I welcome the Minister of State, Deputy Harkin, to the Seanad.
Nithe i dtosach suíonna - Commencement Matters
Education Schemes
The Minister of State is very welcome. I am delighted, as this is relevant to both of us in our area.
I will give some background to Project WAVE, which stands for Working towards Academic and Vocational Equity. It is a project which everyone associated with Atlantic Technological University, ATU, is very proud of. It gives students with intellectual disabilities the opportunity to attend college.
The students attending Project WAVE recently visited me here in Leinster House and met several Senators and TDs. These students defy all expectations that many people hold regarding people with what would be better described as intellectual differences, rather than intellectual disabilities. The students may have Down's syndrome, autism or other forms of neurodivergence.
In the course they study, core topics include ICT, personal development, learning skills and employability, as well as other elective modules, depending on the campus they are based in. For example, in Donegal, the focus is on hospitality. In Mayo, it could be business and early childhood education and care. In Sligo, we have students studying early childhood care, engineering and creative and visual arts programmes. The range of interests, personalities and talents among the Project WAVE students is as varied and diverse as that of the general student population.
Project WAVE is a two-year project, rapidly approaching the end of its second year. After completing WAVE, many of the participants hope to go onto further study or enter the world of work. All the research for this Commencement matter was carried out by Kevin, who is a Project WAVE student currently doing work experience in my office. Since starting Project WAVE, he has developed into an advocate for the rights of students with disabilities.
Kevin has agreed to my sharing his learning story here today:
I was 20-years-old and a student at another college when I first heard about Project WAVE in June 2024. My mum told me that she thought it would be a great opportunity and would give me a better life. I thought about it and I decided I would go for it. Before I was accepted, I had to do an interview. I told them how I wanted to come to ATU and learn new stuff and I would be meeting new people. The first day I arrived in September 2024, there were nine other students starting. None of us knew each other and I was so nervous. I was thinking of dropping out but decided to stick at it because I knew that someone else would take the chance and lots of other people who interviewed did not have the opportunity, and Project WAVE has changed my life. I am very happy now. Two years ago, I was in a bad place with sensory issues and the staff at the college I was attending did not really understand, but the staff at Project WAVE understand my sensory issues and are very nice to me and I could not hope for better. My goals are to do an access course at ATU or do a PLC course in Ballinode College, and to qualify to get a job in Yeats Library or the ATU or another university, maybe in St. Angela's. I have learned a lot of practical skills relating to the appropriate use of technology, flexibility and time use skills.
The reason I tabled this matter is Project WAVE is funded under a three-year pilot programme, designed at enhancing course provision for students with intellectual disabilities. Just as it is in Kevin's story, the enthusiasm shown among the staff, students and families demonstrates Project WAVE is money more than well-spent. It was so wonderful to welcome them here; we had such a wonderful day.
Education experiences are not transitory or temporary. They pay dividends for years, especially in the lives of people who are denied the kinds of opportunities open to most of us. Can the Minister of State confirm whether funding will be made available for the next three-year period and on an ongoing basis, so that students like Kevin, who should have the opportunities open to every other young person, have them?
I thank the Senator for raising what is truly a very important matter to an awful lot of people. I am delighted to be able to respond positively to her this morning.
First, I will give a small bit of context. As the Senator will know, the provision of courses for students with intellectual disabilities was a key commitment made in the national access plan published back in 2022. Progress on the delivery of the courses has been most encouraging, with 193 students studying in 11 higher education institutions, HEIs, across Ireland on these programmes. This far exceeds the original number of 160. The courses have become a feature of our higher education system, which is precisely what we want to see. My Department has invested over €11 million to provide the courses, and I am deeply committed to ensuring their continuation.
To date, participating HEIs reported they have experienced a high demand for the programmes, and the retention and attendance rates are high, sometimes the highest reported across the entire HEI spectrum. Early reports from the institutions have confirmed the programmes, as the Senator said, are having a hugely transformative effect on people’s lives, on the students and, crucially, the wider communities they are participating in.
