Thomas Byrne (Meath East, Fianna Fail)
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Tá mé lán-sásta gur thug an Ceann Comhairle an deis dom an t-ábhar tábhachtach seo a lua ar an Athló inniu. I am very grateful to the Ceann Comhairle for allowing me to raise this issue.

It is an issue that affects families in County Meath to an extraordinary degree. I have been contacted by parents who cannot get occupational therapy for their children because there is only one occupational therapist, OT, covering County Meath and the town of Kingscourt in County Cavan for children aged between 0 and 18. That person works 17.5 hours per week. As of last week there are 350 children waiting to be seen in County Meath and that one part-time OT has to deal with all of them. A child in County Meath has to wait four and a half years for an assessment. That is what the staff tell us. That is coming straight from the horse's mouth. There are other OTs who work in Enable Ireland and the child and adolescent mental health service, CAMHS, to address the needs of children with diagnosed disabilities, including physical disabilities and autism but primary care is the first point of contact for children so most people coming to the primary care OT have no diagnosis and wait four and a half years for that.

Some OTs left the service in County Meath this year and there has been no word of their replacement. There was a long period when there was no manager to advocate for the service within the Health Service Executive. The OT in County Meath organised meetings of parents because she was so concerned at the situation she and the parents were facing and asked the parents to contact their local politicians such was the gravity of the situation. I have never before seen a public servant gather people together and ask them to advocate for a service. That is the job of the Minister of State and of HSE management, not that of the OT on the ground. It is shameful that children must wait four and a half years for an assessment. It is extremely worrying for parents because they know and hear from others who have gone through the worry and trauma of requiring these services that the early years are when children are diagnosed and their needs are assessed. This needs to be addressed urgently. There are parts of Dublin where there is no problem whatsoever but children in my county have to wait almost five years to be assessed for occupational therapy.

Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Byrne for raising this very important issue about Meath. The HSE has advised that the Meath occupational therapy service is delivered across three divisions: primary care consisting of adult services, including palliative care and children services; social care consisting of the adult disability team, a six to 18 school aged team and older persons and acute care services delivered at Our Lady's Hospital in Navan.

The paediatric service provides an assessment of and services to children up to age 18 years, for whom typical presenting needs relate to, amongst other things, developmental coordination disorder, also known as dyspraxia, sensory processing difficulties, chronic pain and orthopaedic conditions. There is an open referral system in that referrals are accepted from general practitioners, parents, schools and other multidisciplinary team colleagues. I am advised that there are two priority levels in children primary care services and the longest waiting time under priority one is three months and 61 weeks under priority two. The HSE has informed me that there are staffing related matters affecting the delivery of occupational therapy services in County Meath. The complement for Meath occupational therapy services, which include adult and paediatric services, is 8.1 whole-time equivalents. However, the complement delivering services is 6.1 whole-time equivalents; this is due to a number of factors including maternity leave, sick leave and recent resignations. I understand from the HSE that one of the current vacancies has been approved for backfill and the position is going through the recruitment process.

A business case for the backfill of the other vacancy as well as four new additional positions for paediatric services awaits approval. Notwithstanding the change in the staffing complement in County Meath, the HSE assures that the services continue to be prioritised based on clinical need. I am aware that assessment and treatment waiting times in all community healthcare organisation, CHO, areas are dependent on identified need and the capacity and demands on the occupational therapy service in the particular area. In many areas, treatment intervention is completed on assessment and therefore there is no time delay once a client is assessed. Following the screening of referrals, a client's needs are prioritised by a standard prioritisation system. I do appreciate the Deputy's concerns that accessing services can be very difficult for the families and children affected and the need for additional therapy posts is highlighted in A Programme for a Partnership Government. The HSE has established a national therapy service review group to address therapy waiting times, including those for access to occupational therapies. This joint primary care and social care project will include a detailed analysis of waiting times and resource deployment across the country. I will seek to make the services more responsive to people's needs and also seek to put in place a standardised approach to the delivery of occupational therapy services across the country.

Thomas Byrne (Meath East, Fianna Fail)
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I thank the Minister of State for his response but it is not sufficient. His waiting list figures are wrong. The person who spoke to me pointed out that a part-time OT has a responsibility to see eight new cases per month. There are 350 children waiting to be seen. Simple mathematics shows that it takes four and a half years for a child on that list to be seen. The Minister of State says there is a recruitment process to fill one vacancy, which is welcome but I plead with him to speed it up. I find it deeply offensive that a business case must be made to fill another vacancy. These are not extra posts. It is not the case that there is an increase in population requiring extra posts. These are existing jobs that people have left recently. Someone must make a business case so that our children receive the therapies they need. It is scandalous if the HSE thinks a business case has to be made to replace OTs. If the Minister of State is standing over that I suggest he goes back to the HSE and tells it to fill that vacancy as soon as possible. There is a business case because the position was there until early this year. The idea that when someone leaves a job the case to keep that position has to be made while children have to wait four and a half years for occupational therapy services is scandalous, outrageous and unacceptable. I urge the Minister of State to rethink that and go back to the HSE and tell it to sort this out quickly.

Finian McGrath (Dublin Bay North, Independent)
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I disagree with the Deputy because we have approved one position and the case has been made for four new additional positions. I will push the case, and so will the HSE, to get funding because it is very important.

The total staffing complement for adult and paediatric services is between 8.1 and 6.1, clinically availablein situ, excluding maternity leave, sick leave and recent resignations. The two resignations took effect on 31 March 2017. That happens in life and that is a problem we have. It is a reality. The second reality, which is not mentioned in the response, and which I have many concerns about is that many OTs emigrated during the financial crash and went to other European countries and England.

We are trying to encourage them to come home. One resignation was in the social care area. As I mentioned, this position has been for the backfill and is going through the recruitment process.

It is also important to remind people that there are service locations and that the Meath occupational therapist services are delivered from five network bases. They are: network 1 - Navan and surrounding areas; network 2 - Kells and Kingscourt; network 3 - Trim and Summerhill; network 4 - Dunshaughlin, Ashbourne, Dunboyne and Ratoath; and network 5 - Laytown and Duleek.

In terms of investment in occupational therapy services, the last investment in primary care services was in 2013 when 52.5 posts were approved. In addition, under the progressing disabilities services for children and young people aged 0 to 18 years programme, 64.5 occupational therapy posts were approved in 2014. We have to rebuild and invest in services.

A service improvement initiative has been established for the national occupational therapy service to review the existing model of care and develop new models that will be standardised across CHOs to improve waiting times. I will, of course, make this a priority issue when talking to the HSE.