Mr. Durkan: I thank the Ceann Comhairle for affording Deputy Gogarty and I the opportunity to raise this matter on the Adjournment. Peamount Hospital has given excellent service for many years in the area of services for TB and respiratory problems. It established a catchment area from the 1950s onwards. It is ironic that at this time a change has taken place and we hear talk of a new strategy for Peamount. I am always suspicious whenever I hear about new strategies. Being a medical practitioner himself, the Ceann Comhairle must have a view on this.

There is a new proposal to change the emphasis and to provide a hospital rehabilitation section. I have no difficulties with that. It is an admirable proposal, but for a variety of reasons it should not happen at the expense of the existing and established services in Peamount Hospital. Despite the information provided in tabular form by the Department, tuberculosis is still with us and is a serious illness. The Minister of State at the Department of Transport, Deputy McDaid, may find that out. I do not wish to challenge his medical view, but there comes a time when all lay people have the right to challenge the medical view, and may be right.

I want to register the total opposition of all the people in the catchment area to this proposal to dismantle Peamount and introduce what is termed a transitional phase. When I hear about a transitional phase, I get worried, because transition is usually something that is coming to an end in so far as the provision of service is concerned.

I have heard for many years that big is beautiful and that centres of excellence are the order of the day. In a report issued today, one reads of the benefits of the centres of excellence. What is proposed for the hospital in which we already have a centre of excellence? We propose to close it down and replace it with something else. This is extraordinary. It flies in the face of the Hanly report which has just been published.

It is not logical to do what is now proposed. I reject entirely the strategy behind the proposal. If some people think that ordinary Deputies might not know anything about the issue, I served 19 years on a health board, where we examined minutely every report produced. I call on the Minister for Health and Children, Deputy Martin, to use his influence to reverse the proposal.

Mr. Gogarty: The Minister of State at the Department of Health and Children, Deputy Brian Lenihan, is aware of the five year strategy. I broadly welcome it, but there is one item missing, a chest hospital along with related community care for the elderly in the catchment area.
Why are these services being dropped? It does not make sense. It is stated on page 21 of the Peamount strategy document that a chest hospital option was examined. If the time and money were spent examining the option, what case was given for leaving it out? No justification is given for breaking up and scattering the expertise. There is indeed a new centre of excellence in the pipeline for St. James's Hospital, but this is for acute patients, a term not fully explained, not for the vast majority of clients currently treated at Peamount for TB and other respiratory disorders, nor for the elderly residents from Brittas, Newcastle, Saggart, Rathcoole, Lucan and beyond, into north Kildare. Where will they go and what plans are in place for them? Solutions might be found in the future, but if the hospitals are working now, why change a winning formula?

It seems that the board of management is not for turning. The chief executive and chairman have admitted that the process in developing the strategy was flawed. The board seems to have collectively acted incompetently, and members were misinformed as to the board's extensive powers to retain the chest hospital in spite of recommendations from Comhairle na nOspidéal. A false impression was given that what Comhairle proposed is binding.

Two weeks ago I, together with community representatives, met the board's chief executive and chairman. Some assurances were given for the future, including that of community representation on the board and the possibility of changing the charter to allow staff representation. The chairman indicated that if the Minister for Health and Children, Deputy Martin, or even the EHRA, asked for the chest hospital option, the board would have no objection. It could however have taken a pro-active approach. I asked the chief executive to do so. He said that the board had already met. It seems the chief executive was more interested in the primary role of selling off land for housing than acting in everyone's best interests. I found it disturbing that he was not willing to call a board meeting to review the situation in the light of new information, and representation from the community and local representatives who raised concerns on behalf of hardworking and vastly experienced staff.

