Ms Martina Queally:

As Mr. Walsh said, it is really important that all of the services work together in primary care through to disability. As Dr. Burke said, the in-reach from CAMHS teams is important. We always try to give families additional support if we feel they need it but, unfortunately, sometimes that is not enough. The unfortunate circumstances the Senator described occur occasionally when it is simply not enough. We have been in a situation in which respite has been used, even by us, sometimes, when we know a family is at the point at which they cannot cope. We are acutely aware of the impact that has but sometimes these services must be developed, as Mr. O'Regan said. They are not just off the shelf. The child's needs must be met in a particular way and we frequently have to procure a residential place, if required. Concerning ongoing work, we are working with our disability services, CAMHS and primary care teams to look at an integrated model. We have centralised referrals in the CDNTs so they have full view of the demand presenting to the CDNTs. Demand is up across the board. In September, we had the same number of referrals in CDNTs as we had for the full year last year. Demand on the disability side is up. We are 50% ahead of where we were last year on CAMHS. Demand in both services has substantially increased. Equally, as Mr. Walsh said, it is important that we strengthen the primary care end for early intervention with psychology, speech and language therapy and physiotherapy at the earliest possible point in the child's life.

All of our children see our public health nursing service and our area medical officers during their developmental screening as a baby and in the first year of their lives. Our ambition also is to strengthen that front end of our service and to make a much more seamless progression on, where the child needs disability services. One will see in Sláintecare and other documents where that stepped model of care is referred to. That is our ambition, that we would work with that much more integrated approach to services.

We have a waiting list for children who require residential services and more respite and support, and we are working towards having greater capacity right across the board. We are not at full capacity on our CDNTs, primary care teams or CAMHS teams, so that is work that is ongoing with regard to making sure those teams have the full range of staff available.