February 11 2010

Dáil Debates

• Oral questions: home care costs for children with a disability
• Oral Questions: Inspection of disability services

Parliamentary Questions

• New Central Mental Hospital
• Private property accounts and notifying family members
• Inspection of disability service
• Number of special classes for children with autism at primary level

DÁIL DEBATES

• Oral questions: home care costs for children with a disability

Deputy Alan Shatter (FG): asked the Minister for Health and Children the action she will taketo ensure the Health Service Executive engages in discussions with an organisation (detailssupplied) to provide the estimated €1,970,000 per annum additional financing required toenable the expansion of its home care services for severely disabled children to children underthe age of six years; her views on the fact that such an extension of services offers significantcost reductions to the State and also the uniform delivery of better services for severely disabledchildren and their parents; her further views on the conclusions of the report entitled, There’sNo Place Like Home — A Cost and Outcomes Analysis of Alternative Models of Care forYoung Children with Severe Disabilities in Ireland, published on 3 February 2010.

Minister of State at the Department of Health and Children (Deputy John Moloney): The HSE provided funding of €585,000 to the Jack and Jill Children’s Foundation in 2009 and will be happy to consider the report “There’s no Place like Home” as part of its engagement with the foundation this year. Neither my Department nor the HSE was involved in the preparation of this report. I agree that, in general, children’s needs are most appropriately met and provided in the home, and that we need to ensure more efficient use of resources. However, many children availing of services provided by the Jack and Jill Children’s Foundation also avail of other disability services and the report did not compare the respective costs of the home-based care provided by the foundation to the cost of similar services provided by the HSE. The current economic and budgetary position means we can only continue to fund new services by reducing costs and greater efficiency, including achieving greater integration of services provided by the statutory and non-statutory sectors. I should mention in this context that my Department is undertaking a review of the efficiency and effectiveness of the health and personal services provided to people with disabilities. This review is part of the Government’s value for money and policy review programme. The review will focus, in particular, on the scope for achieving greater efficiency and effectiveness from the substantial resources expended on services for people with disabilities and will support the future planning and development of such services. I can assure the Deputy that the issues raised in the Jack and Jill Children’s Foundation report will be considered as part of that review.

Deputy Alan Shatter: Will the Minister of State acknowledge that it was not possible for the report to consider any home-care services provided by the HSE and the costing of those services with the Jack and Jill Children’s Foundation services because the information is simply not available? There is a lack of uniformity across the country in the services available for severely intellectually disabled children. Would the Minister of State agree that the Jack and Jill Children’s Foundation catering for 1,200 families with severe intellectual disability since 1997 has done extraordinary work? Would he accept that in the context of the provision of care for such children the annual average cost to deliver acute hospital care for a severely disabled child is €147,365 compared to the average cost of €16,427 per annum for the child to have home care by the Jack and Jill Children’s Foundation? Would the Minister of State acknowledge that it is desirable that the services provided by Jack and Jill Children’s Foundation be extended to children between the ages of four and six as many of the State and HSE-provided services do not kick in until a child is six? It would require an additional grant of €1,970,000 per annum to the Jack and Jill Children’s Foundation to ensure that a universal service is available to all families with a severely disabled child so that the child could be provided with home care uniformly across the country. Would the Minister of State not merely encourage, but specifically ask the person in charge of these services in the HSE — it is not always clear who that is — to sit down with representatives of the Jack and Jill Children’s Foundation to work out how to most efficiently and cost-effectively provide the essential services needed for all children under six with severe intellectual disability?