The strategy was flawed because the consultants' report was flawed, as was the information-gathering. A staff member complained about inadequate consultation, as did the wider community. There was minimal consultation with staff. The final consultants' report did not have any staff recommendations. No nursing input was sought or given nor was input sought from the multi-disclipinary team. All this expertise was ignored. The Minister must take a hands-on approach to direct the board or the EHRA to review the Peamount strategy and retain the chest hospital. As Deputy Durkan said, Peamount is the perfect location for the control of TB and non-acute respiratory conditions. It has spacious grounds in which people can get plenty of fresh air, all suited to the control of chronic disorders, unlike St. James's Hospital. Given that TB is on the rise, spreading patients throughout hospitals around the country will increase the risk.
Peamount is one of the few hospitals in the country which is working. If it is not broken, why fix it? Let us make positive proposals with the other good recommendations in the strategy for the retention of the chest hospital.

Minister of State at the Department of Health and Children (Mr. B. Lenihan): On behalf of my colleague, the Minister for Health and Children, Deputy Martin, I welcome the opportunity to clarify the position on the issues raised by the Deputies. The Minister gave a comprehensive reply to Deputy Durkan on 9 October in response to questions raised with regard to the future provision of tuberculosis and respiratory services at Peamount Hospital.

In July 2000 Comhairle na nOspidéal made a number of recommendations on the future organisation and delivery of respiratory and tuberculosis services. It recognised the valuable role which Peamount Hospital had played for many years. However, in line with major advances in medical treatment, it recommended that the optimal in-patient care of patients with respiratory diseases, including tuberculosis, was more appropriate to local acute general hospitals, staffed by consultant respiratory physicians and other consultants supported by an array of investigative facilities. Peamount Hospital was not regarded by Comhairle na nOspidéal as an appropriate location for the treatment of TB patients. Comhairle na nOspidéal has considerably more scientific knowledge of these matters than Deputies Durkan or Gogarty.

Mr. Gogarty: It does not have more knowledge than the staff of Peamount Hospital.

Mr. B. Lenihan: There is a very sad outlook for the future of the Hanley report and the health of patients in the greater Dublin area if Deputies are to continue to indulge in this type of parish pumping.

Mr. Durkan: The Minister of State should be ashamed of himself in making such a statement.

An Ceann Comhairle: Will the Deputy, please, allow the Minister of State to continue without interruption?

Mr. Durkan: He should know more about the area.

An Ceann Comhairle: The Minister of State has only five minutes in which to reply.

Mr. Durkan: He is giving a spoof reply and standing over a decision that should not be stood over.

An Ceann Comhairle: The Deputy was allowed to make his contribution without interruption. Will he, please, allow the Minister of State to continue?

Mr. Durkan: I am sorry, he upset me.

Mr. B. Lenihan: The Hanley report recommends the establishment of centres of excellence.

Mr. Durkan: Yes, and the Minister wants to close them down.

Mr. B. Lenihan: We have a scientific body composed of eminent medical men and women telling us what the centres of excellence should be. Unfortunately, Deputies want to indulge in parish pumping. There have been far too many of them in the House during the years - like facts, like cats, like water.

Mr. Durkan: That is a slash and burn policy.

Mr. Gogarty: That is a huge insult to the staff who are the experts in this area.

Mr. B. Lenihan: Comhairle na nOspidéal subsequently appointed a committee to advance implementation of the 2000 report which endorsed the recommendations in the earlier Comhairle report and was adopted by Comhairle in April 2003. Specifically, the committee recommended that Peamount Hospital play an active role in the provision of a range of non-acute support services, including pulmonary rehabilitation, within the South Western Area Health Board. For example, it recommended that patients having been treated in the nearby St James's Hospital and other major acute hospitals and who required ongoing rehabilitative care could be transferred to Peamount Hospital for completion of their care.

