Dáil debates
Thursday, 28 March 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Occupational Therapy Waiting Lists
5:30 pm
Mick Wallace (Wexford, Independent)
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I thank the Ceann Comhairle for selecting the issue. The number of children and adolescents awaiting first-time assessment for occupational therapy nationally as of January 2019 was 16,868, a fairly depressing figure. However, the response to a parliamentary question I tabled last week reveals serious inconsistencies in the number of children and adolescents on waiting lists in different counties and local health areas.
The delivery of occupational therapy across the country is deeply unequal. For example, 1,353 children and adolescents were on the waiting list in Wexford according to the January statistics. A total of 666 of these children and adolescents had waited for more than a year for an initial assessment. By contrast, County Clare had only 41 children and adolescents on the list, 39 of whom had been waiting for less than 12 weeks while the remaining two children had been waiting for between 12 and 26 weeks. The number on the waiting list in Limerick as of January was 95, with only five children in Limerick waiting for more than 26 weeks. While these wait times are not ideal, most people would agree that the occupational therapy departments and staff in these local health areas are performing well based on these figures.
However, the national average number of children and adolescents on waiting lists for paediatric occupational therapy in January was 411. The number of children and adolescents waiting for an assessment in Wexford was more than three times the national average. The number of children and adolescents on the waiting list in Wexford was 33 times higher than the number on the waiting list in Clare. Wexford had the second highest number of children on the waiting list according to the data I received. Only Laois-Offaly had a higher figure. The numbers on the waiting lists in Wexford, north of the Lee in Cork and Laois-Offaly are total outliers and those lists need to be tackled as a matter of urgency.
In its response to me last week, the HSE advised that it could not provide a further breakdown for the number of children and adolescents waiting for more than 52 weeks. However, a letter from the HSE to the parent of a child awaiting assessment in Wexford shows that the Wexford local health office is currently dealing with occupational therapy referrals from June 2016, with a waiting list of two years and nine months. The letter goes on to state that resources are limited in Wexford with a 40% reduction in staffing in the past year and that, according to a children mapping process, Wexford requires 35 posts to deal with the demand for this service. The letter is dated 14 March 2019 and notes that as of that date 1,429 children and young people were on the occupational therapy waiting list in Wexford. This represents an increase of more than 5% on the figure I received for January. Things are getting worse and not better. The tone of the letter is remarkable. It was sent by the occupational therapy manager in Wexford and, based on the letter, she is clearly exasperated and worn out by the lack of resources available to her and her staff.
I am still awaiting an answer from the HSE in response to another parliamentary question on the number and locations of paediatric occupational therapist vacancies nationally. A parent in Wexford has told me that Wexford has three occupational therapy vacancies at the moment. What steps will the Minister take to recruit occupational therapists in Wexford? How many occupational therapists currently work in Wexford? How many occupational therapists is the HSE trying to recruit for Wexford? When does the HSE hope to appoint these occupational therapists? Does the Minister believe that occupational therapy services for children and adolescents are adequately funded?
Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister for Health, Deputy Harris, I thank the Deputy for raising the issue.
The Government acknowledges that challenges exist in access to and the provision of paediatric occupational therapy services in Wexford. The Government and the HSE are committed to improving access to these important services. The Minister has been advised by the HSE that in recent years the demand for paediatric occupational therapy services in Wexford has significantly increased. Along with the increased number of referrals, management in the HSE is reporting that more complex demands are being made on this service.
With regard to the numbers waiting to access paediatric occupational therapy services in Wexford, the HSE has advised that all applications for these services are prioritised upon receipt on the basis of clinical need. High-priority referrals are managed by the HSE in accordance with standard operating protocols with children of the highest clinical need being seen first.
A number of initiatives have been implemented by south east community healthcare, CHO 5, to improve access times to services in Wexford. These include an expanded occupational therapy service to provide assessment and two treatment sessions for school-age children. This is an expansion of the existing service. Additional clinics are also being provided. Under a new initiative, the Central Remedial Clinic is providing an outreach clinic and increased outpatient clinics are being offered to address the needs of the longest waiting.
