Liam Quaide (Cork East, Social Democrats)

I thank the witnesses very much for being here today. In recent years, the problems in children's disability network teams and, indeed, child and adolescent mental health services have been well acknowledged and documented, and there have been efforts to address those. However much of a distance we have to go with that, the first stage is acknowledging the scale of the difficulties. However, what has flown almost entirely under the radar has been the equally serious or, in some parts of the country, much more intractable crisis in primary care services.

For people tuning in who may not know, primary care services support young people with mild to moderate mental health difficulties and also mild to moderate disabilities or developmental issues. CDNTs are for young people with more complex disabilities who require long-term support. As we know, primary care tends to offer a very short-term intervention; it could be three or four sessions of OT, six to ten sessions of psychology and then the young person is typically discharged. One of the main purposes of primary care is to intervene early, before difficulties become entrenched and the young person might need either CAMHS or a CDNT. What anyone in my former discipline of psychology will tell you is that primary care has been neglected for years.

Most parts of the country are now in deep crisis, with waiting lists that are out of control. Staff morale is on the floor. It is getting more difficult for psychology managers to fill the paltry number of posts they are allowed to advertise. Often, candidates would be taking up a role in a service that has been hollowed out. In many cases, the love of working with young people and their families is overtaken by the grim tasks of doing file reviews and informing families that they will not be seen for years or that they need to be redirected to another service.

For example, the primary care psychology service waiting lists in Cork-Kerry in May of last year were in excess of 5,000 people. At that stage, 109 children had been waiting four to five years for maybe seven sessions before they would be discharged again. A year on from that, with recruitment largely frozen for much of the intervening period by the pay and numbers strategy, the list is now up to more than 6,500 people. This is for Cork-Kerry alone. Long before the pay and numbers strategy and long before the official recruitment embargo, there was also the issue that when the progressing disability strategy was being rolled out, a very large volume of the more non-complex disability referrals were redirected from CDNTs to primary care. However, there was not a commensurate recruitment drive in primary care services at that stage. We have definitely had retention issues in CDNTs, but over many years we have not seen the HSE pursuing recruitment in primary care. Basically, this has been a disaster of clinicians which has grown in plain sight over a number of years. It has not really received much political attention. What is the HSE's recruitment commitment for primary care services, as distinct from CDNTs, to address this crisis?