Oireachtas Joint and Select Committees
Thursday, 22 January 2026
Joint Oireachtas Committee on Health
Joint Meeting with Joint Committee on Disability Matters
Primary Care and Progressing Delivery of Policy and Services for Persons with Disabilities: Discussion
2:00 am
Maurice Quinlivan (Limerick City, Sinn Fein)
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Apologies have been received from Deputy Pádraig Rice and Senator Nikki Bradley. The purpose of today's meeting is to discuss primary care and progressing the delivery of policy and services for persons with disabilities. It is a joint meeting between the Joint Committee on Disability Matters and the Joint Committee on Health.
Regarding the format of the meeting, as Chair of the organising committee I will chair the meeting. I will invite witnesses to make opening statements in turn limited to a maximum of five minutes. Once the opening statements have been delivered, I will then call members in the order they indicate to me to put their questions. Questions and answers will alternate between the respective committees, that is, a member of the disability matters committee followed by a member of the health committee; disability matters will go first. It is important to note that each member will have four minutes to engage with witnesses. This includes both questions and answers. If the number exceeds the seating capacity, which has happened before, I will call members to vacate their seats after their questions and answers to facilitate other members, if the place is full, to engage with witnesses. They should move to the back if we are full. I also propose we take a short comfort break at the midway point of 1.50 p.m. and resume shortly afterwards.
I welcome the following witnesses from the Department of Health to the meeting: Mr. Niall Redmond, assistant secretary, primary care oversight and performance; Ms Rachel Kenna, chief nursing officer; Ms Siobhán McArdle, assistant secretary, social care and mental health, drugs policy and unscheduled care; and Ms Sinead Quill, principal officer, primary care. I also welcome from the Health Service Executive: Mr. Pat Healy, national director, national services and schemes; Ms Geraldine Crowley, assistant national director, national services and schemes; Ms Mellany McLoone, integrated healthcare area manager, Dublin north city and west; and Ms Philippa Ryan Withero, assistant national director of human resources.
As always, there is a note on privilege and housekeeping matters. All witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that may be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, they will be directed by me to discontinue their remarks. It is important they comply with any such direction I may make. The evidence of witnesses physically present or who give evidence from within parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege.
I remind members of the constitutional requirement that in order to participate in public meetings members must be physically present within the confines of the Leinster House complex. Members of the committee attending remotely must do so from within the Leinster House complex.
I acknowledge that both committees welcome the opportunity to engage with our witnesses today on such important issues. We are particularly aware of some of the issues across the primary care system and are eager to hear their perspectives and, crucially, solutions that can be delivered and implemented. We look forward to engaging with them all. Once again, I thank them very much for accepting our invitation and coming here to share their experiences and ideas with us. I remind all those in attendance to make sure their mobile phones are switched off or on silent mode.
I call Mr. Redmond to make his opening statement. He has five minutes.
Mr. Niall Redmond:
I thank both committees for the opportunity to discuss primary care and progressing the delivery of policy and services. I am joined by my colleagues, as introduced by the Chair.
Consistent with our vision for a healthier Ireland for all, as outlined in Sláintecare, I welcome the opportunity to outline the significant progress being made in improving access, enhancing performance and making primary care more responsive to the needs of individuals, families and communities. In particular, the national human rights strategy for disabled people provides another real opportunity to further our objective of providing equitable access to health and social care for disabled people across Ireland. Under pillar 4 of the strategy and the programme of actions, we are focusing on improving accessible healthcare, safeguarding, health promotion, youth mental health, support for disabled children, oral health screening and audiology services. This is a key focus under the strategy and a platform to do better across the range of services in primary care. This is the right focus, but I also take the opportunity to recognise that despite a significant number of services delivered, increased investment from the Government and a further focus on building healthcare capacity, I am conscious that far too many people face challenges accessing care across the range of services and are waiting far too long in doing so. I will set out how we respond to some of these challenges currently and the further commitments we are progressing across primary care.
General practice plays a vital role in primary care services, as the committees will be aware. It provides care to patients in the community, with necessary access to the wider health service and preventing escalation to acute settings. The GP chronic disease management programme is a good example of the effective delivery of GP care at primary care level, with over 500,000 patients reviewed in 2025, leading to fewer emergency department, ED, and GP out-of-hours attendances compared to pre-enrolment rates. The number of doctors entering GP training has increased by approximately 80% from 2019 to 2024, with the number of new entrant places increasing again this year to 400. A strategic review of general practice to be completed later this year will further set out our vision and actions to improve GP service, focusing on issues such as GP capacity, GP supports and out-of-hours services.
Turning to mental health, primary care plays a crucial role in supporting people’s mental health and is essential to effective prevention, early intervention and long-term well-being as outlined in Sharing the Vision. A key commitment in the national human rights strategy for disabled people is to ensure that disabled children and young people receive the care they need, when they need it. To strengthen services, additional staff will be recruited to HSE mental health services this year to promote positive mental health, expand intervention pathways and improve crisis responses, ensuring that care is both responsive and grounded in the needs of those who use our services.
The enhanced community care, ECC, programme is one of the most transformative initiatives under Sláintecare, the focus of which is on implementing an end-to-end care pathway and enabling a home first approach in the community. The delivery of the ECC programme is enabling primary care and community specialist teams for both older persons and chronic disease to work together in a more co-ordinated way to support people in the community rather than in hospital settings. At least 450,000 patient contacts were supported through these services in 2025.
In relation to primary care services, particularly therapies, overall activity in primary care therapies was significant in 2025, with over 1 million patients seen across our community healthcare networks to the end of November. However, as I said at the outset, we fully acknowledge that waiting lists for primary care therapies are far too long. To respond to this, the Department and the HSE have established a joint programmatic approach to primary care waiting list management, which is a key commitment under the national human rights strategy for disabled people. Importantly, as well as looking at the long-term changes that are needed, this programme of work is looking at what can be done, right now, to address those who are waiting far too long. Last September, the Minister established a significant new initiative to address physiotherapy, occupational therapy and speech and language therapy waiting lists, with a particular focus on reducing the waiting times for those three therapies to less than ten months. It is estimated that this will remove 60,000 people from those waiting lists this year. This is a priority action for us under pillar 4 of the strategy. It is rooted in a vision where health services are accessible and person-centred. It is driven at regional level but also now overseen by national oversight governance structures.
We are committed to ensuring that primary care continues to develop as a strong, accessible, communitybased system, one that emphasises prevention, early intervention and multidisciplinary support. I look forward to discussing these matters with the committees and to answering any questions.
Mr. Pat Healy:
I am grateful for the invitation to meet with the committee today to discuss matters relating to progressing the delivery of policy and services in primary care. I am joined today by my colleagues as outlined by the Cathaoirleach. I am supported by Mr. Conor Kirwan from my office. In recent days, the committee would have received a detailed briefing on primary care including a submission on waiting lists and staffing as requested by the committee on 28 November 2025.
The implementation of Sláintecare has seen significant expansion in primary care and community-based services. The enhanced community care programme saw investment of €210 million and 2,800 additional WTEs, including over 1,100 health and social care professionals and 600 community nurses. GP training places have increased with a total of 1,300 trainees undertaking the four-year programme in 2026. Over 300,000 patients with chronic disease are now routinely managed in primary care. A key reform has seen the shift from a unidisciplinary to a multidisciplinary team approach, delivering integrated care locally through community healthcare networks, CHNs.
Despite the progress that has been made in primary care and the wider health and social care services, there remain many challenges for children and adults, their families and those who care for them. The HSE is very conscious in particular of the vital role that primary care therapies play in supporting them. I want to acknowledge that our primary care therapy waiting lists are not where we want them to be. While good care is being delivered by dedicated therapists across the country on a daily basis, our waiting lists and length of time waiting are simply too long. For example, there was an overall 22% increase in CHN therapies over the period from June 2023 to October 2025. While dietetics and podiatry reduced in that period, speech and language therapy, occupational therapy and physiotherapy have all increased significantly, ranging from 30% to 44%.
To deal with this challenge, the primary care therapy waiting list initiative, approved by the Minister for Health in September 2025, is already reducing waiting lists through a validation and treat approach for patients waiting over 39 weeks on primary care therapy waiting lists for physiotherapy, occupational therapy and speech and language therapy. This initiative has seen these waiting lists, which to date have had a run rate increase of 2,400 every month, reduce by almost 14,000 – the first significant reduction nationally in four years. In addition, to maintain a steady state requires the prioritisation of recruitment of permanent staff to primary care therapy services, with approval of an additional 200 WTE in the national service plan this year.
Turning to psychology, audiology and ophthalmology, the HSE and the Department of Health have recognised the challenges in psychology services for some time. Investment of just under €25 million since 2021 saw 15,000 people removed from the waiting lists. However, significant challenges remain and that is acknowledged. The psychology training initiative has seen an increase of 135 additional WTE trainees over a three-year period. Some 45 were recruited in September 2025 and these additional posts have been distributed across the RHAs. In addition, the psychology assistant grade formally established in 2022 has assisted, particularly in low-intensity cases, with 42 WTE assistants currently in post in primary care. Ophthalmology has seen significant improvement with a new service model resulting in a 15% reduction in waiting lists against a 29% increase in activity. Audiology waiting lists remain a challenge. However, a new children’s initiative in 2026 will see 3,400 removed from the waiting lists. Recognising the challenges in recruitment and retention, the HSE with the support of the relevant Government Departments is expanding student placements for health and social care professionals, increasing the number of sites and supports, with an additional 310 training places in 2025 and 123 in 2026, growing to 461 additional per annum from 2027.
I wish to take the opportunity to reference the single point of access programme, which is a core HSE reform designed to improve how children and families access community-based health services. It responds to long-standing system issues including multiple and duplicate referral routes for children, inconsistent triage practices and fragmented communication across services. The programme establishes a co-ordinated, cross-service entry point that links primary care services, CDNTs and CAMHS. The aim is to deliver a clear, equitable and consistent access pathway for all children, regardless of geography or organisational structure. Phased implementation of this essential programme is already under way and will be progressed significantly in 2026.
Maurice Quinlivan (Limerick City, Sinn Fein)
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I will open the floor to members. They have four minutes each and we are going to alternate between committees.
