David Stanton (Cork East, Fine Gael)
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I thank the Ceann Comhairle's office for selecting this Topical Issue matter and I thank the Minister of State for being here. I recognise the huge efforts and work she is doing in this area. I am sincere about that. I know what is going on. I know the work the Minister of State is doing and I commend her on it.

I was contacted on 20 December last by a family in my area. It is best to give an example here. This family has two children, twin boys, who will be three years of age next week. The parents noticed an issue with one of them in November 2021. He started stimming, which involves repetitive body movements and hands flapping. They did not know what the behaviour was at the time. When they brought the children to see the public health nurse in April 2022, however, the nurse told them that from her observation, she was concerned about their development and strongly advised the parents to have them assessed by the area assessment GP, which they did. That happened at the end of May last year. That GP was quite concerned and she sent referrals for both boys to Cope Foundation as their needs were complex. The situation is that one of the boys nudges the parents to the fridge when he wants something. They are almost three years old. The other child does not do that at all; he just bites them. They believe that is due to frustration through not being able to communicate. Both boys are non-verbal. Their parents hope they will be able to talk one day and want to give them the gift of speech. They do not react to their names being called. They are both attending a crèche to help them improve their communication and social skills but they cannot do any really simple things like feed themselves or brush their teeth.

This family has another child who is nine months old and is ahead of them at this stage. This is causing a lot of anxiety. This can have other serious consequences because the children cannot tell the parents if there is a problem or they are in pain. One of them had a medical problem recently, could not communicate with the parents, was screaming in pain and ended up in a serious situation. It was almost life-threatening. Luckily enough, they got to the hospital and he went through CT scans, was diagnosed with a serious infection and had an operation to treat it. If untreated, he could have lost his sight.

I wrote to Cope Foundation and received a response quickly. This is no criticism of Cope. The chief executive and team are, as the Minister of State will be aware, dedicated and hard-working. When I asked if they could do anything, Cope replied, "Unfortunately, not." It continued:

Given the wait times for assessment and intervention I would expect that this family will be waiting for a considerable length of time before they are seen, possibly up to two years. [The children will then be five.] Children’s disability services are experiencing numerous challenges that are causing such delays including but not confined to - the numbers of children that have and continue to be referred (these were significantly underestimated by the HSE at the time of transfer to the Network Teams) [which is a problem]; difficulties in recruiting and training staff.

Cope acknowledges the considerable work the Minister of State, Deputy Rabbitte, is doing to try to move things on but the challenges remain. Early intervention is crucial, as the Minister of State realises and we all know, in cases like this. These children need intervention now. If the public sector cannot intervene, will the Minister of State make funds available so the parents can access services for assessment, treatment and support in the private sector? That is the only way we can go in this area. I understand that in some instances if parents pay for assessments in the private sector, the public sector does not recognise those and insists on getting them done publicly. If the Minister of State has the funding, will she make it available to families such as this to get essential early intervention in place?

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for raising this important issue. Regarding the case of the two boys, I take on board everything he said and will talk to the Minister of State, Deputy Rabbitte, regarding the issues he raised but I cannot comment on the case because I was not aware of it before I came in here. The Minister of State apologises for not being here. The Deputy is right that early intervention is key and one of the most important things we have for children who need those supports.

With regard to the twin boys, the Deputy spoke of repetitive body movement and other issues and stated that they have been told it will be up to two years before they get support. I will bring all that back to the Minister of State. She is committed to the development and enhancement of children's disability services through the implementation of the progressing disabilities services programme. She acknowledges this change in the programme has been challenging for many stakeholders, particularly children and young people using the service and their families. These challenges have resulted in unacceptably long delays, such as those the Deputy outlined, for families to access much-needed therapies for their children. The Minister of State reiterates her sincere regret at this situation.

