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Dáil Éireann díospóireacht -
Wednesday, 24 Apr 2024

Vol. 1052 No. 8

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services

Good morning. I want to start by laying out the background to the issue relating to SouthDoc in Blackpool. As my constituency colleague, the Minister of State must be well aware of this matter. In 2020, the close of SouthDoc in Blackpool was announced on foot of the Covid-19 crisis. At the time, I raised concerns. Those concerns proved to be well founded when SouthDoc clearly stated that it was not going to reopen its service in Blackpool. This meant that constituents of mine in the north side of the city had to travel over to Kinsale Road in order to be seen by a GP.

I raised this matter in the Chamber at the time with the Taoiseach, the Tánaiste, the Minister for Health and with everyone else in order to outline how important SouthDoc in Blackpool was for my constituency. The HSE expressed serious concerns about the clinical consequences of this decision. The basis for those concerns was that people who should have been attending the SouthDoc treatment centre in Blackpool would have to be driven to the Mercy University Hospital and to Cork University Hospital, CUH, accident and emergency departments which are already severely overcrowded. People on the north side of Cork were so sick and tired of being neglected, they launched a Trojan campaign which led to SouthDoc in Blackpool reopened.

Last year, SouthDoc essentially closed its facility in Blackpool for a second time. It reduced the number of doctors to one, and it is now saying that the doctor who is on call is based in Blackpool. This means that most of the time, people cannot get GP appointments in at the SouthDoc facility in Blackpool. It is not just me saying this. Figures I obtained from the Minister for Health indicate that there was a 70% reduction in the number of people being seen by SouthDoc in Blackpool in January of this year in comparison with previous years. The HSE is telling me that its facilities are closed, but the figures speak for themselves.

Last night, I put a post on Facebook letting my constituents know that I would be speaking here this morning and raising their concerns and asking them to outline their experiences. I invite the Minister of State to go onto my Facebook page and look at the comments they have put in. They indicate how they have been obliged to travel from the north side over to the south side with sick children and sick family members.

I will explain how important SouthDoc in Blackpool is. One lady told me how last August when the service was still open, she brought her child there. The child was sent straight to the accident and emergency department to have its appendix removed because it was such an emergency. If the service in Blackpool had not been open at the time, the woman would have been obliged to travel across the city with her child. There would have been a delay in treatment as a result. Not only that, because the service in Blackpool is not operational, people are waiting hours not to get appointments but to be called back. The issue here is about clinical need.

Another gentleman contacted me to say that his wife is ill and that he had to take his daughter to SouthDoc. They live in Blarney. The Minister of State knows the area well. The man in question had to travel from Blarney to the Kinsale Road with his sick daughter and his sick wife. That is what happens when SouthDoc in Blackpool is closed. The gentleman has no car. The Government is encouraging people to use public transport, but there is no public transport to the Kinsale Road. It costs up to €80 to get a taxi there and back. The man to whom I refer explained the situation to me.

The people of the north side of Cork city want a guarantee that SouthDoc will be kept open and that there will be no more closures.

Ba mhaith liom comhghairdeas a ghabháil leis an Aire Stáit, an Teachta Burke, ina ról nua.

I thank the Leas-Cheann Comhairle.

I thank Deputy Gould for raising this issue and for his consistent engagement in respect of the SouthDoc treatment centre. I am dealing with this matter on behalf of the Minister for Health, Deputy Donnelly.

The Minister fully understands that the Deputy is acting out of a genuine concern, his own and that of his constituents, regarding the ongoing provision of out-of-hours GP services in the north side of Cork city. The Minister for Health has regularly engaged through the HSE with SouthDoc with regard to the Blackpool treatment centre as a result of the Deputy's ongoing expressions of concern in this House. I must emphasise that the Minister has regularly received assurances from SouthDoc that there is no intention to close any of its treatment centres.

The Minister also wishes to add that he fully supports this position and has made clear that he is to be advised in advance of any change in this position. SouthDoc has emphasised in its communication with the HSE that any person in Cork city who requires out-of-hours GP care will be provided with that care either at one of its treatment centres or, where the clinical condition of the patients so requires, in the patient's own home. SouthDoc GP appointments are provided on the basis of appointments which are available following contact with SouthDoc call centre and triage services. This is the case for all patients, including those wishing to attend the Blackpool treatment centre.

