Mary Butler (Waterford, Fianna Fail)
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I thank the Minister of State, Deputy Jim Daly, for taking this issue. I assumed I would be speaking to Minister of State Deputy Finian McGrath, about this because I have spoken to him about it previously.

It is with deep concern that, once again, I must raise with the Minister of State the fact that there is no psychologist providing services for children with disabilities, including autism, aged between six and 18 years in the Waterford area. In Waterford Community Services, there are 1.6 whole-time equivalent staff providing early intervention psychological services. An additional senior psychologist commenced towards the end of last August, which is very welcome. This brought the figure up to 2.8 whole-time equivalent posts, but this increase has still not resulted in the targeting of the children between six and 18.

I have had several meetings with parents, Oireachtas Members and the staff of the HSE over the past two years. The HSE staff in Waterford have made the decision to aim all the psychological resources at those between birth and six. As we all know, early intervention is key and the most headway is made at an early age. I, for one, am not criticising what the staff do. They are the experienced psychologists but I have just outlined the facts of the matter. This is an extremely difficult decision for any team to make. Although the section is understaffed, however, the service provided is excellent once a child can gain access to it. I genuinely thank the team involved. It does fantastic work with limited resources.

When a child in Waterford reaches his or her sixth birthday, the service of a psychologist stops. It is non-existent. All the good work in the previous years lies dormant, with no follow-up of any substance. The children aged six are placed on a waiting list and the average waiting period is three years. This means the service simply ceases for a child in need of support who has just taken the first steps in formal education and who is learning how to cope in a classroom environment and learning new coping, socialising and behavioural skills, or for the parents of that child.

Mothers have sat in front of me and cried when their children turned six, knowing the excellent support their children received previously and the improvements made through early intervention would just stop. A mother told me yesterday that her son, who was recommended for emergency intervention 18 months ago, is still waiting. He is aged 11. Parents are trying to fumble their way through meeting their children's needs and demands. They are doing their best, hoping they are proceeding correctly, and they have no guidance or input from the professionals when their child reaches the age of six.

Just before the summer recess, Deputy Cullinane and I brought two parents from Waterford here to meet the Minister and HSE representatives. They said they would consider the issue, but unfortunately parents have informed me nothing has changed in regard to those aged between six and 18. How can the Minister, the Department of Health and the HSE stand over a system in which a group of children with disabilities, in their formative years and who are crying out for help are unable to gain access to services when they reach the age of six? This has been permitted to go on for too long. It results in isolation and a sense of betrayal among parents in addition to a sense that their children are not regarded as worthy of services. The Government, including the Minister of State, does not want to be responsible for this. Fundamentally, it wants to ensure that all children in need of services are treated equally. Unfortunately, because the children in question live in Waterford, this is not the case.

The reason I draw attention to this matter today is based on an answer I received to a parliamentary question as late as last September. The line in the response that is so damning states there is no psychologist providing services for children with disabilities, including autism, aged between six and 18 years and living in the Waterford area. That is the fact of the matter.

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputy for raising this important issue. I am pleased to outline the position on psychological services for children with disabilities, including autism, in Waterford. Waterford disability services provide a range of multidisciplinary supports and services for children with disability, including early intervention for those between birth and six, and school-age services for those between six and 18. There have been significant year-on-year increases in the number of children applying for assessment, including for autism spectrum disorder, and for disability services generally, which has led to delays in timeframes.

With reference to psychology posts, there are 3.8 whole-time equivalent psychologists providing services within Waterford early intervention services to children up to six years of age. There is currently no psychologist providing dedicated services for children with disabilities, including autism, aged between six and 18 in the Waterford area. This is due to a combination of factors, including increased referral rates and demand for services ,which outweigh current capacity, more complex cases presenting, and a reduction in trained paediatric staff available to address the waiting lists. There is also a national shortage of psychologists. However, every effort is being made in the area to examine the available resources across children's disability services as a whole and find a solution for the provision of this service to children of school age. There is also some limited psychology service provision as part of a pilot project in Waterford city for those between six and 18 years.