The Senator specifically referred in her question to Atlantic Technological University. In context, ATU has received over €500,000 under PATH 4 phase 1 2022-2026, and a total budget approved for PATH 4 phase 2 for ATU is €938,000, nearly €1 million. As she knows, the courses are at national framework of qualifications, NFQ. level 6, and a key feature of the programmes is there are no course fees attached. Alongside delivery of the courses, the funding has been used to provide supports to students. Whether that is financial supports for students who may be financially disadvantaged, or assistive technology, personal assistance or transport, there is funding there to help with that.
As the Senator said quite rightly, both students and the colleges they attend are very happy with their achievements.
I am pleased to be in a position to provide her with an update on the continuation of the courses. Just last week the Minister, Deputy Lawless, who is the Minister in charge and who I am speaking for, brought a memorandum to the Government to ensure the continuation of these courses for the next two-year cycle. This decision provides certainty to the students, families and providers and will allow for the courses to be advertised for next September. As the Senator said, this is good news. She spoke about a young man, Kevin, who is working in her office. It is certainly good news for him but also for all the staff and students at ATU and the 11 HEIs across the country which are, as the Senator said, anxious to find out if the funding will be extended post 2026. The simple, straightforward answer to that is "Yes".
That is wonderful news. Gabhaim buíochas leis an Aire Stáit. I am delighted to hear it. People will be absolutely thrilled. It is not only for the students. Kevin said that it was an emergency and that there were only eight weeks left. It will alleviate so many of their concerns and worries. It is fantastic news. I give a big shout-out to all the staff like Tamsin, Jeanette and Róisín for all the work they do and the impact it is having not only on the students but, as the Minister of State said, on the wider community within the colleges and the places where they are doing their work placements as well. I am delighted and again thank the Minister of State for confirming it.
I thank the Senator. There is not a lot more to say except that it is good news all around. The HEA is in the process of engaging an expert consultant to work with the participating institutions on a common evaluation instrument. That is an important part of any aspect of funding. The outcomes of that evaluation will inform the next steps regarding the expansion of the programme in line with the programme for Government commitments. As I said, the answer to the Senator's question is "Yes". It is good news for Kevin and good news for all the people who make such an effort to make a difference to the lives of those students and also to the wider community. I certainly include myself in that. I will not speak for Senators but we all need to have a better understanding of the contributions every single one of us as individuals can make to society. Courses like this give opportunities to people that were not there previously.
Gabhaim buíochas leis an Aire Stáit. While we wait for the Minister of State, Deputy Grealish, I welcome to the Public Gallery visitors from John Scottus National School who are guests of Deputy Hayes. There are also two guests of the Minister, Deputy Foley. I apologise as I do not have their names. Also here are Caitríona Boyd and her grandfather Tony Dunne. You are all very welcome. I hope you enjoy your visit to the Oireachtas. Those who are here from the national school will have no homework for the rest of day as is customary here in the Seanad. Enjoy your day.
Special Educational Needs
I welcome the Minister of State, Deputy Grealish.
I thank the Minister of State for being here. Dyslexia affects an estimated 10% of the population with about 4% experiencing severe dyslexia. In every classroom in Ireland there are children with specific reading difficulties. For some, mainstream supports are sufficient but for others they are not. Reading classes in schools provide specialised, short-term interventions for children with these difficulties. These classes operate with small pupil-teacher ratios, specialist methodologies and structured literacy programmes.
Recently I met the principal of St. Rose's National School in Tallaght, which is one of the few dedicated reading schools in the country. The demand for places speaks for itself. This year St. Rose’s received 120 applications for just 30 places, which means that for every child who was admitted, three were turned away. The criteria for admissions are strict in that children must be aged between eight and 12 and dyslexia must be their primary difficulty. Children must have average or above-average intelligence and have an educational psychological assessment. Enrolment is limited to between third class and sixth class and children attend for a maximum of two years. St. Rose’s provides a targeted, intensive intervention. The school operates a 9:1 pupil-teacher ratio. Every child participates in the Wilson programme, which is a systematic, structured literacy programme designed to improve reading and spelling for those with dyslexia. I spoke with the students when I visited and they told me why their school works for them. They said there were fewer people in their classes and that they used programmes to break down words. They were really complimentary about the Wilson programme. They said it gets you ready for secondary school. One child told me that if there were more schools like St. Rose’s, people would not have to travel as far. That child travels an hour each way to attend. Having to commute long distances is the reality for many families but for others it is much worse as they cannot access a place at all.
