Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I am very pleased to be back here in the Seanad today. I thank the Acting Chairman for the opportunity to speak on this Bill, which deals with how we, as legislators, set about meeting the needs of those with autism. I join colleagues in the Oireachtas in thanking Senator James Reilly for his work and for his interest over a long period in this very important matter. I have been campaigning for a national autism strategy since the age of 15 or so. The Oireachtas and I, as Minister, now have an opportunity to make this a reality. We all share a common desire to have the best possible policies and services for all children, adolescents and adults with disabilities across this country. Both personally and as Minister for Health, I want everybody with a disability, including those with autism spectrum disorder to have access to the necessary supports to enable them to achieve their full potential and maximise their independence and live a rich and fulfilling life. It is easy to say those words but there is a lot of work we need to do as a country to make sure they are meaningful in the lives of so many individuals and their families across this country.

When we debated the Second Stage of this Bill in May, I highlighted the aspects that would need to be addressed in a considered fashion and with input across a number of other Departments. I am pleased to hear all Senators saying that. It is not just a health issue or an issue for the Department of Health. Since there was a short timeframe for the Bill proceeding to Committee Stage – I understand why – it has not yet been possible for proper consideration to be given to a number of areas across several Departments involved, and the appropriate legal input from the Office of the Attorney General. We have an opportunity, as this legislation moves to the other House, to have an input from other Departments.

In recent years, national policy has moved to focus on the services to be delivered to support the needs of the individual rather than the provision of services based on a specific disability diagnosis. The national strategies on disability, such as the forthcoming national disability inclusion strategy and the comprehensive employment strategy, have been led by the Department of Justice and Equality. This reflects the shift away from viewing people with a disability as a patient or solely the responsibility of the health services towards mainstreaming supports and services into communities and wider society.

The national disability inclusion strategy, which will be published this Friday, will take a whole-of-Government approach to improving the lives of people with disabilities. The strategy is envisaged as a "living document". Its implementation will be supported by independent analysis and advice from the National Disability Authority, and also by periodic review and oversight by the Cabinet committee on social policy. This model of measured, well-thought-out strategy formulation ensures that the policy will fulfil all its objectives in an efficient and costed way.

I am very supportive of the overarching objective of this Bill, the preparation of a cross-Government autism spectrum strategy. I am a keen believer in the maxim that what gets measured gets done. I would add a corollary to that: what gets written down gets measured. In this regard, it should be noted that the forthcoming national disability inclusion strategy will include a specific action for the implementation of an action plan on autism, in addition to this legislation. I believe that this is the most equitable approach to ensuring that people, regardless of diagnosis, are provided with the supports required to reach their potential.

As Minister for Health I recognise the need for a strategic approach to enhancing the responsiveness and effectiveness of services to meet the evolving needs of people with autism spectrum disorder. At my request, the HSE has set up a working group to consider the effectiveness of existing services and identify models of good practice among such services to meet the needs of people with autism spectrum disorder. I have done this not only because I want to identify models of good practice but also because I want to identify, through this process, practice models that are not having a positive impact. It is important that we identify where in the country services are operating well and where they are not. We should map them out so we can identify the scale of the challenge in an organised way.

There is clearly a need for service providers to set up data collection systems to record the number of their clients with autism spectrum disorder in order to gauge the bigger picture of the resources required. With this in mind, I have asked my officials to initiate an epidemiological research study into the prevalence and future projections for autism spectrum disorder later this year. There is no point in planning just for the here and now; we need to consider the prevalence of autism now but also the projected level in the future so we can plan and future-proof our strategies for people with autism.

Subject to the advancement of both of these tasks, I intend to proceed next year with the strategy for enhancing the health service response to people with autism spectrum disorder. Importantly, I want to see that models of good practice are replicated. Equally, where the evidence does not support existing practice, I want it discontinued and replaced with models of good practice. This is where my own thinking overlaps with this important Bill. There are, however, some points of difference, most notably on the prescriptive nature of the Bill and the very broad scope, which goes beyond the health area, and which requires my consultation with Government colleagues. Let me be absolutely clear: I wish to see the development of an autism strategy and I will work to achieve this, including with Senator Reilly and all Senators, but there is an onus on me, as Minister, to set out some of the possible legal difficulties with the Bill before us, which I have discussed with Senator Reilly and on which we are committed to working together as this legislation proceeds to the other House. These include the fact that the proposed Bill, however well intended as currently drafted, confers additional rights to some individuals that persons with other disabilities would not have. This obviously raises serious equality concerns, which we need to address. Assigning an operational role to a Minister in respect of one disability would potentially undermine the statutory legal structure under which the health service is provided in the State. Under the governance structures laid down in the Health Act 2004, the Minister for Health has responsibility for developing policy and monitoring its implementation whereas the HSE has responsibility for all operational matters, including the implementation of those policies.The implications of the Bill for the Disability Act 2005, the Education for Persons with Special Educational Needs Act 2004, as well as any other relevant Act which may need amendment on foot of it, are yet to be determined. The Bill imposes a statutory mandatory duty on the Minister for Health for the actual implementation of the autism spectrum disorder strategy, including those parts relevant to other Ministers or bodies outside his or her area of statutory responsibility. This raises the potential for conflict with existing laws which set out these statutory responsibilities. It is important that this be teased out because I agree with Senator James Reilly that one Minister needs to take responsibility, but it must be ensured the statutory responsibilities of other Ministers will be aligned in legislation.

We also need to recognise that there will be additional resource implications attaching to implementation of the Bill. There will be costs in providing access to all of the services in the manner proposed. There is a need for a subject-to-resources provision in the Bill, notwithstanding that the explanatory memorandum purports to convey that the positive duties are intended to be carried out within existing resources. We need to be honest and ambitious in acknowledging additional resources will be required and that we need to work together to secure such resources to make the a strategy a reality. This obviously raises questions about the need for a money message as the Bill progresses through the Oireachtas.

There is no commencement provision in the Bill. This means that it will come into operation on its enactment, a proposition which will pose a difficulty if all aspects of practical delivery of what is intended under the Bill are not in place. In other words, if we pass the Bill, we need to get on with making the strategy a reality and consulting the community in its drafting. What is needed is detailed engagement and consideration by the Departments of Justice and Equality; Education and Skills; Social Protection; Jobs, Enterprise and Innovation; Children and Youth Affairs; and Housing, Planning, Community and Local Government. We will then build on the useful engagement my officials had with Senator James Reilly recently to see if we can further address the issues raised in the Bill with an input from across government.

I am not pouring cold water on an important Bill and a strategy which should be underpinned by legislation. Today, however, we are taking a big step forward with the passage of the Bill in the Seanad. It will then obviously be brought to the Dáil when I hope there will be an opportunity to engage in consultation with the various autism groups which would like to contribute their views. Perhaps that might happen at the relevant Oireachtas committee. We have a large body of work ahead of us, one for which we are all up in this House. We are taking a seismic step forward in making it clear that it is my wish and that of this House, on a cross-party basis, that we see the Bill being advanced under Senator James Reilly's leadership and stewardship and that we work together to put a national autism strategy in place. I thank Senators for their close attention to this complex legislation. I look forward to working with everyone in this as well as the other House to develop the legislation further.