At present there are huge challenges in recruiting and retaining staff in the healthcare sector, particularly with regard to the therapy professions required in children’s disability services. This is leading to vacant posts in children's disability network teams, CDNTs, across the country. There are 14 CDNTs in Cork-Kerry community healthcare. The location of each aligns with the 14 community healthcare networks. Vacant posts in Cork, excluding special schools, stand at 38 whole-time equivalents. Local HSE officials are actively working with national HSE in recruitment for these posts. Lead agencies have ongoing recruitment campaigns and panels are in place for vacancies.

The measures to enhance recruitment and retention of staff across CDNTs include: target national and international recruitment to include an agreed relocation allowance where appropriate; apprentice and sponsorship programmes for therapy grades; employment of graduates as therapy assistants as they await CORU registration; and the expansion of therapy assistants into the system with HSE supporting individuals to return to education to qualify as therapists. While recruitment efforts proceed, the HSE is also driving a number of initiatives to reduce waiting times for children and families and provide the support they urgently need, such as sourcing therapy assessments and interventions externally via private service providers, to which the Deputy referred. CDNTs have prioritisation systems and caseload management systems, including assessment and intervention pathways in place, ensuring children with the highest priority of needs can access services.

Notwithstanding these challenges, it is important to acknowledge the significant work involved in establishing the CDNTs and the services that are being delivered. Approximately 35,000 children are currently receiving supports and services from these teams across the State. However, there is much more work to do. Funding has been provided to the HSE for additional posts in recent years to strengthen the capacity of CDNTs to ensure services can be provided. This funding provides for more than 600 additional whole-time equivalent posts for children’s teams throughout the country. Vacancies are arising not because of a lack of resources but because of supply issues in the health and social care sector for specialist therapy professionals.

David Stanton (Cork East, Fine Gael)
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I thank the Minister of State for her response and acknowledge the work the Minister of State, Deputy Rabbitte, is carrying out in this area. A number of issues arise. The externally provided private services, as far as I am aware, in this and other cases were not made known to the parents. If the Minister of State could organise a pathway to be made available and known to parents in such cases, it might resolve issues pretty quickly. If these two boys are not seen for two years, they will be five. Now is the time. Early intervention is vital in these cases.

The Minister of State referred to retention and it may be time to consider a retention bonus for critical staff to hold them in position in the HSE and other services. I know of a number of people leaving these services for all kinds of reasons. It is not always pay; sometimes it is morale, burnout, overwork and so forth. The Minister of State and Department should consider carrying out an assessment, consisting of an interview, questionnaire or whatever, with some of these critical staff to see why they are leaving and what is going on. Pay is a factor, but not always; sometimes it is the way they are being treated and the culture in that organisation.

What can I say to the parents of these two boys, who need assistance and support now? Maybe the Minister of State, Deputy Rabbitte, or one of her team can contact me next week to let me know how we can assist them. There are many others. If it is not a matter of resources, let us divert resources to an area through which services such as assessment, supports and therapies can be provided. That is the way to go. I acknowledge the Minister of State said that but it does not seem to be something the parents are being made aware of, and they probably should be.

Mary Butler (Waterford, Fianna Fail)
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In addition to the funding provided to enhance capacity to the CDNTs in recent years, the Government committed to providing an additional 136 posts in 2022 to facilitate the reinstatement of services in 104 special schools. The allocation for special schools located in Cork is 22 whole-time equivalents and the HSE is actively allocating posts here. Cork-Kerry community healthcare - and this might be important in respect of what the Deputy said about organising a pathway - will establish family forums in each CDNT from March 2023 in line with the CDNT national governance policy. Cork-Kerry community healthcare is committed to ensuring parents' voices are at the centre of CDNT delivery of service and I welcome this approach.

The Deputy used the word "urgent" in raising this issue and he is correct. I assure him and the House that the Minister of State, Deputy Rabbitte, will continue to work tirelessly with the HSE, as will I, to find immediate and lasting solutions to staffing issues, which, when resolved, will ensure children and young people can access the services that are vital for their development. I will ask the Minister of State’s office to contact the Deputy. He might provide the details and we will see if there is anything we can do to expedite the vital supports these two young boys need. I thank him for the manner in which he raised the matter.