Dáil debates

Thursday, 20 January 2022

Saincheisteanna Tráthúla - Topical Issue Debate

Disability Services

6:25 pm

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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I thank the Minister of State for taking this debate. This is an issue I have been trying to raise for some time. Children's disability services in my constituency of Cork North-Central are in crisis. Unfortunately, my constituency is topping the chart in respect of many of the waiting lists. In November, we had the second longest waiting list for an assessment of needs in the State. In December, we had the most children waiting for speech and language therapy, with the numbers waiting for occupational therapy and physiotherapy following close behind. In November, more than 800 children in the Cork north Lee area were waiting for occupational therapy. Behind each of these statistics is a child and a family on a waiting list. That child is probably regressing and is certainly not making any progress.

I was in contact with a lady whose ten-year-old daughter has been diagnosed with anxiety and dyspraxia but who is still waiting on an assessment of needs. Without this, she cannot access much-needed targeted services. In other words, her life is on hold.

I am helping a young boy who was referred for an assessment of needs in October 2019. He was assessed in April 2020 but no service statement was issued until July 2021. He needs occupational therapy, speech and language therapy, physiotherapy, psychological treatment and social work. In July of last year, his mother received a letter informing her that her child would begin to receive services in July 2022. For a short period of time, this child was getting services. That is the tragedy here because, in that time, the child began to learn words. He was beginning to communicate with his family but, because of the loss of services, he has now regressed and no longer has any words to speak. Can the Minister of State imagine the devastation that his parents feel when they see how their child has regressed before their eyes?

In another case, a mother has told me that her child is waiting for access to speech and language therapy. This mother has gone on a 12-week course which has essentially taught her how to provide her child with the therapy needed. I have spoken with dozens of parents whose children have special needs.

What all those parents tell me is that as soon as their children need a diagnosis, from that moment on they must fight the State to get the services their children not only need but are entitled to.

I am dealing with parents in my constituency weekly who have children in need of these vital services. It is unbelievable that in 2022, given all we know and all we have learned, that we are allowing children and families to be in these situations. Some parents tell me that they go without themselves because they cannot get the services they need and they are now trying to pay for these services privately. Many families cannot afford to do that. It is tragic when parents are trying to provide services that the State should be providing and that the Government has committed to providing, but has failed to do so.

6:35 pm

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important issue. I also acknowledge my colleague, Deputy Christopher O'Sullivan, from the same area of Cork, who would echo Deputy Gould's frustration, and, indeed, he has done so. It is important to acknowledge that the HSE has had considerable challenges implementing the progressing disability services programme. This has resulted in delays for families trying to access much-needed therapies for their children. I regret that, of course, and I once again express my sincerest apologies to any family experiencing such delays and the hardship as articulated by the Deputy this evening. Behind every child is a family and siblings, and all of them are impacted by these situations.

In Cork, and indeed around the country, one of the issues with the reconfiguration has been staffing. To get a proper insight into the shortages that children's disability network teams, CDNTs, were facing, I asked the HSE to conduct a staff census across the network. I confirm to the House that it has found that 24% of posts are vacant because of statutory leave and unfilled vacancies. This means that the teams are, essentially, operating at 75% before considering any of the additional posts they need. The reality is that there are recruitment challenges due to the significant availability of new posts across the wider HSE, in areas such as primary care, services for older people and acute hospitals, as well as in the private sector. Coupled with this are temporary absences on some teams related to maternity leave and, in other instances, Covid-19-related sick leave.

This is not to make excuses, but to be open with the Deputy and the House regarding the issues I am trying to address to get the service to a level where children are receiving therapies, rather than languishing on waiting lists. In Cork specifically, as the Deputy will be aware, the children's disability network teams have been reconfigured since April 2021. I travelled down with Deputy Christopher O'Sullivan and met representatives of Enable Ireland during the summer. There are 14 CDNTs in the Cork-Kerry community healthcare area and the location of each aligns with the 14 community healthcare networks. Each network team is managed by a lead agency, namely, the Cope Foundation, the Brothers of Charity, Enable Ireland, Co-Action or St Joseph's Foundation. I met representatives of all those organisations in the last three months to articulate exactly the issues the Deputy raised this evening, namely, how we are going to get the interventions, how long children are waiting and when we can cut the waiting lists to ensure there are timely interventions. I want to get rid of this situation where securing assessments of needs has turned into an industry. What families need is intervention.