Deputy John Moloney: The Deputy has asked a number of questions. There is no dispute over the figure of €143,000 as compared to the cost of care provided by the Jack and Jill Children’s Foundation. I acknowledge the value of care provided by the Jack and Jill Children’s Foundation. I dispute the Deputy’s contention about availability of comparative information. That information is available. Naturally, when we consider the €1.6 billion that is now provided to support people with disabilities, that is the main frame for the review. I do not want to use the review in the context of a money saving exercise — it is far from that. It is an attempt to ensure that the €1.6 billion that is being provided provides the maximum level of care. The review is not all about value for money or savings. It is also about policy. It is very important in the context of what the Deputy just said and in particular by the way of the services being provided by the Jack and

Jill Children’s Foundation that we also look at the proposal by way of direct payment to families and clearly this is part of the policy review. I must accept the point the Deputy makes that in comparison to the cost to the State of the care provided by the Jack and Jill Children’s Foundation, the jury is certainly in on that one — the value is far greater. The review proposals are not long term — they will be with the Department by June. In the meantime, I intend, with the departmental officials, to meet not just representatives of the Jack and Jill Children’s Foundation, but also many other providers to ensure they are involved in the review.

Deputy Alan Shatter: I very much welcome that the Minister of State will meet representatives of the Jack and Jill Children’s Foundation. That would be a major step forward. I understand that while the Jack and Jill Children’s Foundation on occasions works in co-operation with different sections in the HSE, its representatives have found it impossible to identify a person in charge who will sit down and talk to them about the national service it provides. I ask the Minister of State to communicate with me as to who they should contact in that regard and to encourage the HSE to engage in such discussions. Does the Minister of State have the figure for the cost being incurred on an annualised basis by the HSE service to assist the parents of severely intellectually disabled children who are providing home care to them? I ask him to make the comparator public. What is needed is a coherent uniform service delivered by the most cost effective and well staffed service provider. The Jack and Jill Children’s Foundation has an extraordinary imprimatur from all families to whom it provides assistance. I ask the Minister of State to consider a policy direction to the HSE to provide this service through the Jack and Jill Children’s Foundation and to extend it to children aged between four and six.

Deputy John Moloney: I take precisely the advice the Deputy is giving. I have already initiated those policy decisions under a number of headings. I have no difficulty meeting the HSE and providing publicly the comparator figures. I insisted that two people from the disability sector — one from the intellectual disability sector and one from the physical disability sector — should be on the review committee examining the funding for disabilities to ensure that everything the Deputy is saying would be put in place. I agree with the Deputy that probably owing to the changeover from the old health board system to the HSE there has been certain confusion as to who is the lead in disabilities in each area. I do not use the review in the context of a long-fingered approach. I am talking about having the review completed and report published by mid-June. That part will bring total clarity to those in charge in each specific local health area.

• Oral Questions: Inspection of disability services

Deputy Bernard Allen (FG): asked the Minister for Health and Children when she will introduce legislation to regulate and inspect disability services;

Deputy Thomas P. Broughan (L): asked the Minister for Health and Children her views on reports that more than 500 complaints were made in the past two and a half years relating to the treatment of persons with disabilities in residential care; when all residential care centres for persons with disabilities will be subject to independent standards and inspection;

Deputy John Moloney: I proposed to take Questions Nos. 10, 49 and 56 together. As Deputies will be aware, the National Quality Standards: Residential Settings for People with Disabilities, which relate to adult services, have been published by HIQA. Following a public consultation process initiated by HIQA, these standards were formulated by a standards advisory group which comprised officials from HIQA, the Department, the HSE, service providers, organisations representing people with disabilities and service users. These standards will provide a national framework for quality, safe services for persons with disabilities in a residential setting. In light of the current economic situation, the move to full statutory implementation of the standards, including regulation and inspection, presents significant challenges at this time. However, notwithstanding the difficulties of immediate statutory implementation, the Department, the HSE and HIQA have agreed that progressive non-statutory implementation of the standards will now commence and that they will become the benchmark againSt which the HSE assesses both its own directly-operated facilities and other facilities that it funds. Discussions are ongoing regarding the development of self-assessment tools, providing awareness training for service providers and the introduction of an appropriate level of external validation for relevant settings. A number of preliminary processes are already in place within the HSE to facilitate this work. For example, compliance with the HIQA standards is included in the service level agreements being implemented between the HSE and service providers. As part of the ongoing review of service level agreements, service providers will now be required to demonstrate compliance with the standards through the provision of audit outcomes. I am informed by the HSE that the majority of service providers have already commenced a review of their services within the context of the HIQA standards. Many service providers have also achieved external accreditation over the past number of years. I am assured by the HSE that it has a robust system in place to deal with any complaints made in respect of the treatment of persons with disabilities in residential care. This includes ensuring that all HSE-funded service providers of residential care have appropriate complaints procedures that are in line with HSE policy.

