Ivana Bacik (Labour)
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I welcome the Minister of State, Deputy Rabbitte, to the House and congratulate her on her appointment. I wish her the very best in this important post. I am glad to be speaking in my capacity as Labour Party spokesperson on children, disability, equality and integration and, in that regard, to ask the Minister for Health or the Minister of State to make a statement to the House on the provision of nursing care plans for children with complex needs to enable them to participate in education and to commit to the provision of nursing care for a child whose plan has already been prepared and who is due to attend a particular primary school in Dublin in the coming weeks.

My starting premise, which I know is also that of the Minister of State and her Department, is that children have a right to education. This is one of the most important rights children have as bearers of rights. Whatever the needs of a child, we must always strive to ensure he or she can exercise that right to an education. I am, of course, conscious that children who have complex needs need particular care. I have just come from a briefing with Inclusion Ireland on the needs of children and adults with intellectual disabilities, but my question relates to children with complex physical needs. These children have a right to an education in mainstream schools and require care packages to enable them to participate.

We all acknowledge that this issue cuts across the roles and responsibilities of both the Department of Health and the Department of Education and Skills. I also acknowledge the immense work of the HSE and the HSE co-ordinator for children with complex needs, who has a very important role. I also acknowledge the role played by special needs assistant, SNA, provision through the Department of Education and Skills and nursing care provision through the Department of Health. Enable Ireland has been working very hard on this issue and has run a pilot access and inclusion programme which aims to steer a path and navigate between health and education.

The particular case which has been brought to my attention by a parent and a school principal, and which I have also brought to the attention of the Minister of State's office, illustrates the difficulties experienced when children with complex needs seek to exercise their right to participate in education. When I was contacted by the parent and principal in respect of this particular pupil, about whom the Minister of State has details and of whose case she is very well aware, I was told that the child had a very particular physical condition which required a care package. The child is due to start fifth class in October. The family and school have been through the process of obtaining an SNA and nursing support. This process was at a very advanced stage. The HSE co-ordinator had been working with the family, and I understand the package of supports was in place and lined up. At the very last minute, just weeks ago, the child's family and school were informed that funding was not available for the nursing package. I understand that is what happened.

Since then, the family and the school have been in contact with different officials. The child has written a letter to the Minister of State, Deputy Madigan, whom I have also contacted. Her office told me that it was a matter for the Department of Health. I contacted the Minister, Deputy Stephen Donnelly, but have not yet received a response. I thank the Minister of State very much for the response I received directly from her, in which she said that she is looking into the issue. I really do thank her for that response, which I acknowledge. This matter clearly has a wider impact for children beyond this particular case. While I am today asking for the Minister of State to commit to provision for this particular child, I want to raise this matter as a broader issue for children more generally.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank Senator Bacik for raising this issue. Before I begin reading my script, the Deputy is right. There is a wider conversation to be had which goes further than the one case she has brought to my attention. As she will hear throughout my speech, there is a need for really good collaboration between the two Departments to ensure all children have the right of access and are supported. I thank Senator Bacik for raising this issue. I begin by noting that the Senator's question relates in part to a particular child. It would not be appropriate for me to comment on that individual case and I have referred this to the HSE for more information and an update. I will share that information with the Senator as soon as it comes to hand.

As the Senator will hear, while there is some overlap with the Department of Health on this issue, as well as the fact that it relates to children with disabilities, the main policy issues involved fall under the remit of my colleague, Deputy Madigan, who is the Minister of State with responsibility for special education. Indeed, Deputy Madigan would probably have been the more appropriate Minister to attend this session today, although I will do my best to assist the Senator. I am also happy to pass on any further concerns to the Minister of State, Deputy Madigan, who is more appropriately placed to deal with these issues, for which the Department of Education and Skills is responsible.

In recent years, there have been developments in interventions for young children with complex conditions which have led to greater numbers of children with disabilities participating in school. In the past, these children either did not attend school or were in special centres or special schools managed by voluntary bodies, where nurses and care assistants were on-site as part of the overall staffing complement. Children with higher levels of need now often attend special schools and a small number of children are supported to attend mainstream schools.

