Seán Sherlock (Cork East, Labour) | Oireachtas source

I welcome the motion, which we will absolutely support. I note that the Government is not going to oppose it. If I may, I will quote directly from my copy of the Minister of State's speech. When talking about making the services more effective and the CDNTs, he referred to what the Minister of State, Deputy Rabbitte, has said, which is that:

...the HSE’s messaging around this has not been clear and it has been perceived as shifting more responsibility on to parents. While all families are willing to do their very best for their children, parents or guardians are not therapists. The family-centred approach must be underpinned, supported and facilitated by specialist therapy personnel. Nobody is trying to remove clinical supports from children. We need to bolster them, not reduce them. The family-centred model is a complementary approach to providing therapeutic supports, rather than an alternative approach, which has been suggested in some quarters.

I am glad that the Minister has at least clarified that, but it leaves a question over the constitution of the children's disability network teams. I note the presence of the senior Minister and I am glad to have the opportunity to address him directly. Where the teams have been created, there is acknowledgement that this is not a perfect model. Some work is ongoing internally on how those teams will be rolled out.

I can understand a proposal to bring families into the therapeutic process. However, the evidence shows that there is still a massive waiting list not only for assessment of needs but also for psychological services. I am not talking about CAMHS; I make a distinction between access to child and adult mental health services. There are 9,554 children waiting for psychological services at the moment; 14,619 waiting for occupational therapy; 8,666 waiting for physiotherapy; 33,106 waiting for some form of speech and language intervention or assessment; 5,590 waiting for access to dietetics sister; 16,838 waiting for ophthalmology services; and 8,457 waiting for audiology services.

I do not want to become excessively rhetorical about this because we are talking about children here. I am trying to understand how the CDNTs will evolve. The challenges therein have been well articulated. Parents and public representatives have pushed back on the HSE on that issue. The Government or the HSE did not buttress those teams with the resources to allow for the follow-on services such as I have mentioned. It is not just about the AON. The assessment is a vital element to get the child in the door but they then need the follow-on services. I have been around these Houses for a reasonably long period. I am confused over how the supply of professionals who will deliver these services will match the demand. I still cannot see how the Government will do that. We have not seen an articulation of that yet through what are supposed to be the children disability network teams.

I take the Minister of State, Deputy Rabbitte, in good faith, as we all do. We all welcomed when she pushed back on the HSE in the recent past in respect of the CDNTs. However, once a child gets through the AON, how do the follow-up services such as psychology, occupational therapy, physiotherapy and all have the other services wrap themselves around the same child with that need? That is the missing piece of the jigsaw.

I could give the Minister chapter and verse about the HSE's apparent lack of internalisation as an institution culturally of its need to be transparent about how it spends resources. The HSE does not seem to have internalised that obligation it has. We saw evidence of that at the Committee of Public Accounts in recent weeks where the Comptroller and Auditor General highlighted the lack of transparency - my words - in respect of how budget lines are spent right down to provision of the services we are discussing. I do not want to make political hay out of this issue. All I want is for the children in my constituency who require the services to be able to get the services, as we all want in all our constituencies. Somebody needs to come up with a plan to bridge that gap without trotting out the same lines, day in day out about recruitment issues.

For people living in the Leas-Cheann Comhairle's region, CHO 2 covering Galway, Mayo and Roscommon, only two children are waiting more than two months or three months. However, in my area, CHO 4, covering County Kerry, Cork north, Cork north Lee, Cork south Lee and Cork west, it is 500 children. I am sure the Minister is aware of this. In some places, the system can be made to work to deploy the resources across geographical locations and county boundaries if needs be or across the CHO areas so that they follow the child where there is spare capacity in one part of the system. That is what the Sinn Féin motion calls for; that is what we have all been calling for, including Fianna Fáil Deputies. If that can be made to work, that would be a good day's work.

I do not doubt the bona fides of the Minister of State, Deputy Rabbitte, in seeking to push the HSE along. Having been in government, I know what it is like to sit at that side of the table and I know what it is like to be held accountable for my actions. The same applies to us all if we are line Ministers. Sinn Féin Members will also be accountable when they are in government. I look forward to that time. We all are accountable ultimately as the makers of policy. We cannot keep hiving it off to the HSE. At some point there must be political accountability for these decisions as they affect our fellow citizens and children.

I ask the Minister for Health to redouble his efforts to bridge the gap so that we as a nation do not have 16,838 children waiting for follow on ophthalmology services and 14,619 waiting for occupational therapy. All of these figures come from the HSE's replies to parliamentary questions. In fairness to the HSE, it is extremely good at answering parliamentary questions. It will provide chapter and verse, line by line of all the details. The additional layer that I would see being put on top of that and I think we will all start asking these questions fairly quickly is: where is the expenditure to match the needs? Ultimately, that is what this motion is about.

I support the motion and I am glad it has been brought before us. Collectively, we have all been talking about this issue. I would like to take the heat out of it and let in some light if we can. I know the Minister will want to achieve much along with his ministerial colleagues to address these issues because the law now demands it. There is a corpus of law and the High Court has adjudicated on it. I am glad to see the shift in respect of what was an extremely flawed model relating to the CDNTs. How will the Minister underpin and buttress those teams across the country so that we can have that kind of complementarity between families and therapists to deliver for the child?

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