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Dáil Debates & Questions
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JUNE 5 2008 Dáil Debates
Parliamentary Questions
DÁIL DEBATES An Leas-Cheann Comhairle (Brendan Howlin TD): Before coming to the Order of Business I propose to deal with a notice under Standing Order 32. I call on Deputy Seymour Crawford to state the matter. Deputy Seymour Crawford (FG): I seek the adjournment of the Dáil under Standing Order 32 to debate the following urgent matter, namely, the failure of the Minister for Health and Children, Deputy Harney, and the Health Service Executive to provide an interim measure to deal with the crisis that is preventing the subvention office paying the necessary funds to those who cannot afford private nursing home charges but are forced to avail of these facilities because of the lack of public beds. I am aware of an individual who has been asked to pay €1,117.24 for the month of May, which he cannot afford. Another man has two sisters in a nursing home, one with multiple sclerosis and the other with cerebral palsy, and cannot afford these types of costs. There is an urgent need for a debate on this issue and an examination of how the €110 million set aside for the fair deal programme has been spent. This House cannot retire for a long summer break while leaving elderly and disabled persons and their families in the lurch. An Leas-Cheann Comhairle: Having given the matter full consideration, I do not consider it to be in order under Standing Order 32. Deputy Seymour Crawford: It should be.
Deputy Kathleen Lynch (L): The issue I wish to raise arises as a result of the answer to a parliamentary question I submitted, just in case the Tánaiste suggests the matter is more appropriately to be dealt with by way of parliamentary question. Legislation has been enacted to deal with this issue and I want to know when it will be fully implemented. It relates to people with an intellectual disability who are inappropriately placed in psychiatric hospitals. I received the reply to my question this morning and it makes harrowing reading. I want to talk about the timeframe for introducing statutory instruments. I will read the last paragraph. An Leas-Cheann Comhairle (John O’Donoghue TD): I wish the Deputy would not. Deputy Kathleen Lynch: It is very brief. An Leas-Cheann Comhairle: If it is a very serious matter, it can be dealt with by way of Adjournment Debate. Deputy Tom Sheahan: Consistency is not futile. Deputy Kathleen Lynch: Every time the Tánaiste stops to rest today — I know that will not be often — she should think about one of these people. There are 98 people, one third approximately—— An Leas-Cheann Comhairle: While I agree this is a very serious matter, it is not appropriate for the Order of Business, as the Deputy knows. Deputy Kathleen Lynch: ——with a mild disability in psychiatric hospitals, one of whom needs to be moved to a nursing home. There is another group investigating it. An Leas-Cheann Comhairle: It is not appropriate to raise it now. Deputy Kathleen Lynch: It is appropriate in so far as we need statutory instruments to deal with it. An Leas-Cheann Comhairle: The Deputy might consider submitting a request to have the matter discussed on the Adjournment Debate. Deputy Kathleen Lynch: The Adjournment Debate will give me the contents of the reply I received this morning, which is of no benefit to the 329 people—— An Leas-Cheann Comhairle: It would be better if the line Minister were here. Deputy Kathleen Lynch: ——who are in psychiatric hospitals and should not be there. Deputy Michael D. Higgins (L): I raised this matter before, but it is necessary to raise it again. This week is the first ever disability and international development week. On the ratification of the United Nations Convention on Disability, I received a reply indicating that the Minister for Health and Children or the Minister for Justice, Equality and Law Reform would reply to me directly, but that has not happened. If other countries proceed to ratify ahead of Ireland not only will Irish citizens with a disability not have access to the protection of the convention, but also Ireland will only be entitled to be an observer at the monitoring committee on its implementation. An Leas-Cheann Comhairle: On the ratification of the convention. Deputy Michael D. Higgins: Will it be ratified in the lifetime of the Government? The Tánaiste: I know the Taoiseach raised the matter at the Deputy’s behest with the Minister for Foreign Affairs and he will be in touch directly. I will give him a reminder on the matter. Deputy Dan Neville (FG): asked the Minister for Health and Children her view on the findings of the Inspector of Mental Health Services who stated in her 2007 annual report that she has serious concerns regarding the conditions of long-stay wards in psychiatric hospitals, that the recruitment embargo has greatly impeded the development of mental health services and that there has been little progress in implementing A Vision for Change; if, in view of the development of a quality national mental health service, she will reconsider the decision to relocate the Central Mental Hospital to Thornton Hall in view of expert opinion and have it reconstructed on the current grounds of the Central Mental Hospital, Dundrum, County Dublin; Minister of State at the Department of Health and Children (Deputy John Moloney): I share the concerns of the Inspector of Mental Health Services regarding conditions in the long-stay wards of some psychiatric hospitals. I point out in this regard that capital funding of €145 million was provided and expended on the upgrading of mental health facilities under the National Development Plan 2000 to 2007 and additional funding of €20 million per annum will be provided from the new plan in the period 2008 to 2011. A Vision for Change, the report of the expert group on mental health policy, recommends that a plan to bring about the closure of all psychiatric hospitals be drawn up and implemented and that the resources released by these closures be protected for reinvestment in the mental health service. Work is advancing nationally on the process of replacing the remaining psychiatric hospitals with a range of modern health services. I expect that closure plans for existing psychiatric hospitals will be put in place by the end of 2008. These plans will have due regard to the preferences and the assessed needs of each patient. I also understand that a comprehensive programme for the valuation and sale of mental health facilities is currently in progress. Revenue raised from these sales will be directed towards improving mental health services. The recruitment pause put in place in September 2007 was initiated as part of the HSE financial break-even plan to facilitate the delivery of services on budget in accordance with the provisions of the 2007 national service plan. This temporary pause in recruitment ended just three months later on 31 December 2007 and any posts falling vacant from 1 January 2008 can be filled, subject to the provisions of the HSE employment control framework for 2008. With regard to the implementation of A Vision for Change, the position is that the HSE recently approved an implementation plan which sets out six key priorities for 2008 and 2009. Following concerns raised by the Office for Disability and Mental Health regarding the need for a longer-term focus, the HSE has indicated that it will prepare a more comprehensive plan before the end of this year. A Government decision in May 2006 approved the development of a new national forensic mental health facility at Thornton Hall, north County Dublin. The new hospital will provide a therapeutic, forensic psychiatric service to the highest international standards. The decision to relocate the Central Mental Hospital is consistent with A Vision for Change. In the circumstances, there are no proposals to revisit the Government decision of May 2006. Deputy Dan Neville: I congratulate the Minister of State on his appointment as this is his first time to answer questions in the House. I wish him