Seán Crowe (Dublin South West, Sinn Fein)
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I have raised this matter directly with the Taoiseach and the Minister for Education and Skills. I have also written to the Minister for Health, the Minister of State with responsibility for disability and the Minister for Children and Youth Affairs. I hope I will get an answer to my question today.

I am sure the Minister of State will agree that it is appalling that a child with profound and complex needs must wait 42 months to have its needs assessed by a team and, hopefully, addressed through speech and language therapy. That is the official waiting time for a child in community healthcare organisation, CHO, area 7. In response to a letter I wrote in June 2018 concerning a child who had been waiting for assessment since 2016, I was told there were 95 other children ahead of the child in question and the team was working at maximum capacity. At that stage, the team was dealing with referrals made in May 2015. In December, I wrote another letter to CHO area 7 about a separate case. This time, I was told that there were 298 children ahead of the child in question on the speech and language waiting list, a further 80 children were being screened and a further eight were waiting to transition from the early intervention service to the speech and language service. There are currently 222 children ahead of this particular child. The current waiting time for assessment is 42 months.

According to the reply I received, there has been no movement on the waiting list in the past 11 months owing to the large number of children who have transitioned from the early intervention service, the capacity caseloads of team members, delays in filling vacancies and the failure to replace staff on maternity leave. I was also informed of the staff positions that are vacant. A staff grade educational psychologist post has been vacant since December. A staff grade psychologist is only available on a half-time basis and a half-time senior speech and language therapy position is also vacant. Other posts that remain unfilled include a social worker and a staff grade physiotherapist. It is clear the team is broken and that this is causing the backlog.

A significant increase in health and social care professionals is required to adequately meet demand for services for children in CHO area 7. Additional resources are required to address the backlog. It is unfair that any child is left in this position. One expert told me that every day that a child is left without this support represents a backwards step of two days. For a child waiting three and a half years that represents seven years in his or her development. This must not be allowed to continue.

The latest census figures suggest that the increased population and increased prevalence of disability will result in increased demand in future. Families and parents are at their wits' end. Where do they go from here? Clearly, the system is broken. One suggestion is that parents should go down the private route, but that is a costly alternative. Many of the families who contact me are not in a position to take the private route.

Does the Minister of State agree that the policy of early intervention is not working if children must wait 42 months to secure access to a team? God knows how long they must wait after that to receive speech and language therapy.

Catherine Byrne (Dublin South Central, Fine Gael)
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CHO area 7 covers some of my constituency and I deal every day with some of the issues raised by Deputy Crowe. It is very disturbing and frustrating for parents who are left waiting for such a long time.

On behalf of the Minister for Health, I thank the Deputy for raising the very important matter and for providing the opportunity to update the Dáil.

The Government accepts that there are challenges in accessing times for speech and language therapy services and that this is a concern for patients and their families. I assure the Deputy that every effort is being made to reduce waiting times nationally and at the local level in Dublin South-West. The challenges we face in ensuring timely access to services should not be underestimated. Not only is the demand for speech and language therapy and other therapy services increasing across the country, but the HSE reports that the complexity of individual cases is increasing.

The speech and language therapy team in Dublin South-West works across primary care and disability services. In the primary care sector, the majority of the service is focused on the needs of children under 18 years of age. In the 11 months up to the end of November 2017, 1,377 referrals were accepted in the area. The current position is that 713 people are waiting to be seen for an initial assessment, 244 of whom have been waiting for longer than one year. All of those waiting over one year are under 18 years of age, with the majority of these individuals awaiting specialist disability multidisciplinary team assessments and interventions. In addition, 313 individuals are waiting for initial intervention following assessments.

It gives me no pleasure to inform the Deputy of such numbers. The Minister, Deputy Harris, is conscious that behind these figures are real people seeking care and support. Access times for speech and language therapy services are too long, and it for this reason that we have introduced a range of measures to address the problem.