Research consistently shows that early, structured intervention is critical for children with dyslexia. Without it the consequences can be long-lasting, including school avoidance, reduced academic attainment and impacts on confidence and employment prospects. International evidence demonstrates that structured literacy approaches, delivered intensively in small groups, significantly improve reading accuracy and fluency for children with specific learning difficulties. Articles over recent years have highlighted the emotional toll on children who fall behind in reading. Children as young as eight internalise failure. They begin to believe they are not intelligent. Reading skills disrupt that narrative. They do not just provide literacy intervention but restoration of confidence.
The provision for reading classes in schools is patchy and uneven. Across the country there are 14 reading classes and just four reading schools, three of which are in Dublin. Children and families face what can only be described as a postcode lottery. If St. Rose’s is receiving 120 applications for 30 places, that indicates unmet need on a significant scale. I am asking if there are plans to establish additional reading classes, and more importantly reading schools, in under-served regions. Reading schools change trajectories and we owe it to those children to ensure it is not a rare exception to get a place but part of our national education structure. We must expand provision and ensure every child with a specific reading difficulty has an opportunity to succeed, regardless of their address.
Gabhaim buíochas leis an Seanadóir. I am taking this on behalf of the Minister for Education and Youth, Deputy Naughton. It is Department policy, in accordance with the principles of inclusive education, that students with additional learning needs are supported in mainstream classes along with their peers, with additional supports provided as necessary. Schools are advised to provide the highest levels of additional teaching support for those students who have the highest levels of need, including students with literacy difficulties.
The Department has invested considerably in ensuring that all recognised mainstream schools have been allocated additional special education teaching resources to support children with special educational needs, including students with a specific learning disability, SLD. Guidelines for schools on the organisation, deployment and use of their special education teachers have been published on the Department’s website. There are 15,000 special education teachers allocated to primary and post-primary schools to enable them to support children with special educational needs. Funding is also made available to schools for the purchase of specialised equipment such as computers and software, or both, to assist children with special educational needs, including children with a specific learning disability, where relevant professionals recommend the equipment as being essential for the provision of education. Schools apply to the NCSE through their local SENO for such support.
A continuum of education provisions is in place covering the full range of need spanning placement in mainstream classes, with support to more specialist placements, either in a special class or a special school, depending on the complexity of need. It is important to note, though, that the majority of students with literacy difficulties currently receive additional teaching support from a special education teacher in a mainstream class. This is provided on the basis of the individual student’s learning needs, identified in schools, as opposed to being based on a requirement for a child to have a diagnosis or an assessment of a particular disability.
There are four schools dedicated to supporting students with an SLD. There are also 14 SLD classes in 11 mainstream primary schools located across the country, though mainly in urban settings, in counties Dublin, Clare, Louth, Galway, Kerry and Wexford. These schools and classes have a teacher-student ratio of 1:9 and are attended by students normally aged between eight and 12 years for a maximum of two years. Students will have a diagnosis of dyslexia and a score at the second percentile, or lower, on standardised literacy tests. They will also have an average or above average level of intelligence.
It is important to note that these classes were established at a time when significantly fewer resources were available to mainstream schools. The inspectorate has evaluated provision in special classes for children and young people with an SLD. The purpose of the evaluation was to examine the quality of provision for children and young people with an SLD, with particular reference to understanding the placement of children and young people in these classes and to identifying the strengths and areas for improvement in learning and teaching in these classes. The inspectorate’s report will inform the development of policy in the Department’s special education section in relation to the overall effectiveness of SLD classes in the context of emerging international trends for inclusion.