well. Deputy John Moloney: I thank the Deputy for his good wishes. Deputy Dan Neville: The Minister of State must be extremely concerned and appalled at the recently published report of the Inspector of Mental Health Services showing the unacceptable squalor that many psychiatric patients live in while the mental health services and the HSE are sitting on billions of euro worth of property, which the Minister of State has again committed to sell on behalf of the health services. In 2006, over €1.3 million worth of health service property was sold and €776,000 worth was sold the following year, but all of the proceeds of the sales were surrendered to the Exchequer and nothing was reclaimed to fund developments in the psychiatric service. The inspector stated that the condition of our psychiatric services was poor, to put it mildly, as was the structural fabric of the hospitals. She stated it was a running battle to keep ahead of damp, mould, falling plaster and peeling paint and that the funding needed to maintain these hospitals is considerable. Does the Minister of State accept it is not acceptable that the most vulnerable people are forced to live in these conditions? The commitments made since 1984 by various Ministers have not been implemented. Given that there are no further funds for the introduction of A Vision for Change this year, how can we have confidence that something will be done? The problems filling the multidisciplinary teams and the vacancies that occurred had an enormous effect on the delivery of services in 2007, according to the inspector. The problem is that the vacancies that occurred between September and October are not being filled. Deputy John Moloney: I have also read the report of the Inspector of Mental Health Services, which was published on 29 May. I am in this job three weeks and I give a full commitment that, whatever has happened before, I intend pushing forward immediately with the sale of lands and properties owned by the HSE. I do not intend to travel just for the sake of travelling. The hospitals outlined specifically in the report need to be sold off. I have asked the officials of the Department to draw up a current list of valuations. I intend to invite the Oireachtas Members who represent the specific areas to a meeting in Leinster House this month to get their public support for selling those properties. I accept the views expressed in the report with regard to the need to move from the old days — some of these institutions have been there for 150 years — and to build proper modern facilities. I intend to progress this and I will not make a report on progress next year or the year after, but on a six-monthly basis. Not all of the expressions in the commission’s report are bad news and it is important to note the report is broadly positive. I recognise not just the fact that facilities are poor, but also the positive structures which are moving us to a situation where we are doing what is right for people who suffer mental health difficulties. The report highlights the significant changes that have occurred following the full implementation of the Mental Health Act 2001 and it makes the point that this includes the independent review system for those admitted involuntarily, which is important. We had looked for this process for years but the tribunals are now in place. All of these matters are positive. I ask that rather than being critical of what has happened, let us move forward on a positive note. Following the meeting with Oireachtas Members, I intend to invite in all of the stakeholders, as the Minister, Deputy Harney, did in the area of cancer. We can progress, evaluate and realise the valuable assets we have. I give the following specific commitment. What is raised in this area will go specifically and only into mental health. Deputy Dan Neville: In view of the concern and the round rejection by all concerned with forensic medicine of the move of the Central Mental Hospital to Thornton Hall, will the Minister of State revisit this matter? There is overwhelming expert opinion with regard to locating a therapeutic centre beside a custodial prison. Deputy John Moloney: I want to be direct in all my answers. I have no intention whatsoever of reviewing that. The Deputy asked me some minutes ago how we were to implement A Vision for Change and what we were going to do for the psychiatric services. The nonsense that we are talking about a prison and a hospital in the very same setting could not be further from the truth. It is two separate approaches and two separate roads. More importantly, if we are talking about scarce resources, the sale of Dundrum would realise €350 million and the building of a hospital would cost €150 million. The balance of €200 million will be invested in exactly what the Deputy is seeking. I am as concerned about the patient as anybody else. If the Deputy is blaming—— Deputy Dan Neville: Everybody, including international opinion, says it is wrong. Deputy John Moloney: I am trying to answer the question. On the one hand, the Deputy is blaming Government for not initiating change. On the other hand, I am criticised when I try to do that. Deputy Dan Neville: I am consistent in discussing the position of patients. Deputy John Moloney: I am also being consistent. Deputy Dan Neville: They do not agree. Deputy John Moloney: I have every confidence in the ability and expertise of the medical staff in Dundrum—— Deputy Dan Neville: Then listen to them. Deputy John Moloney: ——and I am certain they will put the patient at the centre—— Deputy James Reilly: They already have. Deputy John Moloney: ——just as I do. In regard to wasting time on revisiting Government decisions, I fully intend to implement this policy and I am putting the funding we can secure from the sale of the Dundrum lands into the same basket as other properties we sell throughout the country. I hope we receive the support of the public in ensuring patients come first. Deputy Dan Neville: That is what we want. Acting Chairman: I wish to be associated with the congratulations to the Minister of State on his recent appointment on which I wish him well. Deputy James Reilly (FG): I do likewise. Deputy John Moloney: I thank the Acting Chairman and Deputy Reilly. Long may it last. Deputy Martin Ferris (SF): asked the Minister for Health and Children if she will establish a national working group comprising children with specific speech and language impairments and their parents and key agencies involved in service provision including her Department, the Department of Education and Science and the Health Service Executive, with a view to reviewing and establishing agreed terminology and diagnostic criteria for specific speech and language impairments and addressing policy and service development. Deputy Ruairí Quinn (L): asked the Minister for Health and Children if she will meet the Irish Association of Speech and Language Therapists to establish a national working group to address issues regarding speech and language impairment; the co-operation and interaction between her Department and the Department of Education and Science; Deputy John Moloney (Minister of State with Responsibility for Disability and Mental Health): I propose to take Questions Nos. 6 and 66 together. Recognising the cross-cutting nature of the national disability strategy, the Government established the Office for Disability and Mental Health in January 2008. This office helps me in exercising my functions as Minister of State with responsibility for disability and mental health across the Departments of Health and Children, Education and Science, Enterprise, Trade and Employment and Justice, Equality and Law Reform. The office brings together responsibility for a range of different policy areas and State services which directly impact on the lives of people with disabilities and mental health issues. The office will aim to bring about improvements in the manner by which services respond to the needs of people with disabilities and mental health issues by working to develop person centred services, focusing on the holistic needs of clients and