Funding was provided in 2016 for speech and language posts to prioritise the longest waiting children. CHO 7 was allocated an additional 16 posts under this initiative. Other actions taken to improve services in the area include the establishment of drop-in clinics that provide advice and support, the provision of maternity leave cover and the introduction of new models of working. Of particular note is the in-school speech and language therapy demonstration project that is now up and running in CHO 7, covering Dublin, south Kildare and west Wicklow. This joint collaboration between the HSE, the Department of Education and Skills and the Department of Children and Youth Affairs provides occupational therapy and speech and language therapy services across 150 schools and preschools. Under this scheme, children can receive in-house therapy services with the aim of delivering therapeutic interventions as early as possible to support their social skills, mental health and academic performance.

The HSE's national service plan 2019 reflects the Government's commitment to improve access to primary care services such as speech and language therapy. It contains provision for the recruitment of 170 additional community nursing and therapy posts and sets a target of 4,500 additional patients to be seen in 2019, with a full-year impact in 2020 of 9,000 additional patients seen. An additional 100 therapy posts are planned to reduce waiting times for the assessment of need under the Disability Act 2005.

The Government appreciates that delays in accessing services can be difficult for the families and children affected. However, the recent investment in speech and language therapy posts, along with new ways of working, such as the in-school project, will support improved access to services and have a favourable impact on the long waiting list, including children on it. Furthermore, the 2019 national service plan contains a number of provisions aimed at improving access to therapy services. This additional investment should make a real difference to patients and their families.

Seán Crowe (Dublin South West, Sinn Fein)
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We raise these issues to try to get some action on them. This year's budget provided an allocation for 100 new therapy posts, but the CHO 7 area has yet to be advised how many of these will be allocated to it. Clearly, this sector needs to be prioritised. It is unacceptable that any child should have to wait 42 months to access key services that would transform his or her life. Not getting that access impacts on the child's development.

To be positive, will the Minister of State ask the Minister to use whatever influence he has in this matter? I have outlined the gaps in the area's team. I do not blame the team operating out of Chamber House, as it does not have the key personnel. This is not the team's fault. However, families and children are being impacted. I have tried everything and do not know what else I can do. The only route I can recommend to the families is for them to go to the courts. I do not want any family to have to do that just to get what the family's children are entitled to, but that seems to be the only option open to them. It would be a costly affair for the State, which will have to deliver services for these children eventually anyway. Clearly, the State is not doing so now. No one can say that the system is working.

The Minister of State's response was actually more depressing than the figures I outlined. This matter needs greater focus from the Minister. I realise that he faces other difficulties, but these are vulnerable children and this issue will not just affect them now, but also as they get older. I ask that whatever resources can be allocated to these children be put in place, particularly the additional resources that were budgeted for this year. This sector needs to be resourced immediately.

Catherine Byrne (Dublin South Central, Fine Gael)
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Numbers speak louder than words. I read this response before coming to the Chamber and was shocked by the numbers. The Minister acknowledges this situation as well, though, and is concerned that efforts are taking so long, particularly given the number of individuals under 18 years of age who still have not been assessed. Access to multidisciplinary assessments and intervention at an early stage is important. In many ways, this is why the new in-school support service has been put in place. Via my grandchildren, I witnessed it starting to operate recently.

I acknowledge that the Deputy has raised this matter with the Minister and the Taoiseach previously and is pursuing it again today. I always say this, but I mean it - I always revert to the main Minister and outline the concerns and anger expressed at the state of the services in question. Deputies do not come into this Chamber to raise concerns like these unless they affect the people in our communities whom we represent.

We have a great deal of work to do in this sector, as I know from the area I represent. In Deputy Crowe's area, my area and others where people are less fortunate and living in communities with multiple problems, people can sometimes be left behind. As soon as the Minister has returned to the House, I will raise the issue with him. I will also raise it with the Taoiseach when I see him. There is a great deal happening in the House, as everyone knows, but issues like this that affect children and others in our communities should be prioritised and addressed.

I compliment those who work in the primary care services, in particular speech and language therapy. They do a job that not only needs a great deal of compassion, but also a great deal of energy, as they work in difficult situations.

I hear the Deputy's concerns and will make it my business to ensure that the Minister hears them loud and clear.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Minister of State. That is appreciated.