CHO 5 is also increasing the number of group programmes on offer in the school-age service. A total of 110 children are currently being assessed and provided with group intervention in the first quarter of this year with the aim of providing intervention prior to entering the school-age service.
In order to address waiting times nationally and improve access to services, the Government has committed to increasing the number of occupational therapists in primary care. The HSE’s national service plan for 2019 contains the commitment to recruit 170 community and nursing therapy posts, including 40 additional occupational therapist posts. These additional occupational therapist posts will focus on addressing patients waiting over 52 weeks. The HSE anticipates that over 350,000 primary care occupational therapy patients will be treated in 2019.
The development of primary care is central to the Government’s objective to deliver a high-quality, integrated and cost-effective healthcare system. A Programme for a Partnership Government and Sláintecare commit to shifting the model of healthcare towards a more comprehensive and accessible primary care service in order to deliver better care close to home in communities across the country.
The HSE has also established service improvement groups to develop new standardised models of service provision to support the delivery of occupational therapy and other therapy services. The national service plan for 2019 commits to the implementation of the recommendations from these reviews on a phased basis within existing resources, which will help to address difficulties and pressure areas in therapy services.
Mick Wallace (Wexford, Independent)
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I know it is not the fault of the Minister of State, Deputy Catherine Byrne, but this is crazy. She is telling me that the HSE intends to recruit 40 occupational therapists nationally when 35 occupational therapist posts are needed to meet the demand in Wexford according to the occupational therapy manager in the county. This is off the Richter scale. What kind of impact will 40 make on the problem nationally if 35 are needed in Wexford? It will not scratch the surface of the problem. I do not understand that.
The waiting times are shameful and make a mockery of the idea of early intervention. The disparity between the different CHO areas beggars belief. These children are waiting for an initial assessment only. They would then have to wait again for a further appointment. The number of children awaiting an assessment in Wexford is more than three times the national average. I would like an explanation for that. Somebody - I do not know who - is responsible for that. The Government has a responsibility to hold somebody to account for that. There has to be an explanation. The Minister of State probably does not have it front of her, but the Government should supply it. People in Wexford and the parents of the children who are waiting for their initial appointment deserve an explanation.
We know that Wexford is the third most deprived county in the country and in some areas it is the worst. It is unbelievable. The HSE letter to the parent of a child awaiting assessment in Wexford has shown that occupational therapy in the Wexford local health office is currently dealing with referrals from June 2016. This is March 2019.
Can we get some answers and accountability?
5:40 pm
Catherine Byrne (Dublin South Central, Fine Gael)
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I acknowledge the Deputy's concerns about this issue. Unfortunately, I do not have the statistics in front of me to which he referred. All I can tell him is that the Government has acknowledged the challenge that exists in providing paediatric occupational therapy services in Wexford. There is a campaign to recruit people throughout the country and it is more difficult to recruit in some areas than in others. I am not here to give the Deputy an answer as to why more children would be waiting longer for an assessment in one area compared with another area. I do not know the reason for that and I cannot understand it, to be honest.
However, the challenges that face us all are to make sure that intervention is provided for children who need it. As I stated in my reply, provision has been made for the inclusion of expanded services for school-age children and for additional clinics delivered by the Central Remedial Clinic to address the needs of those who are waiting the longest. It is significant that there is such intervention in schools and that is becoming more prevalent with speech and language therapy and occupational therapy services.
I am here to read a statement but also to note the concerns raised by the Deputy and to acknowledge that in his role of representing Wexford, there are needs in this area that must be addressed. Unfortunately, I cannot address them at the level that he requires. However, I will, as usual, relay the information to the Minister and ask him to come back to the Deputy personally on some of the statistics, when people will be seen, and when the staff who are required will be recruited into the services in Wexford. Unfortunately, I do not have any other answer for the Deputy. I could read a prepared response in conclusion but it would just outline what I stated in my initial reply.
Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We understand the Minister of State's predicament.