Deputy James Reilly (FG): The Minister of State will acknowledge that there are 8,000 adults and 400 children in institutions of care and that there are no independent inspectors. Hundreds of complaints have been made about these institutions in the past two years. These complaints relate to issues from poor accommodation to allegations of abuse or neglect. Last year, the Ryan report illustrated the extent of the abuse that took place in industrial schools in the past. This week, “Primetime” reminded us of the dreadful living conditions and absence of therapeutic treatments in State psychiatric hospitals and institutions. I know the Minister of State accepts that we must protect the disabled from abuse. I put it to him, however, that the €5 million that could have been saved by applying the full 5% pay cut to senior civil servants would pay for this inspectorate to be put in place by the end of the year. I am seeking from him a commitment to the effect that he will find the money to allow this to happen. We are discussing the most vulnerable people in our society and they must be protected.

Deputy Jan O’Sullivan (L): I support the comments made by Deputy Reilly. More than 500 complaints have been made in the past two and a half years. There is a need to shine a light on these institutions. The Joint Committee on Health and Children, of which some of those present are members, must visit these facilities and members of the public must make constant visits to their relatives and friends within them. Unfortunately for many of those who live in these institutions, no one visits them or sees what is happening.

Deputy James Reilly: They do not have anyone to speak for them.

Deputy Jan O’Sullivan: What is planned is welcome but it must be put in place sooner rather than later. As public representatives, we have a duty to visit the institutions to which I refer.

Deputy Caoimhghín Ó Caoláin (SF): Deputy Jan O’Sullivan referred to the 500 complaints that have been made in the past two and a half years. The reality is that the people living in these institutions are often voiceless and are not in a position to make such complaints, which underlines the need to put in place an inspection regime.

Deputy John Moloney: I do not want to offer excuses in respect of this extremely important issue. Last year, Inclusion Ireland complained that we were not carrying out inspections in respect of children. The position in this regard has changed and such inspections will be forthcoming before the end of this year. I wish I could say when all of these matters will be dealt with. The report is imminent and I am committed to securing the funding to provide for an inspectorate. I take the point made by the Deputies in respect of the many people who live in institutions of this nature. While I accept that 500 is a large number of complaints — I do not wish to reduce the import of what was said by Members opposite in this regard — many of those complaints could easily have been dealt with if the inspectorate were in place.

PARLIAMENTARY QUESTIONS

• New Central Mental Hospital

Deputy Róisín Shortall (L): asked the Minister for Health and Children the decisions that have been made regarding the construction of a new Central Mental Hospital; if funding is available for this purpose;

Minister of State at the Department of Health and Children (Deputy John Moloney): It had been intended to locate the new Central Mental Hospital (CMH) at Thornton Hall, Co. Dublin; however it has been ascertained that the site proposed for the development of the new hospital is not large enough to accommodate an Intellectual Disability Forensic Mental Health Unit and a Child and Adolescent Forensic Mental Health unit, the need for which has been identified by the HSE. The question of the relocation of the CMH to an alternative site is currently under consideration. In the context of discussions regarding the Capital Programme for Budget 2010 it was agreed that alternative financing models would be explored for the development of the new CMH. 

• Private property accounts and notifying family members

Deputy David Stanton (FG): asked the Minister for Health and Children if, in relation to the payment of funds into patient private property accounts under the provisions of the Health (Repayment Scheme) Act 2006, consideration was given to notifying family members, in particular parents, of persons who were deemed to not have adequate mental capacity; if same were in fact notified, regarding their right to apply to the judge of the Circuit Court to have the payment made elsewhere;