I am aware of the recent experience of a member of the Deputy's family about which he has spoken in the House previously. On that occasion, incorrect information was provided that the Blackpool treatment centre was closed. Doctors are rostered to provide services in the Blackpool treatment centre. As a result of the Deputy raising those events, the HSE made contact with SouthDoc, which has subsequently taken remedial and retraining steps to ensure that all staff are fully aware of the service delivery throughout the co-op.

The Minister for Health values the Deputy's ongoing engagement on this matter and wishes to provide assurances that there are no plans to close SouthDoc's Blackpool treatment centre.

I do not want to be disrespectful, but if the Minister for Health does not understand what is happening in the HSE in the context of SouthDoc in Blackpool, that is shocking.

Some €7 million was paid to SouthDoc to provide an out-of-hours service, which it is not doing. If the Minister of State looks at my Facebook page, he will see the number of constituents by whom I have contacted who cannot get appointments there. The only time someone can get in there is if the doctor is not on call. This means that at least 70% or 80% of the time, there is no doctor in Blackpool. I spoke to a person yesterday who contacted the Blackpool treatment centre at the weekend and was told that the doctor was making a house visit in Macroom. I have no problem if doctors need to go out to visit people in their homes. That service needs to be there, but what happened at the weekend meant that there was no doctor in Blackpool for the over 100,000 people who live on the north side of Cork city. People have informed me that they have to wait for hours.

I have seen the service level agreement agreed in 2020 by SouthDoc and the HSE. SouthDoc is not living up to its side of that agreement.

Last month, I asked the Tánaiste, Deputy Micheál Martin, a fellow Corkman, about this matter. He told me that he would contact the GP services and the HSE.

Does the Minister of State have any response from the Tánaiste regarding what he was told because Southdoc in Blackpool was not operational at the weekend?

I just want to let the Minister of State know that two more people contacted me to say the same happened to them in recent days. I have a story for him. A lady took her son, who had food poisoning, to SouthDoc on the Kinsale Road. The child was sick all the way out in the car and all the way back while SouthDoc in Blackpool across the road from her house was empty and closed. How can that be fair?

The Minister of State is a constituency colleague of mine. The north side is fed up of not getting a fair shake.

It is important to remind the Deputy that we also have the minor injuries unit on the north side.

It is not open out of hours.

No. The minor injuries unit covers people from both the north side and the south side. I just want to be clear that not everything is on the south side. Second, I have checked for myself and SouthDoc saw more than 220,000 people last year.

Only in Blackpool.

Deputy Gould raised the issue of SouthDoc not doing its job. SouthDoc saw 220,000 patients last year. It has 19 vehicles available to call out to people as well, so there is a whole rota of people available to call out to patients. If a patient is deemed to be so unwell that he or she cannot travel to a centre then SouthDoc will arrange a visit. Patients are seen, on average, within four hours from the time a call is made. That is the service SouthDoc provides. One in eight of the people who go to SouthDoc is referred for further care, either to the accident and emergency unit or to one of the hospitals in Cork or Kerry, whichever the case may be. It is important to emphasise that.

I thank Deputy Gould for raising this issue. It is important that people do have access to services in a timely manner. SouthDoc is committed to the long-term continuation of its out-of-hours services in Cork city. I reiterate that there are no plans to close the Blackpool treatment centre. The Minister for Health has made it clear that he is to be informed if there is any change in that position. He has engaged regularly, through the HSE, with SouthDoc as a result of Deputy Gould's engagement in this House and he will continue to do so, as necessary. The Minister is aware that the Deputy has also had direct contact with the HSE regarding this matter. The Minister and the Government remain committed to ensuring access to of-out-hours GP services on an equitable basis. Therefore that is the-----

On the north side.

I am sorry but we are way over time.

-----response. I fully understand where Deputy Gould is coming from. The concerns he outlined have been raised with me as well. We need to make sure that the service continues, as I am sure it will.

