Seanad debates

Wednesday, 23 June 2004

Autism Services: Statements (Resumed).

 

1:00 pm

Photo of Ulick BurkeUlick Burke (Fine Gael)
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I welcome the Minister of State at the Department of Health and Children, Deputy Tim O'Malley. The last occasion we debated this issue I expressed concern in regard to what was happening in the west as a result of a conflict of interest between the Irish Society for Autism and the Western Autism Society and the tragedy of the power struggle that took place for the control of property and institutions. Thankfully it has been resolved, not before the litigation proposed and eventual settlement prior to going through the courts.

Despite the fact that so many, particularly parents and siblings of children with autism, have given so much time and effort to improving the lot of such children, occasionally an incident such as this distracts from the focus of attention originally intended. It is important that all these well-intentioned groups continue to keep a focus on the original intention of improving services for those with autism. I said previously it was remiss of the Western Health Board which stood idly by not to move to resolve the situation when there was a clear necessity to do so. While a member of the Western Health Board I tried to encourage the management to participate to resolve the situation but, unfortunately, to no avail.

Until recently it was the parents who discovered their child was suffering from autism rather than the general practitioners. This was not the fault of the general practitioners but they were unfamiliar with the way in which they could diagnose the condition.

Since the last debate on the issue, I read with interest of Raun Kauffman who came to Dublin and gave a lecture. He gave his life story to the meeting as he has done throughout the world. His case is similar to many of the tragedies with which we can associate ourselves as public representatives. When he was 18 months old he was diagnosed as autistic with an IQ measure of less than 30, which placed him as severely intellectually disabled. His parents were told to forget him, to go home and look after the other children and to leave him in the institution where the experts would be better able to manage him. They were told that in time, perhaps, he could be taught to dress himself or to use a knife and fork. He would never speak, have friends or go to school. His future was hopeless.

Thankfully his parents said no. They brought him home and started to work with him. For years they worked really hard with him and got their just rewards. Raun graduated from high school with honours and graduated from university and earned a degree in biomedical ethics. Raun now tours the world lecturing on what his parents did for him. The question must be asked whether this story is a miracle or a case of wrong diagnosis. Sadly, that is a situation that still exists in many instances throughout the country. If anything can come from this debate, the Department of Health and Children must initiate a thorough investigation into the causes of autism. Statistics and studies here clearly indicate an incidence of one in 166. That is a high occurrence of autism. If there is such a high incidence there is a need for services to help the parents and siblings of families who have a child suffering from autism. It is necessary to put proper facilities in place. It is unfortunate that the Ballinasloe advocates have had to come on deputations on several occasions to various Ministers over the years to seek a simple respite service to give them the break they need.

People only get a break of one day per month, never a weekend. How can parents continue to educate and do everything they can for their children at home when there are no reliable community facilities on which they can depend for a respite break? This needs urgent attention. Can one think of any need in society that demands higher priority than this?

Brendan Daly (Fianna Fail)
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I join in welcoming the Minister of State, Deputy Tim O'Malley, to the House. He will be aware that more than one year has passed since he outlined in a thorough way his Department's proposals and initiatives to deal with the issues facing people with these problems.

Today is a great day for people with special needs, because earlier in the day, the Minister of State at the Department of Education and Science, Deputy Brian Lenihan, outlined the details of the Education for Persons with Special Educational Needs Bill 2003. One of the difficulties is to try to precisely define who is responsible for what at the initial stages, when it is identified that a person has special needs. This may be manifested at a very early stage, before a child goes to school. It is at this initial stage when parents are distraught that they may be irritated and agitated by the response they get when seeking information. It is timely that the Departments of Health and Children, Education and Science and Finance and whatever other Departments are involved work together to address this.

I note that in the Education for Persons with Special Educational Needs Bill 2003, there are many references to dealings with the health boards, but very soon the health boards will no longer exist. In my view, the demise of the health boards will create a vacuum and issues of a local and regional nature will be dealt with differently. The health services executive is now taking shape, but already the spina bifida organisation has identified that it will not be catered for under a scheme. It is time a one stop shop was put in place where people could go for information and advice on how to deal with the issue confronting them, in particular in cases such as autism.

