05 OCTOBER 2010

Dáil Debates

• Order of Business: Capacity Legislation
• Priority Questions: Census

Parliamentary Questions

• Report of the expert working group on the financing of health services
• Policy on replacement of speech therapists in context of moratorium on recruitment
• Number of physiotherapists employed in each HSE region
• Budgets for community care
• School age disability speech and language therapy service in Dublin West

DÁIL DEBATES

• Order of Business: Capacity Legislation

Deputy Caoimhghín Ó Caoláin (SF): …With regard to promised legislation, the State has not ratified the UN Convention on the Rights of Persons with Disabilities and one of the essential steps in bringing us to that point is the passage of the mental capacity Bill. At what stage is preparation of the Bill? When will it be published? The revised programme for Government promised an independent electoral commission but going through the legislative programme for the current session, there is no reference to this promised legislation. When will such legislation be published?

The Taoiseach: I understand the mental capacity Bill will be published this session. Ireland has signed the ratification of the UN Convention on the Rights of Persons with Disabilities and there will not be an undue delay in following up on that. It is the Government’s intention to do so as quickly as possible, taking into account the need to ensure all necessary requirements under the convention are being met.

Deputy Caoimhghín Ó Caoláin: I understand the convention has not been ratified.

The Taoiseach: That is right.

Deputy Caoimhghín Ó Caoláin: Is the Taoiseach confirming that is the case?

The Taoiseach:    We have to take that into account the need for all the necessary requirements under the convention to be met. We hold to the legal tradition of not ratifying treaties until it is considered that domestic law in general is in conformity with them. While Ireland has not ratified the convention, that does not mean progress is not being made in meeting the requirements. It means that when we ratify it, the process of implementing its provisions will be enhanced. That is the way in which we will proceed.

Deputy Caoimhghín Ó Caoláin: Is the Taoiseach certain that we will have the mental capacity Bill this session? Can he guarantee that?

The Taoiseach: I am informed that the answer is “Yes”.

Deputy Caoimhghín Ó Caoláin: Regarding my second question on the independent electoral commission promised in the programme for Government, when will we see legislation to bring that about?

The Taoiseach: There is a great deal of work to be done on that, which is ongoing. I will get the line Minister to talk to the Deputy about that directly. 