Liam Quaide (Cork East, Social Democrats)
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I thank the HSE and Department of Health officials for attending today. I acknowledge the immense challenges they face in their roles. As I said in the health committee yesterday, the HSE is reliant on the Government when it comes to its budget. I know it is under severe pressure to work within those restrictions and to meet the huge challenges in the system. However, I have to put it to the officials that there has been a great deal of deflection and opacity going on when elected representatives have been trying to get a clear picture of the crisis in primary care. For instance, last year I was told repeatedly by the HSE in responses to parliamentary questions that it only kept statistics on long waiters within a category of over 52 weeks. I knew well that this was not the case. It took major persistence, with follow-up parliamentary questions, to bring to light the fact that young people were waiting 200, 300 or 400 weeks across the country and across disciplines. There is a very big difference between 53 weeks and several hundred weeks. I tried to access staff-per-population ratios across health regions in a parliamentary question in recent weeks. It was sent back to me for clarification last week. I was asked whether I was seeking this for primary care or for CAMHS. I could not have been clearer in the question that it was primary care. This very much seems like a flagrant delaying tactic in advance of today's meeting. The HSE is also claiming it is not able to find clinicians when the truth is that it has not been trying to recruit to anywhere near the level required, due to the pay and numbers strategy, the recruitment embargo prior to that and years of under-resourcing prior to that again. In so doing, the HSE is essentially gaslighting its own staff, who are submerged in these waiting lists. The HSE cannot address the crisis if it does not even acknowledge its existence or causes.
What benchmarks of staff per population do the officials believe are needed in primary care services? How many occupational therapists, physiotherapists, psychologists and so on should we have per head of population? We have those clear benchmarks in A Vision for Change. I do not believe we can have meaningful workforce planning without them.
Mr. Pat Healy:
We do not set specific benchmarks for each of the grades of staff, basically because it is based on need so we do not set a benchmark. However, what I have set out in the note and what the primary care therapy waiting list initiative clearly sets out is that we do not, today, have enough physiotherapists, occupational therapists or speech and language therapists.
Liam Quaide (Cork East, Social Democrats)
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Would Mr. Healy even have a general sense of the benchmarks? That was the real strength of A Vision for Change. Without it we are kind of operating in the dark.
Mr. Pat Healy:
With the waiting lists we have at the moment there is a significant number of people over 39 weeks. The initiative will reduce that on a once-off basis by 60,000, which will mean all those who are waiting over 39 weeks will be seen and the waiting list will be brought down to 39 weeks. The key point the Deputy is making, which I think we realise, and which I said in the opening statement, is that if we want to maintain it at that level we need additional staff. We reckon we need 500 staff to maintain it at that level. This year we have approval for 200 additional staff.
Liam Quaide (Cork East, Social Democrats)
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I am aware that with the waiting list initiatives in some parts of the country the contracts are short-term agency contracts. In some cases, there is a budgetary allocation for the year. Staff, essentially, have to be laid off in December and re-employed in January. This really flies in the face of continuity of care and it makes for high staffing costs because a premium is being paid for those staff.
Liam Quaide (Cork East, Social Democrats)
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That is what I am hearing.
Mr. Pat Healy:
If I can just clarify that, we do not run a system where it is necessary for people to leave to live within a budget. If there are specific cases, I could try to deal with those separately with the Deputy. I will say very clearly that - I know the CEO has been before the health committee and the disability committee - we are trying to employ as many therapists as we possibly can. This initiative is particularly focused on primary care, but there are other initiatives. At the moment, as everybody here knows, there is significant competition for therapists right across the board. We are looking for them in primary care. People are looking for them in disability services, mental health, acute services and so on. An important point we are making, though, is that this waiting list initiative will target specifically the reduction to 39 weeks. We reckon that 60,000 people will be taken off the waiting list and we will bring it to 39 weeks. The key thing then is that we maintain it at 39 weeks.
Liam Quaide (Cork East, Social Democrats)
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That is not using short-term agency staff.
Maurice Quinlivan (Limerick City, Sinn Fein)
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I will have to interrupt Mr. Healy, but I thank him. Deputy Quaide, I am afraid your time is up. I am going to be very strict with everybody because there are a lot of people here and I am going to try to get everyone in.
Peter Roche (Galway East, Fine Gael)
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I thank the witnesses very much for being here. It is our pleasure to have them here. This meeting is a way for us to understand exactly where we are at when it comes to health provision. One of the things that always concerns me, because it is particularly difficult for them, is parents waiting for speech and language therapy for their loved ones. Any time I hear there is a very considerable delay in getting access to it, that really grieves me to a degree because early intervention is really what it is all about. Any delay in that is a disservice to the child, the family and the community.
I listened to both statements, and there is good news in there and some not so good news in there. I am reminded that Mr. Healy made reference to needing 500 and having approval for 200, which leaves a shortfall of 300. I am anxious to understand and I will ask the questions as I go along.
In terms of the shortfall, how do we make up that deficit in terms of supports for people or is it the case of the Department saying quite clearly that it does not or cannot give approval for the additional 300? Is that the case or am I reading that wrong?
Peter Roche (Galway East, Fine Gael)
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Okay.
Mr. Pat Healy:
There is a global shortage of these therapists. This is recognised. The World Health Organization says it. In Ireland, because of the way we are developing, which is a good thing, we are developing integrated care. We have primary care, the CDNTs and mental health. The issue is that all of those areas are looking for therapists. The figure of 200 is a practical number we think we can deliver in 2026.
The key thing, however, is that while we are putting those staff in the place, we are not just sitting on our hands. We are proceeding now with the waiting list initiative. We have started already and are making progress. This is not just about getting people off the list, but also about ways of working and developing how we are working. We had the two demonstration sites, one in the south east and one in CHO 9, between 2023 and 2024. What we have learned is how to do this better, and part of what we are going to be rolling out during this waiting list initiative is that type of approval, that type of change and improvement programme that we are doing. We will also be taking 60,000 people off the waiting list.
Hopefully, we will secure those 200 staff. The idea would be that, in 2027, we will progress again and that, over a period of two and a half years, we will secure the additional 500 staff. Once we bring the waiting time to 39 weeks, the critical thing is that we keep it at that level.
Peter Roche (Galway East, Fine Gael)
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I am minded to ask a question when I hear about primary care centres. I have this sense from what people are saying that, while there was great fanfare around the launch of the primary care initiative and we had those very fine facilities built, I am absolutely certain that a lot of them are not equipped or staffed to the level desired, given that this is about community-based services. I look at the closest one to me, which is in Tuam, and I know that any day of the week I pass there, and I am sorry to say this, there is little or no activity or cars in the car park. I am looking to a day where we can see that providing a fully equipped, fully staffed serviced that will take people away from having to go to University Hospital Galway, UHG, which is traffic gridlocked.
Unfortunately, I am out of time.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Mr. Healy, to respond very quickly.
Laura Harmon (Labour)
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I thank the witnesses from the HSE and the Department of Health and recognise the challenging work they do. I thank them for that work.
I would like to raise the topic of the south Lee primary care services where I am from in Cork. They were identified as a black spot for psychology waiting lists in 2024. I know the south Lee is the largest local health area in the south-west health region, with a population of almost 236,000 in the 2022 census. It includes Carrigaline, Douglas and Ballincollig, all of which large urban areas. There were 1,743 young people waiting for a primary care psychology appointment in May 2024. Many of them had been waiting for a number of years, some between four to five years, yet the staffing levels in the south Lee primary care area in August 2024 comprised just one psychology manager covering Cork west and Kerry, just 0.8 of a whole-time equivalent senior psychologist and some assistant psychologists. The statistics provided for today’s meeting show the longest wait for psychology services in the south Lee area as at the end of October 2025 was 234 weeks, so four and a half years. I think that is very stark. Can the witnesses comment on why the psychology waiting lists are so extreme in the south Lee primary care area, given that this issue received quite national attention a year and a half ago and was brought to senior management in the HSE? It is my understanding that a new layer of psychology management was implemented in the Cork primary care services, including a director of psychology. I am wondering how many ground-level clinicians were recruited in that year and a half as well.
Mr. Pat Healy:
What I can tell the Senator is that a huge amount of work is going on in psychology generally, including in Cork. Cork has had a challenge in the south west in relation to psychology for a long time. When I was there as a regional director, we had the problem then. There was just a difficulty in getting people to take up roles there. Some of that has to do with the fact it has not been well developed over a period of time. We are starting to do that now. If we look at psychology overall, one of the challenges is that, of all the therapies, the referrals are going up very significantly - by 62% since 2017. We have increased the number by 110 psychologists, which is significant. That is over a third more compared to what it was in 2023.
There has been a huge focus over that period, but there is an issue of recruitment and trying to keep people there. I think there were answers to parliamentary questions from public representatives in the area. A particular set of initiatives have been set up locally over and above what we are doing nationally. There is no absence of commitment locally. One of the issues for those in the area is trying to secure sufficient additional staff and maintain that level within the area. That is one of the big challenges we have. What they have started to do, outside of that, is look at alternative ways, with counselling and other supports, to deal with lower acuity issues. They are trying to be creative in how they deal with that, but it does not take away from the fundamental problem.
Laura Harmon (Labour)
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Would Mr. Healy be confident that those waiting lists will be reduced over time?
We know that the crisis affects all primary care disciplines and all health regions. Are there plans to create new management roles for directors of occupational therapy, speech and language therapy and physiotherapy?
Mr. Pat Healy:
There has generally been a significant increase in the numbers. Cork, in particular, has looked at a set of issues it is trying to deal with locally and it is tackling these issues because they believe this is what they need for the system. The REO running the area, Dr. Andy Phillips, feels that this is what he should do because he needs to do something different, perhaps, to attract staff. He will continue to do this. One of the key things for us is to bring in more staff at all levels.
Mr. Niall Redmond:
Mr. Healy has covered this well. The new regional director of psychology was mentioned. This person has been assigned particularly to look at psychology services and review them in the locality. I know a significant amount of work is going on and there are a number of active recruitment processes to try to fill some of the vacancies Senator Harmon referenced. If it is helpful, we can put together a bespoke note for the committee on where these recruitment processes are at and the numbers involved, and provide it after the meeting.
Marie Sherlock (Dublin Central, Labour)
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I thank all of the witnesses. I want to ask about recruitment. I know an enormous amount of work is going on and there are a huge number of constraints in the system. I acknowledge the work going on and we need more of it. With regard to recruitment, we understand there were 489 vacancies at the end of 2024. How many vacancies were there at the end of 2025? I heard what Mr. Healy said about approval for 2026 but what was the number of vacancies at the end of last year?