When the Minister of State opened the debate some time ago, he gave a comprehensive report on the number of entrants to the various professions but as he is aware, occupational therapists, speech therapists and psychologists are in short supply and in many cases, in spite of the positions having been advertised, the health boards, such as that in my area, have been unable to fill the jobs. Although we have adequate funding, and the jobs have been advertised, people have not taken up the positions. My colleague, Senator Dooley, mentioned that the Peninsula Carers who made very strong representation to us recently and outlined their frustrations and annoyance that a service on offer could not be provided because the staff were not in place. In my opinion, people are not interested in taking up positions in isolated locations. It is a source of annoyance when people cannot find the professional help they need at a time when they are most in need of support. One of the challenges facing the Government is how to provide a service in isolated areas, whether through outreach programmes from existing established centres or by making transport available to the centres where professional help is available. There is no doubt that parents and carers are frustrated and disillusioned when the professional help that is needed is unavailable. People expressed their frustrations and growing discontent with services generally during the local elections.

I do not know the solution to the shortage of human resources, but the Minister must take steps to deal with this. In other areas, ways and means were found to accelerate the number of professionals coming to the area to provide a service.

The voluntary organisations are doing tremendous work. A person telephoned a local radio station recently and said that her child would not have received any service but for a voluntary organisation. The person did not make the point that the voluntary organisation was being funded substantially by the Mid-Western Health Board. The health boards provide significant finance to voluntary organisations, but are the first to come out and say enough is not being done and point the finger at the Department of Health and Children. That is not acceptable.

I hope that something will be done for isolated families in remote areas such as the Loop Head peninsula. There is a necessity to co-ordinate activities and I am not certain the new proposal will deal with the immediate problems that arise before a child goes to pre-school or primary school. If autism is to be dealt with successfully, it must be diagnosed and managed as early as possible and certainly before the child goes to primary school.

Research in this area is essential. While there has been a great deal of research into autism there is no substantial evidence yet of a cause. Important research has been conducted in the United Kingdom and the United States on various related issues. Some funding should be provided for major research into the cause of autism, whether through the budget for education or for provisions introduced under the health Bill, promised by the Department of Health and Children, to give local bodies an influence on and a say in the delivery of health services. No one can explain the significant incidence of people with various intellectual disadvantages and the escalating number of children with autism at a time when we have one of the most sophisticated health services in the world. I would support a Government initiative to put substantial funding into research on the causes of these disadvantages.

3:00 pm

Photo of Brian HayesBrian Hayes (Fine Gael)
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I welcome the Minister of State to the House and thank him for returning for this resumed session of statements on autism. As Senator Daly said, it is good that today the attention of the House is virtually exclusively focused on special needs and people who have autism and how the parents of many children must cope with that. It is important that the Minister of State is present to hear these statements.

Some years ago in my constituency a large group of parents with problems not properly addressed by anyone in the Irish medical service, such as dyspraxia, attention deficit disorder and mild forms of autism, organised a major conference. We were invited to attend as public representatives. It was an amazing conference one Saturday in the National Basketball Arena in Tallaght which more than 1,000 people attended. The day was organised into modules led by various experts, many from the United States and elsewhere, describing various intellectual and mental disabilities suffered by children. It was astonishing to hear one parent after another identify cases presented by the experts with their children. People have a deep yearning and need for information on this issue.

One area where our health service falls down is in following up on young parents and their children. While vaccinations are administered at an early age very often the first formal interaction between the child and the State is in national primary education. One lesson we can learn from other models of medical service, particularly in the European Union, is the need for early intervention by the State to ensure that where difficulties emerge the parent is given this information. The conference revealed the parents' deep need to discover if their child's difficulty is part of a pattern and whether it can be identified and fits with some of the major diagnoses of mental or intellectual disability. Early intervention is crucial in this area, particularly between the ages of one and five, to see if the pattern is such that one can identify the particular problem a child presents.

Senator Daly made the interesting point that there is sometimes a failure on the part of voluntary groups to recognise that they receive funding from the State and various health boards in order to help parents, particularly those with autistic children. Many of these organisations stress that their funding is given on a year to year basis. One recommendation to emerge from the White Paper on volunteerism is to move to multi-annual budgeting. In other words, an organisation working in the Mid-Western Health Board Area would know its funding on a three-year basis rather than year to year. We must do that because many of the organisations helping parents through this difficult time need to know their budget with a degree of certainty over a few years. If the Minister of State could guarantee the financial status of these numerous organisations, they could fulfil their plans over time. Could the Minister of State address this with the various authorities to organise it on a more concrete basis?