service users and actively involving them in their own care. A key priority for the office is to support the implementation of the health sectoral plan under the Disability Act 2005 and the planned implementation of the Education for Persons with Special Educational Needs Act 2004. The office will focus in particular on facilitating the delivery of integrated health and education support services for children with special needs by further developing existing mechanisms for co-operation and co-ordination between the health and education sectors at national and local levels. A cross-sectoral team consisting of senior officials from the Office for Disability and Mental Health, the Departments of Health and Children and Education and Science, the Health Service Executive and the National Council for Special Education meets on a regular basis to address issues arising in respect of the implementation of both Acts, as well as issues of crosssectoral responsibility. The focus of the team is on the interaction required between the education and health sectors in order to advance and enhance services to people with disabilities. The matter raised by the Deputy regarding the provision of appropriate services to children with specific speech and language impairment must be considered within the overall context of preparations within the health and education sectors for the implementation of the Education for Persons with Special Educational Needs Act. I have asked the cross-sectoral team to consider the matter in this context and to report back to me in due course. Deputy Caoimhghín O’Caoláin (SF): I tabled this question last week for a written response and I received almost exactly the same reply. I do not wish to begin on a feisty note but nowhere in the reply is reference made to speech and language therapy, even though this is the critical focus of my question. I ask the Minister of State to pass that on to those who assist in the preparation of these responses. The Minister of State might take this opportunity to correct the remarks made by the Taoiseach on 14 May. He caused concern within the sector by suggesting that the shortage of speech and language therapists was caused by the requirement on new graduate therapists to undergo a one year period of supervised clinical practice. Does the Minister of State agree with the statement of the Irish Association of Speech and Language Therapists that the Taoiseach’s comment was ill informed and does he accept that one year of supervised clinical practice is an internationally recognised best practice approach for all health professionals? Does he agree that the problem is not caused by the requirement on new graduates but by inadequate resourcing, insufficient posts to meet the demand for speech and language therapy and poor management by the HSE? Does he acknowledge that the services are not properly co-ordinated? Implementation is required of the recommendation by the Irish Association of Speech and Language Therapists on a national working party. The Minister of State referred to the cross-sectoral team but the critical difference between that and the proposed working party is that the latter would directly involve service users, including children and their parents, and the Department of Education and Science and the HSE. That is clearly absent from the formula used in the replies given to the questions tabled today and last week. I acknowledge and welcome the 300% increase that has been made to the number of training places for speech and language therapists. However, that will not work on its own if it is not matched by the development of critical posts. With the recent HSE cuts, we face the prospect of increasing numbers of trained therapists leaving the country while children are deprived of the therapy they desperately need. I ask the Minister of State and his departmental colleagues to ensure that the increased numbers of trained therapists are retained within the system and that posts are opened up. They are clearly required given that children need intervention as early in their lives as possible. Deputy Jan O’Sullivan (L): I congratulate the Minister of State on his new position. I support Deputy O´ Caoláin’s comments regarding the need to establish this group. I am also concerned about the Taoiseach’s claim that one year of supervision was somehow holding up the provision of services to people who need speech and language therapy when that is in fact the international norm for ensuring new therapists are clinically safe. The record needs to be corrected by somebody in Government. Does the Minister of State consider it acceptable that children have to wait up to two years to receive the speech and language therapy they need at a crucial stage in their lives? What will be done about that situation? Due to embargoes and posts going unfilled despite the availability of trained graduates, that is the reality on the ground. I understand that disability services in certain parts of the country have not yet been given their budgets for 2008. Can the Minister of State clarify that? Deputy James Reilly (FG): I concur with the previous two speakers. There are precedents for clinical supervision. A newly qualified doctor has to serve an intern year under full supervision before being considered a fully fledged professional or continuing on to post-graduate training. The Taoiseach was unwise to use that example. As I noted earlier, 4,136 Dublin children are waiting an average of 18 months for speech and language services. If a child with autism does not receive an intervention between the ages of three and six, the window of opportunity is closed. Half of that period could be spent in waiting. It is an unacceptable situation and the Minister of State will have to address it in a more forceful manner than has formerly been the case. An entire class of physiotherapists have been trained at great expense and are badly needed for community and primary care, yet they are leaving the country because they cannot find employment. Deputy John Moloney: I am not in the business of correcting the Taoiseach because he is usually right. I will not speak on his behalf until I consult him directly. Deputy James Reilly: He is achieving a status similar to that of papal infallibility. Deputy John Moloney: He is close enough to doing so. I do not want to make little of the response. However, I want to be as direct as possible. I made the point that those involved with education for persons with special needs and the cross-sectoral team will meet shortly. The former Taoiseach, Deputy Bertie Ahern, established the new office with responsibility for disabilities and mental health, which has only been up and running since January last. Prior to that issues had always arisen in respect of the HSE and the Departments of Health and Children and Education and Science. The establishment of the new office represents an attempt to deal with these issues in one place. All of the issues to which the Deputy refers come within the remit of the office. As reports are received in the coming months, it will be our responsibility to decide how to proceed, particularly in the context of learning and special educational needs. From the figures, one might obtain the impression that we are downgrading services. I do not wish to use the time available to rattle off details of what has been achieved. However, it is worth placing on record the fact that the number of physiotherapists has risen by 230, or 20%, that the number of occupational therapists has risen by 320, or 45%, and that the number of speech and language therapists has risen by 140, or 28%. Deputy James Reilly: From impossibly low bases. Deputy John Moloney: I accept that we are coming from a low base. However, I ask the Deputy to bear in mind that the office was only recently established. The Government recognises the importance of the work of the office. It also accepts that we need to catch up quickly and that is what we are doing. The first priority on the agenda of the cross-sectoral teams is how the issues should be resolved and how the required professional staff