One of the key recommendations contained in the inspectorate's report is the need to build the capacity of mainstream schools to meet the needs of students with reading and literacy difficulties. In that regard, I am pleased to say the Department and NCSE officials are working on a measure to support the development of students’ literacy skills. This will see a number of graduates of an MEd dyslexia programme being facilitated to provide advice and support to a number of schools in their local areas. This programme, which will be provided on a trial basis, will be operational from September next. The special education section will continue to consider the findings and recommendations of the inspectorate's report and may in time request the inspectorate to review provision for children with SLDs in special schools.
I have spoken to the children, who have a lived experience and are saying they need more reading schools. I am not happy with the answer, if I am being honest. This is about two years of children's lives and getting them on the right road so that things can be turned around. I am dealing with one child who is under the second percentile, cannot get a place in a reading school and is getting slagged in the mainstream school. It is not good enough.
Everybody's situation is different and requires a different approach. If we are coming from a base where, as the Minister of State said, the special schools were set up at a time when there were no other supports, then we need to get more schools now. We are at a place where there is no additional support if, for example, 120 people are applying for a school in Tallaght and only 30 are getting in. These are children who, for two years of their school lives, could be focused on and set up for secondary school without being slagged for being stupid. They are being called stupid by their peers. Kids do not understand.
I will pursue this further. I thank the Minister of State for coming in today, but I would like it to be relayed to the Minister that I am not happy with the response and I feel that we are really letting down children with dyslexia.
As I said, I am only representing the Minister for Education and Youth. I listened to the Senator and I have heard the issues she raised. If she would be willing to drop a note into my office, I will personally ensure the Minister will reply directly to her on the issues she has raised. They are very important issues. The most important thing everybody would like to do is ensure students get the right and proper services when they go into school, and support, which I think is crucial. The Senator made a strong and valid case for the school in her area, so if she drops a note to me, I will ensure the Minister will reply directly to her on the issues raised.
Dental Services
I welcome the Minister of State and thank her so much for coming in. I am going to talk about dental care, particularly in schools. Access to dental care is in crisis and staffing has become a very serious issue, with staff shortages the main concern for dentists and dental staff. In 2024, 65% of dentists were unable to recruit candidates for dentist positions. A quarter of dentists said they were not taking on any new private adult patients and a third stated they were not taking on any new child patients.
My concern here, however, is about children. I can still remember the day so vividly when the dentist came into my school when I was six years old in 1981 and taught me how to brush my teeth and we got a lovely little colouring book. In 1981, I had access to a dentist in school but in 2026, my children, aged ten and 11, have never seen a dentist in school. Apparently, children should be having check-ups in second, fourth and sixth classes, but they are not having the first of these until fourth year in secondary school. Dentists are saying they are being forced to choose between which children they believe are in most pain and which to treat first. Analysis from the Irish Dental Association shows we need an extra 500 dentists across the private and public sectors immediately. Ireland currently trains fewer dentists per capita than most OECD countries.
A lady contacted my office. Her daughter was seen in May 2024 and put on the priority list for braces. She was told the dentist was working off the 2021 priority list. Her daughter will be 18 in December. A procedure will now have to be done for her daughter whereby she will have to be put under anaesthetic, even though she qualified for braces two years ago. In the public dental service, the lack of dentists has led to a situation where fewer than half of the children who should have been seen as part of the dental school programme have been seen. Children in parts of the country are facing a ten-year backlog.
I am in the very lucky position where I have been able to bring my own kids to a private dentist, but my kids were diagnosed with molar incisor hypomineralisation, MIH, two years ago, an enamel defect affecting the first permanent molars and incisors. The enamel is softer than normal, leading to discolouration, increased sensitivity and the potential for chipping and decay. Enamel is the outer, strong part of your teeth, and if it is not there, your teeth are not good. MIH affects approximately one in eight children in Ireland. Early detection is crucial to prevent further tooth damage and reduce the need for extensive restorative work. The defective enamel can lead to rapid tooth decay or crumbling. It is typically identified when children are aged around six or seven.
