Vol. 1084 No. 4
121. Deputy Liam Quaide asked the Minister for Children, Disability and Equality the number of staff assigned to each regional single point of access referral pathway for children's disability and mental health services, including primary care; the number of single point of access units established to date per health region; the disciplines represented on each; and the governance arrangements in place to adjudicate contested cases. [29469/26]
The Taoiseach told us this week that the single point of access initiative is being rolled out across child and adolescent mental health services, CAMHS, children's disability network teams, CDNTs, and primary care so that young people are not languishing on one waiting list after another. There is serious concern, however, within the services that buy-in to the single point of access is not consistent across all parts of the system, including psychiatry, and that there is an absence of a clear adjudication mechanism for contested cases. What procedures are in place in each region to make this work on the ground?
The Government and I recognise the importance of early intervention for children with disabilities and ensuring they receive the right services at the right time.
The HSE has been developing a single point of access, SPoA, referral model. As Deputy Quaide has said, this will ensure that children are referred to the appropriate healthcare service, whether that is primary care, disability services or child and adolescent mental health services at an early stage. As a result, children will not be put on multiple waiting lists or be passed from one service to another. I am sure the Deputy has had the same feedback from parents and families, as I have from constituents. Sometimes parents feel they get to the top of the waiting list and they are told they are on the wrong referral path and they go to the bottom of another queue. This is to solve that problem because we know that is not fair.
The roll-out is expected to commence on 24 June and will continue throughout this year. The SPoA model will be supported by the Health Service Executive's community care record at that time as a key enabler for the administration and delivery of services. A national oversight group and six regional implementation groups are leading the programme.
The single point of access referral model across all six regions will be achieved through resourcing, partnership and collaboration, and the design and development of a single integrated pathway and streamlined referrals process. It is not expected to give rise to an additional staffing requirement but local areas will deploy existing resources in a way that best suits the needs of their area. A standardised, online, publicly available children and young people’s services referral form has been finalised by the HSE and that single form and will replace over 20 manual forms that have been used until now. It is now being digitised to optimise the referral pathway and timelines for signposting each child to the service or services most appropriate to meet their needs.
Following the receipt of a digital referral form and engagement with the person who made the referral, the referral will then be reviewed and triaged, and this triage will continue to be locally led.
The single point of access is a sound concept and I fully support it. Young people are, as the Minister of State said, getting passed from one waiting list to the next and that is happening mainly because services have been understaffed for years and they respond to this by becoming more rigid in their gatekeeping of referrals.
There is also an issue of power imbalances that we need to focus on. For instance, it is very difficult for a basic grade speech and language therapist or a basic grade occupational therapist to hold the line with, for instance, a consultant psychiatrist, that CAMHS is a more suitable service for a young person even when, objectively, that is clearly the case.
I am hearing of concerns within services that psychiatry has not fully bought into the single point of access model in each region. I ask the Minister of State again whether there is an ongoing dispute between CAMHS, primary care and CDNTs about which service best fits a young person's needs. Who has the authority to make a final decision in that instance? Is there a named adjudicator? Is there a formal escalation pathway? Is there a timeframe for determination?
The Deputy is right that more complex cases will often require further clinical interventions or reviews to ensure the most appropriate pathway of care. Decisions on how this is managed will continue to be made at a local level. Once the work for a single point of access is complete, the outcome of the referral will be communicated to the referrer, and the child will then be assigned to the appropriate service.
In recent weeks, the HSE access and integration team, which is leading the single point of access programme, has developed a high-level standard operating procedure, SOP. That sets out the core processes and requirements necessary to deliver on the single point of access commitments. This is currently under review by the six regions. It has gone to the six regions for their input and based on their feedback, regional implementation plans, which were developed in late 2025, may require further refinement to ensure full alignment with the agreed national approach and with the supporting digital infrastructure.
Ultimately, and this is the important bit and goes to the nub of the Deputy's question, clinical governance for each area will remain under the remit of the regional executive officer. Local areas will continue to exercise their clinical and professional judgment to manage and find resolutions to cases in line with existing HSE policy, practice and procedures.
