Dáil debates

Thursday, 9 December 2021

Saincheisteanna Tráthúla - Topical Issue Debate

Disability Services

3:15 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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This Topical Issue matter is to ask the Minister of State to give an update to the House on the roll-out of the progressing disability services for children and young people, PDS, programme in Waterford and in the south east. There is also the related issue of the operationalising of the children's disability network teams in the same region. I thank the Ceann Comhairle.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Ceann Comhairle for selecting this issue and for giving me to the opportunity to respond. I also thank the Deputy for putting this Topical Issue matter down for debate. From the outset, I wish to acknowledge that there have been considerable challenges in certain parts of the country in the implementation of the PDS programme by the HSE. This has resulted in delays for families to access much-needed therapies for their children. I, of course, regret that and I wish to put on the record my sincerest apologies to any family experiencing such delays. I have only just come off the telephone with the HSE and, as such, my script has changed.

There are 12 teams in the area that the Deputy has mentioned in the south east. These 12 teams are made up of one which is led by Enable Ireland, based in Kilkenny. One is led by the Central Remedial Clinic, CRC, which is for the Waterford south city location. The other ten areas are led by the HSE, which comprise Carlow, Thomastown, Enniscorthy, Cashel, Clonmel, Dungarvan, Waterford north city, New Ross, Gorey and Wexford. The whole-time-equivalent staff complement working within all of that area is 168.15. There are vacancies there at present. When I refer to vacancies, the Deputy should be aware that I am talking about people who are on maternity, sick or parental leave or shared time which is 40. The number of complex needs children is 4,600.

I refer to active recruitment in the context of 2021 and the funding I provided in phases 1 and 2 and the special schools. It comes to 16.05 in terms of whole-time equivalent staff. In that regard, staff have been recruited to only three of the new additional posts that I allocated to CHO 5. That is not down to a lack of funding. The funding is there. Three staff have been recruited and there is a shortage of 13.05 whole-time equivalent staff. In addition, 40 staff are on various types of leave. That is a considerable number of individuals missing from key posts within the various groups.

That is not to take away from the work being done at present. I compliment the staff who are there on the front line and who have helped with delivering assessments of need in the past 12 months. The reconfiguration took place on 27 September 2021. For the three months beforehand, access was determined taking account of what was closest to your school or your address and families had a choice in all of that. I compliment the Minister of State, Deputy Butler, because she brought to my attention that the access was not working and that on the Dungarvan side, for example, people were getting notified that they must choose a particular location. We changed that to give parents the choice of closest to home or to the school. That is an overshot from an operational point of view in terms of exactly where we are at this moment in terms of the progressing disability services, PDS, model being rolled out in the south east.

The recruitment is being progressed as a matter of urgency by the HSE national recruitment services, and directly in the case of section 39 lead agencies, to support network teams to optimise service delivery. The area represented by the Deputy is in a fortunate position because ten of the teams are run by the HSE. Only two of the teams are section 39 groupings. The complete control, ownership, power, direction and sense of travel all rest completely with the HSE. It knows exactly what the service level provision is. It sends that in. It is in control of the direction of travel. This model of PDS is one it has designed and implemented and has been ongoing since 2014. I have just finished a phone call with Gobnait Ní Chrualaoí of CoAction in Cork who was part and parcel of the setting up of it at the very beginning. There is nothing new here for the HSE. It is just that, as part of the reconfiguration, the transfer of files took longer than would have been optimal. Communication has not been of the best quality but I am confident that now that we have reconfigured, communication will improve.

3:25 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I welcome the acknowledgement by the Minister of State that there were difficulties and challenges in rolling out these services and establishing the networks. Any Deputies who understand changing structures know that doing so is very difficult and challenging and, obviously, trying to align staff under the new structures was always going to be a difficulty. I certainly accept what the Minister of State has said in good faith. However, I want to get to an important part of the scripted response circulated on her behalf. It states:

Of the 100 additional development posts that were approved to strengthen Network Teams across the country in 2021, 13 were allocated to CHO5. However, only 3 of those posts have been filled due to challenges in recruitment and due to staff preferences for work in other care group areas.

We know there is a difficulty in the recruitment of staff in many areas of the HSE. We are seeing it in the area of home helps as well. The difficulty is obvious in the area of support staff and very important staff needed to roll out services for children with disabilities. There are several issues that arise from that.

I met a group of parents from the south east last week. They had mixed experiences. Some were getting good services, while the services others were getting were not so good. I found that the service level overall was very patchy, depending on where the person lived or the type of therapy his or her child was getting and possibly depending on availability. The Minister of State referred to the Minister of State, Deputy Butler. We met Finian McGrath when he was Minister of State with responsibility for disabilities several years ago regarding the need for additional speech and language therapists, occupational therapists and other posts to ensure the capacity was there. I am not sure that capacity was ever put in and I am not sure there is currently the capacity necessary to provide the services. For all the talk of early intervention, it still does not happen for too many children. What really concerns me is that the Minister of State's scripted speech notes there is a current waiting list of more than 1,000 children for ASD diagnostic assessments in the south east. That is a very high figure.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Absolutely. The Deputy is right in respect of retention and recruitment and the challenges that exist in the context of trying to make disability attractive as a workplace. This week, I met Mark Smyth of the Psychological Society of Ireland, who sent me a submission relating to various grades and preferences. In fact, if there are more senior posts, it may be easier to attract and train in staff. We also need to look at the panels. I am sure the Deputy is considering that in his role as a member of the Opposition. The panels have been in place for the past ten years and we have to question whether they are effective.

It must be acknowledged that it is predominantly a female workforce. We need to start factoring in the fact that people are on maternity leave, paternity leave or extended leave. That comes at a price of 40% over and above the baseline. That is what we need to discuss. Prior to the call with Gobnait Ní Chrualaoí I was on a call with Deborah Jacob of CHO 7. We discussed the need to have relief panels booked with the HSE so that there are people with a rich skill set available to cover for staff on maternity leave and be put into one of the teams. That would ensure consistency in the delivery of care and the continuation of that pathway and the level of clinical governance and oversight for the junior grades. Deborah and her eight counterparts around the country would be in control and we would at all times be able to identify the needs and fill the gaps utilising a rich team of therapists within the gift of the HSE.

To go back to the Deputy's final point in respect of the 1,000 children awaiting ASD diagnostic assessments, it is a priority for me. Like the Deputy, I was very disappointed to see that figure this afternoon.