MIH-affected teeth are often harder to numb, which means dentistry for these patients can be challenging and may require specialised care. As we can appreciate, it really is unpleasant. As a mammy, it is horrible to bring your kids into the dentist for these treatments. Now that my children have been diagnosed with this condition, I cannot believe the number of other children I know who have it. When I explain it to parents, they often fear that their kids might also have it. White spots on the front of the teeth are a clear sign of it.
My kids have had fissure seals and crowns. They have both had four teeth removed in hospital in their very young years. The cause of the condition is not entirely known. We have been researching it in Ireland over the last 20 years, but it can be due to a baby having a low birth weight, having been a C-section baby or having taken a lot of antibiotics in his or her first two years. I dread to think how many kids are suffering from this condition in Ireland and do not even know because a public dentist has not come to their school and they cannot afford to go to a private dentist.
Our dental schools do not have the basic capacity to educate and train enough dental practitioners to meet population demands. Only half of the students who graduate here each year stay, given that most of them are international students, as the Minister of State knows. We need more investment in our colleges, and I very much welcome the opening of the dental education centre last year. We need specific training in other aspects of dentistry and we need to change the work permit rules for dentists and dental nurses. If we do not do this, I dread to think what will happen to our children's teeth in the future.
I have heard the Minister, Jennifer Carroll MacNeill, mention the need for prevention screening, cleaning and good habits. I have also heard her say our workforce is not working well enough and that dentists are moving into cosmetic treatments such as injectables and Botox treatments. How can we perhaps use our dental hygienists more? How can we get early screening and get dentists into our schools? How can we convince enough dentists to commit to public dentistry?
The bright light here is that I really trust the Minister of State and the Minister, Jennifer Carroll MacNeill. I know they know what is going on. Highlighting this situation will ensure there is more pressure, more talk and more discussion about the situation, and I hope we can get the investment in it.
I thank the Senator for articulating a pressing issue. It is a question I have answered many times in the Seanad and the Dáil. I am taking this matter on behalf of the Minister for Health.
I am grateful to her for the opportunity to address the issue of access to oral healthcare services for children, including orthodontic treatment.
The HSE oral healthcare service aims to provide an oral examination and necessary treatment for children at ages approximating to second and sixth class and, in some cases, fourth class. Emergency care is provided for children of all ages up to 16 and for those with complex and additional needs. The HSE provides orthodontic treatment to patients with the most severe and complex treatment needs.
The Minister is aware that there are currently backlogs in the HSE’s child oral health examination programme, which has meant that the sixth-class groups are being prioritised. As the Senator said, it used to be second class, fourth class and sixth class I recall all my children getting the fissure seals, which make such a difference when they are heading into their teenage years. The Government is committed to addressing the immediate difficulties patients are experiencing in accessing oral healthcare services. The Senator asked an awful lot of questions at the end and they are the driving questions we have at the moment regarding why some dentists do not take public patients. We are losing people when they are trained. They decide to work abroad. People who come here for excellent training go back to their home countries. It was interesting when I met the Belgian minister for health in Brussels, I think it was in 2023. It was during a St. Patrick's day visit. At that time we were just coming out of the Covid-19 pandemic. I recall asking the Minister what his most pressing concern was at the time and he said it was the lack of dentists in Belgium. We have population growth here. In 2015, we had 900,000 children in the country; now we have 1.2 million. It is so important. Everyone knows that there is nothing worse than a toothache. This situation is challenging.
Last year, over 146,000 new patients were assessed in the public dental service, including approximately 100,000 under targeted programmes in schools and special care programmes with over 46,000 others attending for emergencies.
The Minister acknowledges that the current system, which was developed in the 1990s in response to the identified oral healthcare needs at that time, must be modernised and aligned with current needs. The national oral health policy sets out the vision for oral healthcare services in Ireland and has two key goals: first, to provide the supports to enable every individual to achieve their personal best oral health; and, second, to reduce oral health inequalities across the population.
The Senator raised MIH, which she has lived experience of and knows a lot more about than I do. It is a specific pattern of enamel defects in adult teeth. While there is no definitive cause, it is thought that the defects are due to issues arising at the time of development of these specific teeth. The impact for the patient can be wide-ranging, with some experiencing very little impact on the incisors, but a common presentation is sensitivity in the molars.
