Fergus O'Dowd (Louth, Fine Gael)
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I am grateful to the Ceann Comhairle for allowing this debate. I welcome the Minister of State. His commitment to his duties is top class. I have come across him many times on active service in County Louth-----

Finian McGrath (Dublin Bay North, Independent)
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That could be dangerous.

Fergus O'Dowd (Louth, Fine Gael)
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-----meeting people who have concerns. There is nothing more important than him examining the issue of speech and language deficits in the county on his next visit, which will not be too far in the future.

The younger somebody who needs speech and language therapy obtains access to the service, the more influential it will be on their lives. The huge waiting list in County Louth in unacceptable. A total of 284 people are on the list and they have been assessed as needing this provision. They have been waiting less than a year but the number of the waiting list post-assessment in the adjoining county, Meath, some of which is in my constituency, is 27. There is a significant difference in the service provision in counties Louth and Meath. This is shocking, discriminatory and entirely unacceptable. I do not blame the Minister but rather the HSE, which does not examine these issues in the detail it ought to. For example, nine new speech therapists have been appointed to both counties, six of whom will be deployed in County Meath, which has the shortest waiting list. This is shocking and disgraceful and I ask the Minister of State to intervene and to act urgently on this matter.

I wish to draw attention to another waiting list.

The number of adults deemed to have intellectual disabilities who are on the waiting list for speech and language therapy in County Louth is 400. They have no service. They have no dedicated speech therapist. That is compared with County Meath where there are five people with intellectual disability aged over 18 awaiting speech and language therapy. I am not pitting one county against another but whether one lives in Mornington in County Meath outside Drogheda or Monasterboice on the other side of Drogheda, one should not have to wait on a geographical basis. A person should get the service because he or she needs it. The people in Louth need it now. I urge the Minister of State to address that huge, unacceptable deficit. I understand from speaking to Inclusion Ireland that it is a huge issue nationally. We need to increase very significantly the number of speech and language therapists nationally. I await the Minister of State's reply on the matter.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Fergus O'Dowd for raising this very important issue. In the Louth area, Deputy O'Dowd is very committed to supporting the rights of people with disabilities, particularly intellectual disabilities, and also pushing for speech and language therapy services.

The Government recognises, as Deputy O'Dowd has said, that waiting times for speech and language therapy have posed significant difficulties for families and their children. However, I can advise the Deputy there has been a reduction of almost 8% in the overall numbers waiting for speech and language therapy services over the period December 2015 to September 2016. Furthermore, there has been a reduction of over 18% in the numbers waiting for more than eight months for speech and language therapy services over the period November 2015 to September 2016. The enhancement of therapy services for children and adults has been the subject of particular focus in recent years and has benefited from the investment of significant additional resources. In 2013, additional funding of €20 million was provided to strengthen primary care services and to support the recruitment of prioritised front-line posts. As part of this initiative, the HSE recruited for more than 260 additional posts for primary care teams. This included 52 speech and language therapist appointments. Since 2014, the roll-out of the programme for progressing disability services for children and young people up to 18 years entailed targeted investment of €14 million and the provision of 275 additional therapy staff including 88.5 speech and language therapists. I am advised that in 2015 four speech and language therapy posts were allocated to Louth under this programme.

There are currently 21 directly employed whole-time equivalent speech and language therapy posts in Louth covering primary care and social care. Nationally, the primary care and social care division also indirectly supports a number of voluntary agencies which employ additional speech and language therapists to deal with the lists. The combined staff see and provide services to approximately 21,000 patients per month. In addition, in 2016 development funding of €4 million was provided to focus specifically on speech and language therapy waiting lists in primary care and social care for children up to 18 years old. This funding represents a long-term increase in speech and language capacity. This investment is enabling the HSE to fill 83 new recurring posts in primary care to address waiting lists, prioritising the longest waiting children. I am advised that three posts have been allocated to Louth under this initiative. Each additional whole-time equivalent will provide capacity, on average, to undertake 800 initial assessments or 1,400 therapy appointments per annum. When the 83 positions are filled, the number of speech and language therapy staff in the HSE’s primary care and social care services will be close to 700. The HSE aims to ensure the resources available are used to best effect to provide assessment and ongoing therapy to children and adults in line with their prioritised needs. Along with the significant investment in recent years, a range of new approaches have been developed and used in many speech and language therapy services. The HSE has established a national therapy service review group to address therapy waiting lists, including speech and language therapies. It is anticipated the group will have completed its work by the end of March 2017.

As Deputy O'Dowd says, it is not acceptable to have children like that on waiting lists for speech and language therapies. I will bring the Deputy's message directly back to the Minister and the HSE.

Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister's comments but it is unacceptable that almost 300 people are waiting for speech and language therapy in Louth whereas the adjoining county, Meath, has fewer than 30 people waiting after assessment. When the allocation of posts was taking place, six went to Meath and three to Louth. I agree there must be enough therapists for everybody but this discrimination against County Louth is absolutely unacceptable and unforgivable, particularly in light of the fact that 400 adults with intellectual disability have no service whatsoever. There is no waiting list and no therapist in County Louth, yet the adjoining county of Meath has a waiting list of five.

The other point I want to make is on the workload of speech and language therapists in County Louth. It is recommended in primary care for people aged under 18 that there should not be more than 100 people per whole-time equivalent therapist. In Louth the figure is 180 so the caseload is approaching double the maximum it should be. If one looks at the adult network figure, the recommendation is 38 to one but the actual figure is 93 to one. For disability services, the ratio is 50:1 in both the under-six and six to 18 age groups whereas it should not be greater than 38:1.

There is a huge challenge here. I rely on the Minister of State's interest to address this matter urgently. We cannot continue to deny fundamental rights to access to services for everybody but specifically in County Louth, which is being discriminated against. In that discrimination, the greatest discrimination is visited upon the 400 adults with disability who are on the waiting list in County Louth. They have no services and I hope it ends now.

Finian McGrath (Dublin Bay North, Independent)
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I accept Deputy O'Dowd's point about Louth and Meath. We have to ensure there is equality in the distribution of services. It is a point I will go back to the Minister and HSE with. We have to deal with the challenges that exist when recruiting for new positions. In some cases, the successful candidates are HSE staff from elsewhere in the country, so enhancing capacity in one area means a vacancy arising elsewhere. Nonetheless, as indicated, in net terms overall capacity has already been substantially increased and will be added to further in the coming months. It is something I am in further talks about at the moment with regard to the HSE service plan. We have to respond to this.

In the meantime, it is important that while we are trying to address this crisis in our speech and language therapies, we look at a new range of approaches. To keep things on the road, new approaches have been developed and used in many speech and language therapy services. These include providing structures, training and support to parents and carers in order that they can work to help to improve the individual's speech and language. In addition, therapy is delivered in group settings, where appropriate.

The issue of speech and language therapy services has to be dealt with. I will bring back the Deputy's concerns, particularly those on Louth and Meath.