Special Educational Needs

Education is the great leveller. Education should be an opportunity to give every child the ability to reach his or her potential. It is so important that, as a country, we make sure we have equality within the education system for pupils themselves and for parents. The information that I am getting back from a large number of schools at the moment is that there is a crisis first of all in being able to access teachers in general because of a shortage of teachers in a number of different areas, but my understanding is that this is particularly acute in the context of children with additional needs and special needs within schools.

I have an example of a school in my constituency that is renowned for its work in terms of inclusion and providing services for children with additional needs. That is so much so that parents have moved from different parts of the country to the locality because the school works so hard to be able to provide the best education to children with additional needs. It is an incredible situation that because of their work, they have managed to raise the standards and the outcomes in the school. Many parents have glowing reports of how their children have come on in that regard. The Minister of State can believe it or not, but even though the school has an increasing school population, it is to have a reduction in the number of special education teachers. In a response she gave to a parliamentary question, she indicated that some schools got an increase in special education teachers and others had a reduction but, in the main, those that had a reduction were schools in which the population was falling. This school falls into the 10% of schools in areas where there has been an increase in population, yet there was a reduction in the number of special education teachers. The difficulty here is that some of these appraisals are being made by the Department on the basis of the averages of the school outcomes, but different pupils in the class have far different levels of ability and need far more help.

We have this crazy situation where schools and principals are struggling to get the necessary supports. They are getting two and a half hours here and two and a half hours there. Special education teachers are spending their day driving from school to school to fill in those small little gaps. Schools are being forced into the appeals process, which is a full-time job in itself. I talk to teachers who tell me they are spending weeks working until 1 a.m. or 2 a.m. completing forms for an appeals process. The appeals process only looks at pupils from junior infants up to second class and, incredibly, ignores the pupils in the latter years of school. Some of the junior pupils cannot even get appraisals because the system is so log-jammed. One parent of a child in junior infants was told they would have spend €2,500 to get an assessment for the child.

The system is grinding to a halt. I do not believe this is just a bureaucratic issue. There is a funding issue and a recruitment issue at the heart of this and, as a result, schools are suffering significantly. There are many parents with children who, if they had the inputs that were needed would be able to develop far more successfully, who would be able to reach a greater potential and would be able to enjoy and achieve far more in life, but the Government is actually taking that resource, which is having a material effect on each of those individual lives and their families. I implore the Minister of State to look at the schools that have been battling to try and get special education teacher resource and to do her best to make sure that they have them without this constant battle.

I thank the Deputy for raising this issue and giving me the opportunity to set out the importance of the special education teacher allocation in supporting children with special educational needs in mainstream schools.

At the outset, it is very important to state that there will be more special education teachers in our schools in September 2024 than ever before - an increase of 1,000 from the 2020-21 school year. This is in addition to a significant reduction in class sizes at primary level over three budgets to the point where the pupil-teacher ratio at that level is now 23:1. This means, more than ever, children with special educational needs in mainstream schools are best supported to meet their needs. In addition, the model will now be run annually in line with general teacher allocations. This allows schools to better plan their staffing structures and gives them time to arrange clusters in areas where schools share a special education teacher.

I would like to clarify that the special education teaching model is an allocation model to provide schools with additional teaching hours to support the teaching needs of their students. When the 2017 model was introduced, it replaced a diagnosis-led model with one based on need. That has not changed for 2024 and the allocation to schools is to support all of the children in school who require some level of additional teaching support.

There has been a limited change to the method used to allocate special education teachers to mainstream classes. The Department of Education commenced a review of the model in late 2022 to ensure that it was meeting the changing needs in special education. This review involved extensive consultation and visits to schools by the National Council for Special Education to look at the strengths and shortcomings of the allocation model. The feedback has been incorporated into the revised model for 2024-25. The allocation model for 2024-25 distributes the total available number of special education teaching posts in line with each school's profile of need. The model makes an allocation on the basis of a number of inputs, including enrolment numbers. It also uses school-level data from standardised tests in order to reflect levels of overall need and complex need within a school. It seeks to distribute teaching resources in the fairest possible manner, taking into account quality, robust evidence in respect of individual schools.

This ensures that resources are in the right place at the right time to meet the needs of children in mainstream schools. The model is now utilising data provided to the Department of Education by individual schools to ensure that resources are in the right place at the right time. The revised model is providing an annual allocation of special education teaching hours, using the best possible available data sources, and is ensuring that the right resource is available to children with special educational needs. Schools have autonomy to deploy those resources to meet the needs of their students.

