Dara Calleary (Mayo, Fianna Fail)
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I thank Ceann Comhairle for allowing me to raise this Adjournment matter and the Minister for Health, Deputy Simon Harris, for coming to the House to take it. I refer to the provision of speech and language therapy services in County Mayo, in particular Ballina. A number of parents have brought to my attention that there is a serious deficiency in the delivery of the service. I tabled a parliamentary question about same. The difference between the reply received and the reality in Ballina is quite stark. It shows that it is quite often the case that managers in the HSE seem to live in one universe while parents and others have to deal with the reality of a situation.

The initial response concerned a referral that was made to the speech and language therapy services in March 2015. The child was seen in August but for nine months, there has been no intervention. The parents are frustrated in terms of trying to get a service, access information and receive appropriate care for their child.

There has been no intervention and there has been frustration in terms of trying to get service, access information and to get appropriate intervention. As the Minister is aware, early intervention is crucial, especially when one is aged three, as this young child is. There is no backup or service. I understand a staff member was on maternity leave last year and there were other leave issues relating to the Ballina area which added to the waiting list but surely provision could be made in a case such as the one outlined for backup facilities and services to be provided.

When we tabled the parliamentary question we were informed that currently, following initial assessment, the waiting list in north Mayo has 60 cases categorised as high priority and 26 cases categorised as moderate. In north Mayo there have been 101 referrals to the speech and language therapy services up to 17 May, yet there is no full-time speech and language therapist assigned to the Ballina area. The area is covered by travelling practitioners from Castlebar on an irregular basis.

There was a line in the response from the HSE to the effect that waiting times after initial assessment can vary due the number of referrals in a given area and the severity of the cases referred. One would imagine, given that there are 60 high priority cases and 26 moderate cases, and 101 referrals in less than five months, that Ballina would be seen as a priority for a full-time appointment and for a backup service to deal with the list and to assess the groups of 60 children and 26 children and get them into a treatment plan as soon as possible.

There are no audiology services available, so as well as difficulties speaking, many of the children in question cannot hear and cannot avail of support. The service is broken in the eyes of the children on whose behalf we speak and in the eyes of their parents. As one mother told me, she would travel to the moon to get a service, but because she lives in Ballina she is not allowed to access services in Castlebar. Neither can she go to Sligo because her address precludes her from getting the necessary treatment there. That is not good enough in any country, especially not in a republic.

We are either serious about the issue or not. The value of early intervention is crucial. The Minister is aware that if we get early intervention it would save further intervention down the line. Until such time as we get a full-time speech and language therapist and devote full-time attention to dealing with the waiting list, there will be many more children who do not get the necessary intervention who will become dependent on the services. It is no criticism of those working in the service. We need more of them. Parents are taking a stand for their children, their loved ones. Parents are at their wits end in trying to get even basic information. I highlight the difference between a reply to a parliamentary question and the reality on the ground.

Simon Harris (Wicklow, Fine Gael)
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I thank Deputy Calleary for raising this very important matter and for presenting the starkness of the difference between what he was informed by the HSE by way of parliamentary question and the reality facing families in the community he represents. It is important that we hear that difference. It is something I will take back to HSE officials.

I advise the Deputy that each individual that presents to the HSE's speech and language therapy service has an initial assessment to determine their individual need for therapy. The therapist, in conjunction with the parent or carer, will determine the severity of the individual's difficulties and prioritise for therapy accordingly. The level of intervention is in line with clinical policy, age and severity of the diagnosis. The waiting period for intervention is dependent on the nature and severity of the disorder following assessment.

In terms of primary care services nationally, the HSE has prepared proposals to improve access to primary care speech and language therapy services and to address the waiting lists for assessment and therapy treatment. Dedicated funding of €4 million has been provided in the HSE's national service plan to specifically address this issue and details of the new proposals will be announced by me shortly. The HSE has advised me that current waiting times for initial assessment are standard across County Mayo for primary care cases. Clients are screened three times annually - in February, June and October - meaning children wait a maximum of four months from referral to initial assessment.

As I outlined, waiting times after initial assessment may vary due to the numbers referred and the severity of the cases referred. The Deputy quoted the same figures. Currently, following initial assessment, the waiting list in north Mayo has 60 cases categorised as high priority and 26 cases categorised as moderate. To date this year, in north Mayo, I am informed that 139 referrals have been made.

The HSE has advised me that there are no posts affected by sick leave or maternity leave in this area at present and it is continuing to manage and work through the waiting list. Children are entitled to HSE audiology services free of charge. These include screening, assessment, investigations, treatment, rehabilitation and devices. The HSE is conscious that the initial assessment and review of children is vital to ensure that they have the appropriate interventions and aids required for linguistic development and, as a consequence, improved social skills and educational capacity.

The report of the HSE national audiology review group, published in 2011, identified some inconsistencies and shortcomings in audiology services around the country, including unacceptable waiting lists. It made recommendations to address those issues. An integrated audiology programme was put in place and is now addressing the issues. With regard to County Mayo, audiology services to children aged over four years and adults are being provided in Ballina. The service to children under four years is currently provided from Castlebar. Waiting lists in County Mayo were tackled by a time limited overtime initiative last year. Following a procurement process, the HSE has now contracted an external provider and aims to clear the national paediatric waiting list for audiology services this year. A model for assessing and triaging children awaiting hearing testing is currently under evaluation. This model, if validated, will be used by the external provider to assist in reducing the audiology waiting lists for children nationally on a phased basis from the third quarter of this year.

I will continue beyond my script in the time available to me because the point Deputy Calleary made on speech and language therapy and early intervention is crucial. The point he made about the postcode lottery system and the inconsistencies based on where one lives is clearly not acceptable. That is something we have never quite got right in this country. I am informed that the care divisions in the HSE are now doing a detailed analysis of the inconsistencies in waiting times and resource deployment across the country. It is considering validating the waiting lists and standardising the prioritisation system. One cannot have a situation whereby one gets a better service because one lives in one county or one part of one county than another. We must consider increasing the number of speech and language therapy drop-in assessment clinics; agreeing flexible opening hours in the context of evening and weekend sessions; recruiting additional therapists; providing for maternity leave substitute posts; reviewing existing practice and considering examples of innovation and international best evidence and; agreeing performance monitoring and measurement arrangements.

In 2013, additional funding of €20 million was provided to strengthen primary care services. That comprised more than €18.5 million for the recruitment of more than 260 primary care team posts and more than €1.4 million to support community intervention. Additional funding of €4 million was provided this year specifically for speech and language therapy services and new initiatives. I look forward to developing those proposals and announcing them shortly.

I accept the valid criticism Deputy Calleary made in terms of speech and language services. The current waiting lists are unacceptable. It is something we are going to need everybody in this House to work with. We are going to need to put the resources in place. There are additional resources this year. The current situation is inadequate, but it is not fair that some children in the country receive less of a service purely based on where they are located. Part of the process the HSE is examining at the moment relates to those inconsistencies so that fairness can be provided throughout the country. I will revert to the Deputy on the matter.