Senator Ulick Burke said that the high incidence of autism is a cause of great concern. He said that one in 166 children presents with some form of autism. Senator Daly made the point that we need to commit funding to research the reasons for this. I am not aware of any other country in western Europe where the incidence of autism is as high as it is here. We must commit funding to that soon. The Tánaiste has committed substantial funding to research on the economy and has rightly said that the Government wants to concentrate on this. The Minister of State must commit greater resources to research in this area to see whether there are particular conditions here which have not been met to reduce that incidence.

The main bugbear for parents in my constituency, and this is reflected across the floor of the House, is that there is no single agency to which they can turn for help. If one has a child presenting with a form of autism there is no agency which will give the financial, moral or psychological help one needs. I hope the Minister of State will turn his attention to this. I do not propose a one-stop-shop, as some have suggested, in each county area. Several officers should be charged with co-ordinating a plan for the child, including the provision of finance for the child and its parents, ensuring intervention and contacting the parents to tell them the State cares about their dilemma. That is the most important issue brought to my attention as a public representative; people want a representative of the State to call and say it cares, and to co-ordinate the services. Every family in this position needs such a response. Respite is a serious issue for parents of a child with autism to enable them to get away for a week or a weekend to rest and take time off from their task of rearing the child, with all its attendant difficulties and challenges. One of the best initiatives of the Government in its last term was the introduction of a respite care grant through the then Department of Social, Community and Family Affairs. It was very beneficial to carers but unless there is a place where one can leave one's loved one with confidence that the person will be well cared for, parents often cannot get away for even a few days. Could the Minister of State ensure that officers at various health boards would be responsible for various parents and intervene earlier to help them?

One reason we are learning so much about the area of special needs and autism is that we are catching up. We have a great deal to learn from our EU partners as recent investment catches up on minimal investment over the preceding 20 or 30 years. Often in the past these problems were not recognised as educational difficulties. We are running to stand still in terms of our recognition of the issue here.

If, as Senator Ulick Burke stated, the fact that someone has a form of autism is recognised when they are at an early age, that child will have massive potential in terms of breaking through the educational difficulties to which I refer and the outlook for them in later life will be great. There are amazing stories about people with autism and other forms of disability. If we can intervene at an early stage, ensure that the correct resources are in place and draw up educational plans for such people, there will be opportunities for their lives to be transformed. We must get this extremely positive message across.

The major issue relating to many of the special needs within our education system is that of early assessment. As Senator Daly correctly pointed out and as the Minister of State is aware, there are not enough speech therapists or people involved in the area of ongoing psychological assessments. If we cannot produce them locally, we will have to enter the marketplace in Europe to recruit them.

Speech therapy courses are available at Trinity College. Has there been an increase in the total number of places on offer in the undergraduate courses at the college in recent years? We must double, treble or quadruple the number of places on offer there to ensure that there will be an adequate number of professional staff in place to deal with this matter in the future. We will, otherwise, be obliged to carry out a massive recruitment campaign in England, France and Germany to ensure that the assessments that are needed are actually carried out. I welcome this debate and I thank the Minister of State for his attendance.

Margaret Cox (Fianna Fail)
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It gives me great pleasure to contribute to the debate on autism. It is indicative of the importance given to this matter by people at all levels that we are debating it now, following this morning's debate on the special educational needs legislation.

I am sure the Minister of State has noted with interest the agreement that has emerged between Members who have spoken during this debate and earlier debates on this matter regarding the issues faced by the parents and carers of children or persons with autism. Those with autism do not remain children; they grow up and become adults and need ongoing care for the remainder of their lives.

Almost every speaker referred to the complete lack of adequate respite facilities for people with children, young adults or persons with autism in their families. Access to respite beds for any period is practically absent throughout the country. We need to address that matter. When the need for respite care beds for the elderly arose, we entered into public private partnership type arrangements with tax incentives to encourage the provision of such beds. Perhaps the Department should discuss this matter with the Department of Finance. Would it be possible to address it in the next finance Bill and put in place some form of tax incentive? There are now many nursing homes throughout the country and there is an adequate supply of step-down facilities. Would it be possible, perhaps in association with the new regional structures that will be put in place, to create tax incentives using the private facilities already in existence to provide for respite places? We could then provide adequate training and backup resources to allow parents to take some much needed time off.