The Minister understands that, in addition to the Comhairle na nOspidéal advice on this issue, the board of Peamount Hospital has developed a strategic plan for its development over the next five years. The hospital employed external support to assist it in this process and advise on developments in the wider health care environment. The strategy adopted by the board proposes considerable enhancement of existing services and development of new services in the areas of rehabilitation and continuing care of older people, persons with intellectual disabilities and adults with neurological or pulmonary illness. The implications for the acute respiratory services currently provided at the hospital are being assessed following which it is understood there will be further consultation with a range of relevant parties. The Eastern Regional Health Authority will participate fully in this process to ensure the interests of, and potential benefits to, patients of the region are fully realised.

Mr. Durkan: This is a sad day for medicine.

Mr. B. Lenihan: It will be a sad day if the Deputy continues in that manner.

Mr. Durkan: I am surprised at the Minister of State letting people down in that way.

An Ceann Comhairle: The Deputy's colleague, Deputy Neville, wishes to make his contribution.

Mr. Durkan: I am sorry, the Minister of State upset me.

Mr. Gogarty: The Minister of State has upset many

The purpose of the Bill is to make detailed provision through which the education of children who have special educational needs because of disabilities can be guaranteed as a right enforceable in law. This right is already enshrined in the Constitution. I shall come to section 12 later. There are difficulties in allowing these rights to be implemented without the allocation of resources. That is the reason I say the Bill is not rights based, at least not to the extent that matters, because it is not resource guaranteed. It is more of wish list. We live in an Internet society and we are trying to get children in schools to use computers more. If one goes to Amazon one always sees a wish list. In that context, the Bill could be described also as a wish list, because without the money to back it up that is all it will ever be. The provisions are welcome but they need tweaking. My colleague, Green Party justice spokesperson, Deputy Cuffe, will speak more about the rights based legislation at a later date. Other Deputies and I will examine with the Bill, section by section, at the Select Committee on Education and Science. Unlike Deputy O'Sullivan I do not half an hour to deal with the intricacies of the Bill.

Ms O'Sullivan: The Deputy will have to join the Labour Party.

Mr. Gogarty: Maybe the next time around. I wish to deal with some aspects of the Bill which will be debated on Committee Stage. If we are aspire, as a democratic society towards equal citizenship we need to examine the education of our citizens, particularly those with special education needs. Section 1 contains the definitions of "child with special educational needs" and "educational disability". I will not repeat what other speakers have said but already we are running into difficulties, because a huge range of educational disabilities are not covered under this definition. I welcome the Minister's statement about an amendment to include dyslexia. I hope it will be included in the wording of the Bill as many educational disabilities are not, such as all the autism spectrum disorders, which need also to be clearly defined.

Sections 3, 4, 5 and 7 which concern parent and principal involvement, are of concern to me and a number of others. In section 3 there is no provision for the child and the family to have access to independent opinion. There is no provision to allow parents to be involved in consultation straight away. Groups such as the Federation for Voluntary Bodies and parents associations welcome the sections but consider they are too weak. In terms of amendments to the plan, parent involvement should be crucial at every stage of the process.

Some groups propose that the wording in all of these sections be amended to ensure that parents are identified as essential members of the team. The principal, as Deputy Crowe said, is a busy person and in some cases does two jobs. Therefore it is difficult to expect the principal to have the time, let alone the knowledge or training, to carry out assessments. The key point in regard to section 5 is that a school principal does not necessarily have the qualifications or expertise to decide who needs assistance. Therefore, he or she would not be the appropriate person to determine who should make up the team. Sometimes the principal might be the primary person but that would depend on the principal's expertise and aptitude. The provisions in this context should be widened substantially.

Deputy Enright raised the issue of unmet resources as things stand. She mentioned NEPS and therapists. Section 4 places an obligation on the health board or the council to cause assessment to commence within three months. Is there any provision included in the Bill to ensure that happens? It should be written into it in order to make it a rights based Bill. In practice, will the health boards be able to deliver on their commitments, as outlined in section 4? Someone alluded earlier to the Minister saying this Bill could be implemented within five years. However, the Minister for Health and Children, Deputy Martin, has spoken of ten or fifteen years depending on the specialised staffing required. If it takes that long, the Bill will not work but will remain a wish list. The only way this Bill can be made wholly rights based is to include an obligation in the Act to ensure this provision is made.