• Priority Questions: Census

Deputy David Stanton (FG): asked the Taoiseach the status of presentations on the Central Statistics Office Census 2011; the possibility of expanding the Census 2011 questions or those of future Census to collect disability statistics; Government Chief Whip and Minister of State at the Departments of An Taoiseach and Defence (Deputy John Curran): The Government decided in July 2008 that a census of population will take place in 2011 and gave the CSO the green light to begin immediately the necessary preparatory work associated with the holding of the census. Part of the preparatory phase of all recent censuses in Ireland is to consult with users regarding the questions to be included on the census form. In this regard the CSO conducted a public consultation by inviting members of the public and various interest groups to make submissions on the topics to be covered, and on the outputs to be produced. A notice to this effect was published in the national press in September 2008 seeking submissions, and all Departments were contacted for their input.A census advisory group was set up in autumn 2008 to consider the submissions received and to advise on the questions to be tested in a pilot survey planned to be carried out in April 2009. The census advisory group consisted of representatives of central and local government, the social partners, universities, research bodies and other users of census data along with relevant CSO personnel.Over 90 submissions covering 31 topics were received in response to the public consultation. The pilot survey was held on Sunday, 19 April 2009. It covered 32 enumeration areas spread throughout the country and the sample consisted of 11,400 households. The main purpose of the pilot survey was to test public reaction to the wording of a number of new questions, and changes to existing questions. The CSO finalised its analysis of the results of the census pilot in October 2009 and, following a further meeting of the census advisory group, made recommendations to the Government.Based on the recommendations from this group, the Government, at its meeting on 11 December 2009, agreed to the topics to be included in the questionnaire for the 2011 census. This list of topics is available on the CSO website, along with the report of the census pilot survey. The content and layout of the census form were subsequently finalised. The Government also decided that the next census will take place on Sunday, 10 April 2011. I am advised by the CSO that all of the 2 million census forms required to conduct the census have now been printed and are in storage ready for delivery to the field staff early next year.The second phase of this consultation process, which focuses on the dissemination of the results of the census, was launched on 4 March 2010. This was conducted via the CSO website and through direct e-mail contact with over 400 interested parties. The census advisory group was reconvened on 26 April 2010 to assess the responses and the census 2011 dissemination strategy was subsequently published on the CSO website.Two questions are included on the census form that deal with disability. The format and wording of these questions were agreed following consultation and testing and this process will again be implemented in deciding the content of future census questionnaires.Preparations for the processing of the census returns are well advanced. Processing will involve the capture, coding and verification of approximately 1.7 million census forms over a six-month period between June and December 2011. Following an open competitive tender, the contract to design the processing system was awarded on 10 July 2009 to a UK company, CACI UK Limited, the same company retained to assist in the processing of the 2002 and 2006 censuses. The contract covers the printing of the census forms, which is now complete and was carried out by DCKebrook in Citywest, as well as the software and hardware solution for the processing of the information returned on them.The recruitment of the required 5,500 field staff and 150 additional headquarter staff to conduct and process the census is now also well under way. The headquarter staff will be sourced through a mixture of redeployment of staff from elsewhere within the public sector and the creation where appropriate of some temporary clerical officer positions. The recruitment campaign began on 29 April with the advertisement of the 50 senior manager positions. The first of these staff were appointed on 27 September and will work for nine months from now until June of next year. The remaining 44 regional supervisors are due to take up duty on 19 October and these staff will also be employed until June 2010. The recruitment of the 440 field supervisors, who will be employed for six months on the census, has also begun. The applications closed on 24 September and they are due to be appointed in early January 2011. Some 5,000 enumerators positions will be advertised on the 29 December and they will be appointed for a ten-week period from 7 March to 13 May 2011. Applications for all posts are being accepted through an on-line application form on the CSO website and are being advertised in advance through FÁS on www.publicjobs.ie and in the national press.I am happy to report that preparations for the 2011 census are progressing well and that with the full participation of the public at the time of the census, the results will be an important input into planning the future of this country.

…Deputy David Stanton: Will the Minister of State agree that this is an ideal time to collect proper statistics on disability? Will he agree there is no data on people with autism or ASD? Has the Government received the recommendation from the National Disability Authority or the Health Research Board, on the matter of collecting information on disability and specifically on autism? As there is no such data in existence, how can we plan for services for people with disabilities if we do not have the complete picture? Is the census not a golden opportunity by which to collect this information?How does Ireland compare with other countries in this regard? Do other European states collect information on specific disabilities? How can we facilitate a comparison of data from other states as I believe we agreed in Washington a number of years ago?

Deputy John Curran: I will be as brief as possible. With regard to the areas of disability and autism, a specific census advisory sub-group was convened to consider the disability questions on the 2011 census form. This group was composed of representatives from the National Disability Authority, the Equality Authority, the Disability Federation of Ireland and the National Federation of Voluntary Bodies. The proposal to list specific disabilities within the disability question, namely, to make specific reference to autistic spectrum disorder or Down’s syndrome in the category of a learning or intellectual disability, was considered at the second meeting of the group. The group concluded it would not be appropriate nor would there be enough room on the census form to list all individual disabilities. However, in order to go some way towards accommodating the request, the existing 2006 category of a learning or intellectual disability, was split into two categories: an intellectual disability and separately, a difficulty with learning, remembering or concentrating. This was tested in the pilot survey. The group was of the view that this approach narrowed the categories and thus helped to address the issue of autism while allowing the questions to remain as inclusive as possible. The Deputy’s specific question about autism was considered by that group and it has changed the wording of the 2006 census by breaking the question into two parts. The concern was that it was not possible to list a whole range of individual disabilities so the group has undertaken a pilot test of this particular wording and it is satisfied with the results. This wording will appear on the census form.