should be put in place. I ask the Deputy to give the office a 12-month settling down period. When we return with a proposal in September or October, we will clearly show how we intend to deal with the matter of recruitment. It must be remembered that there are industrial relations issues with which we must deal. Deputy James Reilly: Will the Minister of State offer those physiotherapists who achieved of the order of 580 points to gain entry to courses and who are now fully trained an opportunity to earn decent incomes? Deputy John Moloney: The awful reality is that when the jobs in question were advertised three to four years ago, we could not get people to even apply for them. Deputy Jan O’Sullivan: Now the Government is going to export them. Deputy James Reilly: Are we going to live in the present or is the Minister of State determined to remain in the past? Deputy John Moloney: The establishment of the office underlines the commitment on the part of the Government to ensure that the issues raised by the three Deputies will be dealt with. We will communicate further with them in October or November when the process has been properly evaluated and when the position regarding need and demand has been established. Deputy James Reilly: What will be the position as regards the class of 2008? Acting Chairman: I must allow Deputy O’Caoláin to put his supplementary before the Minister of State answers that question. Deputy Caoimhghín O’Caoláin (SF): In a previous reply, the Minister for Health and Children, Deputy Harney, referred to the National Treatment Purchase Fund. Will the Minister of State, in the context of question I posed, indicate where stands the commitment in the programme for Government to ensure that any child under five waiting more than three months — not the two years to which Deputy Jan O’Sullivan refers — for occupational or speech and language therapy will be allowed to access these services automatically through the National Treatment Purchase Fund? How many children have been given such access? Deputy Jan O’Sullivan: Will the Minister of State indicate the position in respect of the disability budget for 2008? Deputy John Moloney: I am evaluating the commitment to which DeputyO´ Caola´ in referred. That evaluation will not be completed for at least six weeks. Deputy Jan O’Sullivan: Has the disability budget for 2008 been allocated? Deputy John Moloney: Not yet. Deputy Jan O’Sullivan: This is a matter of serious concern to people who cannot return to the community and who are occupying hospital beds. Deputy Jimmy Deenihan (FG): asked the Minister for Health and Children the status of the nursing home repayments scheme; the reason only one appeals officer has been appointed to deal with the large number of appeals; Deputy Joan Burton (L): asked the Minister for Health and Children the reason it is taking so long to process applications and appeals relating to the health repayment scheme; if she plans to address these delays; Deputy Mary Harney (Minister for Health and Children): I propose to take Questions Nos. 7 and 32 together. The Health (Repayment Scheme) Act 2006 provides a legal framework to repay recoverable health charges for publicly-funded long-term care. The Health Service Executive, HSE, has advised that as of 16 May 2008, more than 14,000 offers of repayment totalling more than €250 million have been made. Further offers continue to be issued every week. As a result of these offers, almost 10,500 payments worth in excess of €200 million have been made. The HSE has indicated that the time taken to process each application varies depending on the complexity of the application and the availability of accurate records. Every effort is being made to complete repayments as quickly as possible. However, there have been some delays in making repayments under the scheme due to legal and technical issues. A very high number of deficiencies have appeared on claim forms and these must each be rectified before claims can be processed. These claims have taken longer to process because the scheme administrator must be provided with certain information in order to ensure that the correct amount is repaid to the correct person. The scheme administrator and the HSE have taken a proactive role in clearing these deficient claim forms. They have conducted an intensive roadshow campaign throughout the country in order to address these issues. This campaign was widely promoted through advertising on local radio and in regional media. More than 12,000 estates which lodged claims to date had not extracted a grant of representation in respect of the estate of the deceased patient. In these instances, the person entitled to extract the grant of representation must be identified before an application can be processed. To date, more than 11,000 certificates of entitlement permitting individuals to apply for repayments have issued. The scheme administrator is confident that the majority of claims submitted by the public will be dealt with by the end of this month. The health repayment scheme appeals office is independent and was established to provide an appeals service to those who wish to appeal decisions made by the scheme administrator. Following the establishment of the office, a temporary appeals officer was seconded from the Office of the Chief State Solicitor. Subsequently, a recruitment process was undertaken by the Public Appointments Service and a panel of appeals officers has been established. A second appeals officer is due to begin work shortly. In addition, four administrative staff have been appointed to support the current appeals officer. Up to 23 May, the health repayment scheme appeals office had received 3,173 completed appeal forms. The appeals officer must investigate each of these independently and his investigations can require additional reviews by the HSE and the scheme administrator. Certain appeals present a high level of complexity. In addition, a high percentage of appellants have requested oral hearings. Up to the end of May, the appeals officer had completed 471 oral hearings at locations throughout the country. Up to 23 May, the appeals officer had carefully, thoroughly considered and assessed 1,293 appeals and issued decisions in respect of all of them. Deputy James Reilly (FG): I am impressed that a single appeals officer has been able to deal with so many appeals. If that sort of productivity existed throughout the health service, we would be doing extremely well. It is extraordinary that KPMG has been paid €23 million — €15 million exclusive of VAT — to administer the scheme. Some 70,000 claims were expected, 39,000 were lodged and 14,000 have been settled and it is hoped that the matter will be dealt with in its entirety in the near future. People feel bamboozled and intimidated. When they appeal, it becomes clear to them that the process is not about fairness but instead revolves around saving money. That money was taken from the elderly illegally and now these people are being thwarted, in their later years, from obtaining justice. Some 12% of processed claims have been appeals and only 25% of the appeals lodged and considered to date in respect of these claims have been successful. A further 10% of applicants whose claims rejected were subsequently judged to be entitled to payment. It is clear that a great deal of activity is being focused on preventing people from recouping what is rightly theirs. Despite the fact that 130,000 people work for the HSE, KPMG is being paid €23 million to administer the scheme. When people undergo the claims process and are obliged to appeal, they discover that there is only one appeals officer. The Minister indicated that a recruitment process has been completed, that a panel has been established and that a second appeals officer will be appointed shortly. What is happening is nothing short of scandalous. What sort of message is being sent to the elderly? Having being short-changed by the State, the latter is now doing everything in its power to obstruct them from obtaining what is rightfully theirs. Will the Minister indicate the number of appeal officers