31 May 2011

Dáil Debates

• Priority Questions: Implementation of mental health strategy
• Order of Business: Primetime programme on carers

Parliamentary Questions

• SNA cuts in Dublin
• Cuts to dental treatment scheme

DÁIL DEBATES

• Priority Questions: Implementation of mental health strategy

Deputy Dara Calleary (FF): asked the Minister for Health and Children if he will provide an update on the implementation of the mental health strategy.

Deputy Kathleen Lynch (Minister of State with responsibility for disability and mental health): A Vision for Change contains 200 recommendations to be implemented over a seven to ten-year timeframe. Progress to date includes: the closure of a number of the old psychiatric institutions with ongoing work on the closure of the remaining institutions; a 17% decline in the number of patients resident in psychiatric facilities since 2006; fewer admissions and involuntary admissions; a year-on-year reduction since 2001 in the number of patients readmitted to hospital pointing to an improvement in community-based services; significant improvements in child and adolescent services with more multidisciplinary teams in place throughout the country and an increase in the number of inpatient beds; significant engagement with service users; and improvements in the forensic service.

An independent monitoring group was established to monitor and assess progress on the implementation of the recommendations set out in the report. I look forward to the group’s annual report for 2010 which I expect to receive within the next few weeks. This will give an independent update on the current status of implementation and will give us the opportunity to take stock of where we are and identify areas in need of further improvement.

The reform of our mental health services is a priority for the Government. I assure the Deputy that I am fully committed to improving our mental health services, and to driving the implementation of A Vision for Change and the transition from an institutional to a community-based model of care. I am working with officials in my Department as well as the HSE with a view to delivering progress on the reform process in this area as early as possible.

Deputy Billy Kelleher (FF):  Has the Minister of State established how many adult and children mental health teams the HSE has established? Obviously it is an issue on which we would like to get some clarity. An implementation group for A Vision for Change was established to ensure there was ongoing monitoring of the implementation of the 200 recommendations. In addition the Office for Disability and Mental Health was established in 2008. Does the Minister of State intend to allow that office to continue so as to ensure a strong emphasis on mental health and disability?

Deputy Kathleen Lynch:  There are approximately 61 multidisciplinary teams which will include child and adolescent services. I am not certain that they are fully functioning. That is something we will need to investigate. While many are fully staffed, not all of them are. We are most concerned about children. Two new purpose-built 20-bed child and adolescent units at Bessborough in Cork and Merlin Park in Galway have been completed. I have visited both of these exceptional facilities. Acute admissions at St. Brendan’s in Grangegorman have now ceased. Enabling works are under way on the development of a 54-bed replacement long-stay facility as part of the Grangegorman redevelopment project. We are making progress. Progress in some areas is easier than in others. The community-based services are important, as are multidisciplinary teams, and the child and adolescent service. There are other areas where there is major resistance to closing old institutions. I do not believe there is one person in this establishment who feels that those institutions should continue as they are.

Deputy Billy Kelleher:  I welcome the Minister of State’s commitment to continue to close the old psychiatric hospitals and to provide community-based facilities. Given the statement of the Minister for Health and Children, Deputy Reilly, that he does not agree with the number of primary care teams the HSE claimed it had established, would it not be appropriate to look at whether these adult and child community mental health teams are operational, as they cross over with the primary care teams?

Deputy Kathleen Lynch:  The commitment to mental health in the programme for Government is very clear. When an institution is being closed it is closed on an incremental basis. Only in the event of all the community services being in place will that institution close entirely. It is appropriate that people in certain areas — we all know where they are — have that assurance. That will be the practice under this Government. All community services will be in place before institutions are closed.

• Order of Business: Primetime programme on carers

Deputy Finian McGrath (I): I want to raise a number of issues and develop some of them further in regard to children with special needs and children and adults with an intellectual disability, whose service is threatened due to the current economic crisis. I hope the Taoiseach is aware of the major problems facing many families of children and adults with disability following the excellent “Prime Time Investigates” programme last night. It was an excellent example of public broadcasting highlighting the needs of the most vulnerable sections of society. This morning I attended a fund-raising event in Donnycarney for autistic children where the issue on the agenda was cuts to those services.

With regard to the intellectual disability sector, is the Taoiseach aware that we have a major problem with 3,845 people with an intellectual disability on waiting lists for residential day care and respite places? In view of that, I ask him not to cut any service for a child or adult with a disability and to make that a priority issue over the course of the next four years. Can the Taoiseach give me a commitment on that in the Dáil today?

Does the Taoiseach accept that children and adults with a disability and their families did not cause this economic mess and should not be blamed or penalised for it? That is an important point. Can he and his Government make that a core principle over the next four years?

Is the Taoiseach aware that 2,158 residential places, 208 day care places and 1,479 respite places are needed to end the waiting lists over the next four years? What are his plans to end those long waiting lists and to support those people and their families?

The Taoiseach (Enda Kenny TD):  Deputy McGrath has raised several issues similar to these in the past and I know he has a deep and personal interest in this area. The children did not cause this problem, nor did their parents. The Government will focus on this area as a priority and when the analysis of the comprehensive spending review is completed, we will know the truth of the scale of the priority that can be accorded to any of these sectors. Obviously, this one is very sensitive and personal to a great number of people.

