Brendan Smith (Cavan-Monaghan, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I am very glad that this item was accepted and am pleased that the Minister of State is here to respond.

I wish to refer to services provided by Enable Ireland for children up to age six and by the HSE's child development team for children aged from six to eight in Cavan-Monaghan. My comments are informed by my constituency work and by ongoing contact with parents of children with a disability, particularly autism. I know from replies from the HSE to representations I have made on behalf of constituents that there has been an increasing volume of referrals to the Cavan-Monaghan child development team. The HSE has publicly acknowledged that referral rates for children in Cavan-Monaghan have increased significantly in recent years and, consequently, waiting time have also increased.

The HSE has identified additional staffing as a priority in Cavan-Monaghan and I sincerely hope that the Minister of State will be able to provide the necessary resources to ensure that an adequate complement of professional staff is based in Cavan-Monaghan. Families need to be able to access the required professional services for children at the appropriate time. Delayed assessment, intervention and service provision for children at the formative time in their lives is not acceptable.

I know from speaking to parents that Enable Ireland provides an excellent service in Cavan-Monaghan. However, parents have made representations to me with regard to the delays they are experiencing in obtaining ASD diagnostic assessments. I understand from parents who have had interactions with Enable Ireland that it is providing services to approximately 430 children aged up to six in Cavan-Monaghan. This includes children with a named disability or a delay in their development, as well as children presenting with features of ASD. Every child that is accepted onto the Enable Ireland programme goes through an initial assessment period to identify his or her needs before an individual intervention plan is put in place. Where there are concerns about a child presenting with possible features of ASD, Enable Ireland discusses the matter with the family and places that child on the waiting list for an ASD diagnostic assessment.

Last weekend, a parent told me that she understood that more than 70 children are awaiting the ASD diagnostic process in Cavan-Monaghan. As we know, the diagnostic process requires assessment by a psychologist, a speech and language therapist and an occupational therapist because the gathering and integration of information from multiple sources strengthens the validity of a diagnosis and age-differential diagnosis in young children. This parent was extremely well informed thorough interaction with other parents of children with autism and through different support groups. She told me that Enable Ireland would only have one whole-time equivalent psychologist post to meet the needs of 420 children across Cavan-Monaghan. If that figure is accurate, the Minister of State will see a huge deficit in that professional service. I have to accept the word of that well-informed parent who gave me that information. With such a limited resource, it is extremely difficult to work through that ASD waiting list in a timely manner while also trying to provide some psychology supports to the other children in the service and to provide support to preschools and schools attended by the children. There are huge demands on that professional service provided so well by Enable Ireland.

Service providers also have to deal with the assessment-of-need process. The relevant legislation requires that referrals received through the assessment-of-need process must be responded to and children must be assessed within a specific timeframe. When the local service providers try to respond to the needs of the children who are presented by parents or by schools and also through the assessment-of-need process, the service providers then have a huge difficulty. Do they only respond to the referrals that come by way of assessments of need, meaning that the other children's assessments will be delayed? There is a conflict and a difficulty for the service provider in the context of meeting the needs of the children while adhering to the timeframes set down in legislation.

Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Brendan Smith for raising this matter. On a recent visit to Monaghan, I met him and Deputy Caoimhghín Ó Caoláin. I thank the people of the area, including many of the parents we met at the intellectual disabilities facility in Monaghan. I also saw examples of good practice in the Monaghan area. I was delighted to find that Monaghan is the only area in Ireland that does not have a congregated setting. All the settings are located in smaller community houses. It was a very important and historic day as far as I was concerned.

I assure the Deputy that the Government is committed to the provision and development of services for children with special needs, and to improving access by these children to assessments and therapy services, in so far as is possible, within available resources. In the Cavan and Monaghan area, the school age team provide autism services to children aged six to 18 years old and Enable Ireland provides services to children from zero to six years old under the early intervention team. The autism-spectrum-disorder service within each team is multidisciplinary in nature.

Unfortunately, there are staff shortages in a number of disciplines, despite much effort going into filling these posts. Currently, there is only one senior clinical psychologist in post in the school-age team covering both counties. I accept the Deputy's point. As a result, the psychologist's capacity to meet the demand for assessment and intervention for children with autism is limited. The demand for this service continues to outweigh current capacity.