In 2021, I secured an additional 100 posts as part of the HSE national service plan 2021 to bolster the teams across the country. Teams in Cork and Kerry received an additional 7.5 posts from this overall pot. In addition, another 85 posts were added under the special schools allocation mid-year last year. An additional 5.8 posts were also added. This was a total uplift of 13.3 posts in 2021, six of which have now been filled. I will share with the Deputy what I found out yesterday, which is that of 180 posts, recruitment has only successful filled 50. That is my challenge. I know what needs to happen but I cannot magic people into posts. The Government has provided the funding, we have done the reconfiguration and the staff are working at 150%. I hear from all my colleagues around me the frustration of the families. The problem is that we do not have enough therapists to fill the posts. As I said earlier, there are considerable challenges, and the filling of the vacant posts will be my priority for quarters 1 and 2 of 2022.

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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I have no doubt that the Minister of State's comments were made sincerely. The issue in Cork now, however, is that there are 11 children's disability network teams but only one of them is fully staffed. More than 800 children are on the occupational therapy waiting list in Cork north Lee, but there is only one occupational therapist, OT, for all of them. Is it any wonder that we are having huge problems with staffing in a health service where the staff are working under these conditions? The pressure and the stress these staff and the therapists are under must be only immense. With two psychologists funded, less than half, 0.4, of the posts have been filled in Cork north Lee. This is a disgrace, because this is a vital service. Children are losing their childhoods while they are on waiting lists. The situation in Cork has reached the stage where there is no longer a postcode lottery. No matter where people live in Cork now, the services are in crisis. The question is how bad the crisis is.

I have heard the Taoiseach, in particular, talk often and loudly about the importance of early intervention. Where is the early intervention for the 293 children who have been waiting for more than two years for speech and language therapy? More than 717 children have been waiting for longer than 12 months for occupational therapy. This situation is not getting better. It is actually getting worse. As for the point the Minister of State made about the challenges, surely someone has looked at the number of children who need support and therapies and has put a plan in place. I say that because there seems to be an ongoing delay in recruitment. When positions come up, it seems to be months before they are filled. We need proactive planning and organisation to fill these posts. The Minister of State, or the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, needs to sit down with the colleges, point out that we have a shortage of therapists and ask those institutions if they can provide the courses to help to fill these posts. We must do something. People, including children, are in crisis. I sincerely ask the Minister of State to do everything she can.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I have sat down and met everybody the Deputy spoke about just now. To recruit and get speech and language therapists into posts takes five years. It is the same in the case of occupational therapists and physiotherapists. Along with the Minister, Deputy Stephen Donnelly, I am working with the HSE on access to care. I refer to getting people off the 24-month waiting list. A plan is being devised, which I look forward to announcing with the Minister later. The Taoiseach has always spoken about early intervention and that is why he has allowed me to undertake the progressing disabilities services programme. The simple reason is that we want no child to age out of these services. We do not want children to be on one queue, only to fall off it when they turn six years old and have to join another queue. In the context of this progressing disability services strategy, this time last year there were only 30 of them. Today, I have them all reconfigured. There is no more aging out of children in this State. When children are on a waiting list, they now stay on that one waiting list.

The Deputy opened his contribution with comments regarding children waiting for autism spectrum disorder, ASD, assessments. Majella Daly is the head of disability services in Cork. I met her on all my calls with the providers. I and Ms Daly, and her team, are putting in place a comprehensive and bespoke action plan in CHO 4 to ensure that we move people off waiting lists. I thank Ms Daly and all the staff and therapists, because they are always willing to change to meet the needs. That is the case at all times. There will be a plan for the parents, not just in CHO 4, but in every CHO around the country.

We are going to cut waiting lists this year. This is my priority. I am prepared not just to rely on our recruitment process to deliver services. I am prepared to look at alternative models.

6:45 pm

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
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It should not be up to a parent to provide a service either. The Minister of State might look into that as well, please.