Pauline Tully (Cavan-Monaghan, Sinn Fein)
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I met some of our guests previously at a meeting of the Joint Committee on Disability Matters. We discussed similar issues then. Unfortunately, I have not heard anything different today. The issue of the CDNTs is raised with me continuously. Is there someone in the HSE who leads on the progressing disability services programme? None of our guests has that specific role in his or her title. Does it not warrant something like that?

What measures are being taken to address the shortage of staff? Our guests rightly mentioned an average shortage of 28%. They stated that career progression within disability services is an obstacle. The HSE has implemented the interim recommendation of the career pathway in primary care only. Why has it not been introduced into disability services? What other incentives to work in disability are being offered? I understand that nurses, for example, are incentivised to work in ICUs and are given an additional payment for doing so. Could something like that be looked at?

Turning to the inclusion of certain therapists on the critical skills list, I understand the HSE has let many staff into the system. Our guests referred to a shortage of graduates within the various disciplines, and I presume they have informed the Departments of Education and Further and Higher Education, Research, Innovation and Science. In a response to a recent parliamentary question, I was told by the Minister for Further and Higher Education, Research, Innovation and Science that 15 additional graduate places were being made available in physiotherapy. I hope I did not get the full answer and that that is not the sum total of the additional places being created.

Section 39 organisations provide services on the HSE's behalf. There is a discrepancy in regard to pay and conditions. Until that is addressed, we are going to continue to lose staff from section 39 organisation to other organisations. I acknowledge that this might not be our guests' responsibility, but if the HSE is contracting these organisations, there has to be a level playing field if they are to work for children. On the issue of putting services back into schools, there is a problem there because the therapists are being taken back into the CDNTs, which are already under-resourced. I do not know how that is going to work.

On assessments of need, a High Court ruling in March found that the preliminary team assessment was not compliant with the Disability Act. Has new guidance on assessment been circulated to the CDNTs since that? Just yesterday, the parent of a five-year-old son who is non-verbal came to see me. He had received an assessment in February and it was deemed to be compliant by the assessment of needs officer but, obviously, that has since changed. I had a quick read of the assessment and it recommended that he be given a full autism assessment. I do not think the original preliminary team assessments were addressing the backlog; rather, they were putting people onto more lists to get a proper assessment for autism or to access services, which they have not been able to access, given most people are coming to me telling me there is a two- to four-year waiting list. If new guidance has issued, what timeframe are looking at to clear those lists?

Professor MacLachlan stated that a diagnosis to access education is not required but, unfortunately, because there are not enough special school settings, schools are insisting on the diagnosis because they want to prioritise those most in need. Having a diagnosis also provides vital information to schools to help that child.

From being a teacher and a special educational needs, SEN, co-ordinator in the school, I know that getting information from the then child development team was vital. It was so good, even in small recommendations on how to assist a child with autism to adapt to a new environment. It made a considerable difference. If the CDNTs are working with children and providing input to schools, that is important.

I have another case where a child who has been diagnosed with ASD and a mild learning difficulty also has a different, quite rare disease. The two are not connected. The child requires intense physiotherapy for the other disease. They have been told that, in being able to access physiotherapy, the child should go on to primary care, but the child would then lose the supports of the CDNT for autism. Can the two services not work together? I was told by the Minister of State at the Department of Health, Deputy Butler, that the CDNTs and child and adolescent mental health services, CAMHS, would start working together better. I am sure the whole lot, primary care included, should be working together.

I have a number of other questions but I will leave them for the moment. I will leave the officials to address those first.