John Dolan (Independent) | Oireachtas source

I welcome the witnesses from the Irish Association of Speech and Language Therapists. I have a long association with the disability Bill - one withdrawn, there was a second one and then, finally, it passed through the Houses of the Oireachtas in June 2005. That was a time of great hope and expectation, that has been badly dented in a number of ways. Emotionally and otherwise, that is where I am coming from in this discussion. The focus on starting with the children and moving along was a practical one in the Act and made sense.

I will respond to some of the points the witnesses made. Ms Kirkpatrick referenced Dr. Cathal Morgan stating here in June last that disability services were under-resourced and hoped that the 100 new posts in the budget which we are all delighted with would be part of a multi-annual provision. Ms Kirkpatrick is at least hinting that there is more needed to do this work.

Then there was talk about replacement and churning of staff, with experienced staff moving on and less experienced staff coming in. Ms Kenny mentioned it takes six to eight months from when somebody goes out the door to get his or her replacement. My question is twofold. The first is a difficult one to be scientific about the answer. In terms of the need for professionals and therapists to deal with this issue, is the bottle half full or half empty? I accept there are many other issues as well. It is important to get some sense of what step change the witnesses feel needs to be made. Second, is allowance made for the effect on teams, including various allied health professionals and clinicians, of somebody stating, "I am out of here. I am moving on. I am going somewhere else." or has everyone their fingers crossed every day hoping that their staff will stay there forever?

Reference was made to the risk of misdiagnosis being prevalent. I do not know what is meant by "misdiagnosis". What I mean by that is often it is about getting from symptoms to a cause. Somebody presents with a symptom or symptoms. Ms Kenny talked about someone being referred to her by the public health nurse and Ms Kenny stating there are possibly other things going on here and she cannot deal with it. It is easy to talk about the person having a condition. In many cases, the person might have symptoms on foot of which he or she needs interventions but that is very different from knowing what are the root cause or causes. What is the impact? How is that dealt with? When we talk about early intervention, there is this idea that it is a matter of whether one can get in to see the speech and language therapist, then it takes time to go and be seen again, and the children have gone through two or three pairs of shoes in the meantime. How does the operation of the Act deal with the greater complexity in getting from symptom or symptoms to a diagnosis? I suppose what I am getting at is often one needs to intervene before one has the final diagnosis. Is that an impediment or how do they work around that?

The final little cluster of questions I have relates to what the witnesses stated on a number of occasions about restructuring. I want to use the words "culture", "approach" or "attitude" in the same discussion. Are there different areas in the HSE where maybe the same resource gets worked better? Clearly, I started off with issues about resourcing but I suppose I am suggesting that is not everything. It is about how one harvests and uses the resources. Are there places that are better able to get product from those resources, by which I mean better support the children and their families?