The HSE has repeatedly told committees in the Oireachtas that the single point of access will stop children from being moved around the system, between primary care, CDNTs and CAMHS. It is still far from clear how this is meant to work when services fundamentally disagree. That disagreement continues about responsibility for a young person and that is the real test of this reform. Will the Minister of State now set out whether the Department or the HSE has formally engaged with the College of Psychiatrists on the single point of access, whether the college has indicated full support for the model and whether it has expressed reservations, particularly around disputed referrals or contested cases, and whether she will publish the governance and adjudication arrangements that are meant to operate when these disputes arise? It is not realistic to expect a basic grade occupational therapist to make a referral to the regional executive officer. Without that clarity this risks becoming another reform that looks nice on paper but leaves clinicians arguing and families stuck in limbo. It is fair to say that all this is happening against a backdrop of services remaining severely compromised by a long-standing failure to engage in proper workforce planning and comprehensive recruitment to disability and mental health services.
I thank the Deputy for saying he feels that the single point of access is a sound concept. It is something I am very much committed to and I know it is something the Ministers, Deputy Foley and Deputy Carroll-MacNeill, are very committed to also. The HSE has done a huge amount of work on this. Ultimately, the rollout of a single point of access will be supported by the HSE community connects ICT system and by the regional implementation plans, which are now with each region so they can be fully refined. We expect this to be implemented soon.
In terms of the HSE and the College of Psychiatrists, if the Deputy would like to suggest to the college to write to me or the Minister, Deputy Foley, we would certainly take on board its feedback and be a conduit to the HSE if it feels there are any roadblocks there. Ultimately, what we all are committed to - the HSE, our Department and every person working in our CDNTs across the county - is ensuring families receive the supports necessary to meet their children's needs. Systematic changes have to happen in order to do that and the introduction of the single point of access, along with the 19% increase in the HSE's disability budget for this year to more than €3.8 billion, are clear steps that show we are very serious about this.
With the permission of the House we will revert to Question No. 120 in the name of Deputy Claire Kerrane. Is that agreed? Agreed.
120. Deputy Claire Kerrane asked the Minister for Children, Disability and Equality if she will include additional institutions to the mother and baby institutions payment scheme; and if she will make a statement on the matter. [28696/26]
I want to ask the Minister about the landmark High Court ruling made in February of this year. It specifically examined two institutions, Temple Hill and St. Joseph's, that are excluded from the mother and baby institutions payment scheme. The judge at that time directed the Minister to consider adding these institutions to the scheme and I would like to seek an update on that direction please.
I thank the Deputy. As she will be aware, the mother and baby homes institutions payment scheme provides payments and health benefits to people who spent time in any of the mother and baby, or county home, institutions. These were institutions that were identified by the mother and baby homes commission of investigation as having a main function of providing sheltered and supervised ante- and post-natal facilities to single mothers and their children. The institutions covered by the payment scheme are set out in Schedule 1 of the Mother and Baby Institutions Payment Scheme Act 2023. Chapter 2 of the social history section of the commission of investigation detailed the different types of institutions that existed and whether they could be considered mother and baby institutions.
While the 2023 Act lists all of the mother and baby institutions identified by the commission, section 49 of the Act further provides that, if it were to come to light that an institution in which the State had a regulatory or inspection function fulfilled a similar function with regard to single women and their children as those included in the payment scheme, the then Minister, with the consent of the Minister for public expenditure, may insert an additional institution into the schedule. The Government recognises there are people who suffered stigma, trauma and abuse in other institutions.
It should be noted that the payment scheme is just one of a large suite of actions being undertaken to respond to the legacy of these institutions under the action plan for survivors and former residents of mother and baby and county home institutions. The current programme for Government has underlined a continued commitment to its ongoing delivery. Of the seven major commitments set out in the action plan, six are now delivered and in place while the seventh is actually under way. Key initiatives in the plan include access to birth information, the services of a special advocate and counselling support, which are all already in place, as well as the ongoing development of a national centre for research and remembrance. The Birth Information and Tracing Act 2022, which commenced in October 2022, has seen more than 17,700 applications for information completed to date since services opened. The Institutional Burials Act 2022 and the establishment in 2023 of an independent office under the Act led the intervention at the site of the former mother and baby institution at Tuam. The Deputy is aware that work is under way there. There has been the appointment in 2024 of a special advocate for survivors, the provision of counselling services and out of hours counselling for survivors, and the administration of a commemorative grant scheme for survivors who wish to hold events.