Depending on the enamel area impacted, management of these teeth can be challenging. Enamel is designed to protect the inner layers of the tooth including the nerve tissue, with MIH patients often experiencing sensitivity to hot and cold due to these enamel defects. The treatment ranges from preventive management through fluoride applications right through to managed extractions at an appropriate age range. These children may present as emergencies from associated sensitivity.
I thank the Minister of State. I appreciate emergency care is provided to children up to 16 years of age but we should not be letting them get to the emergency care situation. The teeth of primary schoolchildren who cannot afford to go to a private dentist are not going to be good. I feel really privileged that I could afford to go to a dentist, but if my children had to wait until sixth class, they would have no back teeth. There would be no enamel. They would be so uncomfortable and it would be emergency procedure after emergency procedure. Parents do not want to see their kids going through that because they do not want them turned off dentists and do not want them going through that pain.
It is so important we get to the primary school age. If I take my own county of Meath, which seems to have been particularly hit, in quarter 4 of 2017, 9,400 children were seen in their school, but in quarter 4 of 2023, only 2,378 were seen. That is three quarters down in nine years. Counties Longford and Westmeath had a population of 142,000 people according to census 2022. They have 31 dentists contracted under the dental treatment services scheme, DTSS, but in Meath we only have 17 for a population of 240,000. Nationally we have a major problem but in County Meath we absolutely need a focus on public dentistry.
There is nothing the Senator is saying that I disagree with. The Government invests annually in oral healthcare with a figure of €240 million this year alone. Over €20 million has been allocated to waiting list initiatives for contracted orthodontic care, resulting in more than 5,200 removals from waiting lists since 2020. This includes a dedicated orthodontic surgery programme that has delivered treatment for an additional 206 patients to date. This funding will continue in 2026 with a further €2.85 million being provided.
I understand exactly where the Senator is coming from. It was part of primary school for all of us to get oral hygiene care. I appreciate that for some families it might be a step too far if they have an issue. However, children will be looked after if they have an emergency. The Senator's point is well made that we should not allow them to get to the point of emergencies. The Minister for Health has a meeting this week on dentists. I saw it in her diary. She is putting a focus on this at the moment to see if we can get some sort of solution to provide more care to those that need it sooner than we are doing at the moment.
Mental Health Services
I welcome the Minister for State back to the Seanad. It is always good to see her. I thank her for coming here to deal with this Commencement matter, which falls within her remit and responsibilities.
I want to set the scene here because that is important. Ironically, I had tabled this Commencement matter yesterday but it was not selected. I am lad it was not selected because today I will be quoting from Judge Alan Mitchell. A posting by RTÉ at 12.10 p.m. yesterday was really interesting because it very much relates to the point I am going to make.
I said to the Minister of State I had watched the "RTÉ Investigates" programme from about two weeks ago entitled "The Psychiatric Care Scandal". It was broadcast over two nights. It was, to say in the least, very disturbing but very necessary viewing. This harrowing documentary laid bare the reality of what the Irish Penal Reform Trust had regularly told us, as politicians in both Houses of the Oireachtas, as did other advocacy groups. It showed the anguish of family members who fear for the well-being and, in many cases, the lives of their loved ones experiencing mental disorders and the health crisis around that. It showed people in the criminal justice system crying our for help that never came in many cases and families watching their loved one's physical and mental health dramatically deteriorate.
Conor Ryan of the "RTÉ Investigates" programme's retelling of the families' stories of grief and pain flowed through our screens and into our homes. It was really public broadcasting, maybe at its saddest, but at its best because it shone a light in a very dark place. It acted as another focus or advocate for the crisis we are referring to here today. I acknowledge Conor Ryan's professionalism with RTÉ's "Prime Time" and RTÉ itself for the amazing investigative programmes it has produced.
"RTÉ' Investigates" exposed what many families, clinicians and advocate organisations have been telling us for years. The State is relying on prisons to manage many people with severe mental illness. The State is failing to provide adequate and appropriate healthcare, despite our domestic and international human rights obligations, including the European Convention on Human Rights and the UN Convention on the Rights of Persons with Disabilities.
