Ciara Conway (Waterford, Labour)
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I thank the Minister and the Ceann Comhairle for selecting this issue, which has been in and out of his office for a number of months now. I am delighted to have the opportunity to raise this issue regarding the lack of community-based speech and language services for adults in Waterford city. The post covers the rehabilitation in St. Patrick's Hospital for adults aged over 18 years in the community presenting with speech and language or swallowing impairment. Client groups include people with acquired neurological conditions, stroke and acquired brain injury, progressive neurological conditions, Parkinson's disease, motor neuron disease and dementia to name a few. It is a very high risk and isolated group.

The post manages patients in their rehabilitative stages of acquired conditions, for example following transfer from an acute setting in a hospital to rehabilitation, and provides support in the community when, in best case scenarios, patients are able to return home. It also provides a service to adults with a diagnosis of progressive conditions presenting with new onsets of speech delay, language and swallowing issues. A service to long-term care facilities such as nursing homes and residential facilities should also be provided should this post be filled.

This post was offered to somebody in 2011 but that person received an e-mail from the then national director of integrated services, Ms Laverne McGuinness, and the national director of human resources, Mr. Seán McGrath, that recruitment was suspended.

To date, there has been no speech and language therapy service for the adult population in the rehab community cohort of Waterford city. People are assessed and treated by speech therapists in the acute hospital, but following their discharge from hospital they are left with no service or support. As the Minister of State can imagine, this must be very isolating for this vulnerable population. The manager has recruited therapists on her team to cover urgent eating and drinking issues, but, unfortunately, this just papers over the cracks and does not highlight the need. This particular population is the most vulnerable in society. Not only are the majority of these people elderly, but they have associated communication deficits which do not allow them to speak or complain about the lack of service.

This for me is the striking issue in regard to this post. We are talking about people who have lost their ability to communicate, to speak up and to engage. We must find a solution to this problem. It is not good enough that adults who have communication difficulties because of acquired brain injury or the onset of a neurological condition are left bereft of services. The position in question has never been filled, despite having been offered two years ago. The issue is not just that the position has not been filled, but that the needs of this vulnerable group in Waterford city and the surrounding area have been left unmet. When these people are discharged from the acute section of the hospital they have no follow-up services. This must be addressed urgently as there are currently no speech and language therapy services for this adult population in Waterford city.

Alex White (Dublin South, Labour)
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I thank the Deputy for raising this issue. I understand this follows on from a query raised by a speech and language therapist in respect of the circumstances surrounding an appointment that was not made.

Waterford community services' speech and language therapy department provides services to adults and children in Waterford city and county, including to St. Patrick's rehabilitation unit in Waterford. Adult speech and language services, including at St. Patrick's rehabilitation unit, are provided by the HSE as required, based on prioritisation of referrals within the speech and language department. Both St. Patrick's Hospital in Waterford city and Dungarvan community hospital are integrated in terms of client care for continuing care, rehabilitation care, respite care, convalescence care and palliative care. Clients are placed for rehabilitation as appropriate where their assessed needs are best met within both community hospitals.

In regard to the 20-bed rehabilitation ward at St. Patrick's Hospital, there is a process in place in advance of discharge from Waterford Regional Hospital for rehabilitation. The service has developed a prioritisation system in order to manage access equitably and consistently. If a patient is assessed by the multidisciplinary team as having a requirement for speech and language therapy support during the rehabilitation phase, then this client will transfer to Dungarvan community hospital rehabilitation ward, which has 14 beds, where speech and language therapy is provided.

The current staffing complement in adult speech and language therapy services in the Waterford area is one whole-time equivalent, WTE, post, with 156 new clients attending to date in 2013, bringing the total number of attendances so far this year to 391. The current staffing complement in children's speech and language therapy services in the Waterford area is 11.3 WTE posts, with 492 new clients attending to date in 2013, with a total number of 6,230 attendances to date this year.

The HSE is required to maximise the use of limited resources at all times within the difficult financial environment we have and the ongoing national moratorium on public service recruitment. Where vacancies arise, they are considered within the overall context of available resources within the speech and language therapy department. The HSE is committed to ensuring the delivery of an appropriate speech and language therapy service across the whole Waterford area.

I have listened carefully to what the Deputy has said and to the case she has made and can only agree with her in regard to the circumstances she has described. The need for a speech and language therapy service is clear. The problem is the constraint on resources. I feel very strongly about the issue of front-line staff and I would certainly support recruitment as soon as resources allow us to recruit for these necessary posts. However, the position is as I have outlined it at this stage.

Ciara Conway (Waterford, Labour)
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I thank the Minister of State for his response. However, I still have concerns. The Minister of State spoke about the services that are available, but those are services in acute hospital settings, not community-based settings. I reiterate that there are no speech and language services for those adults who are lucky enough to be allowed to go home. The Department of Health and the HSE have asked us to look at how we care for people who are sick and infirm. Time and again we hear about the need for these people to go home with the support of care packages. My concern is that we have people in acute beds because of the need for assessment in regard to speech and language therapy. This could be done at home if the post was filled.

In a way, we are robbing Peter to pay Paul. We must find a solution, particularly in regard to posts in the primary care area. I know the Minister of State is a great advocate of the primary care model and that he knows it is much better for the patient and the delivery of service if it can be delivered as close as possible to where the patient resides. Stroke is the third most common cause of death in this country, but it is also one of the most common causes of acquired major physical disability, particularly in regard to impairment of speech. Losing the ability to speak greatly impairs a person's ability to communicate with family, carers and others. The Irish Heart Foundation's stroke guidelines provide clear advice that following a stroke, speech and language therapy in the rehabilitation period is essential. It suggests that after a stroke, speech and language therapy should be provided for between two and eight hours per week and as early as possible. However, if people are discharged from acute hospital settings into the community where there is no service, these patients regress and may have to return to hospital.

I urge the Minister of State to communicate to the Minister my dissatisfaction in regard to the lack of provision of speech and language therapy services for the adult population in Waterford city, particularly those with very debilitating illnesses.

Alex White (Dublin South, Labour)
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I cannot disagree with anything the Deputy has said in respect of the need for care and support in the community. She is right that I have been and remain an advocate of that approach to our health care services, frankly because I do not think there is any possibility of our ever being able to fund and manage these health services in the future, to say nothing about the immediate need the Deputy has spoken about. If we look at the management and future of health care services, we will not be able to manage the funding of those services in acute settings, not to mention the appropriateness of how and where people are treated and cared for.

One of the things I have done since I took up my position was to ensure that recruitment processes were under way and that appointments were made to 265 primary care posts across the board, including public health care nurses, registered general nurses and speech and language therapists. Regrettably, there is not a speech and language therapy post for Waterford among those 265 positions, because the allocation and distribution of those posts was based on bringing each integrated service area where staffing was below the national average up towards the national average. Those areas where staffing was already above the national average did not receive additional posts as part of that process.

I ask the Deputy to accept that it is an earnest of my commitment to the kinds of issue she has raised that we must look to enhance and expand primary care and care in the community, particularly in regard to the ancillary supports that people need so badly.