Martin Browne (Tipperary, Sinn Fein)
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I wish all the women in the House and across the complex - and I better mention my wife Helen at home - the very best of luck on International Women's Day.

The children's disability network team, CDNT, staff census and workforce review was published during the week. To be truthful, its contents are troubling to say the least. Of the 2,102 approved full-time equivalent places, a staggering 707 are still vacant. That equates to a national average of 34%. I want to focus attention on the areas that cover north and south Tipperary, namely, community healthcare organisations, CHOs, 3 and 5 and their CDNTs. As I said, the average staffing vacancy rate for 2022 was 34% nationally. In CHO 5, which covers south Tipperary, the vacancy rate was an astonishing 42%. If we go more local than that, the vacancy rate for the CDNTs operating in Clonmel was 37%. In Cashel, it was even worse at 39%.

The Minister of State might say that vacancies are not as bad in CHO 3 with a 19% staffing vacancy rate. That area also has the lowest allocation of staff and had no additional positions allocated last year. A 19% vacancy rate for that area is atrocious. CHO 5, on the other hand, had a higher number of posts approved; it was up 16%. There was no change in the number of filled posts, however. Consequently, it has a vacancy rate of 42%, which is way above the national average.

The Minister of State will outline the number of additional positions the Department is trying to fill and I appreciate that. The fact is that in CHO 5, where more spaces are being made available, the rate of vacancies can often be even higher. This is due to the Department’s inability to recruit staff because of the additional workload they are expected to shoulder due to the high rate of vacancies and issues with pay parity. Indeed, there are roles where there were fewer staff now than there were even in 2021.

In CHO 3, the number of occupational therapists is down by five. In CHO 5, the number of speech and language therapists is down by five. These are just small examples. Despite more than 25 new posts being allocated, in CHO 5, the rate of increase in actual posts available is 0.01. Across the entire south east, the number of dieticians has not changed. I will get to that matter later. It is also appropriate to point out that more than 500 of the 707 posts vacant last year existed in 2021. It is clear that the Government’s approach is not having the effect it should.

This is what families are faced with. They cannot get the timely services they need and many have had no choice but to get themselves in debt or go private. I cannot tell the Minister of State the number of parents who have done just that or the number who wish they could afford to do so.

Has data been collected from exit interviews to get feedback from workers with a view to identifying how best to address their concerns and issues of pay parity among providers?

Can the Minister of State indicate whether she has faith in the progressing disability services, PDS, programme or if she believes in an independent review with an alternative system in mind? For families who have spent money that they do not have to spare, will there be financial relief for them and for family carers or can provision be made through the National Treatment Purchase Fund?

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this important issue for discussion. As Minister of State with responsibility for disabilities, I want to acknowledge that is has been challenging for many stakeholders, particularly the children and young people who use the services

I again take this opportunity to reiterate my sincere regret about the delays being experienced in the provision of services. There are major challenges in recruiting and retaining staff in the healthcare sector, especially the therapy professionals required for children’s disability services. This is leading to vacant posts in CDNTs across the country. To support the effort to appropriately staff and resource CDNTs, the HSE staff census and workforce review provides invaluable data. It is the second time in a year that we have had that, so at least now I have a comparable figure. When I got it the first year, it was the first time it had ever happened. Now that I have it two years in a row, I have comparable data.

The 2022 CDNT staff census notes an average vacancy rate of 34% across CHOs nationally. However, this is to be understood in the context of an increase in approved posts. An overall analysis of the data from 2021 and 2022 demonstrates an increase of 11% in the number of posts and also a 2% increase in the CDNT workforce. I acknowledge that this is minuscule. This increase has been achieved in a context where there is an average turnover rate 9.6% in health and social care professionals in the past year. That goes to the exact point that the Deputy raised to the effect that staff are employed, find that their workload is difficult, heavy and challenging and are leaving as quickly as they are coming in. As with other areas within disability services, south-east community healthcare, SECH, in CHO 5 and community healthcare area 3 HSE mid-west in CHO 3, both of which service the requirements of County Tipperary-based children and families, are continuing to experience significant recruitment challenges. The Deputy is right. The vacancy rate for north Tipperary is 23%. It is 15% for east Limerick, 37% for Clonmel and 39% for Cashel.