The RTÉ documentary highlighted people who had already been diagnosed with serious mental health conditions. Some were bipolar or had schizophrenia, others were experiencing psychotic episodes, yet despite being in touch with mental health services they were denied the support and the appropriate and necessary treatment they clearly required. The HSE and the national forensic mental health service is clearly under-resourced and overwhelmed. I have spoken directly to some of the people involved here and this is what they tell me. The Minister and I both know and agree that prison is not a therapeutic place. It cannot address the trauma nor heal people who are unwell. Prison staff are not fully equipped to support people with specific psychiatric healthcare needs and we accept that..
The Central Mental Hospital is a facility that cost approximately €250 million when it was built.
The Government press release referred to a new change and a new direction, and one that we all welcomed. I understand that, as of yesterday, one third of the facility's beds are not opened. Some 50 beds remain empty while people remain in squalid prison conditions. I take this opportunity to thank Saoirse Brady, director of the Irish Penal Reform Trust.
There is a report on yesterday's RTÉ News website with the heading, "'No options' for psychiatric patients held in prison, judge warns". Referring to a case before Judge Alan Mitchell, the article states, "Solicitor for the HSE, Alan Doyle, told him that it was hoped 10 beds at the CMH would be opened by the end of March but that this had not been confirmed."
I am here to work collaboratively with the Minister of State and I know she is with me. My focus is on when we can get a timeframe, even a gradual timeframe, for these 50 beds to open.
I begin by acknowledging the concerns raised in the recent "RTÉ Investigates" programme on forensic mental health services. While I am not a clinician, my responsibility is to maintain public confidence in this essential service for a highly vulnerable group of patients and for the dedicated staff who care for them. I have asked the HSE for full reports on the cases highlighted in the programme, particularly those involving the Central Mental Hospital. I have also asked that all appropriate care options for the individuals featured be examined. I recognise the pain expressed by the families who took part. Their lived experience matters and it motivates me to continue improving the system.
It is important to restate that the Central Mental Hospital is a hospital, not a prison. Its purpose is to provide treatment, support rehabilitation and enable a safe, carefully managed return to the community where appropriate. Demand for forensic mental health services has grown significantly in recent years, including increased need for inpatient beds at the Central Mental Hospital in Portrane. The HSE actively manages the admission waiting list and works closely with the Irish Prison Service to prioritise those with the most urgent clinical needs.
The first piece of legislation I moved at the end of 2020 was the legislation to support those living in the Central Mental Hospital in Dundrum to be transferred to Portrane. In 2022, I opened the new Central Mental Hospital at Portrane, transferring 93 patients from the old Dundrum facility. This state-of-the-art campus, one of the best, if not the best, of its kind in Europe, was delivered with €212 million in Government capital investment. The 170-bed complex includes a 130-bed Central Mental Hospital, a 30-bed intensive care rehabilitation unit, ICRU, and a ten-bed forensic child and adolescent mental health services, CAMHS, unit. It was always intended that the full capacity at Portrane would become operational on a phased basis because these are very dedicated specific staff.
There are currently 114 operational beds at the Central Mental Hospital, a 20% increase on the former Dundrum hospital. In budget 2025, I secured €2.1 million to recruit the staff necessary to open the remaining 18 Central Mental Hospital beds - 112 were operational at the time. The National Forensic Mental Health Service was permitted to recruit directly and filled most of these specialist posts in record time. There were 45 posts - 41 for the hospital and four for in-reach into prisons. These beds will open gradually over the coming weeks and months. Two beds opened in December and other beds will open in the next few weeks. When all 130 beds are operational, overall Central Mental Hospital capacity will have increased by 37% since late 2022.
In budget 2026, I allocated a further €2.8 million to fund 30 additional staff to open the first ten beds in the new ICRU. Bringing these beds into use will support smoother patient movement through the Portrane campus’s different levels of care, helping create space for further admissions. This year’s funding will bring the National Forensic Mental Health Service workforce to approximately 580 staff. When the ICRU beds open later this year, the campus will operate 140 beds, an increase of 45 beds and almost 47% more capacity compared with Dundrum. The investment will significantly reduce the current waiting list of 38 people in prison who need hospital care.
