Jackie Cahill (Tipperary, Fianna Fail)
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I want to raise the issue of the number of psychologists on the north Tipperary children's disability network team, CDNT. I recently received a response to a parliamentary question I submitted to the Minister for Health in which I was informed that there are currently seven whole-time equivalent psychology posts in the area. Following further inquiries, however, I came to learn that two of these posts are currently unfilled. As things stand in north Tipperary, we have two senior psychology posts and two staff grade psychology posts filled, two vacant staff grade psychology posts and one psychology post that has been filled. Furthermore, the north Tipperary CDNT currently has a caseload of 1,473 children, 339 of whom are on waiting lists for supports.

North Tipperary also has 42 children requiring an autism spectrum disorder, ASD, assessment. Until this assessment is carried out, it is next to impossible for parents to get the supports and early intervention and help they need for their children.

The HSE was unable to tell me how many additional psychology posts will be necessary in the north of my county to clear the waiting list of 339 children as it currently stands. The HSE was also unable to tell me the caseload figure for each psychologist in the area as the number of clients requiring psychology input changes on a daily basis.

I have serious concerns that the HSE is failing to fill these two vacant posts, one of which has been vacant since March 2022. As long as these posts remain vacant, the waiting lists will continue to grow and families and young people will be left without the intervention supports and attention they need and deserve. The psychologists in the filled posts are doing their best. I am by no means criticising their work but they are under too much pressure.

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They are being assigned too great a workload and those in need are not being seen in a timely manner to get the assistance and the interventions they need at a young age. From speaking to numerous families affected by this across north Tipperary, I know there is a deep cause of frustration and concern from a very significant number of people. Particularly when one looks across county boundaries or even parish boundaries, where other areas are served by a better service under a different healthcare region.

I see in Tipperary that there is a divide between the north and south in disability services for children as the county falls into separate healthcare regions. A person's Eircode should not determine the level of care they get. A parent certainly should not have to see their child waiting and not progressing in life as they should, while they wait for these essential services and while children in other areas are receiving interventions much sooner. That is unfortunately the case for early intervention services all too often in north Tipperary. The postcode lottery needs to be tackled.

With 339 children on waiting lists in north Tipperary and with a team of five whole-time equivalent psychology positions expected to cover this workload, this is only going to see this issue exacerbated.

What plans does the HSE have to tackle the growing waiting lists in north Tipperary for children's disability network team supports? When will the vacant positions be filled? How long will it take to clear the backlog of patients waiting for appointments with psychologists? Why has the HSE failed to fill these two vacant positions to date? If it is a case of additional remuneration required to fill these positions, or better administrative supports so that the psychologists can be freed up to do their jobs to the best of their abilities, then packages need to be put in place. The children of north Tipperary need better, more efficient, and more reliable supports in this area.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important issue and for giving me the opportunity to discuss it in the House this evening. He raised some very valuable questions in his contribution. As Minister of State with responsibility for disabilities, I recognise and acknowledge that the Progressing Disability Services, PDS, programme has been challenging for many stakeholders, but especially so for families, the children, and the young people using the service. It is also important to acknowledge the challenges that are there for staff because they are working under tremendous pressure. These challenges have resulted in unacceptably long delays for families to access much needed therapies for their children.

As Minister of State, I once again want to put on the record my sincerest apologies to any family experiencing such delays. Prior to the introduction of the PDS programme, children in different parts of the country with the same needs could be given much more, or, much less service, based on geography rather than need. This was clearly unfair and needed to change. The core principle of PDS is to achieve fairer and more equitable access to services for all children with disabilities, based on their needs, and not where they happen to live.

Regrettably since PDS was rolled out, there has been a levelling down of services to children and families. As I said previously in this House, the reconfiguration of children's disability network teams, CDNTs, by the HSE across the country has faced particular challenges with regard to recruitment. There is currently an average vacancy rate of 28% across the 91 CDNTs, which equates to approximately 524 vacancies out of a total allocation of 1,892 staff members. Notwithstanding these challenges, it is important to acknowledge the significant work involved in establishing the CDNTs.

Approximately 35,000 children are currently receiving services and supports provided by these teams. The underlying vacancy rate in CDNTs is not because of a lack of Government resources. In that regard, I have secured funding for the HSE for additional posts in recent years to strengthen the capacity of CDNTs to ensure services can be provided.

