Richard Bruton (Dublin Bay North, Fine Gael)
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I do not think this is a new story for Deputies in this House. They are aware of the serious problem we have with parents who get a diagnosis, wait a long period for an assessment of needs, AON, wait further for a statement of service and for the appointment of key workers, and then face a substantial wait for any therapeutic care.

A constituent who is one example among many was diagnosed at the age of four in 2019. A service statement was received four months later. A key worker was appointed over two years later and there is still no clear line of sight on when the needed therapeutic service, psychology, speech and language therapy and occupational therapy will be provided. In my area in north Dublin, over 3,000 children are in therapy and another 3,000 are waiting for it. The prospect for those in therapy of moving quickly through the system is not great.

I call for a root-and-branch review by the Department of Education, the Department of Health and the HSE of whether the system in place is broken. I was encouraged by the establishment of a pilot in the west of Dublin, where 75 schools and 75 preschools were to be supported by, as I recall, 19 therapists with different skills. This was to be the new approach. Although the pilot has reported positive support and success, the HSE withdrew the speech and language therapist and occupational therapist deployed for Covid work and the scheme has run into difficulties since. It has not taken on the expansion.

In a recent court case, the approach taken to try to move children forward has been deemed not to meet the needs of the legislation. We need to look at everything, including the legislation, to see if we can do better for these children. If we are having assessments of needs, the conduct of which absorbs many therapeutic resources, but then have a wait of three years before services are provided, one would question the value of the resources that go into such assessments. Three years on, the situation may be quite different. One wonders whether the education approach could deploy more effectively.

Some people will argue, rightly, that some children need one-to-one care that cannot be provided in a school context, but the HSE has now moved to provide group care support to parents. Why not provide supports to SNAs and resource teachers? There are 19,000 SNAs and, if I am not wrong, 13,000 resource teachers. That is a vast resource compared to, in my area, 230 therapists, where the vacancy rate is almost one third. We have a resource supporting children with special needs. We need a deep reassessment of how we deploy the resource, which includes therapists, SNAs and resource teachers. Can we find a better way to support children, rather than having these long waits? At seven years of age a child is struggling and one wonders if it has been left too late, even if they get that intervention. I call for Ministers to get together, form a working group and have a serious review of this approach.

Josepha Madigan (Dublin Rathdown, Fine Gael)
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I thank the Deputy for raising this Topical Issue matter. It is an important topic. As a previous Minister for Education and Skills, the Deputy did a lot of work. I think he introduced the school inclusion model, which I will talk about momentarily.

My Department's main responsibility in this area relates to the provision of education for children with disabilities, whether in mainstream settings, special classes or special schools. The provision of therapy supports for children with disabilities, as the Deputy pointed out, is a matter for the Department of Health and the HSE.

Having said that, I note what the Deputy said about a root-and-branch review and making sure that involves interdepartmental work. We have to take a cross-departmental approach to supporting our children and young people with disabilities. I assure the Deputy that a lot of work is happening in this space across the education and disability sectors. At ministerial level, I work closely with my colleague, the Minister of State, Deputy Rabbitte, to progress a range of issues and new initiatives.

The Deputy has raised two important topics: reinstating therapy supports in our special schools and the school inclusion model.

It is important for the House to understand that expanding the school inclusion model instead of providing therapists into special schools is not in the best interests of children with special educational needs. The comprehensive on-site health and social supports to special schools that are provided by the HSE are entirely separate to the Department's school inclusion model. The school inclusion model was never intended to replace therapy services being provided by children's disability network teams in the HSE. Children need access to both community and school-based services.

The Deputy mentioned the reinstatement of therapists in special schools and the AON. My Department and the Minister of State, Deputy Rabbitte, have been working on this. My Department has been advised that the HSE has developed a programme for the reinstatement of 136 posts, which is in addition to the 85 reinstated posts for special schools announced in 2021. The intention of the HSE, as we understand it, is to implement the programme in three phases. The first phase will involve reassigning existing HSE staff to fill one third of the posts over September 2022 and the second phase will fill a further one third of the posts via existing panels, supported with further reassignment throughout autumn. In parallel with the first two phases, a number of initiatives will also be commenced, including a high-profile international recruitment campaigns to fill vacant occupational therapy, speech and language therapy and physiotherapy posts.

My Department meets regularly with the Department of Health, the HSE and other Departments to monitor the progress being made on the reinstatement of these posts in our special schools. The latest update from the HSE indicates that 55 of the 85 posts allocated to support special schools in 2021 have been filled. My Department has been advised that the trade union representing personnel involved in this work issued an instruction of non co-operation to its members regarding the reinstatement process. However, I understand that intensive discussions between the HSE and the trade union are ongoing to address the concerns of its members with regard to this initiative. The HSE remains committed to the programme and continues to engage proactively with the union to facilitate a resolution to this matter.

Richard Bruton (Dublin Bay North, Fine Gael)
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I thank the Minister of State for her reply. The root of the problem is that the demarcation between education and health is far too rigid. I question whether that is the reality of the experience of parents. As the HSE is not able to provide the one-to-one therapy, it is moving to group therapy and is encouraging and supporting parents to do drills, supports and activities. We have 19,000 SNAs and we increase that number by 1,000 each year. We have been successful in developing that service. There is not a high exit rate and there is not a problem with filling the posts we are assigning. If the problem is that we cannot fill the therapeutic posts for the foreseeable future, we need to look at whether we can develop a way in which therapists would work with SNAs and resource teachers to provide parents with a better context within which they can support their children. I do not see a prospect of the three-year wait being suddenly reduced. The effort was found to be faulty by the courts. Maybe the existing law is out of touch with the reality of trying to develop services in this area. I would go back to my original request. There needs to be a root-and-branch look at this, rather than the current approach where the two Departments stick to their demarcation lines with one recruiting speech and language therapists and the other recruiting SNAs and never the twain will meet. The pilot was a very good and optimistic route. I admit that it will not solve the problem for every child. However, it would allow us to reach more children and reserve precious therapeutic time for the children who need it most. I strongly advocate looking again at this whole context and framework.

Josepha Madigan (Dublin Rathdown, Fine Gael)
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I note what the Deputy said about the court ruling. He spoke about the demarcation between the different Departments. The Department of Education will be assisting the HSE in relation to the AON process, which will hopefully speed up the time within which children will get therapists and the therapy they require. The HSE is responsible for therapists being provided to special schools. I appreciate the point the Deputy is making about collaboration between Departments. Rather than having Departments in their silos, they can work together. I assure the Deputy that I am working very closely with the Minister of State, Deputy Rabbitte, in this regard to try to sort out these issues, as well as working with CORU on workforce planning for therapists. That is a big issue and is the primary reason the school inclusion model the Deputy referred to has not been expanded. That has recommenced within the pilot, which was run in Kildare, west Wicklow and south-west Dublin. There were 75 participating schools. It was a multidisciplinary approach with occupational therapists, speech and language therapists and behavioural practitioners. We want to be able to expend that throughout Ireland because it would be a gold-star service for our children who so badly need it. That is a separate type of multidisciplinary approach to the therapists that are being provided to the HSE. I agree that we need to keep this under constant review and make sure we are doing everything we can to provide these services to children with additional needs. That might mean changing practices or looking at things differently and I concur with the Deputy in that regard, particularly given the experience he has had as Minister for Education and Skills.