she intends to have in place by the end of the month so that this major issue might be dealt with? Deputy Jan O’Sullivan: I will be very brief. What exactly is the role of KPMG and why was it brought in? Does the Minister consider its service good value for money? Deputy Mary Harney: It was brought in because the HSE felt it would not be able to cope. It has dealt with 39,000 claims and €15 million exclusive of VAT would be regarded by any standards — especially with the overtime bills I see — as enormous value for money. Deputy Jan O’Sullivan: There are many administrators in there already. Deputy Mary Harney: If we were to make the system, with its current staffing complement, deal with this issue, it would have been dealt with on an overtime basis. It would have taken substantially longer and cost substantially more. An assessment was made and that was the recommendation. Deputy James Reilly: What about the thousands in the HSE who do not know what their jobs are? They could be seconded for this. Deputy Mary Harney: Perhaps some of the Deputy’s friends in some of the vested interests could have done it. Perhaps the Deputy should have put in a bid for it. Some 39,000 claims have been dealt with. Deputy James Reilly: That is desperation. Deputy Mary Harney: This money must be paid in accordance with the law enacted by this Oireachtas. We must ensure, in the first instance, that the correct people are paid their money. We do not want a family member or distant relative who may never have visited the old person getting money that somebody else may be entitled to. There is no doubt that it is a very complex legal process but this is necessary because of the law. With regard to the scheme, we appointed at the beginning an oversight group representative of various groups advocating older people. Ms Sylvia Meehan is on it, for example, and it is chaired by Bernard Walsh, a geriatrician in St. James’s Hospital. They oversee this and have given me three reports. I know they remain very satisfied and confident in the manner in which this scheme is being executed. The purpose is to get money to the right people as quickly as possible. As I indicated in my initial reply, the HSE has told me that by the end of June, all the applications will have been processed and determinations will be made. We expect to finish it during this calendar year and do not envisage it going to 2009. I am delighted this is the case. Sometimes, as a result of what we are dealing with, people who make the applications pass away. We are dealing with very old people in residential care who may have been there for some time. Many issues arise but the administrator and the HSE have operated this scheme very professionally and thoroughly. Unfortunately, when legal letters are sent to individuals, particularly older people, I accept they can be intimidating. Every effort is made to talk to people and I understand approximately 800 people were spoken to by telephone about their applications. For example, different parts of the form may have been filled out that were not required or were inaccurate. Every effort is made to deal with these people in as human a way as possible, particularly where older people are concerned. Deputy James Reilly: I have no wish to row with the Minister on the issue, which is very important. I am glad she at least admits that letters can be intimidating, as can telephone calls. People are confused. I wish to ask her questions which require a “Yes” or “No” answer. Is she concerned at the high level of successful appeals, at 25%? That is very significant. Considering the large numbers, how many additional appeals officers will the Minister put in place by the end of the month if she hopes to finish the work? The Minister has indicated the process is expected to finish at the end of this year. Deputy Dan Neville: The Minister might clarify the case of those in psychiatric institutions and the procedure for refunding such patients. What is the position for psychiatric patients in community groups or supervised houses where deductions have taken place? Deputy Jan O’Sullivan: On those phone calls which have been made to elderly people, I understand they are mainly for clarification purposes. Have there been any complaints regarding people feeling intimidated about phone calls received? Deputy Mary Harney: The only one I am aware of is that which arose in the newspaper last week and which was the subject of a Dáil question by one of the Deputy’s colleagues. When I sought to establish the facts, they were very different from what had appeared. The individual who made the application was in her early 80s, which in itself was unusual because generally the applicants are younger relatives or members of the family of the older person. I understand it related to the form not having been completed accurately, and a legal letter was sent. The person who received it felt somewhat intimidated by the letter and thought the letter was indicating she would not get her money, which was not the case. The letter — in legalese, which is intimidating for most of us — simply asked the applicant to clarify the documentation. Many of the applications are made by lawyers on behalf of individuals and I know of a large number of people where the solicitors have made an application on an applicant’s behalf. I understand that with the high number that came in just before Christmas, many were applications made by legal representatives of deceased persons. The same procedure applies for everybody under the Act in terms of the application process and scrutiny. On the appeals officers, we have indicated we need whatever number of appeals officers required to deal with the level of activity. It has not been brought to my attention that there is a shortage, as I indicated. More are being appointed on a temporary basis, and there are four administrative backup staff to help. I have not heard that there is a shortage of appeals officers but if additional manpower is required to clear the appeals in a short space of time, it will not be a problem. Deputy James Reilly: Is the Minister concerned at the high number of successful appeals at 25%, given the amount paid to KPMG? Deputy Mary Harney: Is it 35%? I do not have that data. Deputy James Reilly: It is what I have in front of me. Deputy Mary Harney: I do not have it. If there was a high level of successful appeals, it would indicate first that the appeals process is working. I do not have the figure read out by the Deputy from some note I presume he has from the HSE. It is not in my note that it is as high as 35%. I did sat that of the number of appeal applications made, 35% have been dealt with. Deputy James Reilly: I stated one in four — 25%. Deputy Mary Harney: Yes, one in four has been dealt with but my note does not tell me they have been successful. I am sorry I do not have that information. PARLIAMENTARY QUESTIONS Deputy Seán Barrett (FG): asked the Minister for Health and Children her plans to provide appropriate adult placements for the autistic students leaving a school in County Dublin at the end of June 2008, particularly in view of the oral commitment at a meeting in September 2007 by the Health Service Executive disability manager that no school leaver from the school would be denied services and the HSE’s failure to allocate funding for the appropriate day and residential services needed by these autistic children, with the result that no transition programmes can be commenced for the students; Minister of State at the Department of Health and Children (Deputy John Moloney): The HSE and HSE funded agencies provide rehabilitative training for persons with disabilities to enhance their individual level of skill which will assist in accessing future employment at varying levels. The HSE employ Guidance Officers at local level to assist in the profiling of young school leavers with disabilities to appropriate training and day services. The Guidance Officers work with the school leaver, their family, school authorities and service providers to ensure that school leavers with disabilities have access to appropriate services. The