Liam Quaide (Cork East, Social Democrats) | Oireachtas source

I thank the witnesses from the NDA for being here today. The areas of concern outlined in Dr. Hartney's opening statement are of central importance. Continuing on a theme I spoke to at last week's meeting, I respectfully suggest that any review of children's disability network teams, CDNTs, must include primary care services or we are missing a large part of the picture of disability services for young people more generally. I would go so far as to say that a review of CDNTs that did not include consideration of primary care within its terms of reference is verging on pointless. Clinicians who work in primary care despair when consideration of disability services fails to include primary care. That is because there are vast numbers of young people with disabilities or developmental issues on primary care waiting lists that are now so long that the service may as well not exist for them. These young people are characterised as having mild to moderate or non-complex difficulties. As we know, CDNTs deal with more complex disabilities. However, we also know that without early intervention the difficulties of people in the non-complex range may become more serious and may chain-react at sensitive stages of development.

The other reason it is essential to examine primary care and CDNTs in tandem is that there has been an intimate interplay in the huge challenges faced by both services since the inception of the Progressing Disability Services for Children and Young People programme. That continues to this today. Around the country, families are being passed from one service to another, which is known as "defensive practice". It is almost inevitable when resources are so limited that services put up the shutters and become rigid in their inclusion criteria for fear of being overwhelmed by referrals, hence the single point of entry to child services that the HSE CEO, Mr. Bernard Gloster, mentioned at a meeting of this committee last week. Under that system, a clinician from primary care and a clinician from a CDNT would conduct a referral review together and make a joint and binding decision on the best service to which the young person would be referred. I must admit that I was sceptical of the idea initially but having consulted clinicians, I can see the value of it for more efficient referral processing and a reduction in the defensive practice to which I referred.

I will give a real-world example of defensive practice and disjointed service delivery in action and the impact on families. I spoke in the Dáil recently about a constituent whose son had had an assessment of need with a diagnosis of autism in November 2024. The HSE service statement that issued from that assessment of need was sent to the family in mid-January and it recommended primary care services for that young boy. It projected that a first appointment with a psychology professional would be available in September 2030, five years and nine months later, for perhaps six or seven sessions. It is not a wrap-around or continuous service or anything like it. The boy has not been seen and the family have since been told that following a file review in primary care, he should be redirected back to a CDNT list. This is the maddening fallout of the long-standing neglect of these services.

In the case of primary care, it is much more about a failure to recruit over many years than the difficulty in retaining staff. There are obviously retention issues in CDNTs. Not only has recruitment to primary care been either severely limited or stalled entirely in recent years, it has also had to contend with huge transfers of referrals from CDNTs. In the Cork-Kerry region, for instance, 577 children were transferred from CDNTs to primary care services in 2021. At present, large transfers of referrals are happening in the same direction in parts of Dublin. This amounts to unsustainable waiting lists being placed under further unmanageable strain by scores of redirected referrals. All the while, managers are being prevented from recruiting by recruitment restrictions. In that context, the sense of utter dejection for so many families is inevitable, as is the collapse of morale among staff.

Another issue I want to touch on is the lack of multidisciplinary teams and team working in primary care. We know that the needs of the child are often best met by being seen by more than one discipline in tandem, or at least by having their needs reviewed by two or more disciplines. However, in practice, joint working tends to happen in a much more ad hoc and less co-ordinated way in primary care than it does in secondary services. This also creates inefficiency because a child whose primary need may be psychological may attend an occupational therapist for longer than is necessary if the psychologist is not available to see him or her for many months, or even several years.

I just wanted to set out that context. To what extent is the crisis in primary care services for young people on the NDA's radar? Is it seen as inseparable from the challenges it is reviewing in CDNTs?