Marie Sherlock (Dublin Central, Labour)
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Why not?
Ms Philippa Ryan Withero:
We have the total number of vacancies for primary care itself and at the end of November, which is the latest reporting period, the total number in primary care was 651. This is against the WTE limit agreed for primary care services. We have a breakdown within the staff category level but we do not have the level underneath this.
Marie Sherlock (Dublin Central, Labour)
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Is that for the CDNTs or primary care?
Marie Sherlock (Dublin Central, Labour)
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What about the CDNTs?
Marie Sherlock (Dublin Central, Labour)
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That was in the previous year.
Marie Sherlock (Dublin Central, Labour)
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We have approval now for 200 additional posts on top of all of these vacant posts. What is the plan to fill them? When I look at the numbers going through our universities, there has been a very small increase relative to the need we have been hearing about in recent years. Obviously, large chunks of people are going into the private sector. What is the plan with regard to recruitment?
Marie Sherlock (Dublin Central, Labour)
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There are all these vacancies and there is approval for 200 positions this year. We have harrowing figures with regard to people languishing for nine years in Cavan and Monaghan waiting for physiotherapy and for nine years in Galway waiting for psychology services. How confident is Mr. Healy? Where does he believe we will be at the end of 2026 in terms of filling these roles?
Marie Sherlock (Dublin Central, Labour)
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But 651 are being carried over.
Mr. Pat Healy:
That is the point I was going to make. There is a huge level of opportunity and movement now. The staff themselves are moving regularly. That is where the vacancies arise. There are career opportunities, there is expertise and there are people moving from primary care to disability. There are also promotion opportunities. That is part of what is contributing to vacancies. The REOs have full authority to fill posts in their regions as they see fit. This is important. What we are saying from a national point of view is that there are an additional 200 posts specifically to support this waiting list initiative. We will be putting a lot of focus on trying to make sure these posts are filled in a way that maintains the waiting list as we reduce it to 39 weeks. That will be important.
Marie Sherlock (Dublin Central, Labour)
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I want to say to the Department of Health that we were promised a strategic review of GPs last year and we now hear it will be this year. I do not have any great confidence that we will see it any time soon. The one glaring omission from the statement today is that it does not speak about where GPs are located. This is critical to meet the needs of so many people, particularly in the communities I represent and other communities around the country. We look forward to this as soon as possible.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the witnesses for coming before us. I want to go back to something with regard to the waiting list that caught my attention. The target for the waiting list is 39 weeks. For those on a waiting list who are well above the threshold of 39 weeks, what additional options are there to offer them supports now?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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How many are there? What is reasonable?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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When? Is there a target?
Mr. Pat Healy:
It is 12 months. It is important to say is that this is for everybody who has been on the list for 39 weeks and for everybody we expect to reach 39 weeks during the period. I have been involved in these types of programmes for some time and we have done very well with enhanced community care and others. I have no doubt that what will happen as we go through this is that because there has been lag, other people will come out whom we do not know about yet. Paradoxically, as we reduce a waiting list, it starts to grow again. We will tackle the 60,000 and the people who come on will be new people.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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In relation to the 39 weeks, that is almost ten months. Where is the evidence that this is an appropriate level of time for somebody to be waiting?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Where did it come from?
Mr. Pat Healy:
From what is achievable. Deputy Sherlock asked how many posts we thought we would be able to get. When we look at what we can actually achieve, we will be using overtime in the public system and private sector capability to do once-off work. We will be bringing in additional staff to maintain it and keep it going. When we put all of this together, the issue is that the best we can achieve would be to bring it to 39 weeks and maintain it at this. That does not mean we will stop there but it is what we will try to do in the next 12 months.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Does Mr. Healy understand why I have asked the question?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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If somebody comes into my office and asks me whether this is really how long their child will be waiting, how do they bridge the gap between referral and acceptance and then a wait of almost ten months when they themselves are not the specialists their child needs?
Mr. Pat Healy:
What we will be relying on there, and what does happen, is clinical prioritisation. The lists will be looked at and clinically prioritised. What I am trying to represent here is when we take this in the round and look at what we are doing at a local level. Where this is happening on the ground is why I emphasise the community healthcare networks. Front-line staff and managers at a local level are looking after their 50,000 population. They are the people who will be making the decisions, prioritising and using their best clinical judgment. We will try to support them to do this as best we can.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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There are 200 whole-time equivalent posts that have been approved and a need for 500 has been identified. There are vacancies of 650 or 457, depending on where it is, but Mr. Healy is confident they can be filled. How will the retirements and promotions that have been spoken about be managed within this also?
Mr. Pat Healy:
This is happening all of the time. It is happening today. It is part of what we have to do at a local level in each of our areas. The teams, the REOs, the RHA managers and people such as Ms McLoone are working with this every day of the week when they prioritise. That is the key role of somebody such as Ms McLoone and perhaps she can speak about it.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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When it comes to managing the primary care and CDNT waiting lists, with the staff shortages and escalating lists, is the HSE not simply moving people from one waiting list to another?
Mr. Pat Healy:
Absolutely not. That is why I specifically mentioned the single point of access. Each of those teams is working to the top of its licence. What we are trying to do now, and the good work that is starting, is to bring those together so that they integrate better than they do today, so that they are better co-ordinated and so that the experience, as I mentioned in the opening statement, does not leave the parent or child feeling like they are being moved from pillar to post. We have started to get on top of the CDNTs. As we said, we are recruiting more people to them. That is starting to stabilise. The challenge is that there is a higher level of complexity coming to primary care, which we have to get on top of.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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With the greatest of respect, I must put it to Mr. Healy that it is not that parents feel like they are being moved, but that they are being moved. It is the reality.
Ruairí Ó Murchú (Louth, Sinn Fein)
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We can all talk about the disaster scenarios for those who are on waiting lists, whether for CDNTs or primary care. Once upon a time, primary care was where people were moved on the basis that they could get a service, particularly in occupational therapy and speech and language therapy. That has obviously changed drastically. The HSE gave the numbers. There are 651 unfilled positions. I assume there was a drop in numbers in that.
Ruairí Ó Murchú (Louth, Sinn Fein)
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Mr. Healy is saying that 500 are needed.
Ruairí Ó Murchú (Louth, Sinn Fein)
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Exactly, at 39 weeks, so leaving the 651 to one stage. Mr. Healy is saying that within the year, with those 200, the HSE will be able to deal with people within 39 weeks and it will deal with the backlog.
Mr. Pat Healy:
Everyone who is on the waiting list today, for physiotherapy, occupational therapy and speech and language therapy, and who within the period of the next 12 months would be at 39 weeks, is the number we are targeting. We will target that as a special waiting list initiative to get those people seen. The 200 will start to fill those this year so that when we actually bring it to 39, there are staff in place to assist in keeping it at 39 weeks. To maintain it at 39 weeks with increasing numbers coming, we will have to build up to 500 over a year or two. If we even had approval for 500 posts, we would need to get them in.
Ruairí Ó Murchú (Louth, Sinn Fein)
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Thirty-nine weeks is sufficient but we would like it to be much more reactive to need. Mr. Healy is telling me that at some point before the end of this year, we will reach that.
Mr. Pat Healy:
That is what we are saying. We are saying that these waiting lists were growing by 2,400 each month. For the first time in four years, since we started this, they have dropped by 14,000. When a process like this is started, I have no doubt that there will be ups and downs in different regions across the country.
Ruairí Ó Murchú (Louth, Sinn Fein)
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I accept that. We are talking in generalities. Does Mr. Healy have a breakdown of how exactly that 200 and 500 is made up and where the need is? I have a last question, because we are running out of time. Once upon a time, primary care was where people went to get a service. Now they do not. They go to primary care and, like everyone else, they are thrown on an assessment of need list.
Mr. Pat Healy:
This year will see more than 1 million people in those five therapies, so a significant number are being seen. The issue is that the requirement is far bigger than the resource we have. It is important for the staff who are working there that 100,000 patients a month are being seen by the five therapies together. What was the last question?
Ruairí Ó Murchú (Louth, Sinn Fein)
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I asked for a breakdown and commented on primary care being put on the assessment of need list.
Mr. Pat Healy:
The CEO has agreed with the regional executive officers, in discussion with the systems, that we will leave it to the discretion of the REOs, because when the vacancies and new posts are taken, they will have discretion about how they do that at a local level, and I think that is the best way to do it.
Ruairí Ó Murchú (Louth, Sinn Fein)
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Okay. Mr. Healy might get some information on that and that can be provided to the committee.
Ruairí Ó Murchú (Louth, Sinn Fein)
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On the assessment of need, for many years, I saw people go onto primary care lists for speech and language therapy, occupational therapy or whatever, get a service, and then that was removed. At this point, everyone is being put on the assessment of need list, so we maintain one really dreadful list.
Michael Cahill (Kerry, Fianna Fail)
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I welcome today's joint meeting and our guests. I received an email from a constituent in County Kerry last November. They were contacting me because their son is in urgent need of immediate intervention and the continued failure of the system to provide him with essential therapies has now reached an unacceptable and critical point. They stated that while they have received responses acknowledging the challenges in the disability services, none of these acknowledgements has resulted in any actual supports for their child, and that the ongoing delays are causing permanent development harm. They stated that it is no longer a matter of administrative backlog and is a direct breach of his rights under the Disability Act 2005 and the Education for Persons with Special Educational Needs Act 2004, and Ireland's obligations under the UN Convention on the Rights of Persons with Disabilities. They demanded immediate and concrete action and a confirmed date and time for when their son will receive speech and language therapy, occupational therapy, psychology and all other essential supports, with written confirmation that his case has been escalated to the highest levels within the Department and HSE. They stated that they require the HSE to identify the specific individual who has now taken responsibility for ensuring these services are delivered without any further delay.
In fairness, some of these issues have been addressed in the meantime. The correspondent further stated that their son cannot wait for future reforms or long-term structural improvements, and that every week without intervention inflicts irreversible damage on his development. They stated that the situation is fully within the authority of the Department and the HSE to resolve and requires immediate action. They stated that they expect confirmation of receipt, a prompt response and information about next steps and who is taking charge of the case, and that a delayed reply, vague reply or non-actionable reply is not acceptable. They said their child has waited long enough and the time for immediate action is now.
