Dáil debates
Tuesday, 17 October 2023
Saincheisteanna Tráthúla - Topical Issue Debate
Disability Services
9:20 pm
Joe McHugh (Donegal, Fine Gael)
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I am delighted the Minister of State, Deputy Rabbitte, is here as I know she is very much on top of her brief. This is evidenced by her presence throughout the country, including Donegal where she has visited a number of facilities in her time as Minister of State.
I raise this issue on behalf of the Special Needs Parents Donegal Network Group. Public representatives met with them yesterday and had a very good meeting. No doubt the Minister of State will have received the information in the brief from her colleague the Minister, Deputy McConalogue, who was there. He will have the report and the very intensive research it contains. One of the figures presented by the HSE yesterday was that there is a 56% vacancy level. The vacancy challenge is not confined to the north west; it exists throughout the country so it is a national crisis. I know that the Minister of State would like people to be in those positions in the morning but we have certain challenges. One mission statement from the parents was that their children cannot wait. Intervention is needed at a very young age, as the Minister of State will agree.
Parents have carried out the research and they have come up with solutions. They live their lives in the here and now. They cannot accept the mantra about waiting on people to apply. As public representatives, we have to challenge the argument that not enough people are available to apply. We have to look at alternatives. These parents, who live their daily lives dealing with their own children with disabilities, have come up with four comprehensive solutions. I know the Minister of State will take this back to her officials. I am asking for these four recommendations to be taken very seriously as part of a bottom-up, grounded, common-sense approach. They contain some very pragmatic suggestions.
One thing that was very evident yesterday was the lack of essential equipment. There are communication difficulties when the time comes to get wheelchairs changed, to get bigger equipment and to get measured and so on. The families of children with complex needs feel they are not receiving regular therapy, support or timely access to equipment. No indication has been given to parents on how this will be managed when there are no therapists on the team. That is the first point.
The second point relates to redeployment. The parents have proposed the redeployment of experienced and skilled resources from other areas. They are not looking to reinvent the wheel; they are looking at what we did during the Covid pandemic when redeployment was a major feature of our approach to the challenge we faced then.
The third recommendation relates to parents who are paying large amounts of money on private therapy. They are calling on the HSE to implement an emergency model to support access to private therapies where support and therapy cannot be provided by the HSE.
The fourth recommendation relates to therapeutic support and guidance for schools. The Minister of State will be aware of the pilot model through the Departments of Education and Health. I was involved in that. I know there is some resistance – I will not say whether it is coming from the Department of Health or the Department of Education – but I feel there is a real opportunity to use that pilot as a way forward and to use occupational therapists, speech and language therapists or physiotherapists to take a more integrated approach to health through our schools as well. I know the Minister of State will agree.
Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for raising this matter and giving me an opportunity to engage with him on it. I look forward to taking away the four suggestions made by the parents. It is very important that children are fitted for their equipment in a timely fashion.
9 o’clock
It is very important for children who need access to wheelchairs as they grow that their needs are met. If they are not, other issues will follow suit. I hear what the Deputy is saying about redeployment or even if we could just introduce the HSE's own policy, the national access plan, NAP. The team we spoke about in County Donegal is a HSE team, as is the primary care team. Why can we not apply the NAP, whereby some clinicians working in primary care could assist in the crisis in our disability teams, if nothing else, even from the level of occupational therapy at this point so that children can have proper sitting equipment at school, at home or in the service they attend? That would be our one ask, that the disability lead - and a fabulous disability manager at that - Ms Quinn, work with me and her colleague in primary care. If we could achieve that, we would achieve a lot to start. The Deputy spoke about redeployment; I have looked at County Donegal at lot on this. The panel system does not work for County Donegal by any manner or means. I also do not think the recruitment system within the HSE works for County Donegal. It works very well for recruiting doctors and administrative staff but it does not work for clinicians in certain parts of the country. I would abolish the panel and make it available and let people travel as they so wish, as opposed to waiting for a vacancy to come in County Galway or in County Dublin, for example. The panel system should be abolished completely and it should be made available so that people can move to their desired location, as opposed to waiting for it. The other thing about recruitment with the HSE is that there is an internal model for when you go for a senior post and an outsourcing when you go for an ordinary grade. The recruitment agency within disability is not doing us justice when we have 700 vacant posts. I hear what the Deputy is saying about redeployment.
