Pauline Tully (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I thank all the Deputies who contributed to this discussion of disability services and the Minister and Minister of State for remaining here for the two hours. That is appreciated. It is evident from the contributions that disability services are at an all-time low and there is need for immediate action to address the problems within the services and unmet need as outlined in the disability capacity review published last year. I again call for this disability capacity review action plan to be published without delay. We were told in here in July that it was within weeks of being published. It is now mid-October and we are more or less being told the same thing so it really needs to be published without delay.

Many contributors referred to children's disability services. I will address a few issues here. The problems identified within disability services involve the recruitment and retention of staff. The reason staff are leaving disability services are varied but some of them could and should be addressed without delay. The new Progressing Disability Services for Children and Young People does not seem to have a dedicated clinical lead. As far as I can see, it was established without proper planning or foresight and is basically rudderless. It needs leadership.

There needs to be pay parity for section 39 organisations. These organisations are haemorrhaging staff to the HSE because they are expected to deliver the same services for less money and that is not fair. The recruitment process is still very cumbersome, which has not been addressed. If any of these issues have been dealt with, I will welcome it but I believe the HSE has implemented the interim recommendations of the career pathway review in primary care only. Why has this not been extended to the CDNTs? Why are there no incentives to work in CDNTs - something similar to those offered to nurses working ICU?

I am led to believe that some teams do not have the adequate physical, clinical or office space they need; do not have access to some of the materials they require; and that access to HSE resources is limited to HSE employees and is not provided to section 39 organisations. If that is not true, that is great but that is what I am being told by some of the organisations. I also know administrative support is minimal or non-existent in some of the teams. That is something that could easily be addressed.

Health Services for Children in Ireland: A Guide to Workforce Planning set out the ratio of minimum staffing requirements for the different grades for CDNTs. The HSE is advising that this document is no longer applicable to the Progressing Disability Services for Children and Young People service. I do not know if this is true or not but it has not produced any replacement policy or methodology to determine how the CDNTs need to be staffed. There are also concerns about gaps emerging in the provision of clinical supervision that could lead to risks within the services.

Following the High Court decision in March 2022 regarding preliminary team assessments, I believe there was engagement around the development of a new standard operating procedure and that guidance was developed. I am not sure if that guidance has been delivered. I am led to believe that the process has been in limbo since March.

The Minister of State spoke about therapists going back into special school settings and that there was an issue with Fórsa in that regard. I am led to believe that the issue is that the therapists going back into the special school settings are being taken from the CDNTs. The Minister of State can clarify if this is the case. These teams are already savaged and under-resourced. They cannot afford to lose therapists. We need them in our special schools but we also need them in our disability network teams.

Regarding adult services, much more consideration needs to be given to personal budgets to give people more choice over decisions regarding their lives and to allow them to employ personal assistants or to meet more care needs. A number of speakers have mentioned ratifying the optional protocol. It is bad enough that it took us 11 years to ratify it after signing it but both should have been ratified together, which has not happened.

I commend DPOs and the many parents' groups, which are doing immense work in trying to get services for themselves and their children. They are constantly fighting a battle that they should not have to fight. I again thank all my colleagues for supporting the motion.

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