That seems to be the case for many individuals in Kerry with disabilities. We, including my secretary, my son and my parliamentary assistant, are getting this all the time in the constituency office. We meet people about it all the time. We need to give these individuals and families the help they need. They need it now, as that lady and her husband outlined in the email that I read into the record of the committee. I have no more to add because that says it all. I would like to raise respite today. I will wait for that.
Mr. Pat Healy:
The family Deputy Cahill raised are absolutely the type of family we are trying to address with the primary care therapy waiting list, including physiotherapy, occupational therapy and speech and language therapy. Psychology is a bit different. We would have to tackle it in a different way. It is not as amenable to this type of initiative, but for the primary care therapies, those who are on those lists should definitely get an improved service through the initiative, and we will try to sustain that.
Mr. Niall Redmond:
The one sentence that really struck me is that they do not want to wait for reform but need a service now. That has been the tenet of the programmatic approach we have adopted this year. There are reforms. Mr. Healy spoke about the proof of concept sites that are looking at the longer term, but a major part of this programme is to put services in place immediately. Sixty thousand real people are getting real services in the course of this year. We are alive to getting the balance right with action now and the longer term reforms that are required for a more sustainable service too.
Gillian Toole (Meath East, Independent)
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I thank the witnesses for meeting us. I will try to filter out colleagues' questions so that I do not duplicate. I would also like to thank witnesses very much for the substantial volume of information that they have provided on our request.
I will first ask all my questions. Primarily, my questions are for the HSE team and I have one question for the Department officials.
Why was a centralised dataset not collated sooner? Similarly, while the single point of access is welcome, why did it not happen earlier?
On recruitment, particularly in Dublin and the north east, including my constituency of Meath East, the figures and the wait times in terms of years are horrifying. The breakdown of staffing is as follows: admin, 36%; psychology, 4%; speech and language, 6%; and OT, 9%. In an era of IT and AI, is it not possible to tidy up all of that and for management to prioritise front-line recruitment? What is being done in that space? Is rolling panel recruitment being carried out? If so, that is great, but if not, why not? I have one example. I have been contacted by an assistant psychologist who tells me that their post is capped at a three-year contract. If that is so, why, particularly from the perspective of retention?
In the area of respite, colleagues have asked what can be done now and I have some suggestions, which I have put previously to Mr. Gloster. In the area of alternative respite, there are evidence-based therapies such as art, drama, equine, music and play therapy. Is it a consideration that these therapies could be provided under the National Treatment Purchase Fund similar to the cross-border treatment scheme?
It is fantastic that a reduction of 60,000 people waiting for services is to be achieved and I am aware of the emphasis that has been placed on the purchase of services from the private provider. My question in that space is: how is patient care assessed given that private providers often have shareholder margins to meet?
Finally, for the Department, with regard to accountability and oversight and marrying all of the practice to the provision of funding, how is that carried out?
Mr. Pat Healy:
I will answer a couple of questions and I might ask Ms McLoone to come in on some of this. Technology is a huge part of what we are doing in this primary care therapy waiting list initiative. That is really important.
On the admin piece, it is really important that we keep in mind that one of the things that therapists tell us continually is that if they have admin staff working with them, they can be more productive. We really have to keep that concept of admin being something extra and be careful with that.
I will ask Ms McLoone to talk to her particular area, and I know it is connected to that of the Deputy.
Ms Mellany McLoone:
We started the single point of access as a pilot scheme in June 2024 and, essentially, it was to prove the concept. The important thing about that is that it involves all the services, including the section 38s, for disabilities. It is just to acknowledge the significant work that the voluntary agencies have done in working with us on that because it means now that all their referrals come to a single point, and it does make a huge difference. The implementation of the single point of access is underpinned by the HSE's national access policy. It is also informed so now it means that an individual integrated health area, IHA, level and the individual community healthcare network level are underpinned by integrated children's forums, which means when referrals come in there is very much a "no wrong door" policy. All the providers who are involved in providing service in that area are doing things.
To answer the Deputy's question as to why it was not rolled out, it is now. All of the 20 IHAs across the HSE are actively involved and engaging in this. There is a national template. There will be a single referral form for all children's services. Our GP leads are involved. It is all of our voluntary providers across the disability sector. Our colleagues in CAMHS are also involved. It will be a significant piece of-----
Maurice Quinlivan (Limerick City, Sinn Fein)
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Time is up and apologies for that.
Anne Rabbitte (Fianna Fail)
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I thank everybody who has come before us. I want to acknowledge the work that Ms McLoone and her team have done on the pilot scheme in relation to an access policy.
I want to say to both Chairs that it is remiss that there are no officials present from the Department of Children, Disability and Equality. We have officials from the Department of Health and the HSE but we are missing a huge piece by not having officials from the Department of disability before us. Deputy Toole asked questions on policy and oversight but there is nobody to answer the questions on policy and funding as that all sits with that Department of disability. There is a gap in the questioning this afternoon and nobody will find fault with my commentary on that. It is a fact.
I have listened to a lot of the language used. Language matters in the fact that the HSE and the word "Department" are interchangeable. When it comes to disability and primary care, we have actually two Departments. We have the Department of Health and the Department of disability. Yet again, officials from the Department of disability are not present. I would like to know from the secretariat if they were invited and, if not, why were they not here, if they have not showed up?
My next question is for Mr. Healy. There is a shortfall of 440 staff on CDNTs. He mentioned interdisciplinary between HSE disability and HSE primary care so I am going to comment in the same interchangeable manner. There is a shortfall of 440 staff on CDNTs and 651 in primary care. That is an overall shortfall of 1,091 staff at early intervention primary care with responsibilities for therapy and he said 200 would be recruited. Is that 200 figure in primary care or in disability services?
Anne Rabbitte (Fianna Fail)
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We then do not have the recruitment figure, other than we know the recent budgetary allocation that 100 staff are to be allocated within disability services.
Mr. Pat Healy:
It is just the pay number is after being agreed with the Minister on the disability side. My understanding is that there is an uplift. There has been a 1,000 of an increase each year in the last two years and I understand there is an uplift. I do not have-----
Anne Rabbitte (Fianna Fail)
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What allocation has been set aside under the pay and numbers for CDNTs?
Anne Rabbitte (Fianna Fail)
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Mr. Healy does not have a number for that.
Anne Rabbitte (Fianna Fail)
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My understanding is that it is 100. At the end of the day, the HSE will recruit 200. Mr. Healy talked about figures, including 39 weeks, 60,000 and 100,000. How many are on the overall list? Through using the national access policy, how many children - aged under 18 - between primary care and disability are looking to come in the same one front door, which is now the national access policy? How many children are looking to access that?
Anne Rabbitte (Fianna Fail)
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What is the number for disabilities? Please put it on top of it.
Anne Rabbitte (Fianna Fail)
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The purpose of this meeting is to establish how many children are trying to access their first point of contact. According to Ms McLoone, that pilot is being expanded and rolled out so we should know the number, right across the country, for how many children are trying to access it.
Anne Rabbitte (Fianna Fail)
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Are all children in disability and in primary care part of the 39 weeks and the one front door policy?
Maurice Quinlivan (Limerick City, Sinn Fein)
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The Senator is running out of time.
Anne Rabbitte (Fianna Fail)
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I am going to run out of time but these are important questions.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Does the Senator want answers?
Anne Rabbitte (Fianna Fail)
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The purpose of today's meeting was to establish a ground rule as to what was the number of children who needed access through the one front door model.
My next question is on primary care for Mr. Redmond. Where is the Department's overall line of sight on the number of children needing access?
Maurice Quinlivan (Limerick City, Sinn Fein)
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The Senator is out of time now so there is no time for an answer, unfortunately. I am going to move on to the next person.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Very briefly.
Anne Rabbitte (Fianna Fail)
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I only want a number.
Anne Rabbitte (Fianna Fail)
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Is that between both?
Anne Rabbitte (Fianna Fail)
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I thank the Cathaoirleach
Maurice Quinlivan (Limerick City, Sinn Fein)
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I remind the Senator that this meeting was organised by the members of the Joint Committee on Health and the Joint Committee on Disability Matters, and we carefully chose who we invited. We did not invite officials from the Department of disability because we are discussing primary care and that is why they were not invited.
Anne Rabbitte (Fianna Fail)
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That is okay but there is a gap.
Maurice Quinlivan (Limerick City, Sinn Fein)
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I wanted to put that on the record.
Tom Clonan (Independent)
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I thank everybody for being here today. I also thank them for this comprehensive document, albeit notwithstanding the gaps that have been identified by Senator Rabbitte.
The document is very comprehensive, but it is also very stark. Some 65,000 children, and likely tens of thousands more, are being failed. My first question is this: does the HSE maintain a risk or harm register for those disabled citizens who are not receiving intervention within the therapeutic window? If you are talking about wait times of 300 or 400 weeks, by the time the intervention is there they have had life-altering and life-limiting consequences for them and for their families. Does the HSE record those risks and harms? If not, why not? Does the HSE measure the cost of failure of these interventions and the harm that it inflicts on tens of thousands of children and families due to these wait lists and the cost to the overall health services in the State? Does the HSE look at the impact that this failure has on families? Every week and every day, in families like mine, psychological and physical damage are done because of the moral injury, distress and trauma of seeing your child fail and deteriorating and you have no control or power over it. Does the HSE measure that?
Mr. Pat Healy:
In terms of individual risk, the individual situation would be looked at by the clinical team locally. As a system, we would look at the generic risk and so on. For people like myself, Ms McLoone or Ms Crowley that are involved in this, those very things are why we are trying to do what we are trying to do.
Tom Clonan (Independent)
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The HSE does not actually have-----
Mr. Pat Healy:
We keep risk registers at a national level. Part of what would be on it, part of what I know in my role and part of what we would be focusing on is the fact that these waiting lists are there, the significant impact that is having on families, the serious disruption that is causing and all the type of things the Senator is talking about. We would be looking at that as a risk. That is part of what feeds into why we are actually prioritising this. In putting this whole plan together, that is what is driving it. The fact that these waiting lists are here means it is unacceptable that they are waiting so long, and something has to be done. Behind that, of course-----
Tom Clonan (Independent)
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If the HSE is compiling that risk and the level of failure is of international or global significance, what intervention has taken place?
Mr. Pat Healy:
This intervention of this primary care service waiting list is one part of it. I raise the psychology stuff in relation to the changes in training. I refer to the totality of what we are doing. The single door and no wrong door is a key piece as well because it is not just about seeing people, it is about how we are doing it and joining it up.