Deputy David Stanton: We still do not have specific information about autism. It is a waste of time. Did the Minister and the Government agree with this group? Did they take the advice without making changes? What does the Minister think?

Deputy John Curran: If one is going to receive advice from people involved in the sector, either one has confidence in them or one does not. The advice came from representatives of the National Disability Authority, the Equality Authority, the Disability Federation of Ireland and the National Federation of Voluntary Bodies. We either have confidence in their advice or we do not.

Deputy David Stanton: Did they all agree?

Deputy John Curran: I do not have the full report.

Deputy David Stanton: Can the Minister of State make it available to us?

Deputy David Stanton: I think it is available but I do not know. The results of the pilot programme are available. I have not seen the full report but the recommendations are very clear that it was not possible to name a range of individual disabilities. The group was quite specific on this. It broadened the categories. Some groups were involved in the area of autism and are working with the CSO because it is now a question of analysis of data. That work is ongoing. Regarding international comparisons, it is important to know that will be a census across Europe in 2011. A range of issues common to each country will be included in ours and our census will include further additional categories to those specified for the EU.

PARLIAMENTARY QUESTIONS

• Report of the expert working group on the financing of health services

Deputy Joanna Tuffy (L): asked the Minister for Health and Children if she endorses the report of the expert working group on the financing of health services; if she intends to implement its proposals;

Minister for Health and Children (Deputy Mary Harney): The Report of the Expert Group on Resource Allocation and Financing in the Health Sector was submitted to the Minister for Finance and I on 9 July 2010. The Expert Group was asked to analyse the current resource allocation arrangements for health and personal social services and recommend changes which would support the core objectives of the health reform programme. It was also asked to take a view on the most appropriate financing mechanism for this purpose in Ireland.The Report of the Expert Group includes 34 recommendations on a wide range of issues, including:• Developing an operational population health resource allocation model• Introducing a prospective based funding model for all relevant areas of the health and social care system; and• Addressing the burden of chronic disease management through an integrated care model and a new graduated form of eligibility.The Group supported many of the recent health reform initiatives, including Fair Deal, the development of clinical care pathways, the policy of delivering integrated care outside hospitals as far as possible, the work being done on a unique health identifier and the development of more individualised funding options for persons with a disability. I am giving detailed consideration to all the recommendations contained in the Report. I intend to bring the Report to Government for its consideration shortly. I further intend to put in place an implementation process based upon the decisions of Government. 

• Policy on replacement of speech therapists in context of moratorium on recruitment

Deputy Joe Costello (L): asked the Minister for Health and Children her policy on the replacement of speech therapists in the context of the moratorium on recruitment; if her attention has been drawn to the gaps in the service resulting from the availability of such a service both in the community and in hospitals in some parts of the country;

Minister for Health and Children (Deputy Mary Harney): There has been a growing demand for, and investment in, speech therapy services over the last number of years. A particular priority for my Department and the Department of Education and Skills in recent years has been the expansion of the supply of therapy graduates. The Government has invested heavily in the education and training of such personnel in order to secure a good supply of graduates to provide for the healthcare needs of the population into the future. As a result, the numbers employed in speech and language therapy has grown significantly, from 282 whole time equivalents employed in December 1997 rising to 838 whole time equivalents in July 2010, which represents an increase of 197%.With regard to the continued recruitment of speech therapists, my Department has written to the Health Service Executive setting out the overall approved employment control ceiling for 2010. As part of this approval, written confirmation has been provided to the HSE that the general moratorium on recruitment, promotion and the payment of acting up allowances does not apply to specific designated grades. Delegated sanction has been given to the HSE for the creation and filling of frontline posts, including speech and language therapy posts. The approval indicated that vacancies in existing posts in these grades may continue to be filled. New posts may also be created in these grades, up to a specified limit, provided that the HSE is satisfied in each case that there is no scope to redeploy an equivalent post from the hospital sector to the primary and community care sector. This moratorium exemption provides for an increase in the number of speech and language therapy posts, in line with Government policy, in order to meet the requirements of integrated care delivery and primary care needs particularly in respect of children at risk, the elderly and those with disabilities. 