I do not have the detail of the number on waiting lists for respite care to which Deputy McGrath referred but that is not just a statistic. Such care goes on every day, night, week and month and that places very considerable emotional and social pressure upon parents who did not cause this problem. I agree with the Deputy 100% in that regard.

The work being done by the Minister for Education and Skills for those with special needs and by the Minister for Health and Children in respect of respite care and waiting lists, and that entire area, is also being examined and referred to by the Ministry for children and youth affairs. These matters are all intertwined and interdependent. I do not have the details of the respite lists the Deputy mentioned but these matters are a priority.

Deputy Finian McGrath:  I thank the Taoiseach for his response. On the figures I gave, they are the up to date Health Service Executive figures and they came from the Minister for Health and Children.

Many parents have asked me if the Government is taking the issue seriously. For example, many parents were in the audience of “The Frontline” programme on RTE 1 last night yet not one senior Minister or Minister of State could be found to appear and put the Government’s position on the table. Many of those parents were offended by that and many people throughout the estate were upset about it. Will the Taoiseach take this issue very seriously?

On other issues, particularly related to education, is the Taoiseach aware that one class of 28 six year old boys, with two children with special needs and others with severe behavioural problems, has had its SNA hours reduced to three days per week from 9 a.m. to 11 a.m.? In addition, one of those children is incontinent and at times has to wait until another SNA can come to provide support from another part of the school. Where does that leave the dignity and the long-term health implications of the child, with the child being forced to wait for these services? Also, is the Taoiseach aware that an ABA school in Donaghmede on the north side of Dublin will close in July due to lack of Government funding?

The Taoiseach:  I will refer the Deputy’s last point to the Minister. I assume the school to which he refers is an official school in respect of ABA. I am well aware from meeting parents of children in schools that have been set up around the country because parents believe in ABA that such schools are entirely voluntarily funded, and the pressure on those people to continuously raise funds for teachers in whom they believe is quite considerable. This morning the Government approved the publication of the report into SNAs, which is an issue that should be debated in the House. The Deputy will find matters of considerable importance in that report that should and will be discussed here.

As I understand it, the Minister was not consulted about the preparation of the programme yesterday. I believe contact was made some time before the broadcasting of the programme asking the Minister to appear in respect of a programme that he had not seen…Nobody over here has any difficulty about appearing on programmes. The Minister will do a programme on this issue very shortly. I would like to think that some of the issues dealt with in the programme last night should have been dealt with long before now. For example, why does somebody have to wait for four years to make his or her home wheelchair accessible? Why is somebody suffering from motor neurone disease turned down for a medical card? One of my best friends died from that disease. I know, from a layman’s perspective, the sad and tragic path of that disease, yet one cannot get any facilities without a medical card, even though it is a terminal illness. Some of the shocking revelations that were made in the nine cases outlined last night speak for themselves. That is precisely why we have to review the entire structure of the way services are delivered and money is spent. This goes on every day and it is a shocking indictment of society in 2011 that many of these things came to light. I do not deny that and I sympathise and empathise with those people whose cases were highlighted last night. Many others who we both know have to contend with this every day, and that is not the way things should be. When the Government gets the truth about the scale of this, that is not the way it will be. I would like to think that we could reverse all of these things overnight, but we cannot do that.

It is important that everybody has a genuine interest in these things and we in the Oireachtas should see to it that when we get the relevant Ministers’ responses to the comprehensive spending analysis, we determine what is in the best interests of those who should be given a clear priority here.

PARLIAMENTARY QUESTIONS

• SNA cuts in Dublin

Deputy Mary Lou McDonald (SF): asked the Minister for Education and Skills the number of special needs assistants that schools in the Dublin central constituency will lose in the next academic year 2011-12; and if he will provide details of the schools affected. Minister for Education and Skills (Deputy Ruairí Quinn):  I wish to inform the Deputy that there has been no overall reduction in the number of Special Needs Assistants in our education system. The Deputy will be aware that it is necessary to ensure that educational services are delivered within the resources available due to the current fiscal position. I intend to prioritise and support special educational services. However, I cannot re-visit the previous Government’s decision to place a cap on the number of posts available under the Special Needs Assistant (SNA) scheme. This number is 10,575 whole time equivalent (WTE) posts. This is a significant number of posts and unlike other areas of the public sector vacancies are being filled up to this number. It also represents continual increases in the number of SNAs over recent years.It is considered that with equitable and careful management and distribution of these resources that there should be sufficient posts to provide access to SNA support for all children who require such care support to attend school, in accordance with Departmental criteria. The NCSE has issued a circular to all schools advising of the allocation process for the 2011-2012 school year. A key feature of the amended scheme will be to provide for an annual allocation of Special Needs Assistant support to eligible schools. 

• Cuts to dental treatment scheme

Deputy Peadar Tóibín (SF): asked the Minister for Health and Children if he will reverse the cutbacks to dental treatment schemes;

Minister of State at the Department of Health and Children (Deputy Róisín Shortall):  Given the current difficult position of the public finances, the budget for the Dental Treatment Services Scheme (DTSS) has been capped at the 2008 level of €63 million. While it is not possible to increase spending on the DTSS, the HSE is working to ensure that patients with special needs, high risk patients and those who have greater clinical needs are prioritised for treatment.

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