Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister of State, Deputy Rabbitte, for coming in to take this Topical Issue matter. We have considerable issues in community healthcare area, CHO, 5, especially in County Carlow. The children's disability network team, CDNT, in Carlow has more than 200 children on the waiting list for autism assessments. The children are taken off the list by the CDNT, per date order, unless prioritised as high-risk. These children are getting lost and we do something urgently about it. A facility in Carlow, which looks after children with special needs, has children scheduled to attend primary school in September who have never seen a therapist, or had any assessment of need. Holy Angels in Carlow has operated for more than four decades and has never experienced this lack of service. County Carlow is operating with one psychologist for the entire county and the psychologist has very little support. That facility is on its knees with regard to funding. It was allocated €21,000 for emergency support but its gas bill alone was €29,000. The facility is really struggling.

There are other considerable issues in special needs supports for children in CHO 5. Just last month, trainee educational and child psychologists undertook independent work in schools, under supervision of the senior psychologists throughout the country. In practice, this meant they were in schools by themselves, working on cases that are part of the caseload and were responsible for this. It included undertaking assessments of learning needs, identifying dyslexia, dyscalculia and other issues, solutions-based work with teachers and parents, or interventions around children's learning and emotional or behavioural needs. If the 25 trainees were not there to do this work throughout the country, the already overworked National Educational Psychological Service, NEPS, psychologists would have to take on these cases. The waiting times for assessments would be even longer. They receive no financial reimbursements, other than the reduced rate of petrol expenses for travelling, which is another story. I wish to address that with the Minister of State the next day.

All children must have the opportunity to thrive and have access to an educational assessment of needs; the development of an individual education plan; the delivery of education supports and an independent appeals process. Schools must be fully accessible for all. We are waiting for a new chief nursing officer, CNO, for Carlow and I will ask the Minister of State to look at that, too. We are seeing considerable delays in assessments. Some assessments from 2019 are only being looked at now, in 2023. I know the Minister of State is aware that recruitment is a considerable issue. The already overworked staff are just not able to get to the work. All the benefits of early intervention are being lost.

I see these issues with my own eyes. Last week, I held a public meeting to assist the community to make submissions for the departmental review on educational needs, for children with special needs. I wanted to hear from families living the reality of this. The stories I heard were horrific. In one case, a child has no access to occupational therapy, OT, speech and language therapy, or assessment of need, even though his needs are acute in the school. We cannot give children the correct access education, if they are not being met. We need to sort out the recruitment and the system has to work for every child. We need urgent attention for children's health services in CHO 5 in Carlow. Will the Minister of State confirm that the CHO has resources?

I also have to ask whether she has confidence in the HSE that these services will be delivered. We have children who are really suffering and families who are crying out for help. Parents have come to me very upset, because their children are not accessing the service they need.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for tabling this important Topical Issue matter. I would appreciate it if I could unpack it. If I am listening correctly, the Deputy's question is to do with the HSE and CDNTs, Holy Angels and preschool services; schools and educational psychologists and NEPS. Let me try to unpack it.

With regard to Holy Angels and its receipt of €21,000, the centre is designated under special education in the Department of Education. The funding it received from my Department was a recognition of the service level agreement, SLA, that we have in place between Holy Angels and the HSE. I do not have full control over Holy Angels, rather I have only a portion of control. The Department of Education has a role to play here, in supporting certain bills that are required to be paid, which includes the ESB bill. Maybe the Deputy can assist the management at Holy Angels, in that much of the burden of expense it has encountered over the past number of years was when it lost the community employment, CE, support workers who used to assist it. The loss of those workers meant Holy Angels had to take on additional staff, at a cost. I know, very clearly, Holy Angels has a serious deficit, but I think the deficit is because it may have leaned considerably on the CE scheme workers in the past, who were absolutely brilliant when it came to maintenance and cleaning, but also when it came to the support of an additional staff member in a room. It was more than ratio, it was a support to the individual.

