Dr. Noreen O'Leary:

Building on what Ms Moran was saying and touching on the point the Deputy mentioned, recruitment and retention are important. The roadmap mentions that there are high rates of staff turnover within CDNTs, and there is anecdotal evidence of the loss of many experienced clinicians. One of the concerns we have is that if we do not address these more fundamental issues with a model for delivering children’s disability service that is grounded in evidence-based principles, then, even with increased resourcing and recruitment, we will continue to still see the high level of staff turnover. It is obviously difficult in any health services but I think it is more so within children’s disability services, where relationships with children, young people and families are very important because it can take a long time to get know a child, to get to know the child’s communication style and their preferences and to build trust with their families. If there is high staff turnover, it is very impactful for a service and it creates a great deal of disruption. It is so welcome that there will be increased resourcing, but we need to look at this in a much more fundamental way. When people are in these posts and within the teams, how are the teams being supported to function and work in a way that is providing meaningful interventions? Assessment is definitely an important part of the work of disability teams, but there is a risk that if we overly focus on assessment, it is to the detriment of interventions. Inclusion Ireland compiled a survey in 2022 which indicated that while families want access to proper and comprehensive diagnostic pathways, once they know what their child’s needs are, there needs to be pathways to be able to access the interventions.

I agree with the Deputy. Coming back to point he mentioned about the waiting list times varying in different areas, one of the core aims of PDS was that it would address what has been called the postcode lottery. Data gathered shows there are very different waiting times. Again in 2022, another a survey commissioned by Inclusion Ireland indicated that 33% of families in Ulster were still awaiting services. That was up to 59% in Munster, with varying numbers in between. We can see that the goal of providing comparable service wherever in the country a person lives is not happening. That is obviously impacted by the staffing levels.

The Deputy mentioned the oversight group in the context of the roadmap. With regard to the work we have done so far, that is not an area we have been involved with. We – and, I think, many stakeholders – would absolutely welcome an opportunity. It is part of the reason we felt it was very timely to make this submission to the committee. Because the work relating to the roadmap is under way and has not progressed too far yet, there is an opportunity to perhaps pause and consider, as well as issues around staffing, retention and infrastructure, the more fundamental issues.