The HSE regrets the difficulties in accessing psychology services. It is seeking to reduce the waiting times and address issues arising for all children and their families through a number of measures, including outsourcing some services for children with ASD to reduce waiting times.

Mary Butler (Waterford, Fianna Fail)
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I thank the Minister of State for his answer. I acknowledge he has to read out what has been given to him but unfortunately it states once again that the service is not available for children aged between six and 18. We are going to have to find a solution, and I believe we can. I welcome the pilot programme, although it is phased. It is a small step in the right direction that will deal initially with some children in Waterford city. We need this programme rolled out across the whole city and county, however. I definitely regard it as a step in the right direction.

An issue arose over the posts. There were originally 1.6, which increased to 2.8. There are now 3.8 but the additional post is only temporary for 12 months. Savings found in a different department were allocated to increase the number to 3.8, but the post is not permanent. The fundamental point is that we need whole-term equivalent senior psychologists. We need to be guaranteed at least six of them. I acknowledge it is all down to budgets but, ultimately, when the HSE states there is no psychologist available to a child aged between six and 18 in Waterford, just because of where he or she is living, it is very damning.

I do not wish to play one county against another but I refer to Kilkenny because it has a similar population base. Kilkenny actually has six posts. We have 2.8 permanent posts and the same population. We need to find a solution and find one fast. The only way we will find one is by having permanent posts because, unfortunately, it is very hard for any qualified psychologist to uproot himself or herself and his or her family and move to Waterford if the post there is not guaranteed and is only temporary for 12 months. I welcome the small steps regarding the pilot programme but I believe the only way forward is to get some kind of guarantee that we will have whole-term equivalent senior psychologists.

Jim Daly (Cork South West, Fine Gael)
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The Deputy makes very fair and valid points and has always been very reasonable and particularly constructive in her approach. In addition, her constructive approach has been very consistent. She has been consistent on this matter, and it deserves more attention.

As it happened, I had a number of meetings on more global issues this morning. They covered the provision of services to young people, in particular, and trying to deal with the child and adolescent mental health services, CAMHS, waiting list. These matters are all connected. There is a shortage of psychologists. This is difficult for me and the Department, and much more difficult for those waiting to gain access to services. To address this, we must examine how we do what we do and start doing it in a different way.

As the Deputy will be well aware, a consultant psychiatrist heads each CAMHS team but the reality is that we cannot have a consultant psychiatrist filling every gap that exists. There are similar difficulties at psychologist level. We are currently trying to recruit assistant psychologists. Assistant psychologist is a lower grade. "Grade" might be the wrong word but I refer to a lower level of intervention. We are trying to recruit 114 assistant psychologists, which is proving challenging. In the next year, I hope to roll out a system whereby we would operate a scheme such as CAMHS but with lower level intervention services for children across the country, thereby trying to fill in the gaps with assistant psychologists.

This morning, I said to my officials in the Department that I would like to see tele-psych services in operation. IT has enormous potential in the area of mental health. It does not with physical health. There would not be a need for a consultant psychiatrist to travel 100 km from one post to another if the patient could avail of tele-psych services in a primary care centre through digital technology. The technology is so advanced nowadays that the experience would be the exact same as sitting in a room with the psychiatrist.

There are new ways at which my team and I are looking to address these issues. I will continue my drive and focus in that regard. I will also continue to keep a close eye on the service in Waterford and liaise with the Deputy on it. I appreciate that by raising it here she has provided me with an opportunity to focus on the particular matter to see if we can address the significant issues involved, particularly the disparity between the numbers employed in Kilkenny and Waterford. I will also take up the Deputy's point about whole-time equivalents with the HSE.

Mary Butler (Waterford, Fianna Fail)
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I thank the Minister of State for his reply.