Tom Clonan (Independent)
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Has the HSE measured the cost of this harm overall in the health service?
Tom Clonan (Independent)
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My final question is for anybody. Is the HSE carrying out any assessment of the damage? It is not just tens of thousands of children, but tens of thousands of families that are being traumatised. The harm is-----
Tom Clonan (Independent)
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Is the HSE measuring it?
Ms Mellany McLoone:
We do not measure it and do not have any data. One of the things that we have started to do is to have the family forums at a local network level, particularly in the context of disabilities. If I can only talk to my own area, one of the things that we have done in response to that is to try to increase the respite services that are available because they are an extraordinarily valuable tool to families. One of the things we did in response to that was develop the alternative model of respite because our experience from talking to parents and families was they were not comfortable putting children under the age of 12 in overnight respite. We developed alternative respite services for after school, at the weekends and for bank holidays. No, we do not have unequivocal research to do it. We do it.
I have a final point, if the Chair does not mind. One of the next stages in our implementation of Sláintecare is putting in integrated managers who will drive and lead integration across all services at a network level of 50,000. One of the key things we will be doing in relation to that is actually engaging with the population of that network. We need to get much better at stopping telling people what we are going to do but asking them what they want and need. We will be doing that through children and adults.
Margaret Murphy O'Mahony (Fianna Fail)
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I welcome the witnesses this morning. I thank them for the work that went into their opening statements and the work they do every day. If someone with a disability gets sick, the GP is the first port of call. We have all heard stories of how a GP can handle things badly or correctly with regard to someone with a disability, often with a parent or sibling. If it is handled badly, it can throw the whole thing up in the air. Are GP trainees receiving mandatory training on competence and communication with the person with a disability and their families?
Margaret Murphy O'Mahony (Fianna Fail)
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Does Mr. Healy think most of them are doing it?
Mr. Pat Healy:
At this stage, given the importance and scale of the level of knowledge of disability, it is very much-----
Margaret Murphy O'Mahony (Fianna Fail)
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It would be important.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Would anyone from the Department like to answer that?
Maurice Quinlivan (Limerick City, Sinn Fein)
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Is there a policy on it?
Margaret Murphy O'Mahony (Fianna Fail)
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I suggest that with the increase in cases of how things are handled badly at times, it should be mandatory.
With regard to HSCP student placements, are disability awareness, accessibility and inclusive practice embedded into the training of these students?
Mr. Pat Healy:
In the training that is happening now, work is done on all of that. Ms McLoone has just reminded me that it is an integrated approach. The colleges are one of the things we have talked about in terms of the GP strategic review and in terms of medical colleges generally. The more they have to work together as part of the modules, as part of their work and as part of the training, the more of contribution it will make to how they will work together later. Much of what we talk about now is teamwork, integrated working and joined-up working. Some of it was said earlier. There are CDNTs, CAMHS and primary care. All of those are working well individually. We have to try to get them to work collectively across the population.
Ms Mellany McLoone:
All of those professionals are required, as part of their training, to do a specific number of placements in mental health, in disabilities, in primary care and in an acute hospital setting. When they are in those placements, they work with experienced health and social care professionals who monitor and manage their training and supervise their placements. Therefore, they are learning for the period that they are doing their placements. They are learning from experienced professionals who have been working in those areas for a number of years. While it may not be mandatory, they get exposure to it. It is a requirement of their training. They have to do placements in specific services.
Margaret Murphy O'Mahony (Fianna Fail)
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This question is for the Department of Health. I raise the implementation of pillar 4. How is the Department ensuring meaningful participation by people with disabilities in the governance structures that oversee the strategy? It is important that people who are directly affected form part of the strategy.
Mr. Niall Redmond:
In terms of the overarching strategy for disabled people, the governance structures are being developed by the Department of children and disability. We are part of those governance structures. In the development of the strategy, there has been a huge amount of engagement and workshops with disability groups and people with disabilities in terms of the development of the actions and the plans. We have had really good feedback in terms of pillar 4, and in our engagement with the disability community in relation to these matters.
As the Government structures move on and we move into the implementation phase, there will be regular check-ins then as well in terms of those engagements.
Séamus Healy (Tipperary South, Independent)
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Apologies for my late arrival as I was in the Dáil Chamber. I think most areas have actually been well covered. The phrase "at local level" has been used a number of times. At a local level I am told that the CDNT team at Clonmel now is almost non-existent. There are no psychologists, no physiotherapists, no dieticians and so on. Are the witnesses aware of this and, if so, what steps have been taken to try to solve the problem? Is there any indication as to how long it will take to solve the problem?
Mr. Pat Healy:
I will have to find out the specific the details on the team in Clonmel and get back to the Deputy on it. I do know that right across the board there has been significant increases, which we have talked about it in terms of additional staffing. I am not sure what the particular challenge is in Clonmel but I will come back to the Deputy on it.
Séamus Healy (Tipperary South, Independent)
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Obviously, it is a very difficult situation for families and for patients. I would appreciate if Mr. Healy would come back to me as soon as possible.
Manus Boyle (Fine Gael)
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I thank the witnesses for coming in. I want to thank Edel Quinn in Donegal, who does a good job. I want to come in on the speech and language issue. To be honest, I had a family member who had speech and language problems. He got very early intervention and it made a wild difference. He was allowed two years in the national school in Edenmore and after a year he was gone. He was out through it. He found it very hard to pronounce his words, but after three weeks, his mother and I could see a very big difference in him. That is down to good staff and I would like to thank them immensely for what they have done. Now we cannot get him to stop talking, to be honest. This shows that early intervention is important. His mother copped it very early and we got the transition started. That is one thing I would really push for, especially in Donegal. There are 200 new speech and language therapists coming in, is that correct?
Manus Boyle (Fine Gael)
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How many of them will you be sending up to me?
Manus Boyle (Fine Gael)
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I really do see the merits of the early intervention. We had a young boy who could not pronounce his words and six months later he could put sentences together and he could move on. In fairness, he has never looked back since. The 200 staff will make a big difference to the whole of Ireland, but we also have a big problem with physiotherapists and occupational therapists. Is there any way we can use private physiotherapists to come in to try to take some of the people on the waiting lists? Older people are always coming to me and telling me that they cannot get an appointment because the list is full and they might be waiting for six months. This is of no use to someone who is 75 years of age and in pain. We really need to get a grip on it quicker.
Mr. Pat Healy:
That is an important point because in recognition of the need for us to use all the resource we have available to us, we are targeting overtime on the public side so that we keep the existing people focused on what they are doing but that we give them an opportunity to do work in clinics on weekends and at night-time and we are using the private sector to do additionality in this once-off waiting list. That enables us to take on staff for the public system on a permanent basis. We will use every avenue available from the private sector to be able to support this once-off initiative in primary care therapy waiting lists. We will be maximising those within the public system who want work overtime and so on.
Manus Boyle (Fine Gael)
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Mr. Healy mentioned earlier and we had it at the health committee yesterday about CAMHS and the transition on through. There is a serious problem which came up throughout the meeting yesterday. Once a person reaches 18 years of age, they fall off cliff, so to speak, and they have to wait to get back on. We need to have a controlled plan the whole way through.
Mr. Pat Healy:
That is the intention of the single point of access. One of the key things that group is looking at, and Ms McLoone has talked about the forums and so on, is the transitions of care, as they are some of the most critical. By this I mean the transitions between services and the transitions from children to adult services. That is one of the key areas of focus. As I said in the opening statement, we need to reduce duplication, miscommunication and all of that. We need to simplify it for parents and families and the type of thing that Senator Clonan was talking about so that the parents and the families have a straightforward ability and that they are kept informed. The communication is really important and we will be taking that on board in a significant way.
Manus Boyle (Fine Gael)
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It came up yesterday at the health committee that there was no pathway and it just seemed to be a drop. Ms McLoone touched on respite, which I think is very important. Is there anything we can do to try to improve the respite for parents, because they feel they have no place to go?
Ms Mellany McLoone:
Absolutely. Anybody who is involved in any way with providing children's services knows how important respite services are. There is a huge amount of work being done and I think, to be fair, there has also been a significant additional capital allocation for disabilities this year, which is extremely welcome. Across the country what we are all doing is looking at alternative types of respite. It is very much a priority for us for 2026.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank Mr. Healy, Mr. Redmond and their teams for appearing before the committee and for the information they have provided. I just want to get something straight in my own mind. Of the 60,000 on the waiting list, 25,000 of whom are children, do we have a differentiation of how many of those are living with a disability and who are there for other reasons?
Martin Daly (Roscommon-Galway, Fianna Fail)
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We have no way of distinguishing that in a referral sense.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I am not being aggressive, I am just asking the question, is that not a weakness in the data?
Mr. Pat Healy:
As was said earlier, the whole ethos in primary care is that people did not need an assessment of need but rather they needed the first point of contact and so we want to make it as simple as possible. There should be no barriers. At the moment the barrier is that we do not have enough resources to meet the needs there but it is not a clinical or it is not a-----
Martin Daly (Roscommon-Galway, Fianna Fail)
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When a referral is made to the primary care team, is it just simply a case of it being the last in line? Is there any triaging going on?
Mr. Pat Healy:
No, when they get the referral, they look at it clinically, and often it will be a GP or it might be a public health nurse. There might be a concern about a developmental delay or something, and it may well be that someone is immediately of the view that it is obvious it needs to be referred to CDNT because it is a matter of disability and because it is complex. However, in primary care the idea is that the straightforward, non-complex cases will be dealt with immediately in primary care. If the referrer knows already that they are concerned about it, it will be sent to the appropriate team and the clinical team locally will address it.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I am just going to ask this question and I presume Mr. Healy's answer will be "Yes". Are teams being performance managed, with caseloads being looked at to see how people are performing?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Does Mr. Healy see that the development of therapies in schools might reduce the need for referrals to CDNTs?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Coming on to recruitment and retention, how long does it take to appoint someone from the moment of advertising a post to putting them into post, provided a candidate is found? Will Ms Ryan Withero give us a sense of that?
Martin Daly (Roscommon-Galway, Fianna Fail)
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One of the allied professions. If the post has been identified and someone has been interviewed and recruited, how long does it take?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Does that get them into post in 16 weeks?
