Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I want to raise the issue of children receiving substandard services in children's disability network teams, CDNTs, in Carlow. I was disappointed to read in a response to a parliamentary question I submitted that the HSE has delayed a new children's service facility in Carlow which was to be the new home for the CDNT. Part of that was to include the Holy Angels centre.

A funding allocation of approximately €7.1 million was identified for the project, and a design team was engaged and proceeded with the design process last year. My understanding is that the stage 1 report from the design team in December 2023 estimated that the cost of the project would significantly exceed the funding allocation. We welcomed the funding allocation, which is in the capital plan, but we have been told there is not enough money. The HSE disability service estate is arranging stakeholder engagement to review the project and provide a revised scheme of the works and funding. I ask that funding be put together urgently because it is needed.

We need investment, innovation and reform. If we cannot future-proof a development such as this, how will we prioritise our disability services? When we began implementing disability services in CHO 5, the core focus of the change was to ensure the children with complex needs, and their families, would receive an appropriate and accessible family-centred service. However, I am hearing every day that this is not the case.

There is only one CDNT led by the HSE in Carlow, which is located in Bethany House, on Barrack Street. Across that team, there are 294 children with complex disabilities registered for clinical services, 50 of whom have active individual family support plans. Some 230 children are waiting on initial contact. I have been told that filling vacant clinical posts across these teams is the HSE's top priority in order to address the needs of children, deal with waiting lists and provide clinical services to new applicants.

I believe there is a proposal to move to an alternative model of enhanced disability services in the community by way of increased support hours in a home setting, increasing capacity in current respite services and offering alternative models of delivering respite services. We are not adequately serving the needs of the children, however. My office makes at least one representation a day for a child waiting on speech and language therapy, occupational therapy or autism assessments. I know of families who are going into debt in order to get vital interventions for their children.

What priority is being put on recruitment? There is no embargo on recruitment for these posts. When I spoke to Bernard Gloster recently, he assured me that interviews were taking place for staff for South East Community Healthcare services for all vacant clinical posts.

It is my understanding these interviews were completed on Friday, 16 February 2024 and that job offers from the recruitment campaign are in train. Is there any way we can speed up this process because it is so important? In Carlow, family forums have commenced to provide information to families on the services the CDNTs are providing and resources available to them, but families are telling me these are not working the way they would like. They feel they are just a box-ticking exercise. The next family forum meeting was scheduled for today and I will be contacting the families to see how it went. The CDNT in Carlow continues to receive referrals and many end up in the family forums. We need to see real action. Staff growth in this area is very important.

Niall Collins (Limerick County, Fianna Fail)
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I am taking this matter on behalf of the Minister of State at the Department of Health, Deputy Rabbitte, who thanks the Deputy for raising this matter. The Minister is fully committed to the continued development and enhancement of our children’s disability services through the CDNTs, as they seek to ensure equitable access to services for all children with complex needs. The Minister of State acknowledges the difficulties faced by children and their families seeking to access the services of CDNTs in CHO 5 and takes this opportunity to reiterate her unhappiness at this situation and her commitment to addressing the underlying issues.

Presently, there are significant challenges both nationally and globally regarding the recruitment and retention of health and social care professionals, particularly for children’s disability services. While funding has been allocated, vacancy rates in CDNTs unfortunately remain high. In CHO 5, the HSE advises that the vacancy rate of the teams stands at 41% which equates to around 92.05 whole-time equivalent posts out of the approved 223.78 posts. This is based on the 2022 CDNT census. However, the HSE advises that the latest census is expected to be available in the very near future.

The Minister of State can assure the Deputy there is ongoing recruitment for vacant posts in CHO 5, both through the HSE’s national recruitment services and the HSE HR section at a local level. The HSE launched the first nationwide CDNT recruitment campaign in January 2024 with the theme "Be part of our team, be part of their lives". The Minister of State has been advised by the HSE that, at this time,and without prejudging the final outcome of the recruitment and selection process, CHO 5 is anticipated to significantly benefit from job offers arising from this campaign. If those offers were to be accepted by the applicants, it would represent an approximate 25% increase in staffing across CHO 5. However, to sound a note of caution, the applicants concerned may have other offers from the competition, so the Minister of State will await the finalisation of the process and a more detailed report from the HSE.

The Minister of State welcomes additional measures being progressed under the progressing disability services roadmap to increase capacity on CDNTs, including student sponsorship programmes for health and social care professionals; a target of 175 therapy assistants to support health and social care professionals in delivering the most effective and efficient services in environments appropriate to each child’s needs; and dedicated work on marketing CDNTs as workplaces of choice. While recruitment measures are ongoing, the Minister of State can advise that the HSE is driving forward several initiatives to reduce waiting times and strengthen services for children waiting. These include sourcing assessments and interventions from private service providers and the imminent launch of the children’s disability service grant fund. The launch of this fund called for applications from disability service providers and community groups who can provide additional and innovative services, including, but not limited to, recognised sensory programmes; evidence-based therapies; respite services, including clubs, evening and weekend sessions; Saturday clubs; sports sessions; and additional therapy sessions for service users such as managing challenging behaviours. There was a huge response from voluntary and community groups and private agencies, with around 495 applications for funding. The HSE intends to issue letters to applicants in the very near future and commence the process of engagement around the drawdown of funds.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister of State. I was made aware the Minister of State, Deputy Rabbitte, would not be able to take this Topical Issue tonight but, in fairness to her, I have worked very closely with her and can say she is totally committed to trying to recruit for disability services. One of the biggest issues I have been talking to her about recently is the inclusion of assessments and intervention from private service providers, which I welcomed. That made a difference but we still have a long road to go. As I always say to the Minister of State, early intervention is the only way forward. It is important that children are assessed early. That is the most important issue going forward.

I welcome the information on recruitment and await the final numbers for CHO 5. The Minister of State, Deputy Collins, is probably not aware we have a huge HSE site in Carlow and we will be getting a new CDNT building there which also includes the Holy Angels day care centre. I ask him to raise the funding for that project with the Minister of State, Deputy Rabbitte. While I welcome the €7.1 million that has already been provided, the cost of construction materials now means we may need extra funding for that new building. It is important we get that new building. It will make a huge difference to the children in County Carlow.

I referred to a lot of figures tonight but I have families coming in to me daily who are borrowing to get their children assessed because of the long waiting times. Timing is crucial and we do not want any family to have to borrow money from grandparents or other family members. We need to provide these services urgently. I know Minister of State, Deputy Rabbitte, is committed but I ask that she would get back to me directly with regard to the recruitment and what is happening there.

Niall Collins (Limerick County, Fianna Fail)
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While recruitment and retention of staff to CDNTs remains a considerable challenge, the Minister of State wishes to reaffirm her commitment as well as that of the HSE and her Department to exploring all avenues to improve access to CDNTs for children and their families in CHO 5. I will make the Minister of State aware of all of the issues the Deputy raised here this evening.