Alan Kelly (Tipperary, Labour) | Oireachtas source

Three clear components are required for progressing children's disability services, namely, assessment, early intervention and school placement. I will make my comments on these basics, which are considered the norm throughout Europe.

Since 2016, the HSE has been continually promising the roll-out of progressive disability services for children and young people. Obviously, this has not happened. Its goal is to ensure no family will be left without services. It aims to create effective teams working in partnership with parents and education providers to support children in achieving their outcomes. That is what it is all about. This is why I am so glad we are speaking about this today.

The HSE service plans for the years 2016 to 2019, inclusive, state - and, I presume the service plan for 2020 will do so - that the work to reconfigure children's disability services into geographically based children's disability network teams is under way. Every year it is stated that it is under way. I have been in politics for 13 or 14 years and we judge things on our clinics and what issues are becoming bigger. I have never seen as big a crisis in services provision for children who need them as I do now. When I first started in politics there were issues in this area but now my clinics are flooded with them. The Minister of State knows my area very well. During the course of the debate he has received many invitations to visit places and Deputy Crowe invited him to visit his area. The Minister of State knows my area very well because he spends a lot of time down there. I have never seen such a high number of families in distress.

I have never seen so many families in the mid-west and south east, including Tipperary, who cannot get access to services, diagnoses, some form of intervention or school places. It is chronic and disgraceful. I am working with families week in, week out to try to put a pathway in place for them. I am holding their hands while trying to give them some hope. Recently, we started the process of giving families in Nenagh some hope by turning it into an autism-friendly town on the basis of what was done in Clonakilty and by bringing everyone together. Many people turned up and we have a functioning committee. We are going to do it, but the people involved are the same as those who are coming to me with their problems. The situation is disgraceful.

The HSE is consistently failing to conduct the assessments of thousands of children on time. If someone has money, he or she can have an assessment done. That is the bottom line. It creates complications down the line for hard-working families who get their own assessments done, though, given that they must then jump into the public system where some of their assessments are not accepted. Assessments now have to be accredited. I understand that process, but trying to explain it to the families can be difficult.

Children now face the dual hurdles of long waiting lists for initial assessments, which are the gateway to most State-funded therapy, and long queues for overstretched services. In August 2019, 7,615 under 18 year olds were waiting a year or more for an assessment. We have all seen the increases in speech and language therapy waiting lists this year, with 3,118 waiting for more than 12 months or so. Where I come from falls in the mid-west, in that north Tipperary is put with Limerick and Clare. Unfortunately, we suffer from that at times. When there is a lack of personnel, north Tipperary seems to suffer. According to the Government's own statistics, one of the worst areas in the whole country is south Tipperary, which is in the south east.

Basic assessments are not taking place and many children must wait more than two or three years. The knock-on effects on their education are obvious. I heard of one case where a nine year old from Tallaght was assessed as having high-functioning autism but whose parents were subsequently told that they would have to wait 44 months for an appointment. The nine year old would be in secondary school by then. That is the Ireland of 2019. How could any country stand over this? It is a disgrace of the highest degree. There is a ticking time bomb. We have failed in our duty to these children. It would not surprise me if, in the years to come, there are class actions of some kind against the State because of this failure of duty. Please bear that in mind.

One of my pet hates is the problem of school placements. I know a range of schools that provide places for children with autism. The special education needs organisers are left to their own devices and get very little support. They come to my office and say that they have rung every nearby school that provides services, including Kilruane, Puckane, which the Minister of State knows well, and Boher. All of these schools provide fantastic services. Some have been doing so for a very long time. After every school has been rung, the parents find out that they will not get a place. They will not even get a place the next year, although they might the year after that. This is not acceptable. I have raised this matter with the Department of Education and Skills.

There needs to be an holistic approach, as there are whole towns that do not have service provision, school placements and the capacity for these children. The Minister of State has taken direct action in respect of an area of Dublin and somewhere else. Service provision needs to be mapped so that there is timely educational service provision for all of these children. Why should they be discriminated against and not provided with educational opportunities and, unlike everyone else, have to wait?

I wish to discuss the geographical inequalities that I believe exist in the provision of services by the HSE. There is a postcode lottery. I urge that a mapping exercise in respect of service provision be carried out. If someone is in a certain district, he or she can potentially get a decent service. If that person is in other areas, though, he or she cannot. It depends on which division one is in and where there are staff shortages. This is not the way a service should work. There must be a relationship between divisions. We will have to map out the areas. I know them, given that both sides of my county, south and north, are up there in terms of having the greatest issues. If there is one thing I urge the Minister of State to do, it is to examine service provision and waiting lists geographically. Heat map and colour code them, then intervene directly. That is my only request of the Minister of State. It is a reasonable one. If the Government did that, I would come along the road with it and compliment it on finally doing something very productive.

There are major issues with the recruitment and retention of specialists in speech and language therapy, psychiatry and so on. We understand that, but there must be a staff retention strategy. I have raised this matter with the Minister numerous times. When someone leaves a post in any CHO area, the duration of that vacuum is colossal. This impacts on children's lives far beyond what should be the case. It happens because someone is retiring or, as is usual, leaving the country or changing jobs and moving into the private sector. We must have strategies in place to deal with that.

I ask that we adopt a strategy whereby the money follows the children, access to services is equal for all, and service provision and large waiting lists are heat mapped. On top of that, I ask that the Minister of State work with the Department of Education and Skills in an holistic way to ensure educational provision for these children so that they are not left in limbo, which they are being across the country and definitely in Tipperary where there is no such service provision. There needs to be joined-up thinking between the Departments of Health and Education and Skills on this matter.

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