The Department acknowledges that every school is different and that schools can experience unique circumstances that may be difficult to reflect in any standardised method. This is always a challenge when making allocations to 4,000 schools. It is for this reason that the Department, working with the National Council for Special Education, NCSE, has streamlined the review process for special education teaching hours. Schools that have any concerns can engage with the NCSE in respect of their allocations. Reviews are being conducted by the NCSE between March and May to better enable schools to plan for September. Additional resources will be provided to schools in cases where the NCSE has identified that this is required.

The NCSE has responsibility for planning and co-ordinating school supports for children with special educational needs. It has advised that it has reviewed and streamlined the special education teacher, SET, review process following feedback from schools and our education partners. That new review process was introduced for the SET allocation for the 2024-25 school year. A school can request a review of its allocation through the NCSE portal in March 2024. The NCSE also has committed to completing these reviews in the period between March and May of this year, and they will be prioritised.

With respect, that is the theory. The practice, unfortunately, is different. I understand that Ministers will be told by their senior civil servants that everything is grand, but the fact is that we are being told by people on the ground that it is not grand. I will give an example of the theory and the practice colliding. A principal sent me a letter they received from the National Educational Psychological Service, NEPS. In that letter, NEPS congratulates them and says it continues to recruit, in this case, additional psychologists and hopes to assign a psychologist to the school at the earliest opportunity. NEPS states by way of reminder that if the school needs to access the service for an urgent reason, it will be provided. Then we receive further information in an email to the effect that NEPS is experiencing staff shortages and the NCSE is operating on a prioritised work schedule. The principal is asked to send an email, etc. Alternatively, they can get in contact by phone. In other words, the service is there. When you want to access it, however, it is not. We know that the majority of children and adolescents in Ireland with autism, for example, have stated that they have not received in the past year the services they need. Over 74% said that one more service that was promised to them in the past 12 months has not been given to them.

I understand that the Minister of State is doing her best to try to improve the service and that she is being told by her Department that the service is running fine. The reality is, however, that a significant number of schools across the country are having these services taken away. This is having an enormous impact on those children. When they go to appeal the reduction in service, it is so onerous that it is nearly a full-time job to apply. I know from my experience that Departments can be inordinately bureaucratic in respect of these issues. Schools say they do not need diagnoses in respect of the children, but then they are told they need proof that the child needs the service, so the Department is saying two different things to schools at the same time.

I will contact the NCSE about the review process if it is overly onerous and will give it that feedback. There is significant consultation with all the stakeholders - management, teachers, schools - right across the country in order to ensure that this review process is up to date and that every year we get the correct data in order that this is efficient. The reviews coming back from the NCSE are being prioritised and the council is liaising directly with schools that have applied for this review where they feel they have not got adequate allocation of SETs. That process is under way for some within the Deputy's constituency. Deputy English raised one specific school in that regard. That work will be ongoing, but if the process is very onerous, I will raise that.

As regards the 2024 budget, the Department will spend €2.7 billion on special education, excluding capital expenditure, which is estimated at over €200 million.

Schools have been able to request reviews of their allocations directly from the NCSE through its website portal since 1 March last. A total of 218 applications have been received from schools during this period. Applications received from schools that are developing or rapidly developing receive first priority. Reviews, as the Deputy knows, are conducted by the NCSE between March and May to better enable schools to plan for the following September. This process has commenced and the first tranche of schools, numbering 30, will be contacted over the coming weeks to advise them of additional allocations. It is important that schools that have a concern that they have not got adequate SET allocations go through that review process. I will engage with the NCSE on the issues the Deputy has raised about the process being very onerous.

Health Services Staff

In the early hours of Tuesday, 17 October 2023, unions reached an agreement on pay parity for section 39, section 56 and section 10 workers who are employed in community services. The agreement came about on foot of a long-running dispute relating to the pay they were receiving and the pay their counterparts directly employed by the State were receiving. A proposal was agreed acknowledging that the workers in those sections deserve pay equality. That was a very significant step for those organisations. A pathway was set out whereby an increase of 3% backdated to 1 April 2023 would be paid before the end of the year, with an increase of 2% from 1 November and an increase of 3% from 1 March 2024. That would come to a pay increase of 8% to those workers within 12 months.