The Minister will no doubt acknowledge the ruling of the court and the views and comments made, most especially by Judge Alexander Owens about the exclusion of the institutions, particularly of Temple Hill and St. Joseph's, because they were the cases brought before him by survivors of both institutions. I have raised the case of Michael Grant in this Chamber and in committee many times. He spent the first year of his life in Temple Hill. He was a healthy child and his mother paid rent for him to remain there for the first year of his life before he was fostered.
Temple Hill appears to have been identified as a hospital. I do not know of any hospital in the State where you pay rent to keep a child. I think that is an omission and that is the ruling and the finding of the judge who considered both Temple Hill and St. Joseph's so carefully. The Minister mentioned a shelter for children. That is exactly what Temple Hill was for Michael Grant. Will the Minister give me any information about the direction she has been given?
Specifically, in relation to the case, I acknowledge that the Department of children is responsible for overseeing the administration of the mother and baby institutions payment scheme and it must do so in line with the legislative scope and the intent of the Mother and Baby and Institutions Payment Scheme Act 2023 as enacted by the Oireachtas.
There has been considerable consideration of the legal advice that has been rendered. The Deputy is correct in seeking two institutions to be added to the scheme but I am obliged to take the advice of the Attorney General. The advice is unequivocal on the need for an appeal of the High Court and recognising that as a necessity. The reason is the grave degree of uncertainty generated by the judgment in terms of the interpretation of the Act and the related scope and parameters of the scheme. In a very detailed and comprehensive judgment, the State's position on a number of relevant matters was agreed with but there was also an indication there had been an error in law in one issue.
I acknowledge a review is coming up. I understand the review is quite niche but I hope the Minister might be able to confirm that the review towards the end of this year will look at the institutions. The special advocate who has been put in place to do a job has been clear in seeking the urgent expansion of this scheme. Having met Michael Grant and his daughter Rachel, my genuine fear is that he may not live to see such an expansion to institutions like Temple Hill. There are other survivors in that situation as well. We need to do right by them. Will the upcoming review look at institutions that are excluded and will it look at exclusions to the scheme as is?
I do not at all take away from the individual cases the Deputy referenced. I have to say in sincerity that I am obliged to accept the legal advice presented by the Attorney General and the legal teams. The legal advice that I have received is quite categoric in that it proposes that the decision as it stands would create a number of significant unintended difficulties. That is the clear-cut legal advice.
In terms of the scheme in general, more than 7,000 applications have been received and 6,500 notices of determination have been issued. Over €78 million has been paid out. Approximately 2,800 people have qualified for health benefits. The scheme is open for five years until March 2029. I acknowledge as well the UK Government's recent announcement on disregards they will allow when people who are in the UK are being assessed for social welfare benefits in the UK.
We want to see more people applying for this scheme. To date, over €1.8 million has been spent on advertising. The Deputy is correct that there will be a review before the end of the year. It is very much meant to be a technical review.
122. Deputy Claire Kerrane asked the Minister for Children, Disability and Equality if she is aware of serious concerns raised in relation to the new national service for guardians ad litem; and if she will make a statement on the matter. [28697/26]
I appreciate the Deputy raising the question and I acknowledge that she has raised it previously. The guardian ad litem, GAL, service is a nationally organised and managed service established to ensure that children's voices are heard and their best interests are independently presented in childcare proceedings by an appointed guardian ad litem. The target is 23 June for commencement of Part 7 of the Child Care (Amendment) Act 2022. The Department is continually working towards this launch date. The commencement of the national service marks a significant transformation of the sector. Children and their best interests are at the centre of the guardian ad litem national service. The need to reform the guardian ad litem rule under the Child Care Act 1991 had been highlighted for many years. The lack of defined qualifications, role and status, as well as an absence of appointment procedures for the guardians, has been widely acknowledged for many years. The new national service will create a national, professional and highly qualified service that better serves children in the courts.