Recruitment for a second psychologist continues to be actively addressed as recruitment campaigns to date have proven unsuccessful. There is the gap in the system. I accept it is not acceptable and we have to ensure we fill that post. There are similar recruitment issues in the areas of speech and language therapy services, and in occupational therapy services. I assure the Deputy that the HSE is committed to fill these posts and reduce waiting times for assessments and therapies.

In the meantime, the Cavan-Monaghan disability services school-age team continually reviews existing waiting lists and is in the process of reconfiguring services to provide greater access for children requiring a multidisciplinary team autism assessment.

The HSE has recognised that early intervention services and services for school-aged children with disabilities need to be improved and organised more effectively and this process is well under way nationwide. The HSE's national programme on progressing disability services for children and young people from zero to 18 years aims to bring about equity of access to disability services and consistency of service delivery, with a clear pathway to services for children with disabilities and their families, regardless of where a family lives, what school the child attends or the nature of the individual child's difficulties.

The programme has entailed targeted investment of €14 million and the provision of 275 additional therapy staff, in order to increase services for children with all disabilities. In 2016, €4 million was provided under the HSE's national service plan to focus specifically on speech and language therapy waiting lists in primary care and social care for children up to 18 years old. This investment represents a long-term increase in speech and language capacity that is being maintained in 2017. It is acknowledged that waiting times to access required assessments are high in some areas, including Cavan-Monaghan. There has been continual additional investment in this area in order to support the HSE as it faces significant challenges in respect of meeting the statutory timeframes which apply to the assessment-of-need process.

Brendan Smith (Cavan-Monaghan, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for his reply. As he said, Deputy Caoimhghín Ó Caoláin and I had the pleasure of accompanying the Minister of State that evening in Clones when we met families and the support groups. Excellent work is being done by community groups throughout Cavan-Monaghan. The Minister of State would be very welcome to visit the area again. I know of his personal commitment to this area.

Whenever there is a shortage of resources there is a risk of creating a two-tier system whereby the children coming through the assessment-of-need option will be seen and the children being referred otherwise will not be seen. The danger with the lack of resources in Cavan-Monaghan is that Enable Ireland, as the service provider for children up to the age of six, could become an assessment service only and would not be in a position to provide the interventions and the services we all want to see provided for the children. We do not want Enable Ireland, for example, just to become an assessment service because it does its job so well and professionally in delivering services where it has the necessary resources.

I understand that in the Cavan-Monaghan area the number children aged up to six years of age presenting to Enable Ireland has more than doubled since 2008, which indicates the demand for the services and the need for the additional resources for that area. All of us through our ongoing constituency work meet parents who are utterly frustrated. Neither the family development team with the HSE nor Enable Ireland is able to advise parents of when assessments will be carried out and this is adding to the difficulties and concerns of parents.

I welcome that the Minister of State will encourage the HSE to ramp up its efforts to recruit additional professional staff to try to ensure this is prioritised. It is much needed as he recognised in his contribution and as he will have heard from parents and support groups that evening in Clones.

Finian McGrath (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

I will not accept a two-tier system. However, I accept that we cannot have an assessment service only. We have to move on that. There are huge demands on existing services. As the Minister of State with responsibility for disabilities, it is my job to ensure we develop these services. As I explained earlier, we have a problem recruiting people. Unfortunately, the disability services have been drained over the past seven or eight years. We are now trying to catch up and reinvest.

Sadly, many of our speech and language therapists and educational psychologists have gone to other countries. We have an issue trying to fill posts, in this case in Cavan-Monaghan. My job is to get the HSE moving to fill the posts. I also accept the Deputy's point about the frustration of parents. Failure to intervene early will damage the children and will also cost more in terms of services.

The social care disability service plan for 2017 has a budget of €1.688 billion, an increase of 6% from last year. I accept that there are major problems, but we are trying to reinvest. I want to reform and focus on the person with the disability. That is my vision and strategy. Let us see if we can go ahead and do it.