That pay agreement has not been honoured. Of the 3% pay backdated to April, only 80% has been paid to date. I am less concerned about that because that is backdated pay and can be addressed. The increase due on 1 March was not paid on that date. A successor to Building Momentum was agreed with public sector workers since then, and they received a pay increase on 1 January, which means that the pay disparity between the section 39, section 10 and section 56 organisations and their public sector counterparts has widened again. This is causing huge concern within organisations, specifically those providing community services to disabled people.

For example, in my locality, the Irish Wheelchair Association in Cavan has had to reduce its service to an outreach service, consistent with what it offered during Covid times. It is holding Zoom meetings and maybe a limited community contact day once every couple of weeks for service users. It is also carrying out home visits. The staff in the service are excellent. They are doing absolutely everything they can to ensure that the service users get as much contact as possible, but it will not address the needs of those service users. They are so disappointed. The service had been reduced in recent years due to the lack of staff but now it has gone to zero service days. It is not the only organisation faced with this. It may have come to that crunch point at this stage, and it is to be hoped it can be addressed very quickly. It is engaging with the HSE, and we hope there will be meetings to try to address the staffing issue. Other organisations are in similar situations in that they may not quite have got to that point yet but they are very close to it.

There may be a number of reasons for this, but the main one relates to the pay disparity.

I am aware there is a recruitment crisis within the social and healthcare sector as it is, but if there are organisations that can pay, at the basic level, €4 to €5 per hour more than the HSE or section 38 organisations, employees will go to them. You could not blame them. We have a cost-of-living crisis and the employees have high rents or mortgages, so they will take the option.

The IWA in Cavan stated it recruits and trains people to an exemplary standard over six months but that they leave afterwards and go to organisations where they get a higher rate of pay. It also stated the strike and the action that preceded it highlighted the pay disparity. Many workers who had been very happy in their work and wanted to stay felt they had no option but to go elsewhere to secure more pay because of the pressures owing to the cost of living, rental or mortgages.

Comhghairdeas leis an Aire Stáit. Go n-éirí léi ina ról nua.

Go raibh maith agat.

I thank Deputy Tully for raising this issue for discussion in the House. She has been an advocate for people with disabilities and those working with them, which I really appreciate.

The Minister, Deputy O'Gorman, and the Minister of State, Deputy Rabbitte, wanted to take this opportunity to acknowledge the essential role section 39 community and voluntary organisations play. Their staff provide excellent health and social care services and supports to so many throughout the country.

The Government recognises that the ability of organisations to recruit and retain staff is crucial to the delivery of quality services and the overall sustainability of the sector. In recognition of the staffing challenges experienced by providers, the Department of Children, Equality, Disability, Integration and Youth, the Department of Health and the relevant funding agencies proactively engaged with staff unions through a WRC-facilitated voluntary process.

As the Deputy has said, the agreement reached last October committed to a significant increase in investment in the sector, amounting to a phased 8% increase in funding for the pay for staff in section 39, section 56 and section 10 voluntary organisations. This significant increase was welcomed by all parties. The Department of Children, Equality, Disability, Integration and Youth provided an additional €14 million to meet the 2023 costs of this agreement, and a further €41 million is being provided in 2024 to support section 39 organisations in meeting the full-year costs of the pay increase. The HSE has put in place the necessary arrangements to make this additional funding available and accessible to qualifying organisations.

As a first step, interim funding was paid in late January and early February to all section 39 organisations in receipt of annual funding above €250,000. All eligible section 39 organisations, regardless of the level of funding, were subsequently issued with a prepopulated template to facilitate claims for the full amount of funding due to their employees. Templates were issued to more than 1,140 organisations to facilitate the uploading of relevant information through a dedicated portal. The administrative arrangements developed by the HSE are designed to make funding available as efficiently as possible to the employer organisations while also providing for appropriate accountability in the expenditure of public moneys.