Minister for Health and Children (Deputy Mary Harney): Under the Health (Repayment Scheme) Act 2006, a relevant person or a connected person as defined in the Act was entitled to apply for a repayment under the scheme. A relevant person is a person who was charged and paid recoverable health charges. A connected person includes the following:(a) a person who has been nominated in writing by the relevant person(b) the Registrar of Wards of Court if the relevant person is a ward of court,(c) a person with an enduring power of attorney in respect of the relevant person,(d) a next friend appointed by a court, (e) the HSE if none of the aforementioned is applicable to the relevant person, and the relevant person is unable to make an application due to a physical or mental disability or ill-health,(f) a living spouse or living child of the relevant person who has paid recoverable health charges on behalf of the relevant person.In regard to patients in the care of the HSE who were deemed by a medical practitioner not to have sufficient mental capacity to understand the scheme and for whom there was no other connected person as mentioned earlier, the HSE made application to the Scheme Administrator for a repayment on their behalf. As provided for in the legislation, all such payments made in respect of HSE applications were lodged to the patient’s own private property account. The legislation also provides that an application may be made to a judge of the Circuit Court for the repayment to be made otherwise than to the patient’s private property account. Where monies have been lodged to the patient’s private property account the HSE ensures that this money is used only for the benefit of the patient. Where monies are required for the benefit of the patient, contact should be made with the relevant care centre for access to the funds. During the lifetime of the scheme, it was the HSE’s policy to advise and discuss with family members, claims that were made by the HSE on behalf of the patient. In addition, Section 9(2) of the Health (Repayment Scheme) Act 2006 provides that the account holder or a next friend appointed by a court may direct the HSE (a) not to invest money held in the account on behalf of the account holder and (b) not to use money in the account for the patient’s benefit. 

• Inspection of disability service

Deputy James Reilly (FG): asked the Minister for Health and Children when she will introduce legislation to regulate and inspect disability services;

Minister of State at the Department of Health and Children (Deputy John Moloney): I will shortly be bringing detailed proposals to Government with regard to the protection of vulnerable adults with disabilities who are currently in institutional care. As Deputies will be aware, “National Quality Standards: Residential Settings for People with Disabilities” which relate to adult services have been published by HIQA. Following a public consultation process initiated by HIQA they were formulated by a Standards Advisory Group that comprised officials ofHIQA, my Department, the HSE, service providers, organisations representing people with disabilities and service users. These standards will provide a national framework for quality, safe services for persons with disabilities in a residential setting. Given the current economic situation, to move to full statutory implementation of the standards, including regulation and inspection, presents significant challenges at this time. However, notwithstanding the difficulties of immediate statutory implementation, my Department, the HSE and HIQA have agreed that progressive non-statutory implementation of the Standards will now commence, and that they will become the benchmark againSt which the HSE assesses both its own directly operated facilities and other facilities that the HSE funds. Discussions are ongoing regarding the development of self-assessment tools, providing awareness training for service providers and the introduction of an appropriate level of external validation for relevant settings. A number of preliminary processes are already in place within the HSE to facilitate this work. For example, compliance with the HIQA standards is included in the Service Level Arrangements being implemented between the HSE and service providers. As part of the ongoing review of Service Level Arrangements, service providers will now be required to demonstrate compliance with the standards through the provision of audit outcomes. I am informed by the HSE that the majority of service providers have already commenced a review of their services within the context of the HIQA standards and many service providers have also achieved external accreditation over the past number of years. In addition, I am assured by the HSE that it has a robust system in place to deal with any complaints made in relation to the treatment of persons with disabilities in residential care. This includes ensuring that all HSE funded service providers of residential care have appropriate complaints procedures that are in line with HSE policy. 

• Number of special classes for children with autism at primary level

Deputy Brian Hayes (FG): asked the Minister for Education and Science the number of special classes for children with autism at primary level on a county basis; the name and address of each school making such provision;

Minister for Education and Science (Deputy Batt O’Keeffe): As the Deputy is aware the establishment of the current national network of autism-specific special classes in schools has been a key educational priority in recent years. In excess of 380 classes have now been approved around the country at primary and post primary level, including many in special schools. The NCSE will continue to establish additional special classes as required. I have arranged for a detailed breakdown of these classes to be forwarded directly to the Deputy.

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