Martin Daly (Roscommon-Galway, Fianna Fail)
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Why then at times do we have a situation that we see at times where a very good service, such as a community physiotherapist in a primary care centre, for example, suddenly stops because the physiotherapist goes on what is planned maternity leave? There is nothing.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Is that not something that can be planned?
Mr. Pat Healy:
There has been a history of primary care services not being as developed when it comes to providing for maternity leave. It is something we are going to have to take on board. It is often raised. The services, Ms McLoone and the team and all the integrated health areas, IHAs, across the country raise it. It is something we are going to have look at as we go forward.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Finally, I have a question for the Department. In the context of CORU and the recruitment of people internationally, are there issues with CORU in that regard? For example, in physiotherapy, we now have a good degree course in athletic therapy from DCU. It is highly rated. I know the disciplines are different in the United States, Canada and Europe. There is not just physiotherapy. Rather, there are different specialties like respiratory therapy and physical therapy. Is consideration being given at opening up because musculoskeletal therapy to a master's degree level out of somewhere like DCU suggests there should be a role but there is no position in the health service for it?
Ms Rachel Kenna:
One thing to draw the Deputy's attention to is that, from a regulation perspective, we are looking at the common training framework for physiotherapists which will increase mobility through the European Union based on common training under the professional qualifications directive, PQD. We feel that will be beneficial. It is in its early stages but it is certainly a step in the right direction to increase mobility across that workforce.
In respect of musculoskeletal therapy or other qualifications that could assist, one group that we have been working and in contact with is athletic therapists, for example. We are engaging with them, with a particular focus on community and primary care settings and working with older people.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Even in the context of emergency rooms, they are used in the United Kingdom and the United States.
Keira Keogh (Mayo, Fine Gael)
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Gabhaim buíochas le gach duine for being here this morning and for the work they are doing to try to get on top of the demand and waitlist. With regard to the single point of access and the one-door policy, I understand it is still a pilot and still being rolled out but we are hoping to have that single point of referral and integrated team work and integration. I will outline two examples and I ask the witnesses to provide a real world example about what they are trying to do and how the system will change for the two examples.
The first example is that of a boy sent to primary care psychology who is put on a waiting list. Two years later, he gets the psychology assessment and does not come out with an autism diagnosis. He is then referred to CAMHS. CAMHS screen the child for ADHD but he does not meet the criteria. He is sent back to primary care psychology for intervention and put on the bottom of the waiting list even though he never received intervention. He is then also referred to the National Educational Psychological Service, NEPS, but because there is no communication between CAMHS and primary care and NEPS, that referral has to go through his teacher. He eventually gets a diagnosis from NEPS but he still needs behavioural support and is now waiting on the back of a primary care psychology service. That is one example.
The second example is that of an adult who was never within the service until he was over the age 18. He is in the HSE service now but has a dual diagnosis under mental health and autism services. The section 39 day service he visited wants him to attend but he needs a referral from the HSE. The HSE tells him that he does not need to go to that day service but, rather, he should go to the mental health service. The mental health service has no ability to take him, however. The day service cannot take him without the HSE referral.
For those two examples, where are we going and what will the story look like for them in six months or a year?
Ms Mellany McLoone:
I will deal with the example of the child first. As Senator Rabbitte mentioned, we have a national access policy. That is being implemented across all 92 or 93 networks within the HSE and it involves all of the professions. Over 80% of the referrals that come into us are reasonably straightforward. The national access policy provides for an integrated children's forum. That forum involves all of the services, including primary care, disabilities, CAMHS and, occasionally, our colleagues from Tusla. We have not quite expanded to education yet but we will get there. Tusla is also involved in it and the GP lead for the network. That referral will come in and an assessment will be made. The first thing that should happen is that child should not have been sent to primary care. The child should have gone to CAMHS if it was felt necessary. The first thing I expect is that the child will go to the appropriate service from the beginning.
Keira Keogh (Mayo, Fine Gael)
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It was a query of autism so that is why-----
Ms Mellany McLoone:
Collectively, people will make a decision. The second thing that will absolutely happen is that child will transition seamlessly. If he is going to CAMHS for a diagnosis of autism or ADHD, he will literally go back into primary care. Under no circumstances should that child have been put to the end of a waiting list. At the integrated case forums, there is regular communication with all the stakeholders. Certainly, that child’s experience, and that of his parents and family, should be far more seamless. The work is done behind the scenes so that the family are just told where their appointment is.
Keira Keogh (Mayo, Fine Gael)
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At what point does Ms McLoone believe we will get there?
Ms Mellany McLoone:
The single point of access will be implemented across the HSE before the end of this year. The other great advantage of them getting the opportunity to say now is that there is also an IT system, Community Connect, that will be implemented as part of the roll-out of the single point of access. It means there will be shared records. There will be an IT system to cover the sharing of information, the recording of data, details about where children are going and all of that.
Keira Keogh (Mayo, Fine Gael)
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We have just gone over time. I seek a quick answer on the adult example.
Ms Mellany McLoone:
With regard to the adult example, I have never come across that. Generally, our experience has been that if an adult wants to go to a particular service, there should be no impediment as to why that should not be facilitated. If we get the details of the individual case, we can follow it up.
Colm Burke (Cork North-Central, Fine Gael)
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First, I apologise on behalf of the Cathaoirleach of the health committee that he could not be with us here today. I am Leas-Chathaoirleach of that committee and that is why I am here at the top with the other Comhchathaoirleach, Deputy Quinlivan, who has managed this meeting very well.
I wish to raise two issues. I thank the witnesses for the work they are doing and their presentation here. I apologise for being late. I am a member of the drugs committee which is also running at the same time. I have two issues I wish to raise. The first relates to GP training. I know the increase in the number of trainees was mentioned in the opening statement but a lot of that is not going to come on stream for another two or three years. We also have a lot of people retiring. In that two-year period, we will have challenges and I am concerned about that, particularly in areas of the country where it is difficult to get GPs to take over practices that already exist. That is one issue.
The second issue about which I am concerned, and I have dealt quite a bit on this over the last six months, is the co-ordination of services between Tusla and the HSE. As the witnesses know, Tusla has carried out a review of over 40,000 cases. I am concerned because I am dealing with a number of cases where I do not see that co-ordination in providing services to children. Is there a structure in place to deal with that, both at local and national levels, especially with regard to vulnerable young people? They are the very people who fall through and do not get access to services, particularly where there is a problem where the parental support that should be there is not. For instance, I visited one school where 42 out of the 220 pupils are regarded as being in the red zone, meaning there are concerns about the support in the home and the challenges the particular school has. Will the witnesses deal with those two questions?
Mr. Pat Healy:
I will take the question about general practice first. There is a recognition that we need to increase the number. As I said in the briefing note, we are at about 7.4 per 10,000 at the moment. We hope to get 9 or 10 per 10,000 by 2030. The increase in training places will contribute to that. It has already started to contribute to that.
In the meantime, there are a couple of things we are doing.
The GP agreement of 2023 we negotiated with the IMO and which it is supporting us in implementing provided specific issues for the remote and rural medicine and we are targeting that. We have tried to improve the arrangements there and see where people could dovetail together and use the arrangements in a general locality to maintain more GPs. That is one thing. The other important one in the short term over the next couple of years is the international medical graduate system that we agreed initially with the ICGP and the Medical Council, and which we are working on with the IMO now in terms of rolling out. That is going to be really positive because we have 111 already brought into the system and they have targeted the western seaboard in particular. We are also targeting areas of urban disadvantage, which is important, and there are 58 more of those earmarked in the current year. Obviously, we will have to build and the training will come through, but in the meantime we have started to implement that.
Significant work has been done in recent years in relation to co-ordination between us and Tusla. That was pretty well embedded in my time. It has been a while since I was involved in that side of it but there was a national group and so on.
Colm Burke (Cork North-Central, Fine Gael)
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There is a gap in the system. On the one hand, Tusla is providing support but there does not appear to be that connection at local level with the medical services. I have certainly come across that.
Colm Burke (Cork North-Central, Fine Gael)
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At local level is there a constant-----
Mr. Pat Healy:
As Ms McLoone has said, there is a joint protocol and that has been reviewed and so on. The idea is that it was to cover and address those issues so there would not be gaps at a local level. If there are particular issues, I certainly have no difficulty in looking at that and coming back specifically on that.
Colm Burke (Cork North-Central, Fine Gael)
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If something is identified as an issue, is that relayed back to the appropriate people?
Colm Burke (Cork North-Central, Fine Gael)
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Has it been reviewed at any stage?
Colm Burke (Cork North-Central, Fine Gael)
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I am talking about recently. We are talking about far bigger numbers now and, in particular, because Tusla has to review 40,000 files.
Colm Burke (Cork North-Central, Fine Gael)
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It is something that really should be looked at.
Maurice Quinlivan (Limerick City, Sinn Fein)
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I am going to move on to Deputy Aird and he will be the final person to speak. Will people indicate whether they want to come in for a second round? Do the witnesses want to continue or take the break we suggested we would have? They are okay to continue on.
William Aird (Laois, Fine Gael)
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The best wine is kept until last, and I am the last speaker. I am delighted to get this opportunity and to see so many people represented here today. How does the Department ensure people with disabilities in rural counties like County Laois have equal primary care access?
Mr. Niall Redmond:
In terms of deployment, if we look at the programmatic approach we are introducing, some of which the Deputy may have missed earlier, we are targeting the removal of 60,000 people from the waiting list waiting over 52 weeks to bring it back down to 39 weeks. That is targeted equitably across the country. That is a short, sharp intervention over the course of this year to bring our waiting lists right down. The second phase of that, which is critical, is to sustain and maintain part of that. That means putting in permanent posts equitably across the country in terms of where the needs are. The regional executive officer will have the opportunity to deploy those in relation to where the most need is. That is 200 additional posts going in this year across the country.
William Aird (Laois, Fine Gael)
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Is it the size of the waiting list per county that will judge what time the delivery will happen in a county like County Laois?
William Aird (Laois, Fine Gael)
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Which disability services policies are fully implemented and where are the main gaps or delays?
Mr. Niall Redmond:
Regarding disability policies, the most recent one and the one that is very active and live is the new national disability strategy. That is new and rolling out now from the Department of Health and the HSE around health services pillar 4 of that strategy, which is a significant body of work in implementation. That is starting now. One of the flagship implementations is the programmatic approach to the primary care therapies waiting lists. We have spoken about that in terms of some of the initial successes of that already with 14,000 coming off the waiting list over the last number of months in support of that. That is going to be our focus and concentration over the course of this year and into next year.