It is not just parents who have a need for respite, it is entire families. Autism is a particularly difficult disability if one is a sibling. If one has grown up with an autistic sister or brother, one's entire family will have been affected because such siblings require more attention. This creates a range of issues for the wider family. It is not just the parents or carers who need the respite, it is the entire family. It is important to bear this in mind in terms of our attitude and approach to how we intend to deal with the area of respite care.

The issue of education was discussed this morning during the debate on the Education for Persons with Special Educational Needs Bill. I do not intend to rehearse the arguments I put forward this morning. However, I made one point in the debate on the legislation which I wish to reiterate, namely, that the definition of a child as someone who is not more than 18 years of age is not acceptable. It must be stated repeatedly, and loud and clear, that it is not acceptable that people with special needs are defined, for educational purposes, in legislation as children and are only catered for until the age of 18.

Major strides forward have been taken in the education sphere, particularly in terms of autism services. Special classes have been established in national schools throughout the country. Such classes are made up of six or eight children, special needs assistants are provided and wonderful methods of education are employed. The results achieved have been great. To the teachers who provide these classes and the parents who send their children to them I say "well done". There are also special classes, some of which follow different methods. It is important to monitor the different methods and identify which is the best model to employ. The latter might incorporate a number of models to cater for each child's need, his or her family's circumstances and the location of the school.

As someone stated in this morning's debate, needs and levels of access are different throughout the country. Senators Brian Hayes and Daly referred to speech therapy. Trinity College is no longer the only institution producing speech therapists. A course has been established at the National University of Ireland Galway, on which physiotherapists, speech therapists and others in the paramedical area are being trained so that much needed resources can be provided.

We must also take cognisance, however, of children whose first language is Irish and who are growing up in families which speak it daily. These children will enter schools where their friends and teachers will also speak Irish. This creates an additional set of needs in this area. The challenge the Government, the Minister of State and the Department face is to ensure that we cater equally for people who have particular needs as regards the Irish language. This is something to bear in mind as regards the emphasis in the training and education programmes we put in place to produce the necessary human resources. The term "human resources" is the wrong one to use because these people are specialists and are dedicated to what they do. Anyone who works in the area of disability must have a vocation because they go far beyond the call of duty in terms of the dedication, loyalty, commitment and love they show towards these special people.

Senator Brian Hayes referred to analysis. Parents bring their children to public health nurses for check-ups at three months, 12 months and again just before they begin attending school. These check-ups are extremely important but more is required. It must be made clear that if people feel there is a small difficulty with their children, they should know where to go and should not be ashamed, embarrassed or left to wonder whether it is too early to seek assistance. We must alter people's perceptions. Asking questions does not make one a good or bad parent and it is nothing of which to be ashamed. If parents believe that something is wrong, they need immediate access to some form of analysis so that their concerns can be allayed. There is nothing worse for a parent than spending six months worrying about whether their child will be diagnosed with autism or whether there is anything wrong at all. Sometimes those six months can be wasted.

Immediate access to diagnosis and to a range of services that will show people how to move forward is required. Ireland has developed enormously in terms of its recognition of special needs and also in respect of what it does for the families of children or people with special needs. However, that information must be shared. Families do not have the time to worry about their entitlements, such as medical cards and grants, where their children will attend to school or the facilities that are available. Parents cannot afford to have such concerns because they must care for their children at home on a daily basis and try to do their utmost to help them. Early diagnosis and intervention and the formulation of a pathway and plan for the child through all the stages of his or her life are very important.

Senator Daly spoke about the vital area of research. The research environment that pertains in Ireland is part and parcel of the issue and how we deal with it. We cannot always operate in the American mould; we need to have our own mould and devise our own models. To do that, we need to conduct our own research. The message to the Minister of Sate today is that all Members are speaking with one voice. Some of us think we are doing a better job than others in terms of the services we provide but everybody recognises that we have more to do, particularly in this area. The Minister of State is faced with a challenge.

