Liam Quaide (Cork East, Social Democrats)

There is a close relationship between this Bill and the HSE's corporate plan. In the HSE's corporate plan for 2025 to 2027, there is a stated commitment to, "Reduce waiting times for primary care therapies by standardising the management of referrals, waiting lists and discharges."

There is no mention of a recruitment drive for services that have been hollowed out by years of recruitment restrictions imposed by successive Governments and senior HSE management, so much so that waiting list figures for them are so stratospheric that they have to be read more than once to be believed.

I raised the crisis in primary care waiting lists for young people with the Minister in the Dáil two weeks ago, with particular reference to psychology services. I highlighted that people are being moved from one waiting list to another with no intervention in sight, and that there has been a stranglehold on recruitment in primary care services for young people resulting from the pay and numbers strategy, the official recruitment embargo before that and years of passive neglect even prior to that.

I referenced from a reply to a parliamentary question a wait time in the Dublin and north east health region involving a child initially referred to disability services nine years ago, who is now facing yet another wait of unknown duration for primary care psychology. I set that out at the time and the Minister's response was to quote figures referring to generalities in primary care staffing in the context of the pay and numbers strategy. These generalities did not in any way relate to the waiting lists I raised. There was no acknowledgment that there was a crisis in primary care services for young people. There was a suggestion made of an alternate reality in which these services were actually better staffed than ever, which is clearly not the case.

This week, at Leaders' Questions, my colleague Deputy Cian O'Callaghan highlighted the scale and depth of the crisis across health regions and across disciplines revealed by further parliamentary questions I submitted in recent weeks. He raised the fact that the longest wait times nationally are up to seven years for physiotherapy in Cork North Lee; up to six years for speech and language therapy in Dublin North-West; up to nine and a half years for occupational therapy in Dublin North; and a staggering 13 and a half years for psychology in Dublin North-West. I have mentioned Dublin and Cork quite a bit but it is a national crisis. We have also had, for instance, a wait of nine and a half years for psychology in Galway. The Taoiseach's response was:

There has been no recruitment embargo. We do need to get a bit real here.

[...]

so do not say we are cutting back or are not allocating. The Deputy cannot say that with credibility.

He said this to Deputy Cian O'Callaghan with clear impatience, bordering on disdain, for the questions being put to him around the need for a comprehensive recruitment drive in primary care services for young people, as if he was dealing with an unserious, politically motivated and entirely unreasonable line of attack. Both of these responses, from the Minister two weeks ago and the Taoiseach yesterday, reflected either complete detachment from the reality of primary care services for young people or a wilful denial of that reality. If I was a clinician working in one of these services in Cork, Dublin or Galway, where recruitment has been so restricted for years, or if I was a parent whose child was on one of those epic waiting lists, I would have been left feeling utterly distraught hearing those responses. You cannot address the crisis if you do not even recognise the reality of its existence.

The Government's only consistent response to questions on the primary care service crisis has been to refer to a need to change disability legislation, strongly hinting at a dilution of the right to an assessment of need. The Minister has made the case that clinicians are overly embroiled in completing assessments of need and not available for interventions as a result. There is a small grain of truth in that but the Government narrative ignores the broad context and the fact that under-resourcing of services is pushing more and more families into the assessment of need process because that is the only right they have in law. The main reason is that a shorter therapeutic assessment in primary care services - for those children who are eligible for primary care - followed by timely intervention is not remotely available to them. It is a complete fantasy.

I ask the Minister to please engage with the clinicians on the ground and the families affected. She will see what various types of recruitment restrictions, as well as the redirection of large numbers of children from children’s disability network teams, CDNTs, without following up with the necessary recruitment, have done to primary care services for young people. This is a disaster with regard to service provision that has been growing in plain sight for years now.

The idea of a single point of access for child services, which is being trialled at present by the HSE, has merit in that it will reduce the practice of children being moved from one waiting list to the next but it will not even paper over the cracks of years of under-resourcing. The reason children are being moved from one waiting list to the next in the first place is that the services are so restricted that they are attempting to manage their waiting lists by becoming rigid in their inclusion criteria. There is no getting away from the need for proper workforce planning and investment in primary care services. We need a clear benchmark for a clinician to population ratio and an urgent, comprehensive recruitment plan to follow that.

A paragraph on trust in the HSE’s corporate plan states: “We will be open and transparent in how we provide services. We will show honesty, integrity, consistency and accountability in decisions and actions.” I was involved in a campaign to oppose the closure of a residential mental health service in Midleton over a number of years. It was an epic struggle, involving the deployment of several Oireachtas committees, multiple freedom of information requests and a litany of parliamentary questions, to expose the serious infringement this abrupt closure imposed on the rights of the residents and people in east Cork who will require residential support in future. The residents, some of whom did not have family support, received a letter from the HSE in June 2021 telling them that, in the context of refurbishment works at the facility, it had become clear that the building could not be made fit for purpose “to meet the high standards of the Mental Health Commission”. The letter went on to say that the building could not be “brought to the standard needed and that you deserve”, addressing the residents directly. The letter reassured the shocked residents that the HSE would “work with each resident individually and with their loved ones to make sure you have a new placement that suits your needs.”

Little did those residents know at the time, as revealed the following year through an FOI request, that the HSE had been planing to move as many of those residents as possible from their single-room, town-centre, long-term residence where they had built up a wealth of connections in the community over years and in some cases over decades. As many as possible were being moved into long-stay wards in St. Stephen’s Hospital, Glanmire, an institutional setting removed from anything resembling community living, surrounded by fields, without even a footpath to the nearest service station, which is 1.7 km away. Added to that, they would have most likely suffered the indignity of sharing dormitories in these long-stay wards and residing in settings that had received some of the worst Mental Health Commission inspection ratings of any mental health service nationally. Meanwhile, Mental Health Commission compliance ratings at the service being closed in Midleton, which is known as the Owenacurra Centre, both at the time of this proposed closure and since, were exceptionally good. The HSE banked on people observing this closure to not even read those Mental Health Commission reports, or not even read the building reports, which also did not stand up to scrutiny. It relented from its plan to close the service, not as a result of self-reflection or being persuaded by the very obvious arguments around patient rights, human rights and the United Nations Convention on the Rights of Persons with Disabilities, but because management caved in under a sustained barrage of negative publicity.

If we are true to that value of accountability, as set out in the corporate plan, where is the accountability for managers who operate in this way towards people with such a high level of vulnerability? Where is the accountability for the managers in the Emily case, who allegedly obstructed the extension of a safeguarding review into other possible cases of abuse within the same facility? If this was a ground-level clinician who was breaching the HSE’s communications policy by criticising the HSE publicly, the sanctions would be swift and decisive.

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