We also have two psychiatric intensive care units at Carraig Mór in Cork and the Phoenix Centre in Dublin. While these provide short-term intensive care, ICRUs offer both intensive treatment and longer term rehabilitation.
I thank the Minister of State for her comprehensive statement. The reality is that there are beds that have not been opened in the facility. Some 50 beds remain empty while people remain in squalid conditions in our prisons. I accept that a lot has been achieved and I would be the first to say that. The reality is that we need to have these 50 beds. We have budgeted for it and the taxpayers have paid. The beds are in place. It is really important that we prioritise. I hear the Minister of State's point about incremental increases. I would like us to be in a position to say at the end of the year that those 50 beds have been filled.
I draw the Minister of State's attention to this article, which I will send on to her office. She may or may not have seen it on yesterday's RTÉ News website with the headline, "'No options' for psychiatric patients held in prison, judge warns". He was sitting at Cloverhill District Court in the prison. He has said he will now have to look at alternatives. It is really important. The solicitor for the HSE, Alan Doyle, is on the record as saying that ten beds would open hopefully by the end of March but was not in a position to confirm that. Could we be ambitious and say that we will have 30 beds open this year? I am not asking the Minister of State to say that now because clearly she will have to think about it and talk to the people on the ground. However, we have the facility and we have the beds. They are there; let us open them. I have no doubt that those involved in the "RTÉ Investigates" programme will be following this story here today. There is a story and it is important that we be ambitious enough to fill the 50 beds that are in place in this facility.
I do not think the Senator listened to my answer, to be fair. I am ambitious enough and I can give him the response because I am the person who secured the funding last year to hire 45 additional very specific staff to work in the national forensic hospital. It is not that these staff are sitting on unemployment lists all over the country; they are hard to get. That is the first point. We recruited 45 of them, including 41 to open 18 beds. We opened two beds in December and will open the other 16 on a gradual basis, which is ongoing at the moment. We should have those additional 16 beds opened by the end of March.
The beds in the intensive care rehabilitation unit are different kinds of beds and this has been lost in the whole debate. These are the sickest people in society and they have come through the courts system. I have provided €2.8 million to fund 30 additional staff to open the first ten beds. It is not one member of staff per bed. These are really dedicated staff. We already have two psychiatric intensive care units, PICUs, open in the country. The National Forensic Mental Health Service is not only there for prisoners or those who come through the court system. There are people living in this country with enduring mental health conditions and about 10% of those patients are in the National Forensic Mental Health Service because they are patients and not prisoners; they are detained patients. This crossover is not being acknowledged; this is a hospital. Some people with enduring mental health conditions might have been institutionalised 30 or 40 years ago and at this stage they might need that forensic mental health support. That is the other point. I have to make sure there is a pathway for them as well.
I also want to touch on the ten beds that were designed at the time for the forensic CAMHS unit and we are not seeing the demand for that at all. There were not 170 beds per se that were going to be provided just for people who come through the Prison Service. We have CAMHS, forensic, the ICRU and also people with enduring mental health conditions who have to come through the system. Additional capacity will be provided this year. An additional 26 beds will be provided, which will go a long way towards dealing with the waiting list. I have also provided funding for further in-reach in Limerick, which will see 11 of the 12 prisons receiving mental health supports.
I do not want to see anybody on a waiting list. We will work on that.
If I had all the money in the world I would not be able to find all the staff in the world to open those beds this year but I will do it incrementally, like I do everything incrementally. It is something I have worked on. It is amazing, when we talk about the National Forensic Mental Health Service, because it does an extremely good job. It is very rarely in the media and it is a difficult job it does. I commend each and every one of those who do this work.
Cuireadh an Seanad ar fionraí ar 11.20 a.m. agus cuireadh tús leis arís ar 11.33 a.m.
Sitting suspended at 11.20 a.m. and resumed at 11.33 a.m.