Sheila Terry (Fine Gael)
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Everybody here is of one mind on this subject and we all wish to see an improved service for the parents of autistic children. None of us appreciates our healthy children until we meet somebody who has an autistic child. I met some of these parents during the recent campaign and they have so many different concerns about their children's futures depending on the current age of each particular child. I can only imagine what it must be like to have an autistic child and to worry about his or her future, particularly when parents are frustrated in their efforts to deliver the necessary services for their children. Even accessing the services is difficult, as Senator Costello observed, because some parents do not even know where to go to get help. We should be able to make it easier for people to access those services.

I met one couple whose five year old child had been diagnosed with autism spectrum disorder, ASD. I shall speak to the Minister of State on another occasion to see what can be done about this particular case. These parents' concern was that their child needs speech and language therapy but is not receiving it. Although he is attending a special school, which has been granted €30,000 in funding by the health board for the provision of this service, the therapists are simply not available. At first the school was prepared to give the parents money to bring the child to a private speech and language therapist but the health board withdrew approval for this option. The parents, who can ill afford it, are now paying €50 per half-hour for twice-weekly therapy for their child. The Minister of State will agree it is unfair that in a society which prides itself on its economic strength, we cannot look after our most needy citizens. These parents have been assured that if their child receives the help he requires he could have a successful future. It is at this critical age that he needs this assistance. I use this child only as an example because his case mirrors those of many others. We need to consider how the speech and language service can be delivered to the people who really need it.

The parents to whom I referred also mentioned their conviction that their child should be entitled to a medical card. He has one currently but it is only for a 12 month period. This is another issue we need to consider if we are to fulfil the needs of these families and their children as they grow into adults.

The other area of concern concerns accommodation and respite. As parents grow older and children become adults, we must consider how we can prepare for the possibly long-term accommodation of the latter and, in particular, to provide respite so that parents can get the help they need. This has been referred to by many Members here today.

In terms of education, the most important issue is early intervention; delivering the necessary services to children at the earliest possible time. We must ensure that the service is there and that parents who are trying to do their best for their children should not have to seek out assistance only to be told that it is unavailable. That the service cannot be delivered is the most appalling aspect of the current situation regarding autistic children and indeed any people with special needs. The Minister of State has a sincere interest in this issue and I hope that he will be able to improve the existing services. That is what every Member wants and we speak with one voice on this matter. We are aware that it will cost money and that such improvements cannot be delivered at the drop of a hat but we have been talking about this for a long time and there are still people who cannot access the service they deserve.

I ask the Minister of State to continue to work on this and I will speak to him later about the individual case to which I referred, which is representative of the plight of many parents with autistic children. If the Minister of State is unable to deliver the necessary services, such as speech and language therapy, he might consider permitting parents to secure such services in the private sector, particularly where money has been identified for that purpose. That is the only option we can pursue until we have the required number of qualified people in the health service to cater for the needs of autistic children.

Photo of Mary O'RourkeMary O'Rourke (Fianna Fail)
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There has been much talk of compassion which the Minister of State has demonstrated clearly since the beginning of the debate on autism. This is the third debate in the House on this issue; the first lasted three hours and the second some two and a half hours. Many Members still wished to speak and so we are concluding the discussion today. We are appreciative that the Minister of State has attended each debate.

I wish to speak on autism from several perspectives. First, I wish to return to the matter raised by Senator Daly. Why is there such a high incidence of autism in Ireland, more so than in any other European country? I am sure the Minister of State will have some facts on this issue in his reply. This high incidence begs the question as to cause. We are told there is some malign gene with which the child is born. Is there a predisposition in the parent or is there something in the environment, diet or otherwise that gives rise to the condition?

Autism is one of the most awful deprivations a child and his or her family can suffer. I speak from personal knowledge. My brother Paddy had a son Caoimhghín who was cared for in a wonderful place in County Galway until his death at 22 years of age. He was a fair-haired young man of 6 ft. 2 in. in height who was diagnosed with the most destructive variant of autism at a very early age. The child did not set out to be destructive but he was born with that gene. His story had a very sad ending. He was a wonderful swimmer and if he had not suffered from autism he may well have made his mark in that sport. He availed of the pool in the place in which he was cared for but one night he got up and pulled back the tarpaulin — he was a very strong young man — and drowned in the pool as a consequence of a fit. It left a huge impression on his family and relations who were devastated; we had all known him as he grew up and he was a beautiful, handsome young man.

