at my Department, Deputy Rabbitte, are fully committed to the development and enhancement of children’s disability services, and to ensure access for all children with complex needs across the country. This includes all appropriate therapies and respite services, including in-school nursing supports. Following discussions with An Taoiseach and Ministers in 2022 regarding the priority requirement to reinstate the health and social care supports that were historically provided in some special schools in the State, it was agreed that funding would be provided for an additional 136 posts to progress this requirement. It was agreed that the special school-based services must be aligned with the existing children’s disability network teams, CDNTs. Having listened to the ongoing concerns of parents of children with complex needs who attend special schools, and mindful of this Government’s priority to deliver comprehensive on-site health and social supports to special schools, the HSE was requested to commence the process of allocating further staffing resources to these schools.

The local CDNT continues to provide support to St. Christopher’s special school within the resources available to the team. Service delivery is based on prioritised clinical needs and available resources. However, as we all recognise, the HSE and the various lead agencies are experiencing ongoing challenges recruiting staff across a range of disciplines and grades to fully staff each team to maximum capacity. These challenges are reflective of the issues affecting the wider health and social care sector and are very much the focus of the Progressing Disability Services, PDS, roadmap that myself and Deputy Rabbitte are working on in conjunction with the HSE. Since St. Christopher’s reopened, the CDNT has provided occupational therapy and physiotherapy supports, both in terms of direct hours of support to the school and indirect tasks linked to supporting children to access their educational placement. These hours are reflective of the prioritised needs of the children currently but will vary from week to week, and month to month.

As part of a Government initiative to enhance supports in special schools, all CHOs received an allocation of senior health and social care posts. The posts in CHO 8 were distributed across 14 special schools. St Christopher's received an allocation of one post and this has just been filled, with a new post holder due to commence in early October.

Specifically in respect of the nursing post, we have requested information from the HSE on the proposed extension from 14 to 32 hours. Unfortunately, because we are dealing with Topical Issues much earlier than anticipated today, I do not have a response for the Deputy right now but as soon as it comes in, I will send it on to him. I am sorry that I do not have it here now but it is just a matter of timing.

On the wider issues, while the recruitment challenges are there and do make things difficult, I want to reiterate my full commitment, and that of the Department and the HSE, to pursuing every avenue to ensure access and availability of appropriate respite and therapies for children with disabilities in Longford and across the wider CHO 8 area.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I acknowledge the Minister's detailed response. However, it is disappointing that the HSE has not responded. While I appreciate that we are taking the matter at an earlier time, I cannot underline enough the seriousness of the situation. There are 40 pupils in the school and there are parents, families and staff who are deeply concerned. I am not overdramatising the situation but clearly it is high risk. As I said, these are some of our most vulnerable people and it behoves us as Members of this House to ensure this situation is remedied. I know the Minister will take a personal interest and I hope it can be resolved in the coming days.

Whilst I have time, the floor and the ear of the Minister, I also want to raise the issue of the staff at St. Christopher's. They are tireless people who have worked time and again. They are section 39 workers who have probably been derided and punished for being section 39 workers for many years. They are on a payscale which dates back to 2021 and, even at that, their pay is significantly off the HSE scale. Unions announced at the end of July that the matter could only be resolved by a sustained campaign of industrial action. The situation has gone on for far too long. These staff, because of poor pay and heavy workloads, are becoming demoralised. They are looking at other job opportunities, particularly in the HSE. That is very unfortunate for the people of Longford because we greatly value St. Christopher's and we are very proud of it. We are also exceptionally proud and supportive of the staff. In addition, during the pandemic there was an expectation that the workers and day and night staff at St. Christopher's would qualify for the essential front-line staff €1,000 bonus. That has not happened. Understandably, it is a further bone of contention for staff. I have seen, first hand, the commitment, absolute passion and dedication of the section 39 staff at St. Christopher's. It is regrettable that they felt they had to take the decision to take strike action.

I have applauded the Minister's enthusiasm for this sector at every opportunity, and I know full well the immense work he is doing. There have been many notable achievements in his time in office to date. I ask him to redouble efforts to assist the workers at St. Christopher's and their colleagues across the country to ensure we reach an agreement on their pay dispute, and also address the long-outstanding Covid bonus payment for them.

Roderic O'Gorman (Dublin West, Green Party)
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On the first point, I do not think the Deputy has in any way overdramatised the challenges faced by staff in St. Christopher's in terms of the complexity of the health and social care needs of the students in that school, including those who have epilepsy, those who use wheelchairs, those with intellectual disabilities, the student who needs to be PEG fed and the various additional supports needed there. We will get that information about the HSE processing of the request for the additional hours to the Deputy as soon as we receive it.

On the broader issue of section 39 workers, and indeed section 56 workers who also fall within the remit of my Department, we all want to see a resolution to this industrial dispute before a strike occurs. We all recognise the invaluable work that section 39 and section 56 workers do. An industrial relations process over the summer resulted in an offer from the Government of 5% from now, 3% of which will be backdated, and discussions on a future link with the wider public sector pay deal. Unions did not accept that offer. I recognise that but it is still on the table. I think it is important that we get unions back into a process. I know there were engagements earlier this week - on Tuesday, I think - between officials and my Department. I understand there are more planned for next week. I know that a long-standing issue here has been the break of any sort of linkage between this set of workers doing the same work as public sector workers but not being paid the same. I understand that long before my time and, indeed, before the economic crisis, there was a link of some element. I can absolutely understand why that is something the workers are calling to be rejoined to some extent.