Patrick Costello (Dublin South Central, Green Party) | Oireachtas source

Like many others here, I have been inundated with concerned parents who are heartbroken, physically broken, who have been worn down by the constant fight by being on the receiving end of that adversarial and hostile response that Senator Clonan talked about and by being forced to fill the gaps in services themselves. In attempting to paper over the cracks, we have tried to make parents the therapists, which just is not working. These are parents who are emotionally, physically and mentally falling apart because of the strain that is being put on them. There are, in turn, other knock-on consequences from that deep physical and emotional strain that we do not have time to get into today but which are incredibly important. We need to start at that point of acknowledging those parents and the continued uphill struggle they are facing.

There is so much we could talk about but on the issue of staffing, at the end of the day, there are just not enough staff members to complete the assessments and do the work. One of the issues here, of course, is retention. I am quite worried. Mr. Reid talked about how there were 35,000 new hires, but a net growth of roughly 14,000. That is terrifying.

That is a huge number of people leaving the service. To recruit approximately 35,000 people and to have a net increase of only about half of that is a sad indication of the loss of staff. We could drill into that. There is a net increase but are we losing clinicians and getting more administrators? What do the figures look like? If that is across the entire HSE, it covers hundreds of grades and roles. What is the net figure for front-line clinicians?

We have discussed conditions a lot here. These people want to be clinicians and they do care, as we have all acknowledged, but they are left managing bureaucracy, juggling case loads and meeting patients to tell them where their place is on the waiting list and how they will not be getting a service. That is all they are doing. We need to fix retention or we will be in a lot of trouble. Much of fixing retention comes through the pipeline, as we have used the phrase here, of getting in new therapists. I am coming at this from my social work background but we have been told that the HSE has specific problems recruiting speech and language therapists and occupational therapists. A psychologist in training who is doing their clinical training is paid a salary. In my time as a social work student, I remember doing my placement in a child and adolescent mental health service in which trainee psychologists who had about as much experience as me, or less, were getting paid while I, as a trainee social worker, was not. The same goes for the speech and language and the occupational therapists. If we want people to engage in the training we need to look at that. Perhaps I should be looking at the Department on that. Alongside that, there are many people who want to do the training and perhaps cannot afford it. We are talking about trying to be creative and find new pipelines. Part of that is recognising non-academic experience and trying to find new ways into the service but also supporting people to get into the education that is there. We need to consider if one of our problems is that people are training and then leaving. I have worked jobs where I have had my training paid for me on the condition that I sign a contract that I will not run away straight away and there are various clawbacks. Why are we not doing that? I appreciate that this may be something for a different Department - that is another siloing thing which we could drill into for hours - but can we explore something like that whereby we pay someone to become a speech and language therapist on the condition that they stay? Then we can get an increase in numbers that would improve the conditions and hopefully get people to stay longer and you would be preventing all of that.

Another issue is filling the gap with private providers. I seek reassurance that any private providers we are using are suitable, up to scratch and properly qualified and that there is proper oversight and that we are not letting rogue elements away with it. I noted in Minister of State's opening statement that the private providers are included in the roadmap which spoke of "piloting the use of groups such as local Down’s syndrome organisations to ease pressure on CDNTs, even if only for a defined period". I must express concern about that because we have a habit of doing things for a defined period in an extreme circumstance and then they become permanent. I am concerned that, as I have seen in other areas, we pull in community organisations to do the work the State should be doing and it becomes a permanent, unfunded or underfunded mandate of these community groups, with the people who are due to get the services being the ones to suffer. I seek reassurance that it is a defined period and that it will be very short. The same logic applies equally to the pausing of the individual family support plans. Many people in my constituency have told me that they feel the individual family support plans are not worth the paper they are written on because there are not the staff behind them to deliver. They would see no problem in throwing out individual family support plans if it meant getting the actual services. Again, we are in the situation where we are scrambling to move beyond the failure but sowing the seeds for failure down the line by removing what can be a very useful service, if properly resourced.

If legislation has not been commenced properly, that is not a failure of the Oireachtas. The power to commence legislation is not in the House but in the Minister's wrist. That is a function of the Executive. If there are issues with legislation needing to be reformed or commenced, that needs to be taken up with the line Minister directly. I am concerned that any attempt to reform legislation must be done in a way that does not undermine the existing statutory rights. We know that parents have had to struggle greatly to have-----