High levels of ongoing support are required to enable this participation. At present, there is no national standardised process for the allocation of nursing supports in schools for children with complex needs. Current provision of nursing supports to schools is provided by the HSE or, on behalf of the HSE, through its funded service providers. Some nurses are also employed directly by schools and report to the school board of management. The provision of nursing supports has sometimes been dependent on the ability of an individual community health organisation, CHO, to fund such supports, leading to inequity of access for children in some special schools.

In 2018, the National Council for Special Education, NCSE, published its comprehensive review of the SNA scheme. The report included a finding that SNAs, who are not required to have any clinical training or qualifications, may nevertheless be expected to support students who require complex medical procedures. Following on from the review and its recommendations, the Department of Education and Skills is reviewing how nursing supports can best be provided in the education setting as part of their wider school inclusion model. The school inclusion model is designed to test a support model for schools which does not rely only on SNA support but which also provides for a range of additional supports, including therapy supports and services in schools. Currently, the school inclusion model is in a pilot programme in HSE area CHO 7.

A nursing group, a sub-group of the school inclusion model working group, has been established to progress the issue of nursing support for children with complex needs. This is a cross-departmental group which includes representation from my own Department. A paper is currently being developed to identify and prioritise the implementation of nursing supports for those children with the most complex needs. The school inclusion model budget is €4.75 million and the nursing provision will be funded through this programme.

Ivana Bacik (Labour)
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I thank the Minister of State for her response. I greatly appreciate her efforts on behalf of the child in the case I have raised with her and I look forward to engaging with her further on that individual case. I stress that the Minister of State, Deputy Madigan, has clearly told me it is not within her brief, and that it is a matter for the Minister of State, Deputy Rabbitte, or the Department of Health, so I will engage with Deputy Rabbitte on that.

The Minister of State's answer raises a much broader concern about the huge gap that exists for children. The one line that stood out for me in the response, and I am sure for the Minister of State, was, "At present, there is no national standardised process for the allocation of nursing supports in schools for children with complex needs." That is a serious gap in our provision for children. I am very concerned that movement between Departments and the crossing over of responsibilities may have left children, such as the child in this individual case, to fall through the gaps. It is particularly sad when it appears funding is available but nobody is quite sure which Department is responsible for allocating it. I understand many disability matters are moving to the new Department of Children, Disability, Equality and Integration, and that movement itself, as I understand it from briefings from that Department, means there will be a delay.I am really concerned that children like the child in this particular case may fall between the gaps as different Departments assume different roles and responsibilities. I appeal to the Minister of State to raise with the Minister of State with responsibility for special education and inclusion, Deputy Madigan, and the Minister for Health, Deputy Donnelly, the need to ensure a co-ordinated joined-up response and in particular to ensure a national standardised process is rolled out for children with complex needs. As the Minister of State said, it cannot be on the basis of the ability of an individual community healthcare organisation to fund such supports or on the fact that a person is in a particular pilot programme area. We all know that is what is happening in practice but it is not good enough for children like the child in this case, who was living in another country where the support was in place. The family were alarmed to discover that there is no standardised package of supports in place here. There really should be for children like this child.

Anne Rabbitte (Galway East, Fianna Fail)
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The current programme for Government document, Our Shared Future, recognises the need to improve services for children with disability through better implementation by the working group across Government. I wish to reassure Senator Bacik and anyone who has a child with complex needs that myself and the Minister of State, Deputy Madigan, will be working closely together on this. We recognise that there are gaps. It is our responsibility to close the gaps and ensure that no child falls through the gaps. Deputy Bacik can be assured, on foot of the cases she has raised this morning, that what we have within our Departments, where we see the national standardised approach, is not standardised. We are going to work on that. We are going to sit down and put together a plan. My move and the moving of the functions from the Department of Health to the Department with responsibility for children should be welcome news, because we want to ensure that all children get the best access to intervention therapies and fair and equitable access to education at the earliest possible stage on the early intervention side.

Mark Daly (Fianna Fail)
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My thanks to Senators for putting in matters and to the Ministers for their responses. If Members are unhappy with the responses, they might raise the matter directly with me. We need a sos to allow cleaning of the Chamber.