Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister of State for being present this morning. I look forward to her response.

We all know the importance of early intervention for children when it comes to critical therapy services. I know this is also a matter close to the Minister of State's own heart, and that of the Taoiseach. I have spoken to both of them previously about cases I have been working on and they are also looking at these issues and trying to find the answers. However, I am sorry to say that in many cases at the moment, we are not getting there soon enough. What is worse, for many worried parents, is the complete lack of empathy shown by the HSE. I will read a recent email from a very stressed parent in my area. She states:

... I have another pressing concern for [my son]. He is in serious need of speech and language therapy. He was [given] an initial assessment for speech and language in Shamrock Plaza in April 2021. We were [given] exercises to do and were scheduled to go back in June 2021. We received communication that we had been transferred to the disability team. There has been a lack of communication from then in the past year apart from last summer when they were in the process of moving this service over.

I've called numerous times to try [and] speak to someone. The only communication I've received in this regard is a letter to tell me to stop ringing them. They are too busy to give [my son] an appointment. It is absolutely ridiculous how our children and the families of these children are being treated.

[My son]'s paediatrician has sent letters to the service explaining the urgency of the situation ... They haven't even received a response to these letters.

[My son] is scheduled to start preschool [at the end of August this year] and national school in 2023. He is being let down by these so called services again and again. He is well able to attend main stream school but the longer he is left without these services, the harder it will be for him to settle into school.

At the end of that email, the lady in question wrote a very serious line, asking, "Can you please help some very stressed parents?" They are at breaking point. What I want to know is how the Minister of State can help. Would she agree that this is no way to treat parents? The parents who are contacting me are at breaking point. The communication from the HSE to the parents has not been acceptable. This lady told me she has been tormented. She has been ringing and ringing and yet has not received any other information. No one is communicating with her. What can we do? How are we with regard to early intervention services for the children who need them in CHO 5, Carlow-Kilkenny?

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important matter and for giving me the opportunity to speak on it. She is right that I take this issue very seriously. A script has been circulated but I am not going to stick to it. I would like to tell the Deputy the case she has raised is unique. I would like to say that parent is the only parent in the country who is experiencing this. I would hate that parent to think I have sat on my hands for the past 12 months. I have repeatedly asked the HSE to improve its communication. To spend the time to write a letter to that parent to tell her to stop contacting the HSE is unforgivable. There is no excuse for that. That woman, like any other parent, is seeking services for her child so she can give him the best start in life. That is what early intervention is about. Time and again, communication has failed us, whether in how we communicate with parents, how we communicated the reconfiguration of progressing disability services for children and young people, PDS, or how we told parents what PDS teams they were part of. We have failed again and again.

That is why I secured funding in the most recent budget to ensure we would have administrative staff on all those teams. If we had dedicated people to answer the phone and ensure communications went out, parents would not get to the level of frustration where they have to continuously contact their public representatives to make representations so their child may get seen to or even find out where they are on the list. The plan was that there would be two posts, a grade 3 and a grade 5, on each of those teams, so the telephone would be answered and proper communications made.

My office has worked tirelessly with national head office within the HSE to support it in terms of what good communications might look like and what parents are seeking, that is, information on when the team will be reconfigured and how the process will involve the parents.

It is regrettable that the parents' forum part of PDS has been established in only five of the 91 teams. Through this forum, parents can come together and get a clear understanding. When I was in Cork recently, one parent said that, if parents knew what the plan was and understood it, they would work with the HSE but that there had been no communication whatsoever. This is no way to treat parents. Communication is the essence of what PDS should be about from the start, not telling parents where their children's cases are in April, moving them in June only to then leave them not knowing what is happening.

Without proper early intervention and diagnosis, services cannot be accessed. The HSE talks about delivering needs-based services, and we know from recent months that, if people want to access social welfare and education services, they must have their diagnoses. Early intervention is key.

The Deputy asked about CHO 5, what position it was in compared with other CHOs and so on. No different from any other CHO, the Deputy's CHO is under immense pressure relating to the recruitment of staff. To support teams on the ground, I wrote to the Tánaiste in recent weeks asking for occupational therapists, physiotherapists and speech and language therapists to be included on the critical skills list. Doing this would be important. I have also met Mr. Paul Reid and the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman, in recent weeks. We want to put together a roadmap - we will have it in the next four weeks - for bolstering our PDS teams. While I am committed to the PDS, we must consider more agile ways of supporting families in getting interventions. This would involve returning therapists to special schools.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I can see how passionate the Minister of State is. I met CHO 5 two weeks ago when I raised my concerns about communications regarding services. The CHO told me it was understaffed. While I believe it is doing its best, there is no communication from the HSE to the many families involved. Some sort of system needs to be put in place so that parents can be told there is a plan. We need a plan from all of the CHOs, although I can speak only about CHO 5.

Early intervention is important. From speaking with parents, I know they are tormented about this and concerned for their children. Could there be at least more communication with them so that they are told what will happen but that it will take a few months longer because the CHO is understaffed? As the Minister of State knows, it is unfair if there is no communication. I am concerned for the parents and the children. It is not good that parents are contacting us saying they cannot get answers. I even feel I am not getting answers unless I go to the Minister of State.

We need to recruit staff as quickly as we can. We cannot have children not being assessed or not receiving the therapies they deserve just because their parents do not know what is happening. We need to sort out this issue as soon as possible. How will we put a better plan in place through all of the CHOs so that there is communication for parents?

Anne Rabbitte (Galway East, Fianna Fail)
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As I have repeatedly stated, it is my job to seek funding for the HSE through the good offices of the Ministers, Deputies Donohoe and Michael McGrath, and then to operationalise that funding. For the past two years, I have been successful in the funding I have acquired. While I am grateful for that, it is disheartening to secure enough funding for 475 posts but for it not to be operationalised on the ground. I was disturbed to discover recently that the HSE did not have a pay grade for behavioural therapists. Section 38 and section 39 organisations do. I am grateful that Mr. Reid has taken on board this issue and I hope to see behavioural therapists as part of my plan.

Funding is available, so this is not a resource issue. We need to consider a more agile approach. I am working with the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, on trying to create more third level spaces, but let us be realistic, it will take three to four years for those places to come on board. This is why the critical skills list is important, as is an examination of what is being produced in Northern Ireland and the rest of the UK in terms of speech and language services. From what I gather from CORU, only two modules are missing. Why not recruit those staff but train them in those two modules while they are in place? The main dearth of delivery is in speech and language therapy. We need to consider a more agile approach that works with the universities across the Border that are producing speech and language therapists and creates opportunities for them. I have also discussed assistant psychologist posts and funding and supporting assistant psychologists in education as a way of encouraging them into the service.

It is important that we return our teams to their maximum capacity. Until such time as they are at least 90% staffed, we cannot train young people coming through college because there will not be proper clinical oversight.

A great deal is happening and I hope that I will be able to answer the Deputy better within the next four weeks.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister of State.