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Therapy services at special school still not restored despite Taoiseach's assurances

One child has been taken out of the school because of the lack of on-site clinicians with the relevant skills.

PARENTS OF CHILDREN who attend a special school in Dublin have questioned why the HSE has not restored pre-Covid levels of access to clinicians following assurances from the Taoiseach.

The Journal previously reported concerns of parents at the removal of on-site therapists from Carmona School in South Dublin, which the HSE said has taken place as part of a new centralised programme called Progressing Disability Services for Children and Young People’ (PDS).

Children who attend the school have severe to profound intellectual disabilities, they are all non-verbal and several are fed through a tube and require respiratory help.

Some of the children on occasion require emergency interventions such as chest compressions or postural drainage (the removal of mucus from the lungs), procedures that require specialist training in respiratory physiotherapy. 

Parents have said a failure to carry out these procedures at the school could result in a child being taken to hospital by ambulance or developing an infection and becoming ill later on. 

For years, up until the pandemic, clinicians who provided speech and language, occupational and physio therapies to children at the school were based on-site full time and were available throughout the school day if required. The physiotherapist on-site was trained in the kinds of emergency interventions some of the children require. 

Since the return to school during the pandemic, this fulltime on-site access to these clinicians has not been restored and parents say this is putting children’s health and their development at risk.

The parents of one child, 10-year-old Hervé Rolland, have taken him out of school as they fear for his safety.

Hervé-2 10-year-old Hervé Rolland has been removed from school because of the lack of on-site therapists to carry out specialist interventions.

Hervé sometimes needs emergency assistance, including chest compressions, and this can happen at any time. Parent representatives have said he is essentially being denied access to an education due to the lack of on-site therapists to intervene if required. 

Andrew Murnaghan, whose daughter is one of 33 pupils at the school, told The Journal that it is “unbelievable stressful for parents and a risk to the children” every day the required therapist is not on site. 

‘Life-threatening risk’

Parents and several TDs have repeatedly raised the issue with the government and in October Taoiseach Micheál Martin told Sinn Féin leader Mary Lou McDonald he had received assurances from the HSE that the pre-Covid allocation of resources “will remain in place” at the school. 

However as the Christmas break approaches, this still has not happened and interviews for replacements will not take place until the new year. 

According to the latest information from the HSE, the temporary arrangement currently includes a physiotherapist on site four days per week, an occupational therapist on site three days per week and a speech and language therapist on site one day per week.

Furthermore, the physiotherapist who was recently temporarily assigned to the school four days per week is not trained in the specialist procedures some children require. 

McDonald again raised the issue in the Dáil last week with the Taoiseach, pointing out to him that the information provided to his officials in October in terms of resources being returned to the school were “simply not correct”.

“A speech and language therapist is on site just one day a week, primarily for the purpose of evaluations,” she said. “The reality for the children is they have had no speech and language therapy since February of this year.”

McDonald said parents have “repeatedly stated to the HSE and the Minister of State that their failure to reinstate this necessary on-site resource constitutes a real, foreseeable and life-threatening risk to children attending the school who are non-verbal and disabled”.

Micheál Martin, in his response, said his view is that the new PDS programme “should be rolling out without impacting on existing services in education or in schools”. 

“We will have to take a serious look at how the progressing disability services (PDS) programme is being rolled out,” he said.

“It should not be done on a basis that undermines existing provision in existing special schools.”

The Taoiseach pointed out that the government had provided the HSE with funding for an additional 100 therapists last year, “so there should be room to develop this new system in parallel”. 

Murnaghan said he cannot understand why the HSE has not addressed this issue after the Taoiseach’s intervention.

“You’re the leader of the country,” he said. “Where is the accountability for the HSE? I’m calling on the Taoisach to hold them to account.

“We know the HSE has been given significant additional funding to carry this out. Parents are outraged, they shouldn’t have to fight for this. It is a disgrace that the most vulnerable children in society, who cannot speak for themselves to say ‘help me’ are left in these dire circumstances.”

Recruitment

Murnaghan said information provided by the HSE recently about the physiotherapy post has caused additional concern as it does not appear that there are plans to hire a physiotherapist who is trained in the specialist procedures some of the children may need. 

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In recent correspondence to Minister of State for Disability Anne Rabbitte, Murnaghan pointed out that the physiotherapist currently allocated to the school for four days per week is not trained to carry out chest compression or postural drainage.

The minister’s office, citing a response it received from the HSE, said the physiotherapist has experience “in the area of children with intellectual disability”.

It said the role of respiratory physiotherapy is considered a specialist clinical area.

“In reviewing the scope of the practice with the Irish Society of Chartered Physiotherapists this skill is considered outside the scope of practice for community based physiotherapists not linked to hospital settings.”

A physiotherapist with this skill has been in place since 2002 and was only removed when the pandemic hit. Murnaghan said parents cannot understand how it is now considered “out of the scope of practice”. 

The HSE has given a commitment to recruitment of all of the three whole time equivalent posts for the school. Interviews for a fulltime physiotherapist to be based at the school five days per week will take place on 21 December.

However Murnaghan said this will not solve the problem if this clinician is not be trained in the specialist emergency interventions some of the children require on occasion.

In a statement to The Journal, chief officer for HSE Community Healthcare East Martina Queally said three meetings have been provided with families and the lead agency Enable Ireland since September this year. 

She said these meetings had been “very valuable in giving parents an opportunity to raise any issues of concern, and have these concerns addressed in real time by the HSE/Enable Ireland”.

She said a list of FAQs from these meetings are in the process of being compiled and key workers have been assigned to each family and individual family support plan meetings have been scheduled.

“Since the reconfiguration of disability services (under the HSE’s Progressing Disability Services for Children and Young People Programme) in September 2021, an increase in therapy staff have been provided to the school from within the existing Children Disability Network Team’s resources while recruitment is under way for more therapy posts,” Queally continued.

“The HSE continue to work towards service development, and some additional supports for families through the new service configuration, such as access to psychology and social workers, have already been put in place where specific needs have been identified.”

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