Section 6 of the Bill refers to the provision of services. The National Federation of Voluntary Bodies has queries concerning the exact roles of the Departments of Health and Children, and Education and Science. It suggests the transfer of support services to the Department of Education and Science from the Department of Health and Children in order to facilitate better collaboration between staff. Speech and language therapists would therefore work as part of the education system rather than with the health boards. This would lead to a more effective, co-ordinated and team-based approach. If the services are driven by the education sector the Bill will work more effectively. If support staff in a school, or sharing schools, are employed by the Department of Education greater opportunities are created because therapy programmes can be integrated in the child's daily activities.

Another concern relates to section 9. The Down's syndrome group says this would create the ghettoisation of schools. Certain groups want their children to be integrated but other groups such as representative bodies for the deaf say they need special schools, which should be facilitated. Section 9 does not create any great distinction. The same is true for section 8 with regard to educational plans. There is not enough emphasis on the individual needs of the student.

Section 12 was mentioned already and concerns resources and the involvement of the Minister for Finance. I ask that the wording of the Bill include measures which will allow money to be spent whether or not the budget is allocated to the Department of Education and Science. This would place an onus on the Minister for Finance to provide the funds.

I agree with other speakers that there has been insufficient reference to pre-school education in the Bill. It is also shocking and incomprehensible that access to education is cut off after the age of 18 years. We should be providing a life-long learning system. The Department of Health and Children should not have the responsibility for persons needing educational services after the age of 18 years and this should be enshrined within the legislation.

Mr. Kelly: In July 2003, the Minister for Education and Science published the Education for Persons with Disabilities Bill. This Bill will provide a statutory guarantee of education services for people with a disability by providing a statutory framework within which the education of children and people who have special educational needs because of disabilities can be guaranteed as a right enforceable in law. The Bill sets out a range of services which must be provided, including assessments, individual education plans and support services. It also provides for a process of mediation and appeals where needs are not met and provides a central role for parents in the education of their children. The Bill establishes the national council for special education through which the Bill, when enacted, will be given effect.

The Bill gives statutory force to a policy of integrated education. It provides that a child with special needs will be educated in an integrated setting unless this would not be in the best interests of the child or the effective provision of education for other children in the mainstream environment.

The drawing up of education plans tailored to meet the educational needs of children with special educational needs is a key provision of the Bill. Through the planning process, disabilities can be identified, needs assessed, goals decided upon and progress monitored. Where a school principal believes that a child is not benefiting from the regular education programme, he or she must take measures to meet the child's educational needs. If these measures do not meet the child's needs, the principal must consult with the parents and arrange for an assessment of the child. This must be carried out as soon as possible but not later than three months from the time the principal formed his or her opinion about the child. Where an assessment establishes that a child does have an educational disability, the principal must ensure an individual education plan is prepared within one month and that, in preparing the plan, the parents, special educational needs organiser and any other relevant person is consulted.
It is intended that a school would draw up the plan where the child's needs are relatively uncomplicated. The Bill provides for a formal planning process to be undertaken by the national council for special education for children whose needs are more complex. In the case of a plan prepared by the council, a special educational needs organiser will convene a team of people which must include the child's parents and may also involve the child, the school principal and a psychologist. Where the plan focuses on educational needs, it must also have regard to any other needs identified in the child's assessment and must be consistent with those needs.

Educational plans will be reviewed at regular intervals. Schools have the primary responsibility for this and must report on it to the child's parents and the council. If the special educational needs organiser takes the view that the child is significantly failing to achieve the goals in the plan, the team may be reconvened to review, and where necessary amend, the plan. In preparing or reviewing a plan, the school or special educational needs organiser must have regard to the educational provision which will be required for the child on becoming an adult and must take steps to enable the child to progress to further education and training.