Liam Quaide (Cork East, Social Democrats)

I pay tribute to Cara Darmody and her dad, Mark. I acknowledge the leadership Cara has shown in bringing us all here this evening with this collective motion.

Clinical services and educational supports for children with additional needs and disabilities are in a dire state, directly resulting from years of poor planning and under-resourcing. All of this did not come about by chance. These are the results of poor political decision-making over many years. They can be resolved by more progressive political decision-making.

The chronic neglect of disability services in special education by successive Governments has left families at the mercy of a disjointed patchwork of a support system for their children. The Disability Act 2005 provided children with a legal right to an assessment of need within six months of being applied for. In reality, more than 90% of assessments of need are completed outside the legally agreed timeline.

A response to a parliamentary question of mine in March showed that the HSE spent €7.9 million between April 2021 and February 2025 defending legal cases against families trying to access an assessment of need. This legal cost equates to 180 years' worth of salary for a newly qualified occupational therapist. For much of that almost-four-year period, the HSE was implementing a recruitment embargo or similar recruitment restrictions, thereby stymieing its own capacity to carry out assessments of need, not to mention much essential clinical work after an assessment is completed. This is a tragic farce among so many other political failings that are having an enormous impact on the lives of children with disabilities.

After completing an assessment of need, families often face a further abyss of prolonged waiting to access therapies and are forced to seek these privately, if they can afford to. What we therefore need is wholesale investment across services. The purpose of an assessment of need is, after all, to access intervention. Children with mild to moderate developmental issues or disabilities may be referred to primary care services, while children with more complex difficulties come under the remit of children's disability network teams. We see the consequences of the failure to plan most dramatically in the south-west regional health area, Cork-Kerry, where the waiting list for primary care psychology services exceeded 6,000 earlier this year. That was after my colleague Holly Cairns highlighted last year that there were 5,000 children on the list. However, we did not see the recruitment drive that was necessary to address this in the meantime.

In January, one Cork East constituent was given an estimated waiting time of five years and nine months for primary care psychology for her son, who had recently received a diagnosis of autism following an assessment of need. The family has since been told – in recent weeks – that following a file review in primary care, their son should now actually be seen by the CDNT. This will involve being diverted onto another set of waiting lists for therapies, which may not materialise for years or may never materialise. Therefore, the initial service statement of the HSE from January has been overturned by other HSE professionals and the boy has not been seen by any of the services yet. This is an example of what is called “defensive practice” among clinicians, whereby services that are overstretched bat referrals back in an attempt to sustain a manageable waiting list. For families impacted by these decisions, it is an extremely frustrating experience to be passed from one service to the next. In that context, it is easy to see how families lose faith in the HSE and feel private clinicians are their only option. How many families can afford to even consider a private clinician?

The HSE cites "recruitment difficulties" as the main source of the crisis in primary care, and in Cork–Kerry it has even created a new layer of management to address this. It fails to mention in its briefings and parliamentary question responses that the main difficulty has been its own failure to pursue recruitment for necessary posts over many years and over-reliance on unqualified assistant psychologists. All of this results from Government policy, including the pay and numbers strategy.

Behind all these waiting lists are families languishing through what feels for them like one purgatory after another, waiting and waiting for an assessment before then being on further waiting lists for support, with no end in sight. The main ongoing roadblock to staffing primary care services is the Government's pay and numbers strategy, which in some cases is proving to be almost as restrictive as the official recruitment embargo that preceded it. It has been roundly criticised by all the main unions as putting a stranglehold on service development. The HSE is increasingly referring assessments of need to private clinicians at an average cost of €3,300 per assessment. What we really need to see is proper workforce planning and a comprehensive recruitment drive to meet the level of need at all stages of service provision. This will provide continuity of care for service users, more integrated services and better morale among existing staff.

The crises in disability services and additional needs education provision are resolvable through reform that is driven by meaningful and sustained engagement with the families and the front-line staff at the epicentre of the crisis. Above all else, we need to see much greater investment by the Government in these essential services for our disabled citizens. We should not have to rely on the remarkable courage and determination of Cara Darmody to see that commitment made.

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