Given a relatively slow initial response from employers, the HSE wrote to all section 39 funded organisations requesting that they submit their claims and offering support to organisations that have queries about the process. As of last Thursday, 18 April, 363 organisations have submitted details, and requests are being validated and processed as they come in. It is the objective of the HSE to make all due payments without delay so employees of the organisations can access their entitlements as soon as possible. The HSE is working through eligibility issues as they arise and dealing directly with the section 39 organisations on a case-by-case basis. Staff employed in these organisations understandably want to see the increases reflected in their take-home pay. The important message for them is that the HSE is progressing the process with their employers as speedily as possible.

It should also be noted that, following agreement on the recent public sector pay deal, in which the Deputy is particularly interested, Departments, agencies and unions will engage in further talks at the WRC next month. It is in the interest of staff that their employers have a direct and proactive role in this round of further discussions. It remains a key objective of the Government to ensure appropriate funding is available to give stability to service providers for the delivery of quality supports and services to people with disabilities, in addition to paying the workers.

I appreciate that and I am delighted to hear there will be further talks and negotiations. If this issue is not dealt with, we will not see an end to this problem. There is a shortage of workers within the sector, so they will go to the agencies and organisations that can pay them more. They will do exactly the same work but be paid better. Several organisations have expressed concern. The IWA expressed concern directly after the unions accepted the deal. While it welcomed the pay increase for workers within its services, it did not feel it would actually address the pay disparity issue. Enable Ireland has expressed concern the money will not be sufficient to cover all the costs relating to the pay increase, such as PRSI and pension costs. These are ongoing issues that need to be addressed.

Many of these organisations get funding only yearly and find it impossible to plan and ensure sufficient funds going forward. The bottom line is the vital services section 39 organisations, in particular, provide impact upon the most vulnerable in society. In this regard, I give the example of a service user of the IWA service in Cavan, a 25-year-old girl called Kaitlin. She was born with Worster-Drought syndrome and she has epilepsy and cerebral palsy, so she cannot talk or walk. She has not been able to do so from birth. She did attend school and knows exactly what is going on. She loved to go to her service, which was available for three days per week at the time. She was promised 26 hours per week but that never came to fruition. She was attending for three days a week for a number of hours but she was told the service would be reduced to three days one week and two the next. The next thing, due to the number of staff off sick, she actually got no hours. Zoom engagements are no good to her because she cannot talk. She appreciates the visits but she is practically a prisoner in her own home because she cannot go to the service she enjoyed so much. Her mother is now practically a prisoner as well because she is her main carer. She cannot get out to do whatever she needs to do because her daughter needs full-time care and assistance at home. What is happening is directly affecting people and their families.

Staff in this sector did not get the pandemic unemployment payment or the recognition payment, despite all the work they did during the Covid pandemic. That was totally unfair.

I thank the Deputy again for raising this important issue. I fully appreciate what she has said about the recruitment and retention of staff. Staff in this area are vital because they provide the necessary resources and support that people like Kaitlin and her family need, and that is why the Department of Children, Equality, Disability, Integration and Youth is committed to sustainable service delivery for the benefit of those who rely on essential services and the workers who are committed to providing a service of the high level in question.

The necessary additional funding has been provided and the HSE is working to make it available to employer organisations as efficiently as possible. Progress has been made in this regard. Once individual organisations have submitted the necessary information to the HSE, it is validated and processed to facilitate the release of the full amount of funding to them. Dedicated supports, including external administrative resources and an online portal, are now in place to support organisations in submitting the necessary information. The HSE is now making payments weekly and the remaining employer organisations are encouraged to submit the required information to the HSE as soon as possible.

The Government has demonstrated its continuing commitment to people with disabilities, with a record €2.9 billion provided in 2024. This includes significant additional funding to help increase service capacity and support providers to deliver more for people with disabilities right across the country. The Minister has acknowledged there is more to do in this area. Following the conclusion of the new public sector pay deal, officials will participate in further discussions with the WRC next month.

Sin deireadh leis na Saincheisteanna Tráthúla, faraor, mar níl an duine eile ann. Táimid roimh ré. Mar sin de, beidh briseadh beag go dtí 9.58 a.m.

Cuireadh an Dáil ar fionraí ar 9.49 a.m. agus cuireadh tús leis arís ar 9.58 a.m.
Sitting suspended at 9.49 a.m. and resumed at 9.58 a.m.
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