increase in services in recent years has ensured that young people with Intellectual Disabilities and Autism have appropriate services in place, to ensure a smooth transition from secondary school. In some cases, the funding provided supported the school leavers to access appropriate day services, in line with a person centred plan. In many cases, this funding provided places for individuals completing rehabilitative training, thereby creating training places for other school leavers. The HSE and HSE funded agencies also provide a range of other day services, designed to meet the needs of adults with disabilities. The Multi-Annual Investment Programme for Disability Services makes provision for the development of additional day, residential and respite places each year between 2006 and 2009 for people with Intellectual Disability and Autism. €50m was provided to the HSE in budget 2008 for additional services to people with disabilities including additional day places. At this time the HSE is still in discussion with the Department of Health and Children regarding the commencement of 2008 developments in the context of the overall financial position of the HSE. The HSE is therefore not in a position to approve the commencement of these developments until these discussions are concluded. Deputy Willie Penrose (L): asked the Minister for Health and Children the progress made in filling the 183 occupational therapy posts that remained unfilled at the end of 2007; Minister for Health and Children (Deputy Mary Harney): As part of the Multi-Annual Investment Programme 2006-2009 under the Disability Strategy, the Government provided the Health Service Executive with an additional €75m in both 2006 and 2007. This funding included monies to provide new and enhanced services for people with disabilities, to implement Part 2 of the Disability Act 2005, which came into effect on June 1st 2007 for the under 5s and also for the continuation of the implementation of the transfer of persons with intellectual disability from psychiatric hospitals and other inappropriate placements. The Government is also honouring its promise in relation to the Multi-Annual Investment Programme for people with disabilities, with a further €50m investment which was announced in the 2008 Budget. I wish to advise the Deputy that almost 130,000 people work full-time or part-time in our public health services. In recent years, the Government’s ongoing high level of investment in health has achieved and maintained significant increases in the numbers of doctors, nurses and other healthcare professionals employed in the public health services. The Government has also 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. Subject to overall parameters set by Government, the Health Service Executive has the responsibility for determining the composition of its staffing complement. In that regard, it is a matter for the Executive to manage and deploy its human resources to best meet the requirements of its Annual Service Plan for the delivery of health and personal social services to the public. The Executive is the appropriate body to consider the matter raised by the Deputy. My Department has requested the Parliamentary Affairs Division of the Executive to arrange to have the matter investigated and to have a reply issued directly to the Deputy. Deputy Alan Shatter (FG): asked the Minister for Health and Children the exact timescale for the implementation of recommendations contained in the report published in December 2007 into services provided by the Brothers of Charity in Galway to provide for adequate protection from physical and sexual abuse for intellectually disabled children and adults in care; if she has received the results of the investigation into the delay of eight years in the publication of the report; if she is satisfied that no such physical or sexual abuse took place in any other institution for which the Brothers of Charity are responsible; Minister of State at the Department of Health and Children (Deputy John Moloney): The HSE has informed my Department that it has carried out a review of the Brothers of Charity services. The review did not reveal any new cases of physical or sexual abuse. The HSE has also advised my Department that it is working with the Brothers of Charity on a comprehensive programme to implement all the recommendations in the McCoy report. As the Deputy is aware, Minister Harney appointed Mr. John Hynes, former Secretary General, Department of Social and Family Affairs, to investigate the delay of eight years in relation to the publication of the McCoy report into services provided by the Brothers of Charity, Galway Services. Mr. Hynes is due to report to Minister Harney on or before 8th July 2008. With regard to the remaining issues raised by the Deputy, the HSE has informed my Department that it will reply direct to the Deputy on these matters. Deputy Caoimhghín O’Caoláin (SF): asked the Minister for Health and Children the number of persons with an intellectual disability and those with autism accommodated in psychiatric hospitals; the number of same accommodated in de-designated units which were formerly designated as psychiatric services; the numbers of same moved from psychiatric hospitals prior to 2002 to alternative accommodation which is now unsuitable for their needs; the names and locations of the hospital, units and other accommodation in each case; Deputy AengusO’Snodaigh (SF): asked the Minister for Health and Children the status of her Department’s programme to transfer persons with an intellectual disability or autism from psychiatric hospitals and other inappropriate placements; the progress made in implementing this programme since 2002; the number of persons moved from inappropriate placements to appropriate accommodation in each year since 2002; Deputy Emmet Stagg (L): asked the Minister for Health and Children the number of people with an intellectual disability who are accommodated in a psychiatric hospital; the number who have been moved from psychiatric hospitals into community residences or other suitable accommodation in each of the past five years; when all those who remain in such accommodation will be moved; Minister of State at the Department of Health and Children (Deputy John Moloney): I propose to take Questions Nos. 42, 55 and 63 together. The National Intellectual Disability Database (NIDD) report for 2007 identified 329 individuals with intellectual disability, all aged 20 years or over, as being accommodated in psychiatric hospitals. It should be noted that registration on the NIDD is voluntary. An integral part of the National Disability Strategy is the Multi-Annual Investment Programme (MAIP) announced in the 2005 Budget, which provides €900m for the provision of specific high priority disability services over the period 2006 to 2009. MAIP commitments include the development of new residential, respite and day places for persons with intellectual disability and autism in each of the years covered by the programme as well as the transfer of persons with intellectual disability/autism from psychiatric hospitals and other inappropriate placements. The Deputy’s specific questions, in relation to the progress and details of the programme to move those individuals to more appropriate accommodation, relate to the management and delivery of health and personal social services, which are the responsibility of the Health Service Executive under the Health Act 2004. Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have these matters investigated and to have a reply issued directly to the Deputy. Deputy Kathleen Lynch (L): asked the Minister for Health and Children the elements of the Disability Act 2005 which relate to her Department that have not been commenced; when they will be commenced; Minister of State at the Department of Health and Children (Deputy John Moloney): The National Disability Strategy, which was launched in September 2004, provides for a framework of new supports for people with disabilities. The Strategy builds on a strong equality framework, which is reflected in several pieces of equality legislation. The main elements of the Strategy include:
The Disability Act 2005 remains the central component of the National Disability Strategy. While the legislation was sponsored by the Department of Justice, Equality and Law Reform, the Department of Health and Children, together with the HSE, are charged with specific statutory duties, most notably concerning the implementation of Part 2 of the Act. As the Deputy is aware, intervention early in life can have a significant impact on the disabling effects of a condition or impairment. In recognition of this, Part 2 of the Disability Act 2005 was commenced for children aged under 5 years with effect from 1 June 2007. This provides parents of young children with disabilities an entitlement to an independent assessment of their child’s health and education needs and a statement of the services which it is proposed to provide for them. To date over 1,800 applications for an assessment of need have been received and are being processed by the HSE. Representatives of the Department of Health & Children, the Department of Education & Science, the Health Service Executive and the National Council for Special Education meet on a regular basis to address a range of issues, including matters arising in relation to the ongoing implementation of the Disability Act 2005. This work includes planning for the roll out of Part 2 of the Disability Act 2005, in tandem with the Education for Persons with Special Educational Needs Act 2004 (EPSEN Act). This legislation, which is the responsibility of the Department of Education & Science, provides for the provision of education services for people with disabilities. The Department of Education & Science has informed my Department that it is envisaged that all sections of the EPSEN Act 2004 will be implemented over a five year timeframe, with the assessment process as provided for in the EPSEN Act 2004 due to commence in 2010. The statutory requirements of Part 2 of the Disability Act 2005 will be extended to adults as soon as possible, but no later than 2011. The recently-established Office for Disability and Mental Health will focus in particular on facilitating the delivery of integrated health and education support services for children with special needs, by further developing these existing mechanisms for co-operation and co-ordination between the health and education sectors. Deputy Seán Sherlock (L): asked the Minister for Health and Children how she will progress the National Disability Strategy; the timeframe for same; Minister of State at the Department of Health and Children (Deputy John Moloney): The National Disability Strategy was launched by Government in 2004 and underpins the participation of people with disabilities in Irish society by building on existing policy and legislation. The Strategy comprises five elements:
Part 2 of the Disability Act provides people with disabilities with an entitlement to:
Part 2 of the Act commenced for children aged under 5 years with effect from 1st June 2007. Children under 5 years were chosen as the priority for the introduction of the assessment of need process under the Disability Act because of the importance of intervention early in life. This can have a significant impact on the disabling effects of a condition or impairment. The commencement of Part 2 in respect of children aged between 5 and 18 will be introduced by 2010, in parallel with the implantation of the EPSEN Act 2004. The statutory requirements of Part 2 of the Disability Act will be extended to adults as soon as possible but no later than 2011. The HSE has also appointed Assessment Officers and Liaison Officers in each LHO area. The Assessment Officer is responsible for the co-ordination of the Assessment Report, while the Liaison Officer has responsibility for the provision of the service statement. At the end of March 2008, 1,836 applications for assessment of need have been received and are being processed by the HSE. The Health Sectoral Plan sets out the actions which the Department of Health and Children, the HSE and 27 statutory bodies will take to meet their obligations under the Disability Act 2005. It represents a commitment at all levels of the health service to access and equity of service for people with disabilities. In December 2007, the Department of Health and Children and the Health Service Executive published the first of three annual reviews of progress on the Sectoral Plan. Further targets have been identified, specifically in relation to planning for the commencement of the Act for 5-18 year olds and adults. This includes work with the Health Services Executive, the Department of Education and Science and the National Council for Special Education and other relevant stakeholders. The Multi-Annual Investment Programme 2006 -2009 was announced as part of the Budget Day package in December 2004. It outlined the Government’s commitment to a programme of revenue and capital expenditure, amounting in total to around €900m, on specific disability support services over that period. The bulk of this funding is being spent in the health services. A key development which will assist in progressing the National Disability Strategy was the Government’s decision in January of this year to establish the Office for Disability and Mental Health. This Office will assist me in exercising my responsibilities across four Government Departments: Health & Children, Education & Science, Enterprise, Trade & Employment and Justice, Equality & Law Reform. The new Office brings together responsibility for a range of different policy areas and State services which directly impact on the lives of people with a disability. The Office will aim to bring about improvements in the manner in which services respond to the needs of people with disabilities by working to develop person-centred services, focussing on the holistic needs of clients and service users and actively involving them in their own care. The social partnership agreement Towards 2016 outlines our vision for people with disabilities, the Programme for Government supports the implementation of the National Disability Strategy. This Government will work with the social partners to achieve continued improvements in the quality of life of people with disabilities. The ultimate aim is to provide people with a disability an opportunity to live a full life and to participate in society. Deputy Kathleen Lynch (L): asked the Minister for Health and Children her views on the proposals by the Health Service Executive to offer voluntary redundancy and retirement to approximately 1,000 administrative staff members; if she has plans to reduce the number of people in senior administrative posts in the HSE; Minister for Health and Children (Deputy Mary Harney): I have previously made it clear that I want to see appropriate staffing structures in place throughout our public health service. This includes management structures and front line service delivery. My main aim in relation to management structures is to ensure clarity of roles, responsibilities and reporting relationships in order to improve the overall governance and management of our health services. The board and management of the HSE have been considering possible improvements in their existing management structures which would optimise their operational or service delivery capacity. These proposals are still being finalised and will be considered by me in the near future. Separately, the HSE has commissioned a review of its administrative staffing. I understand this review indicates that the HSE is not over-resourced in clerical, administrative and managerial staff compared to Northern Ireland, Scotland and Wales. Between December 2004 and March 2008 direct frontline service staff in both the HSE National Hospitals area and Primary and Community Care have increased by approx. 