At that time it was in vogue for families to go to Boston to avail of a special regime involving parents and helpers donating time to assist with autistic children. I saw parents who were absolutely frustrated. My brother and his wife did not go there, but I know other parents who did. Hundreds of volunteers were involved in providing exercise, massage and so on. The programme did not work out and everybody was more disturbed than they had been before.

This is a day to highlight education for people with special needs and I hope the needs of those with autism are fully taken into account when the special needs budgets are worked out. If a rigorous programme is implemented with kindness early on, great steps can be made in terms of social interaction.

Autism varies in degree of severity and there are also related conditions such as dyspraxia, ADD, which is a version thereof, ADHD and other variants which previously were never spoken about because people were unaware of the terminology. Inherent in the condition of autism is a great deal of intelligence gone wrong within the child's brain. I gather from reading about it that the intelligence is often way beyond the IQ level for the age group to which the child belongs. The intelligence cannot be corralled and channelled in the correct educational way, which then leads to highly destructive behaviour in the educational system.

We would be well served if comprehensive research were undertaken on the subject of autism, which could help to forestall the predisposition to it. It would also give hope to parents who usually do not know if autism is present when a child is born. It takes some months before it becomes apparent. Parents are pleased with their children no matter what. It would be wonderful if the Minister could find money for research in this area.

I thought it important to speak on this matter because of my personal experience of it over 22 years. My nephew grew up at the same time as my two children. I was aware of his growing isolation and the growing isolation of his family because of the lack of services available to him even though he was in a wonderful adult care centre. I endorse the point made by Senator Terry that the lives of other family members are completely engaged in the care of such children which can affect other relationships within families. It is heroic the way they continue to provide care. I am interested to hear what the Minister will say in his reply.

Tim O'Malley (Minister of State, Department of Health and Children; Limerick East, Progressive Democrats)
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I thank all Senators who contributed to this debate which, as Senator O'Rourke reminds me, took place over three days. I applaud them on some wonderful contributions and for their interest in the subject of autism. It is only when one gets into individual cases, such as that of Senator O'Rourke's nephew, that it is brought graphically to our attention what people have to put up with when a family member is autistic.

I am delighted to inform Senator O'Rourke, and other Senators who raised the issue of research, that we are endeavouring to participate in an international autism genome project. We are currently discussing this with the National Alliance for Autism Research, a parent-funded group in the United States, and I hope there will be participation by Irish researchers in this project. I agree that there has been a significant increase in the prevalence of autism and I will do everything I can to ensure sufficient funds go to research in this very important area.

Senator Terry referred to speech and language therapy. We are educating more speech and language therapists, among other therapists. Unfortunately, there are not enough of them at present. If Senator Terry speaks to me about the case to which she referred, I will see what I can do.

Members raised many other points. Respite is an issue that is frequently brought to my attention. The Government has invested a great deal of funding in this area in recent years. I am currently looking into the matter of autism services on the Loop Head peninsula referred to by Senator Daly.

Senator Brian Hayes referred to a matter that is close to my heart, multi-annual funding. When I came to the Department I could not understand the lack of multi-annual funding, especially in the area of disability. My departmental officials would love to have multi-annual budgeting but, unfortunately, the Department of Finance does not listen attentively to us. I hope we will make progress on the matter. The more Senators and other people outline the advantages of multi-annual budgeting, the sooner we will arrive at that position.

The Government is conscious of and has acknowledged the difficulties faced by families caring for persons with disabilities, including those with autism. It is for that reason the Government identified these services as a priority area for funding. Since 1997, additional funding amounting to €643 million has been invested in health-funded support services for people with intellectual, physical and sensory disabilities and those with autism. This includes an additional €25 million in current expenditure which was made available by the Minister for Finance in the 2004 budget for services for people with disabilities.

Additional revenue and capital funding of €388 million has been provided for autism and intellectual disability services since 1997. This has provided a broad range of new and enhanced services around the country and includes an investment of approximately €16 million since 1998 in the early intervention, pre-school and multi-disciplinary support services for children with autism and those with an intellectual disability.

Services to people with intellectual, physical or sensory disabilities and those with autism is one of the limited number of areas in which additional revenue funding has been provided by the Government to any Department over 2003 and 2004. In respect of services to persons with autism and intellectual disability, this funding, amounting to €43 million up to the end of 2004, was specifically provided to meet costs associated with the provision of emergency residential placements, extra day services, particularly for young adults leaving school, and to enhance the health-related support services for children.