William Aird (Laois, Fine Gael)
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Being involved in this, is Mr. Redmond happy enough this will reduce the waiting times for people that I, and everybody else here, is being inundated about day in and day out?
Mr. Niall Redmond:
Absolutely, that is the absolute target. We have put a programmatic approach around the joint approach between ourselves and the HSE. We have put a lot of effort into modelling how we can do this and coming forward with realistic targets about what is achievable. There was discussion earlier on about the 39 weeks target. Would we like to be better? Absolutely we would, but we must be honest and realistic about what is achievable. We have set a target we believe is achievable and we believe we will get those 60,000 people off the list this year and put in place the sustain and maintain programme.
William Aird (Laois, Fine Gael)
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How are the service quality and outcomes for people with disabilities measured and enforced?
Mr. Pat Healy:
With all the services we have, including therapy services, it is about the standards that are set. At a clinical level and at a management level we are monitoring those standards. There are regulatory systems like HIQA and the Mental Health Commission and so on that contribute. From a professional point of view, there are professional standards which are set and that is part of what is done. With the like of the HSE from a management point of view, our whole performance and oversight process is about maintaining-----
William Aird (Laois, Fine Gael)
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With everyone who comes into me, and it is the same for others, I can get nobody to praise the situation we are in at the moment. People describe it to me as being like pushing water up a hill. I hope with what we have been told today, we will be able to come back in six months or whenever the Cathaoirleach convenes a meeting like this, which I congratulate him for-----
Ms Geraldine Crowley:
It is important to note when we talk about 39 weeks as an overall target, we are very much looking at it at a network and integrated healthcare area level and there are some areas that require a lot more input to get to the 39 weeks target. Some of the committee members' areas would be in that space.
William Aird (Laois, Fine Gael)
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Will you extra resources in there?
Ms Geraldine Crowley:
That is very much the programmatic approach we are taking. It is not that one solution fits all. There are different challenges in locations. Some just cannot attract the right profile of staff to take up roles. For others, the needs of the populations are different because it is all population based. We are very much tailoring the response to the people waiting and the requirements they have.
Liam Quaide (Cork East, Social Democrats)
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I want to ask a question about morale among clinicians in primary care services. When I first qualified as a psychologist I worked in adult mental health services. At that point in 2013, primary care was seen by many of my colleagues as an appealing place to work. It is difficult for many clinicians to withstand the challenges of working for years in secondary and tertiary mental health services and the lower intensity, short-term work of primary care can feel more manageable. However, recruitment was not really happening to any significant degree during those years and now, because primary care is so hollowed out as a result of chronic under-resourcing and recruitment restrictions, it is increasingly difficult to attract people into those services.
There is kind of a feedback loop which is actually creating a rationale, which I am very concerned about, for private outsourcing for services. I think that avenue is disastrous. Because clinicians are facing into impossible waiting lists and the demoralising task of having to tell parents it may be many months or even years before they can offer an appointment, it is very difficult to maintain morale in these services. Have the witnesses any plans to engage with primary care staff on how they are coping with waiting lists that are out of control?
Mr. Pat Healy:
We engage with them continually. There are a couple of things to say on that. There are challenges but there are also fantastic opportunities. My experience, and that of the team, I think, of rolling out enhanced community care has been fantastic. The buy-in and commitment there is huge. The core thing about that is teamworking and a different model of working together. There is the idea of the community healthcare networks and now the community healthcare areas bringing it up a level again. There is the work we did with general practice. With the therapies, we developed on the adult side specialist teams for older people with chronic disease.
Liam Quaide (Cork East, Social Democrats)
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I was talking about morale in services that are in crisis. Does the HSE have any plan to systematically engage with staff on that?
Ms Mellany McLoone:
We do. The HSE does a national staff survey, which is broken down to the level of integrated healthcare areas, IHAs, and local sites. It is also important to say that all of the community healthcare network managers engage with their own staff in that regard. In fairness to our colleagues in health and well-being, they have done a phenomenal amount of work to support staff. Some of our staff run meditation sessions, yoga sessions and so on. They do this in their own time. We just facilitate premises. The other really important thing to mention is that we also have employee assistance programmes, which are there to support staff.
Liam Quaide (Cork East, Social Democrats)
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They are all very general supports for HSE staff. I am thinking about something specific given the-----
Liam Quaide (Cork East, Social Democrats)
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I am sorry; I want to go onto another point because I have very little time. The single point of access is a good initiative but the reason there is such a need for it is chronic under-resourcing. When services are under such pressure, they tend to pull down the shutters. That is understandable. As a result, children get moved from one list to another. The single point of access will not paper over the cracks caused by chronic under-resourcing. Without proper staffing of services, it will just be a single point of access to an abyss of endless waiting. When Mr. Healy talks about primary care waiting lists going up, it almost sounds like this is happening without a cause or it is just because of increased demand. Does he accept that it is mainly caused by underinvestment over the years and recruitment restrictions?
Liam Quaide (Cork East, Social Democrats)
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I am not saying that it is the only cause but it is the main cause.
Mr. Pat Healy:
I do not think it is. If you look at the evidence, over the period from 2020 to 2023 - I framed it that way specifically because that is when we rolled out enhanced community care, ECC - 2,800 posts were put in. From 2023 to now, the period covered by the pay and numbers strategy, 900-odd staff were employed. The numbers are going up.
Liam Quaide (Cork East, Social Democrats)
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I know of many services that are in crisis. Mr. Healy is talking in very broad terms. I know of many services in crisis where-----
Liam Quaide (Cork East, Social Democrats)
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May I just finish? In these services, recruitment has essentially stalled despite waiting lists ballooning out of control.
Liam Quaide (Cork East, Social Democrats)
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I know that it is more than just the staffing but it is mainly that.
Gillian Toole (Meath East, Independent)
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If I may, I will ask Ms McLoone about respite, particularly alternative respite, and her point about asking parents or children what they want. I will jump the gun and give her some feedback on that from Meath East. In relation to the family forums convened by children's disability network teams, CDNTs, there is a balance to be struck. Therapists are convening the forums but low attendances are resulting in forums being cancelled. That has been happening with my local CDNT. Parental feedback indicates that evening meetings are preferred, possibly with an occupational therapist, speech and language therapist or someone from psychological services being present. A dietitian would also be welcomed. Each would have 20 minutes but it would go on for no more than an hour. I have spoken with friends and family around the country and there seems to be common ground on this. Meetings should last an hour or an hour and half. The parents themselves are interacting. I have done it a couple of times. I have paid for it and was happy to do it. It is working in south Meath.
Alternative respite should be considered. Again, there is feedback from parents regarding integrated, complementary or alternative respite - whatever term we use. There is very strong evidence in favour of art, drama, equine, music and play therapy. There is even a master's degree in music therapy offered by the University of Limerick. These are things that children and parents would like. How can we match the demand for these interventions, the benefits of which are known, in the next three to six months with a small purse of money? Can it be organised through the National Treatment Purchase Fund? I know I am putting Ms McLoone on the spot. We will exchange email addresses afterwards. That is some feedback from my area. Can that be done? Is there something we can do on a pilot basis? It links in with section 38 organisations. I will mention Stewarts Care. Under the former Minister of State, Senator Rabbitte, huge progress was made on resourcing Stewarts Care.
I would like to ask about planning for emergency and out-of-hours respite in the event of - God forbid - bereavement or force majeure. I know of three recent cases of bereavement in my own area where there was no plan. If there are no such plans generally, what is being done or what will be done? What is the timeline?
Ms Mellany McLoone:
In relation to alternative respite, we can absolutely look at the options that are available. Earlier on, one of the Deputy's colleagues made the point that we have to ensure appropriate clinical governance in respect of alternative therapies. We want to avoid a situation whereby people are getting a service that is not what they thought it would be. There is a bit of work to be done in relation to that. With regard to one of the services in my area, equine therapy has been developed and this has become an option for parents. We are very happy to look at that on a case-by-case basis.
In relation to emergency and out-of-hours respite, I am not sure I understand the question correctly. Unfortunately, we have emergencies from time to time where children are unable to come home for whatever reason. We deal with these on a case-by-case basis. We do not have a facility that is left idle in case something happens. Respite services are very short so we have a strong focus on maximising the occupancy of those services.
Martin Daly (Roscommon-Galway, Fianna Fail)
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On accessibility, one of the issues I hear about from the parents of children who are seeking services is that the environment is sometimes not very appropriate, especially for children with neurodiverse disorders. Is the HSE satisfied that there is enough focus on having appropriate facilities, such as quiet rooms and so on, for children who are waiting? Are waiting rooms designed appropriately? Are appointments made in such a way that children are not left waiting? That is another thing.
Ms Mellany McLoone:
Ironically enough, a really good piece of work was done in Deputy Toole's area with specific regard to creating spaces that are friendly for children, including neurodiverse children. This was done in consultation with our colleagues in the capital and estates unit. That programme of work is now going to be rolled out with a particularly strong focus on our primary care centres. Senator Rabbitte has been in a number of our facilities. It is safe to say that our children's disability services are very neurodiversity-friendly. They are specifically created for that purpose. They have quiet rooms and specific sensory rooms. The intention is that all of our primary centres will have a similar kind of room or facility available. Our colleagues in capital and estates are certainly looking to make rooms like that available in all new buildings as we develop new facilities. There will be a programme of work to do that. I need to be really clear that it will only be for bigger centres. There will not be one for everybody in the audience.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I understand that.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Last Friday week, I met six families who had children with additional special needs and complex medical needs. Bringing a child like that who is in distress into a bustling emergency room can be distressing for people who do not live with those conditions. It is something we need to look at.
With regard to barriers, we have seen adults falling between stools in mental health services. They have been in an adult mental health service but were dropped after not taking up a couple of appointments. I really mean "dropped". One person I have spoken to was in a service for nine years. He lives with autism and has an intellectual disability. He was dropped and told he was not suitable for the service any more. He was suitable for nine years but is not suitable any more. He is still waiting to be seen by a psychiatrist specialising in intellectual disability. He also suffers from generalised anxiety disorder.
His mother cannot leave her house. In making sure that we take full cognition of the difficulties that parents face in managing the 24-7 nature of parenting children with additional special needs, do the witnesses think the system is receptive enough to them and flexible enough for them and their children?