10% while HSE Corporate staff levels have been reduced by more than 10%. I believe that a properly planned and managed voluntary redundancy scheme could have an important role to play in helping to streamline management within the HSE and, as a result, in improving the delivery of health services to patients. Such a scheme would need to be built upon a clearly delineated organisation structure and the associated human resource requirements. It would also need to demonstrate that it will deliver value for money, having regard to other options such as natural wastage and the scope for re-deployment. Discussions about a possible redundancy scheme are still at an exploratory stage. In accordance with established practice in the public service, any such scheme would operate on a voluntary basis and would require the approval of the Minister for Finance. There would also need to be discussions with the relevant staff associations. Clearly, it is an option that requires further work but it is also one which could help to deliver significant benefits in terms of a much streamlined and integrated management structure within the HSE. Deputy Tom Hayes (FG): asked the Minister for Health and Children if the Health Service Executive allocation of funding for people with disabilities has been released for 2008; if services have been planned and approved for funding for people with autistic spectrum disorder who are leaving schooling; if ASD placements for people with ASD who are exiting rehabilitative training have been organised and are receiving funding; if transitional facilities are in place for these people to prevent disimprovement in behaviour and quality of life for patients and their families; Minister of State at the Department of Health and Children (Deputy John Moloney): As part of the Multi-Annual Investment Programme 2006-2009 under the Disability Strategy, the Government provided the Health Service Executive with an additional €75m in both 2006 and 2007. This funding included monies to provide new and enhanced services for people with disabilities, to implement Part 2 of the Disability Act 2005, which came into effect on June 1st 2007 for the under 5’s and also for the continuation of the implementation of the transfer of persons with intellectual disability from psychiatric hospitals and other inappropriate placements. A further €50m investment was announced in the 2008 Budget. At this time the HSE is still in discussion with the Department of Health and Children regarding the commencement of 2008 developments in the context of the overall financial position of the HSE. The HSE is therefore not in a position to approve the commencement of these developments until these discussions are concluded. Deputy Bernard J. Durkan (FG): asked the Minister for Health and Children when she will be in a position to provide a comprehensive diagnostic assessment and support structure for the parents of children with autism; when she will provide the research facilities necessary with a view to identifying the possible causes of the high level of autism here; Minister of State at the Department of Health and Children (Deputy John Moloney): In December 2004, the Department of Health and Children, through the Health Research Board, approved expenditure of €5 million on autism research to help improve international understanding of the genetic causes of autism. This €5 million is the Irish contribution to a new major international research initiative called the Autism Genome Project which will receive a total investment of €12 million from a variety of international organisations over the next three years. The other co-funders in the international consortium include Autism Speaks (US), the British Medical Research Council (MRC), Genome Canada and Partners, Canadian Institutes for Health Research (CIHR), Southwest Autism Research and Resource Center (SARRC), and the Hilibrand Foundation. This unique combination of international, public and private partners funding a consortium of clinicians and scientists is a new and welcome departure in the field of autism research. The Health Research Board has informed my Department that this funding was awarded as follows:
This figure represents the largest tranche of funding to be awarded by any of the four funders within the international consortium. The Irish researchers are at the forefront in unraveling the genetic determinants of autism and related disorders. They are using novel state-of-the-art genetic sequencing technology to analyse DNA samples taken from autistic patients to identify candidate genetic markers for autism. They will collaborate with their international colleagues to then link these genetic markers with clinical outcomes. This unique international research effort will greatly improve not only our understanding of the causes of autism, but its diagnosis and treatment. The remaining issues in the Deputy’s question are the responsibility of the Health Service Executive under the Health Act 2004. Accordingly, my Department has requested the Parliamentary Affairs Division of the Executive to arrange to have this matter investigated and to have a reply issued directly to the Deputy. Deputy Michael Ring (FG): asked the Minister for Education and Science the way his Department is rigidly adhering to the new prescribed qualifications pertaining to the providers of the home-based July provision in view of the fact that in some instances it can be difficult to secure people to undertake this scheme. Minister for Education and Science (Deputy Batt O’Keeffe): The Deputy will be aware the July Education Programme is available to all special schools and mainstream primary schools with special classes catering for children with autism who choose to extend their education services through the month of July. My Department also provides for a July Programme for pupils with a severe/profound general learning disability. My Department encourages all eligible schools to participate in this initiative in the interest of the children in question. There has been a steady increase in the number of schools offering the programme since it was introduced in 2001 when relevant schools were circulated with details. Where school based provision is not feasible, home based provision may be grant aided. As home tuition takes place outside of the normal school framework, there is need to ensure that tuition providers are appropriately qualified to give education to the children concerned. My Department’s qualification preference is for a fully qualified teacher. Where parents cannot recruit a fully qualified teacher, then some alternative qualifications are acceptable including certain Montessori qualifications. Details in this regard are published on my Department’s web site. Deputy Seán Fleming (FF): asked the Minister for the Environment, Heritage and Local Government the resources being made available to local authorities and the powers that have been given to them to carry out means tests that are required in respect of applications received under the housing adaptation grant scheme for older people and people with disability. Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Michael Finneran): The revised suite of Housing Adaptation Grants for older people and people with a disability introduced in November 2007 provide a more targeted and integrated response to the housing needs of older people and people with a disability, while ensuring that those households in greatest need benefit from the available funding. Under the new schemes eligibility for grant aid is determined on the basis of household means. Under the previous grant aid framework, some local authorities applied a means test, while others did not. My Department has developed a standardised means test to be used by all local authorities in order to provide a fair and uniform approach to the new schemes across the country, while also ensuring that those households in greatest need benefit from the available funding. The conditions applying to the grants schemes, including means-testing, are contained in the Housing (Adaptation Grants for Older People and People With a Disability), Regulations 2007.
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Inclusion
Ireland, Unit C2, The Steelworks, Foley Street, Dublin 1, Ireland.
Tel: 01 8559891 Fax: 01 8559904 Email: info@inclusionireland.ie |