I am aware of the issues that have been raised by the Association of Guardians ad Litem in Ireland, AGALI, in relation to the new GAL national service. I received correspondence from AGALI on 30 January setting out their concerns. I met with their representatives on 24 February. Specific issues raised by them were referred to the Office of the Attorney General. Department officials have engaged with key stakeholders including: court services; the Judiciary; AGALI; Empowering People in Care, EPIC; the Irish Foster Care Association, IFCA; the NGOs; the Ombudsman for Children; Tusla; and care experienced young people. As part of the establishment of the national service, the Department hosted two policy consultations in Cork and Dublin to discuss professional standards, complaints and the code of conduct. We also hosted a townhall event with stakeholders, including guardians, in Miesian Plaza in June 2025. The executive office will issue further invitations and consultations online from 11 May. These consultations will provide current guardians with the opportunity to provide feedback on the appointment procedure, the training and the supervision policy, and the practice of audit procedures under the new national service.
If anyone wondered about the value of guardians ad litem, they only had to watch the "RTÉ Investigates" programme last night. We saw and heard from guardians ad litem who are powerful voices for the children that they look after, speak for and very much support through what can be a very challenging State care system. We also heard from Judge Dermot Simms, who I had in here last month for a briefing along with GALs to speak to the very serious concerns they have and he has for the national service. On a number of occasions the guardians ad litem have to, for want of a better term, go up against Tusla in a courtroom to speak for and advocate for a child. I cannot fathom how we can retain the independence of GALs as they go up against Tusla while both are under the one Minister and the one Department. That is where the question mark is over independence. The Minister will know of the issue I have raised many times in terms of the legal representation. I cannot understand how that cannot be maintained in terms of guaranteed legal representation.
I do not for a single second underestimate the importance of the powerful advocacy of guardians ad litem. They are hugely important. This process is to ensure that they have the appropriate supports, the appropriate regulation and that everything is as it should be. I reiterate that for many years there have been calls to examine this system to see how we can do better and to ensure that the voice of the child is very much at the centre. They are a very powerful resource. I do not take from that in any shape or form.
The Deputy raised the legal representation. There has been, and there will be, no question in terms of access to legal representation. Advice will be available at all times and a head of legal has recently been appointed. If the guardians are party to a case, are bringing a case or it is a special care application, they will automatically also have legal representation. With regard to their independence, there are many examples of bodies under the aegis of one Department but being entirely independent. I want to be clear that the purpose here is to ensure it is a service that does as it sets out to do and the voice of the child is heard. We are doing all we can to ensure this would be the case.
When I hosted AGALI and Judge Dermot Simms last month I asked them to share one example case with me at that briefing. They spoke about two children under the age of 16 who were received into care for the first time and placed in a special emergency arrangement, SEA, which we saw much of in last night's programme. This was the first time they were placed into care and there was nothing else available. Tusla reported on the SEA over several months and they noted the staff were engaging positively with the children every day, that the children were comfortable and settled and that the placement was being overseen by an allocated Tusla SEA supervisor. When the guardian ad litem met with the children directly, the parents, the school and with Tusla and the SEA staff, they uncovered that the children were not being offered breakfast under the SEA. They were in school early enough to avail of the breakfast club but they were not actually enrolled in any breakfast club. The reported positive engagement was an hourly safety and well-being check of the children in their bedrooms. There was no attempt at connection. These were children who were found to be caring for themselves. Finally, the supervisor had visited the placement and was recorded as having met the children, met the staff and completed a risk assessment in one 21-minute visit. Now more than ever we need the guardians ad litem to have their independence and we need that legal protection retained.
I reiterate that the entire purpose here is to ensure that the guardian ad litem service is doing what it should do.
I recognise that guardians ad litem are an incredibly powerful resource who are hugely important in presenting the view of the child. This is to strengthen the service and ensure the system works. It is important that the system is regulated and there is absolutely no doubt about that. It is important that access to legal support is there where a case has been made in this regard and there is no question of that. There is no question either about the independence of GALs. We can quote many other bodies that operate under the aegis of the Department. There has been consultation right across the board on the changes that have been brought in. There will be further consultations, with town hall events and meetings, and further engagement again from mid-May, and this will continue. This is to ensure we have the best possible service in place.