I wish to address some of the issues raised during the debate. One such matter was access to pre-school services. The direct provision of pre-school services which are educational in focus is not part of the remit of the health services. However, in the past, within the resources available to them, health boards grant aided some special needs specific pre-school services, in addition to assisting individual children with disabilities to attend mainstream pre-school services.

The role of the educational services funded through the Department of Education and Science in respect of the provision of pre-school services for children and in particular children with disabilities is a fundamental issue which requires to be addressed. My Department has advised the Department of Education and Science that the health services are very anxious to work with the educational services to enhance access to pre-school services for children with disabilities, including those with autism.

The Education for Persons with Special Educational Needs Bill 2003 will provide a statutory guarantee of education services for people with a disability. It will provide a statutory framework within which the education of children who have special educational needs because of a disability can be guaranteed as a right enforceable in law. The Bill was considered carefully by the Dáil and a number of changes were made to ensure the delivery of appropriate support services. It was passed by the Dáil on 26 May and Second Stage commenced in this House earlier today.

A number of Senators raised questions related to school supports for children with special educational needs, including those with autism. The Minister for Education and Science, Deputy Noel Dempsey, has approved the allocation of an additional 350 teaching posts for special needs and a new system for the allocation of resources for special needs in primary schools. The new system will involve a general weighted allocation for all primary schools to cater for pupils with higher incidence special needs, those with learning support needs, borderline mild and mild general learning disability and dyslexia. It will also allow for individual allocations in respect of pupils with more acute needs.

The general weighted allocation system will greatly reduce the need for individual applications and supporting psychological assessments and will put resources in place on a more systematic basis, thereby giving schools more certainty over their resource levels. This will allow for better planning in schools, greater flexibility in identifying and intervening earlier with regard to pupils' special needs, as well as making the posts more attractive to qualified teachers.

The question of the current level of uptake of the MMR vaccine was raised during the debate. I have arranged for copies of a reply to a parliamentary question on this subject, which was answered on 21 June, to be made available to those interested in this issue. In accordance with a commitment in Sustaining Progress, the social partnership agreement running from 2003 to 2005, my Department is required to carry out a strategic review of existing service provision, in consultation with relevant interests, with a view to enhancing health and personal social services to meet the needs of people with intellectual, physical and sensory disabilities and autism.

This review is particularly timely for the following reasons. A considerable period of time has now elapsed since the publication of the relevant policy documents in this area. Account must be taken of the effect of Government policy in respect of the mainstreaming of services. The level of additional funding invested in the services in recent years makes an examination of the results of the funding timely and necessary. The implications for disability services of the publication in 2000 of the health strategy, Quality and Fairness — A Health System for You, and the primary health care strategy should be examined. The health services reform programme approved by Government and published in June 2003 will also have far-reaching effects which will influence the delivery of services for people with disabilities. The new legislative measures being introduced in the area of disability will have a profound effect on the future planning and delivery of services.

The strategic review will examine a number of specific areas of service provision. My Department sought and received initial advice from various stakeholders regarding the format and content of the review. Taking this advice into account, a number of specialist study groups have been established to look at particular topics, identify relevant issues and make recommendations on future policy in respect of the specific topic. Some examples of these topics include assessment, early intervention and pre-school services; management of health services for persons with autism; links between education and health-related support services; access to mental health services for people with intellectual disability and those with autism; disabilities and older people; mainstreaming; protecting vulnerable people; supported living and personal assistance; information and databases; training and sheltered work; value for money; and funding.

Significant resources have been provided by this and the previous Government to enhance the overall level of support available to people with disabilities, including those with autistic spectrum disorders. These resources have been provided through the health and education services in addition to other measures such as mainstreaming, which will also impact positively on the lives of people with disabilities. This is very visible evidence of the Government's commitment in this area. Despite the very significant levels of additional funding which I have outlined above, the Government has acknowledged that further significant additional investment is required over the coming years if we are to meet the identified needs of people with disabilities and their carers. Much progress has been made but the Government is not complacent. Much more remains to be done and it shall deliver on its commitments.

I acknowledge the contributions made by all Senators who spoke during this debate. It is through opportunities such as this, in sharing knowledge and information, that we can assist in moving issues forward in a positive manner.

Sitting suspended at 3.35 p.m. and resumed at 4 p.m.