The CHOs continue to progress posts out to current national panels and continues to prioritise local recruitment campaigns. However, the 2022 staff census shows some areas of improvement, with the number of therapy hours pertaining to the north Tipperary CDNT increasing by 26 % from 2021. In order to mitigate recruitment issues, the HSE is also currently taking measures nationally to encourage recruitment and retention of staff in CDNTs.

These measures include: targeted 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 expansion in the number of therapy assistants in the system, with the HSE supporting individuals to return to education to qualify as therapists. These measures were not in place 12 months ago. You can see the influence of the Minister in the Department in the context of the agile, pragmatic approach taken to leading and to supporting the HSE to work differently in its recruitment campaign. We need rolling recruitment campaigns, but we also need to work with the people who are here to support people to come back into education or into assistant roles. The assistant role is incredibly important. If you have a physio who writes out a six-week programme for a child and can only see the child once in six weeks or once in ten weeks, the services of assistant who can make sure that the programme is being done properly are invaluable. This is the type of post we need to put in place in our CDNTs in order that we can start to retain the staff.

Martin Browne (Tipperary, Sinn Fein)
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I thank the Minister of State for her response but the figures she laid out generally relate to positions that are vacant. The vacancy rate among speech and language in CHO 3 is 17%. In CHO 5, it is 46%. That is nearly half of the available posts, and the number of staff has reduced by five in that area. The vacancy rate for occupational therapists in CHO 3 is just 25% - a reduction of 5% on the 2021 figure - but CHO 2 has a 50% vacancy rate. Among psychologists in CHO 3, a quarter of posts are vacant. In CHO 5, at 48%, it is nearly half. These are just some of the figures in the report.

Then there is the case of dieticians, which I have raised here before. In CHO 5, which extends across the south east, there is one post filled out of eight allocated to CDNTs. The vacancy rate is 88%. That is a national scandal. I appreciate what the Minister of State is doing and what is happening, but I have raised the matter of a child in Cashel, my town, with avoidant restrictive food intake disorder, ARFID, in this House many times. That family is one of those who are fighting for services in an area where there is one dietician across the CDNTs. That is wrong on every level. According to the figures in the report, the situation is not improving. That family is caught again and again, and it is not fair on them.

I would appreciate if the Minister of State would answer two final questions. If she cannot answer today, I will contact her office. Does the Minister of State intend to roll out family forums nationwide or only in selected CHO areas? In light of the damning figures in the census reports for 2021 and 2022, will she address the need to develop a strategic workforce plan to train, recruit and retain therapists for the posts currently unavailable to families in Tipperary and in constituencies across the country?

Anne Rabbitte (Galway East, Fianna Fail)
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I will answer those two straight questions. On family forums, the answer is "Absolutely". In addition, I plan to go back to having my ministerial meetings with each of the CHOs. That is happening.

On workforce planning, the Minister for Children, Equality, Disability, Integration and Youth, Deputy O’Gorman, is away this week. It will be one of our key objectives in the Department to develop a workforce plan in respect of disabilities. It is also important that we focus on retention. You can see from the staff census that we are getting people in but we are not retaining them. The turnover is far too high in our disability network teams. We need to retain them. We are doing exit interviews but it is exactly as the Deputy is saying: because we have too few staff on some of the teams, people realise that it is a far bigger challenge than they had envisaged. We are doing that, but we need to bolster the teams, not only with occupational therapists, physiotherapists and speech and language therapists but also with assistants. Furthermore, we need to look at the position relating to the social care model, social care workers, social care assistants and social workers, and link with family workers. We also need to have behavioural therapists and music therapists. We need the full gamut. It is not a case that one size fits all.

I am at one with the Deputy when it comes to dieticians. When you train only 29 dieticians in a year, there is no wonder we have a shortage. The children who apply for the dietician role in the CAO will need 615 and then they will go into a lottery. That is the number of spaces we have. We need far more places on dietetics. It needs to be completely expanded. We need to have a complete suite of measures on this. It is not only dietitians but we need nutritionists and an understanding of food therapy. I agree with the Deputy and 29 is too few. We need multiples of that.