THE PARENTS OF children who attend a special school in Dublin have said they feel the State has abandoned their families after all on-site therapists were removed from the school.

The children who attend Carmona School in South Dublin have severe to profound intellectual disabilities, they are all non-verbal and several are fed through a tube and require respiratory help.

Up until recently, clinicians who provided speech and language, occupational and physio therapies to children at the school were based on site and were available throughout the school day if required.

Now, as part of a centralisation of disability services, all on-site clinicians have been moved from Carmona, despite assurances from the government that the level of service provided to the 36 children who attend would be maintained.

Andrew Murnaghan, whose daughter attends the school, told The Journal that parents have been fighting “tooth and nail” to try to explain to the HSE that it is not longer providing the same level of services and they now feel their children’s health is seriously at risk.

Parents have said there have been three previous medical emergencies at the school involving choking and respiratory issues and the therapists, who have specialist training in these areas, were on hand to deal with them immediately.

“These children can have medical emergencies at any time, eight or nine are in wheelchairs, if they give a bit of phlegm they can’t cough, they need postural drainage from the lungs, they have respiratory issues, they are all non-verbal so they can’t tell you if the are in difficulty,” he said. “There are serious risks here. It’s outrageous.”

The PDS model

The changes rolled out by the HSE are part of the Progressing Disability Services for Children and Young People (PDS) programme, which involves the reconfiguration of specialist therapy services into 91 Children’s Disability Network Teams (CDNTs).

The aim of the new programme was to ensure all children with disabilities across the country would have access to a team of specialists where they live or at the school they attend. 

Murnaghan said there has not been a speech and language therapist at the school since February.

He said parents have been told that the same number of allocated clinical hours for speech and language, occupational and physio therapies are still being provided, but he said those hours “were not reflective of what was going on on the ground” when therapists were always available at the school if an urgent intervention was required. 

“Children don’t have emergencies by appointment,” he said.

I’m shocked as a parent of a child with a disability, let alone an advocate for parents, at the indifference of this organisation to the concerns of parents. There are mums and dads bawling their eyes out about this. They rely on the school, the staff are miracle workers and they’re having support taken away from them.

He said the HSE was “robbing Peter to pay Paul” by relocating on-site staff to fill posts on the new centralised teams.

“The model is a fantastic idea but you don’t help somebody over there with a moderate disability by taking away supports from those with the most severe and profound disabilities,” he said.

“It was never the intention of PDS, the intention was to make it more equitable for society, not to pull supports from the most vulnerable kids. There just doesn’t seem to be any compassion.”

‘No reduction in services’

The development of these area-based teams caused controversy earlier this year when it first emerged that on-site therapists were being relocated from special schools to fill posts.

At the time Minister of State for Disability Anne Rabbitte ordered the HSE to pause the programme and review the services in special schools to ensure they would fully benefit from an enhanced provision. She also secured the approval of an additional 85 therapy posts.

In a statement in July this year, Minister Rabbitte said the HSE had confirmed that “existing therapeutic on-site services provided to the small number of special schools will continue to be provided”.

“There will be no reduction in services to this group of children, while services will be delivered in line with the PDS policy under the governance structure of the newly configured local children’s disability network teams,” she said.

The issue was raised again with Minister Rabbitte in a Dáil debate on Tuesday evening.

Fine Gael TD Jennifer Carroll MacNeill told the minister that Carmona “is not a school, but a centre of excellence for children with severe to profound intellectual disability”.

“As an example of the need for on-site clinicians, one patient is a boy of senior infants age but he is not in senior infants and never will be,” she said.

“He is not going into first class either. His number one learning goal this year is to bring a spoon from a bowl of food to his mouth and back down again. He has three therapy-based learning goals.

They do not involve reading, writing or arithmetic. That is not on the cards. Three are four adults and five children in this room because that is what the children need. Both of that young boy’s hips are dislocated. If he is uncomfortable or in pain, he has no means of shifting his position.

“He needs constant therapeutic oversight and support to prevent scoliosis and to help him to communicate. There is no way of deconstructing his therapy and learning needs.

“Another girl who is ten years of age cannot communicate at all. The speech and language therapies are not there for her. As a result, her behaviour is regressing because she cannot communicate her frustration. She cannot communicate anything to her family. She does not sleep much.”

Her party colleague Neale Richmond said that while the HSE had returned staff to their pre-Covid allocated hours, “it is much less than the service the school provided prior to the pandemic”. 

“There has not been a speech and language therapist in the school since February,” he said. “There are extremely vulnerable children at risk who are not receiving the duty of care from the State in the school. It is not good enough.”

Minister Rabbitte said she acknowledged that Carmona “is not a school in the ordinary sense” and that, having met parents on a number of occasions, she knew the difficulties they had faced during the roll-out of the PDS model. 

She said she had been informed on Tuesday by the HSE that the Children’s Disability Network Teams manager had increased the clinical resource in additional to the original allocation “on a temporary basis” from the existing team.

A meeting will also be scheduled between parents,  the CEO of Enable Ireland, the HSE chief officer for the area, the disability head of services, and the CDNT.

“While they [the agencies responsible for the roll-out] may not need to be made to understand, perhaps they need to be re-informed and retold that this situation is not like everyone else,” she said. “It is a little different.”

Minister Rabbitte said she will not “be found wanting” for what is required to fill the gap at the school. 

“Whatever the outcome, I just want an outcome from the HSE, which is to tell me what the shortfall is so we can ensure delivery of services in Carmona and get on with delivering services and rolling out the PDS model,” she said. 

In a statement to The Journal, Martina Queally, HSE chief office for Community Healthcare East, said both the HSE and Enable Ireland, which are the lead agencies for CDNTs in the area, are actively recruiting to fill the new posts approved by the minister.

“The allocations of therapists to special schools at the level which existed prior to the Covid pandemic have not been removed from any of the schools in the area,” she said.

“From the 13th September 2021, the therapists from the Children’s Disability Network Team (CDNT) will be in attendance at the school as per the existing allocation outlined by the Minister.

“The intervention provided by the therapist may be in the classroom/clinic space in special schools and/or at home as required.

“In addition, under the CDNT service delivery model, the children that attend the special schools will have access to all the therapies available within the team if deemed beneficial for the children to achieve their goals.”