123. Deputy Mark Wall asked the Minister for Children, Disability and Equality if she has identified sites for the Government’s pilot for public childcare facilities, and if she has considered Kildare South, given the urgent lack of childcare places available. [28589/26]
Has the Minister identified sites for the Government's pilot for public childcare facilities? Has she considered Kildare South given the urgent need and lack of childcare facilities in that part of the county?
The Deputy will be aware that we recently announced €135 million in capital investment in buildings for high-quality accessible State-led early learning and childcare. The process begins this year, as he said, with investment in buildings in what will be a groundbreaking initiative for the Government. Capital funding will be used to acquire or fit out building, depending on the requirements. Up to eight buildings will be selected for investment this year and the State-led initiative will provide thousands of places to 2030 using the €135 million provided in the national development plan. The level of investment will ramp up over the lifetime of the Government.
The Department has received project proposals from a number of sources since the programme was launched and there are also projects the Department was aware of prior to the programme's launch. In total 82 potential projects across the country have been received as of 17 April. These projects are at very different stages of development and it is also important to acknowledge this. Some relate to existing buildings ready to be occupied and ready to fit out. Others, however, are much longer-term prospects for the future. Not all proposals align with the programme objectives and some may be funded by other means, including the next round of the building blocks scheme or whatever might be more appropriate to the application that has been received. Some projects have been proposed by an existing early learning and childcare service provider while others relate to a building or property only and a separate process to identify an operator will be required.
Included in the long list are three proposals from County Kildare that have been submitted to the Department. The Department will continue to seek potential projects for consideration. There will be a particular focus in the new State-led facilities on providing places for children aged between one and three, with capacity for these children to continue in the service until they start school, because this is where the need is greatest. The aim of delivering additional supply of this type in suitable locations will include rural areas and urban areas that are not well served at present.
I thank the Minister and I appreciate her reply. The fact we have 82 potential sites throughout the State is encouraging at this stage. Is the process closed for expressions of interest? When the Minister suggests that some projects are from existing suppliers of childcare and others are for properties only, does she have a breakdown of those? With regard to State-led services, is the State proposing to take over existing childcare providers in a State-led childcare service or will it be through co-operation between those existing providers and the State? I stress the problems that I am made aware of on a daily basis in County Kildare. The Minister will be aware that I have raised them a number of times. I would like a breakdown between existing buildings and services and what is property only, and how the Department are treating these.
I acknowledge there are three applications in Kildare and they will be adjudicated in due course. The purpose of the State-led system is to step in where there is no provision. The point I was attempting to make on existing providers is that they may well be better suited to the building blocks arrangement. We have just announced a €10 million investment for private powders or community providers in the core funding model who can apply to extend their premises and provide additional places. Some of the applications that have come in might be more suited to this. I acknowledge that in assessing the sites and buildings, they will have to align with the objectives of the programme. If we have a building that is ready, it will be about the fit-out of the building or maybe the purchase of the building, and there would have to be a tendering arrangement for a provider to come in and carry out the work.
I appreciate the Minister clarifying this as it is an important distinction to make. Existing providers have access to other programmes to increase their level of service and this is important. Are those with a building excluded from putting forward that building? I want to mention the Kilcullen area of County Kildare. I am not sure whether one of the three is for this area. I have raised with the Minister previously the issue whereby upwards of 100 children are without a childcare service in that town. This is replicated throughout Kildare South where the population has increased. We have a very young population. Parents get up very early in the morning to travel 30 km or 40 km to avail of childcare services in other towns. Some of them travel into Dublin to avail of services. This cannot continue. This is a great opportunity for the Government to look at areas such as Kildare and develop State-led services. I ask the Minister to look at this and maybe she can confirm whether the option to propose buildings is still open.
To be fair, it is a rolling application and it is still possible to nominate or submit buildings. There will come a point where we will have to say they will be considered in 2027 as opposed to 2026 and I want to be clear on this. At present we are still accepting them. In terms of Kildare, under the previous building blocks scheme two proposals were accepted and funded. I encourage more providers, either in Kildare or anywhere else throughout the country, to take a look at the scheme extension we announced earlier this week as it is a very suitable scheme for many who wish to extend their premises.