The Deputy spoke about the Education for Persons with Special Educational Needs Act. That sits under the Minister of State, Deputy Madigan. I will not speak to the Minister of State's brief, but I hear clearly what the Deputy is saying, in that we have a deficit when it comes to educational supports for children within education. The Deputy also talked about the 25 trainees and that only for them, children in education may not get the psychological supports they need.

I will refer to my own brief, which is to do with the CDNTs. There are three such teams in County Carlow, with only one psychologist, which is not sufficient by any manner or means. In light of the TV programme that was on last night, it is important to say it was very disturbing viewing. I applaud the Deputy for asking this question, because if we do not have psychologists, we cannot complete our assessments of need. That is a considerable issue for us. However, what I have done is to secure the funding of €11.5 million to clear the backlog of in excess of 10,000 children that are waiting for an assessment of need since 2021. The 2019 figure is educational, because I cleared the backlog. It is gone.

I now have the figure of what has happened due to the preliminary team assessment, PTA, and since the court case last year. We have a build-up of assessment of need, especially with regard to children needing an autism assessment. For 200 children to be sitting on the books of any CDNT is quite disturbing, not just for the child and family, but for the child's development. That is why, having secured the funding, it is my ambition to have regional hubs dealing with assessment of need, to the full criteria that will ensure that every child will be seen in a timely fashion. I will answer on my confidence in the HSE next.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I know the Minister of State's commitment. I have worked with her for a few years. I welcome her comments and the fact she said she now has €11.5 million. She spoke about the 200 children in Carlow. I am very much aware of the cases in the county. It worries me when I look at a school such as Holy Angels that excels in the service it has for children with disabilities. Holy Angels had CE scheme workers who were doing much of the work. It is sad we do not have CE schemes anymore and we need to address that. However, we should also be in a position whereby there would be funding for a school such as Holy Angels, with the service it gives, when it needs recruitment.

I know because I am on the board of Holy Angels. I see the work done by the school, the committee and the volunteers. They are constantly fundraising every few months. I know during Covid, everybody was affected and we understand that. We are always saying, as is the Minister of State, that we have to assess children early. Children leaving Holy Angels schools, who are going to a primary school, are not being assessed because there is no one there to assess them. If they are not being assessed when they are going into primary school, we will not know what we can do for them. Therefore, they need to be assessed before they leave Holy Angels school and go to another school. I know how dedicated the Minister of State is. There are huge issues. We were nearly hitting crisis point. I believe her commitment and dedication, as well as the extra funding, will do a lot of good and will help many children and their families. I have seen the stress on parents' faces at public meetings. I see what they are going through. It is affecting their children. They are there to represent their children, do the best for them and give them the best chance in life.

Anne Rabbitte (Galway East, Fianna Fail)
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I am aware of the Deputy's involvement in Holy Angels and I have visited the centre. I again refer to the €11.5 million. That money must be spent to ensure children have a proper assessment of need. We have a Disability Act and we need to work within that. Children need timely intervention. It can no longer be words or lip service. We need action. The Deputy asked me a pertinent question on whether I have confidence in the HSE. My confidence in the HSE is shattered. What will restore my confidence is a pragmatic and agile approach to ensure we can step up our regional hubs for assessment to ensure we clear that backlog in a timely fashion. We need to work with private industry that meet the proper regulations and criteria set out by the HSE to ensure all children have one. Sensational Kids Kildare, in the Ceann Comhairle's area, is a fantastic resource. In Cork, we have the Rainbow Club. We need to start working more with organisations that have the skills and ability to help us deliver and meet the needs of children. What we witnessed last night cannot continue. Meetings such as the one the Deputy had last week cannot continue. Meetings such as those I had last year cannot continue. It is time now that I demand that we have a pragmatic, pivoted approach from the HSE to take everybody under the tent to ensure we work with all so that no child is left waiting. The Deputy is correct about timely intervention for every child. We should be ambitious that all assessments are done before children go to school so that when they hit education, it is an educational need and not a health assessment need that is required.