Marie Sherlock (Labour)
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I thank the Minister of State, Deputy Rabbitte, for coming to the House and for making herself available for this important question. As the Minister of State knows only too well, the HSE is currently rolling out its reconfiguration of disability services for children and it hopes to complete the centralisation of services July of this year. I understand that when there are waiting lists as long as 25,000, and indeed a family in my area has been waiting for four and a half years for access to therapies, the HSE has to do something. When a school such as the Holy Family School for the Deaf in Cabra is told that it is to lose its on-site specialist speech and language therapy service to resource the development of another service, then the children, the parents, the staff and the principal all deserve answers as to why they are to lose their service.

My question is very much about the research, the evidence-based policy and the clinical framework that says it is better for children to access services in the community, which in reality is effectively them joining a long queue along with many other children in the community, when they already have timely access to a vital service within their school environment. A report produced by the HSE in 2017 related to the national advisory group on specialist services for deaf children. There were nine specific recommendations in the report but it has been there for more than three years at this stage and is gathering dust. The recommendations have been actively ignored by the HSE's current reconfiguration plan for disability services for children. Where is the leading role for specialist deaf services? Where are the specialist mental health services for children who are deaf and their families? Where is the automatic referral for those with severe or profound hearing loss? Where is the expertise in training within primary healthcare and within the community-based teams for children who are deaf or hard of hearing?

This school deserves to hear the rationale as to why it is losing its service. It seems like a retrograde step. The impact of this on the children in the school will include lost days out of school. Children come from as far as Monaghan, Longford, Meath and Kildare, as the Minister of State knows only too well. What are we saying to them with regard to their right to access a comprehensive and full education in this State that they must stay at home to access a service where they reside and not go to school on those days? It is shameful we would have to tell them to miss school. It is about providing a consistent support service to them. Any family that has a child with a disability will say that it has to be consistent as opposed to meeting a different clinician or therapist on each day. There is also a cost to the HSE.

In my conversations with the Minister of State on this I know she is concerned. The Taoiseach has also spoken publicly about this. The school and I received correspondence from the HSE on Wednesday. It was a series of justifications for why it is doing this, which is nothing short of shameful. The HSE has sought to rely on the Ombudsman's report on unmet health needs for children with disabilities. The HSE is relying on that report to justify what it is doing.It is saying that the report states that we need to review the access path and criteria for accessing services. Is the HSE saying that the children in the Holy Family School for the Deaf do not currently need access to speech and language therapy services? That is what it said in its letter. I want to hear the HSE's justification. If this goes through, it will be a hugely retrograde step for the children in this school. I thank the Minister of State for coming into the House.

Anne Rabbitte (Galway East, Fianna Fail)
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I do not know whether to start with the opening or concluding statement at this point. I have an answer but I would like to give the Senator the opening piece on the HSE first. I will then show how I have intervened, as a follow-up to the emails and the conversation the Senator and I had at back of the Chamber last Monday, and the work that has happened in the last four days. The Senator must recognise that what I have been trying to do in four days actually started in 2016. I am coming in at the tail end of a project that has started and been unleashed. I am now trying to manage it. I will put it in that context. I will read the opening script, which outlines where we have been over and back with the HSE prior to my intervention. It is important that I put this on the record because it gives parents who are watching an understanding of how we have come to this space. I will then address the issue about which the Senator has asked. I thank her for giving me the opportunity to do this.

In October 2017, the national progressing disability services, PDS, working group signed off on the report it had received from the national advisory group on specialist supports for deaf children. The report recommended a model of national specialist support to be delivered through a three-tiered approach: training for front-line staff in primary care and children's disability network teams; consultation with staff regarding individual children; and individual specialist assessment only in the very small number of instances when all efforts for assessing a child's needs have been unsuccessful.

The proposed model, as outlined, is in line with the PDS model and the 2016 report regarding guidance on specialist supports. A working group was subsequently formed under the integrated care programme for children to focus on services for children who are deaf and hard of hearing. The national PDS steering group was represented on this group. The findings and recommendations of the PDS national advisory group informed the deliberations of the working group. The national working group for integrated care for children who are deaf or hard of hearing incorporated the relevant PDS recommendations regarding specialist support into its draft report. A draft version of the group's report was circulated in March 2020. However, the subsequent onset of the Covid-19 pandemic has interrupted the work of the group. It is expected that the group will resume its work as soon as practically possible.

At this intervention, it is important for me to say that the remodelling of the PDS network has started and is rolling out. We are still going to reconfigure to have a meeting of the steering group. Therefore, the horse has bolted on this one. I am trying to get a hold of it at the moment. I acknowledge and totally understand the concern, upset and frustration of the parents and staff in the school about which the Senator spoke. I would like to be able to tell her that this school is an isolated incident, but we have many of these schools around the country. Certain things are happening and the programme is being rolled out. As the Senator will be aware, the HSE is currently rolling out the PDS programme, which requires a reconfiguration of all current HSE and HSE-funded children's disability services into 91 children's disability networks across the nine community healthcare organisations, CHOs.

The programme aims to achieve an equitable national approach to service provision for all children based on their individual need and regardless of their disability, where they live or where they go to school. A really positive piece of work is going on right across the country. The reconfiguration of services under the PDS programme is in line with the health service reform and implementation of community health networks under Sláintecare. I have discussed the issue of the PDS with the HSE a number of times over the past week to air some of my concerns, which have been brought to my attention by parents and Members of the Oireachtas. I believe the PDS is the best way forward. I have more to contribute in my concluding remarks, but I get the Senator's point.

Marie Sherlock (Labour)
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I thank the Minister of State for her response and I understand that she understands the seriousness of the issue. Any of us who have dealt with families and children with a disability who are waiting know the distress involved. I understand what the HSE is doing across the country but not for the schools where there is already a good service in place and this had caused the greatest distress to me. There is already a good service in place and the HSE is seeking to remove that. So we are robbing Peter to pay Paul and we simply cannot allow that to happen. The Minister of State is right in that the Holy Family School for the Deaf is not an isolated school. The Carmona School in Glenageary was in contact and there are other schools across the country, including a school for the deaf in Cork.

I plead with the Minister of State and the Government because this is an education and health issue. It is not just a health issue. I understand that the HSE must do what it must do but I ask that the Government takes control and creates an initiative now to protect the education of these children. These children are in mainstream education. We need to protect that and ensure they do not suffer a loss because of a HSE action.

Anne Rabbitte (Galway East, Fianna Fail)
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The Senator is right because I have been approached by my colleague, Deputy Cormac Devlin, and Deputy Jennifer Carroll MacNeill has come to me about the Carmona School. I have heard about it from all over the country. The Government has taken control of this issue. I took control of it last Monday and I have continuously engaged with the HSE for the past week.

I will now read an important piece. In the context, the HSE introduced the national policy on access to services for children and young people with disability and development delay to ensure that children are directed to the appropriate service based on the complexity of their presenting needs rather than based on diagnosis. So the child who travels from Galway or Donegal to attend a special school for deaf children or the hard of hearing that is his or her specialist school. So it is up to every CHO to understand the national policy, and how they implement it and how they communicate it. It is very clear to me regarding communication within the HSE that while I am dealing with the best of people at the top they are not understanding the policy at a CHO level. I rest my case.