I take on board what the Deputy is saying in respect of the remuneration to retain the staff, where if a person has been there for a certain number of years, he or she should be moved to a senior post, so that we can at least backfill into the more junior grades in order to retain that skill set. That it is there. I am very clear in my saying that to the HSE. We need to flush through our panels to ensure we fill as many posts as possible between now and the end of the year and the start of January. Where do not fill them, we need to ensure our senior posts are protected. If people have worked on those teams for a number of years, those staff members need to be given the opportunity to apply for positions, so that at least we have a senior clinical grade on the team.

There are two senior posts, which the Deputy outlined. There are two staff grade posts that are filled and a psychology assistant post that is filled. Currently, there are two vacant staff grade posts that, despite repeated efforts, the CDNTs have been unable to fill. It is regrettable that one of these posts has been vacant since March 2022, and the other since May 2022. The challenge to recruit staff grade psychologists is echoed across the mid-west and nationally. Even in CHO 2 in Mayo, where there are three CDNTs, it does not have one psychologist between the three teams. We need to look at a far more agile approach.

The proposal, which from the Psychological Society of Ireland, PSI, is a very good way of remunerating people and giving them the opportunity while they learn their skill to have clinical oversight and perhaps giving us the opportunity to retain them for the four or five years.

Perhaps if I had not had a more challenging budget, this would have been one of the priorities I would have ensured happened. The two other Deputies in the House are from CHO 4 which this year adopted that exact model in regard to four positions because it was failing to recruit. This is something that needs to be mirrored right across the country. I will deal with the rest of the Deputy's questions in my next response.

Jackie Cahill (Tipperary, Fianna Fail)
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I thank the Minister of State and I acknowledge her efforts in the area of disability. I also acknowledge the work the staff are doing. No staff working in this service want to see waiting lists. When parents who are waiting for an assessment and services for their child ring me, their frustration is so palpable. They very much feel they are letting down their child and not giving them the best opportunity to fulfil his or her potential. That is regrettable.

The figure in the Minister of State's reply that nationally 28% of posts are not filled is very worrying and serious. We have a critical problem here.

The Minister of State referred to the fact that recruiting staff is one thing but retention is another. If the remuneration package is not at a level that is needed to ensure retention of staff in the future, it must be looked at as a matter of priority. We cannot let these young children and parents down. Whatever extra resources the service needs to ensure we recruit and retain staff in these positions have to be provided.

In my county, we have a problem in the north of it. The south of the county is far better served. That brings its own frustration as people see, as I said in my original contribution, that it is their postcode which is resulting in a lack of services. That is very frustrating for parents. I acknowledge the efforts being made but I urge the Minister of State to use her persuasive powers, which are very strong, with the HSE to ensure the remuneration packages in place allow for the retention of staff when we fill posts and that we try to fill those posts as a matter of urgency.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy. I reassure him and the House that the HSE continues to explore a range of options. The targeted national and international recruitment for CDNTs is what I am talking about in terms of the end of the year. There is the sponsorship and the apprenticeship programme, the targeted international recruitment, with an agreed reallocation allowance, a sponsorship programme for therapy grades, an apprenticeship programme for therapy grades, employment of graduates as therapist assistants as they await their CORU registration, and an expansion of the therapy assistants in the system.

Only this week I met with Mr. Maurice Hoare from CHO 3. Believe it or not, while north Tipperary is an outlier in CHO 3, the vacancy rate in CHO 3 in children's disabilities is the lowest in the country at 10%. That is poor comfort for the people for north Tipperary but that is what it is. When I look across the border to CHO 5, its vacancy rates in some of its teams are at 54%. When I look to Kells in CHO 8, it has a vacancy level of 60%.

Talking and scoping are no longer acceptable within the HSE. Exploring has to be a thing of the past. Action is required as the funding is now there. Having that recruitment campaign is one thing, but it can only be measured on what can be converted into a person delivering a service. I again implore the HSE to be agile and pragmatic with the funding it has and to use it to attract people to disability services.

I say again that retention has to be our key objective in disabilities. By not having retention, the gap gets wider. The lists in other primary cares and mental health are driving down while in disabilities, they are going in the wrong direction.