On support therapies and schools, I have given a lot of thought to these matters. Earlier, there was a motion and the Government tabled a counter-motion. My hope is to establish a ring-fenced support mechanism in the coming months which supports parents who access assessments of need privately. I am also looking at that in terms of therapies and what mechanisms can support families to access the package, be it six weeks of occupational therapy or six weeks of speech and language therapy. When we are not able to deliver the service, we have to look at another parallel process of delivery. Some 700 therapy posts not filled is the equivalent of €56 million unspent within my disability budget. I need to look at repurposing if I cannot deliver to meet the needs of the families and, most important, the child at the centre.
On schools, the Deputy is well aware of the school model. We removed therapists from special schools and it ended up levelling down the system. It did not raise it. We talked about equity of access. At the moment, I have partnered with the HSE in County Wexford. The Deputy's colleague, Deputy Kehoe, and Deputy James Browne were there on the day and we are now giving funding to the school to recruit the therapists. They recruited the three of them, would you believe, in the space of two weeks. There is full access to therapists in the school in County Wexford, meeting the needs of the young people. I am addressing that and looking to expand it. I have no problem working with the Deputy or Deputy McConalogue on it.
9:30 pm
Joe McHugh (Donegal, Fine Gael)
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I thank the Minister of State. I appreciate her honesty. It is a sign when a Minister of State deviates from his or her script. It shows a bit of respect to the people who raised this issue. It is a very dignified thing to do; she is talking from her own personal interactions with officials and she has obviously thought about this issue. There are ways forward. I thank the Minister of State for agreeing to look at these recommendations seriously and discuss them with her officials. I join the Minister of State in acknowledging Edel Quinn and her team, who were there yesterday in force. They meant business by their presence. Out of respect to all the parents at that meeting, it is really important. I acknowledge my Oireachtas colleagues who attended that meeting. We were there to listen but there was a very strong message from the parents. They want action because their children live in the here and now.
In the concluding 60 seconds, I know my two Oireachtas colleagues will raise the issue of Letterkenny University Hospital. I do not have time to discuss it now in the short time left but I want to pass on my message through the Minister of State to the Minister of Health to look very seriously at the winter plan for Letterkenny University Hospital to get the patient flow right. There are senior posts needed there, from registrars, phlebotomists, occupational therapists, radiographers, sonographers and nurses to porters. There is a comprehensive winter plan put together by the manager of that hospital. It will not sort all the problems but it will address the fact there are very elderly, frail and sick people spending too many hours on chairs in waiting rooms. I ask the Minister of State to pass that onto the Minister.
Anne Rabbitte (Galway East, Fianna Fail)
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I look forward to engaging with the Deputy going forward on County Donegal and the CDNT. I am concerned about the CDNT in County Donegal for the simple reason that it is a HSE team. If we fail to recruit onto a HSE team, my options are very limited. We have to make it incredibly attractive. The clinicians were incredibly helpful to me during the summer when I was down there. They are the ones who told me about the panel process, what I needed to do and am trying to do. To be very fair to Bernard Gloster, he is more than willing to step up whatever needs to be done to ensure that there is a proper, functioning team, not just in County Donegal but across the CDNTs. At the moment, there is a clear pinch point in County Donegal because when you do not have the occupational therapist assessing the child for their basic need of machinery they require to live a full life, there is an issue. I appeal to the HSE again that, regarding the national access plan, they redeploy staff, even if it is only for a week, to have some of assessments done for children in crisis, for footwear or wheelchairs and that it is a priority. I take that point away from tonight and will revert to the Deputy over the coming days.