• Number of physiotherapists employed in each HSE region

Deputy Pat Rabbitte (L): asked the Minister for Health and Children the number of physiotherapists currently employed or contracted by the Health Service Executive in each HSE region; her plans to increase this number;

Minister for Health and Children (Deputy Mary Harney): My Department has written to the Health Service Executive setting out the overall approved employment control ceiling for 2010. As part of this approval, written confirmation has been provided to the HSE that the general moratorium on recruitment, promotion and the payment of acting up allowances does not apply to specific designated grades. Delegated sanction has been given to the HSE for the creation and filling of frontline posts, including physiotherapy posts. The approval indicated that vacancies in existing posts in these grades may continue to be filled. New posts may also be created in these grades, up to a specified limit, provided that the HSE is satisfied in each case that there is no scope to redeploy an equivalent post from the hospital sector to the primary and community care sector. This moratorium exemption provides for an increase in the number of physiotherapy posts, in line with Government policy, in order to meet the requirements of integrated care delivery and primary care needs particularly in respect of children at risk, the elderly and those with disabilities. With regard to the number of physiotherapists currently employed in each HSE region, as this is a service matter it has been referred to the HSE for direct reply. 

• Budgets for community care

Deputy Róisín Shortall (L): asked the Minister for Health and Children to ensure that the budgets for community care are protected in order that elderly and disabled persons currently receiving home help or home care will not be adversely affected;

Minister of State at the Department of the Health and Children (Deputy Áine Brady): Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. This is delivered through a range of community services such as Home-Help, Home Care Packages, Meals-on-Wheels, and Day/Respite care. Such supports have the added objectives of reducing inappropriate admissions by older people to acute hospital or long-term residential care.  The importance attached to these services is highlighted by the fact that over €200m additional funding has been provided in recent years for these services. The HSE has responsibility for the delivery of Home Care services, in line with its National Service Plan 2010. This commits the Executive to provide 11.98 million Home-Help hours nationally this year to over 54,000 people. The target for 2010 for Home-Help hours is unchanged over the 2009 figure. In addition to the mainstream Home-Help provision, the current Plan is designed to deliver Home Care Packages to around 9,600 people at any one time, or to some 13,000 clients over the course of the year, and to cater for the provision of around 21,300 Day/Respite Care places.In the period 2006 to 2008, over €425m was provided to the HSE under the National Disability Strategy Multi Annual Investment Programme for the provision of additional specialist health and personal social services for people with a disability. In 2009, the HSE provided 3.2 million hours of personal assistant / home care services to people with a disability. In Budget 2010 additional funding of €19.5m was provided to the Executive to respond to demographic growth in demand for emergency residential placements, additional day places, and personal assistant/home support hours. The current HSE Service Plan commits the Executive to providing the same level of service as in 2009, in other words, 3.2 million hours, and an additional 140,000 hours of personal assistant / home care services for people with a disability.Deliberations by the Government on the expenditure allocations for next year are likely to continue up until Budget time, and it would not be appropriate for me to comment further at this stage, pending the outcome of those deliberations. The very difficult financial position facing the Exchequer will obviously require very careful management across all areas of expenditure. Notwithstanding this difficult financial environment, the Government is determined to do everything possible to protect the services referred to by the Deputy, to respond to priority demographic and other needs, and to support ongoing reform of the public heath services within the resources available for health. 

• School age disability speech and language therapy service in Dublin West

Deputy Joanna Tuffy (L): asked the Minister for Health and Children if her attention has been drawn to the fact that, at present, the school age disability speech and language therapy service in Dublin West is not operational; when this service will commence in view of the need to address this situation due to the number of children who urgently require these services;

Minister of State at the Department of Health and Children (Deputy John Moloney): As the Deputy’s question relates to service matters, I have arranged for this question to be referred to the Health Service Executive for direct reply.

BACK TO MAIN DÁIL DEBATES & QUESTIONS PAGE