I also acknowledge the role of local city and county childcare committees. There is a consultation process under way on wider early years and learning in terms of the conversation on education. Great work is being done by the local city and county childcare committees, and those who are willing to put forward their buildings, thoughts or ideas must first go through the city and county childcare committees and I want to make this clear.
124. Deputy Aisling Dempsey asked the Minister for Children, Disability and Equality for an update on the building blocks grant. [29531/26]
As I said earlier, I am pleased to have announced on Tuesday that next phase of the building scheme. It is a €10 million capital funding scheme to deliver a significant number of additional early learning and childcare places. The scheme is being funded under the updated national development plan. The purpose of the building blocks scheme is to deliver additional capacity in the sector by supporting existing early learning and childcare services to undertake physical extensions to existing premises. The scheme will be open to community and private services that are signed up to the core funding scheme and commit to continuing in the scheme and adhering to its conditions, particularly in respect of the fee management rules.
The aim of the scheme is to tackle undersupply of full-time places, particularly for children aged from one to three years of age. Places for children in other age brackets will also be eligible for funding, once services create at least the minimum number of places in the priority age cohort. The scheme will have two strands, one for extensions to existing premises for community services and another for extensions to existing premises for private services. Community services can avail of investment of up to €530,000 for projects up to a total value of €650,000. Private services can avail of investment of up to €265,000 for projects up to a total value of €650,000, with a minimum of 50% funding to come from the operator. Thresholds from the scheme have been updated since the previous scheme to reflect construction price inflation.
All projects will be required to accept a charge on the premises to protect the State's interest in the property and ensure that the capital investment continues to be used for its intended purpose over a long period of time. That is important. The State needs to protect the investment. It is important that if funding is being given to provide additional places, it will be used in the long term for the provision of the additional places, as set out in the building blocks extension scheme phase 2.
I thank the Minister. That is positive information and it is a positive scheme. I have had many inquiries over the last while from childcare providers in my area, both private and community-run, as to when it would be announced. It is important that it is for private and community facilities. We need all of our facilities to avail of it. I know people in Trim who are putting their children's names on waiting lists before they are even signing up for antenatal classes. The demand is that strong and this will make a big difference. Aiming the scheme, as I hope we will, primarily at one- to three-year-olds is also vitally important. They are children for whom we are lacking the most spaces. We need to help parents as much as possible to get back into the workforce if they wish to do so. This is a good scheme for achieving that. The scheme for State-led provision of childcare the Minister is working on will be hugely positive and beneficial.
I thank Deputy Dempsey very much. I acknowledge her personal engagement with me on all matters related to early years and childcare. I know it is a particular priority for her and her constituents. The Deputy is correct that it is important to look at two schemes. The building blocks scheme has incredible potential to support private providers but also community providers and, indeed, to provide additional places. The previous scheme is seeking to deliver 1,500 additional places and this will be a further addition.
The State-led scheme is also an important scheme. As we discussed previously, it is a €135 million investment, with a €10 million investment into the building blocks scheme. However, the €135 million investment is specifically State led, looking at areas where there is an absence of provision and where no other provider, either private or community run, has stepped in, for whatever reason. It involves the State stepping in proactively. It will be not for profit. The opportunity this year is for the purchase of the building and in 2027-28, we will look at other options as well.
I ask that the Department and the city and county childcare committees engage with providers, both community and private. I know a lot of places have identified to me a need for extensions, but some have not yet done so. It would be helpful if they were made fully aware and there was a good advertising campaign and engagement through the childcare committees to make them aware that this funding is available. I understand it is not matching funding for community facilities. It could be hugely impactful in our communities.
I acknowledge the role of the city and county childcare committees. We are indebted to them for their expertise and the manner in which they provide engagement on the ground with local providers, both private and community. I give them a shout-out because we have 50 engagements taking place right across the country on developing phase 2 of our action plan. Part of the discussion or conversation is around education, particularly early years education. Those on-the-ground consultations are very important and, as I said, they are being facilitated by early learning and childcare committees.
On the consultation, we have already had over 11,000 engagements online. There is, therefore, phenomenal interest in the whole area of early learning and childcare. The Deputy can be assured, through the city and county childcare committees, that every opportunity will be taken to advertise and promote the State-led and building blocks schemes to make people aware of the opportunities available to support them in the delivery of early learning and childcare.