Mr. Pat Healy:
It is far more flexible and so on than it was. One of the points in my opening statement was the need to improve access and responsiveness. Those are key, and the CEO of our organisations pushes for them. Going back to my own time as a director of disability, you would have very significant cases. A school might send a child home to mother and there was no one there. The school could not look after the child and sent him or her home. One of the issues for us as a service, and the whole point of the single door and no wrong door approach, is that we may not have the perfect response but we have a response. There is an absolute onus on us to make a response, and the most effective response we can, within what we have available today.
Anne Rabbitte (Fianna Fail)
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I will focus differently this time. I will focus questions on policy and will bring in the representatives of the Department on primary care. Ms Ryan Witherto said that there is a need to wait for Garda vetting. At the same time, children are training to be occupational therapists, physiotherapists and speech and language therapists. They go out from universities and directly into healthcare providers. They are going there with their Garda vetting secured through their colleges. Why do they need to do Garda vetting twice? The witnesses do not need to answer straight away. That is my first question. They should not need to do it twice. We should cut that down. From a policy point of view, I would love to hear, perhaps from Ms McArdle, whether that would be an option.
The HSE does not currently recruit behavioural therapists, yet behavioural therapists are trained in colleges. From a policy point of view, is there a recommendation coming from the Department to see the value and understand why our sections 38 and 39 organisations recruit such therapists? Is there a pathway to support or fund the HSE to recruit behavioural therapists?
An awful lot of worried parents come through the front doors of primary care centres. They are worried if at 18 months, their daughter has not said her As or Bs, or her first words. I wonder from a policy development point of view about technology development, particularly with regard to speech and language, for worried parents. Is there an initiative going on in the Department for primary care from a policy development point of view? The HSE cannot do it unless the policy has been established and funding for piloting has been provided.
I will blend in with what Deputy Toole said about equine therapy. She is absolutely correct. Equine is an alternative therapy whereby you can have one occupational therapist and six horses. The child is still getting the same output from one occupational therapist but with six horses. There are good ideas and operations at Liskennett Equine Assisted Activity Centre. Some 6,500 children are supported per year. I do not think they were tracked previously but they are now. There has been expansion into Kanturk. We see Stewarts Care. I say to Mr. Healy that we have a gap in the west where Toghermore House was. We need to consider alternatives. I am sure that both co-Chairpersons agree there are gaps in their areas.
I will not go into risk management, other than to say that I have a worry about risk at the entry point. There is a fair question about risk at the entry point from the referral. That risk and how it is managed is a cause of worry.
We have a problem with GPs on the western seaboard. I have no doubt there are problems in Cork. We expect some of our GPs to work one weekend in four. From the point of view of referrals and supporting our rural GPs, that is a concern if we want to get our primary care entry points correct. The last thing we want is people attending emergency departments because we do not deal with things well that way. I would like to hear the witnesses' feedback.
Ms McLoone or Ms Crowley said that attracting talent, sometimes in different geographical areas, can be a challenge.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Senator, do you want to get an answer?
Ms Rachel Kenna:
I appreciate that the Senator's question about the Garda vetting system is valid in the context of bureaucracy and getting people into the system. The one differentiation I would make is that when students are in their training capacity, they are heavily supervised when out in practice. That obviously changes when they qualify so there is a legitimate requirement to recheck and test against that. However, I take the Senator's point and we will consider it as we go forward.
There is no limit from a policy perspective on the employment of behavioural therapists. The HSE can set its employment criteria. In fairness to the HSE, we will work with it to develop those. No more than in the case of the athletic therapists to whom we referred earlier, it is about finding the right and appropriate position and place to deliver the service that is needed. The service need must be identified by the HSE. From a policy perspective, we know we have a flexible approach and we will support the HSE in developing that.
Ms Geraldine Crowley:
I might take the question about technology. I welcome the Senator's comments on that issue. We are exploring many options, particularly in speech and language therapy. We will need the support of our colleagues, who are fully on board, around that. It is about having a service in place much earlier post referral, and having the right service. It is about helping people. Everyone is using technology all the time now. It is about doing that. There is space for that, especially in speech and language.
Ms Philippa Ryan Withero:
The Senator is right that we have to look at a range of roles and not just the ones that we have but other roles into the future. We must consider how to expand our workforce. I note that in conjunction with the Department of Health, we are looking to expand the roles we have in the HSE and behavioural therapist roles are among those we are identifying at the moment.
Ms Rachel Kenna:
The Senator knows that virtual and digitally enabled care are priorities for the Department of Health. That Department has joined forces with the Department of children to work on the workforce optimisation and digital assistive technologies expo, which will happen in 2027. The whole focus of that expo is on access to digital care and virtually enabled care.
Maurice Quinlivan (Limerick City, Sinn Fein)
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We will now move to Deputy Ó Murchú. He is not getting an extra two minutes.
Ruairí Ó Murchú (Louth, Sinn Fein)
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The co-Chair shows a lack of flexibility. I recall Mr. Bernard Gloster saying when speaking specifically about CDNTs that the parents who had better experiences were those who had direct communication. That bit is still missing. We keep using the same terminology, and it was used earlier. It is about ensuring there is a single point of access and no wrong door. We must have absolutely clear communication. Parents do not care where they get the service once they do.
We also want occupational and speech and language therapies, which are necessities. I am talking specifically about kids with autism and other comorbidities. The assistance needed most in the beginning, if there is language delay and whatever else, is to deal with meltdowns. A strategy is required across the board and guidelines within schools and all the rest of it. We know where it works and where it does not. We know that staff can change in one setting. If we were starting again, we would not start with CDNTs and primary care and whatever else.
My fear relates to recruitment. We are trying now to recruit for primary care, CDNTs and in-school therapies at the same time. I am afraid. At some level, we need to see - and I overuse this term - how to get the best bang for our buck from the service we have. I agree with what Senator Rabbitte said. Assistive technology can make a difference fast. Perhaps the witnesses could talk to that point. Perhaps they want to tell me in the next two minutes about the perfect system that could be implemented and how we can get rid of primary care and CDNTs.
Mr. Pat Healy:
We talk about lists and all the rest of it, but one of the biggest changes was when we developed the idea of the community healthcare network and teams working at the level of 50,000 of population. That is where things happen, and where you are connected to a locality.
With community healthcare organisations and the ECC programme, the key was developing a model whereby people work in teams. We have got to a stage where the GPs are working very well, there is primary care, there are the CDNTs and so on. We now have to get all those working across the same patch together as a team.
Ruairí Ó Murchú (Louth, Sinn Fein)
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I have heard people say that the RHAs will be a means of doing that, that they will-----
Ms Mellany McLoone:
I am. It is important to say that the community healthcare networks and the children's disability network teams are completely aligned geographically. I think there might be only one small outlier. On a practical, day-to-day basis, if you go out, you will see that is what is happening. A huge amount of work has been done on developing relationships, talking about individual cases and saying, "I can do this."
The other really important point to make in that regard is that it is not just about the HSE; it also includes all our voluntary providers. Particularly within disabilities, a huge amount of work is being done with voluntary groups and community groups on driving that integration. One of the key milestones for success as we move along this will be that it will be an entire public health and social care system response to the needs of the population, of the network. It will not work if it is about only the HSE. It needs to be everybody, and that includes the likes of Pieta House and Jigsaw. As regards the next step of development involved, going to Deputy Burke's point earlier, a huge amount of work is being done with Tusla, particularly for people who have specific disability needs. Conversations are happening much earlier. There are also our LCDCs under the local authorities. A huge amount of work is being done.
Ruairí Ó Murchú (Louth, Sinn Fein)
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I get all that, but at the moment I am not sure the structure is perfect in dealing with the need out there. Even if we get to 200 or 500 or-----
Mr. Pat Healy:
Of course it is not perfect, but it is a matter of starting it. In ECC, for example, there were GPs and CHNs. We now have specialist teams for older people with chronic disease. We now have consultants, cardiologists, virtual calls with GPs and local teams talking about individual cases. That is in a particular service. There is no reason, at some point further down the road, we will not have the same type of thing here. They are specialist services but they can be connected up. Digitally, you get into virtual calls but you have to build confidence first in the system, in people and in parents that this will actually work. It is a step change and it will take a bit of time, but we are starting some of that already and we will build the confidence.
The other point - Ms Crowley made it to me earlier - is that when we went out on the proof of concept, one of the things the therapists said was that if we get to a stage where we reduce the waiting list to a more manageable figure, it improves all that stuff. It improves morale and engagement. I think people will see over the next 12, 18, 24 months that we are moving in that direction and will see that start to build as we go.
Ruairí Ó Murchú (Louth, Sinn Fein)
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It is a matter of dealing with that initial meltdown and providing parents with what they need such that at least we can get to a scenario where they are open.
Ms Geraldine Crowley:
It is about building confidence. We now have consultant geriatricians who are doing consults in nursing homes virtually with patients, which was unheard of ten or five years ago. They are not doing them everywhere, but you have to start somewhere. In changing anything, we must deliver services all the time. We must hold the services we have to deliver but we must also change at the same time. People have concerns and are afraid they will lose what they have, but the intent is that people will get more services and much quicker access.
Maurice Quinlivan (Limerick City, Sinn Fein)
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Thank you. We have just run out of time. I thank everybody who contributed today. I think all the members will agree it was a very useful discussion. I propose that we publish all the opening statements to the committee's website. Is that agreed? Agreed. On behalf of the committee, I thank all the officials from the Department of Health and the HSE for attending and providing the various briefing materials in advance of the meeting, which is always very useful for committee members in our deliberations. The insights and expertise provided today are critical in terms of our knowledge and in shaping and trying to understand what course policy development should take on primary care for persons with disabilities. Once again, thank you very much.
Colm Burke (Cork North-Central, Fine Gael)
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On behalf of the health committee, I am grateful for the contributions made and all the work people are doing right across the board, whether it is in the Department of Health, the HSE or, as I mentioned earlier, Tusla. I thank all the members for their contributions and thank you, Chair, for the way you have managed this meeting, despite the fact that you doubled the numbers to deal with.
Maurice Quinlivan (Limerick City, Sinn Fein)
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I apologise. I should have mentioned Deputy Burke stepping in at the last minute because the Chairperson of the health committee was not able to attend at short notice. Joint meetings are very difficult to do sometimes. Thankfully, this one worked really well, so thanks to everybody for that.