James O'Connor (Cork East, Fianna Fail)
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I thank the Minister of State for being here this morning. I wish to raise the issue of speech and language services that is affecting the east Cork area. We have wonderful healthcare professionals working across the healthcare service in County Cork and Cork city and in other services in west Waterford which are used by people in my constituency. However, we have problems around resourcing. Unfortunately, one of these areas is speech and language therapy.

Speech and language therapy is of huge importance to younger children in particular going through education who need that assistance to deal with issues with speaking, other communication aspects and swallowing. It is an important service for those people who need it, especially children in education.

Unfortunately, what we are seeing is that there is a recommended timeline of approximately 16 weeks for assessment periods in the public system. What is happening in my neck of the woods, which is only a short spin from where the Minister of State is based, is that waiting times are extending to in excess of 30 weeks. We had a brilliant person in Youghal. Everyone was very fond of the individual who worked in Youghal but that role has now been vacated. Youghal town on the east periphery of Cork now has an empty role because of the HSE embargo. I am sure we will hear something about that this morning. That role is now empty and those cases are being pushed on to Midleton. Midleton was already under significant strain. The workload allocation in the Midleton area has taken on a day’s worth of Youghal cases despite the fact there was already a backlog in this area. I am asking that we look at, resource and try to deal with this going forward.

Only a small number of individuals can fix this problem. There is an immediacy around the fact the embargo is having serious impacts, particularly in rural healthcare settings. The whole point of the primary care model was about providing that care within communities. Youghal, as the Minister of State knows, is earmarked for a new primary care centre. The planning has been submitted for this. It is being developed through the private model with the HSE and it is a good thing. People wanted it locally. It was signed off on in recent years under the new HSE capital development plan. However, I am not going to wait for that for this issue to be solved. I want it done now. The embargo needs to be lifted and it needs to be borne in mind that, prior to the embargo, parents with children due to get those assessments were not waiting around the 16-week timeline but were up at more than 30 weeks. For anyone in east Cork who needs these services, this is intolerable and the impact this has on the children and their development, education and other aspects of their livelihoods is something that goes under the radar as an issue versus other healthcare issues.

I know we have a new Minister of State in place and it is very welcome to see him here this morning. He represents the neighbouring constituency to my own in Cork North-Central. For the people of Cork East, this is an issue and I would appreciate it if the Minister of State would take it back to the Department of Health and explain that the embargo is madness and that this role in Youghal has to be occupied. In addition to that role in Youghal being occupied when it is, we have to look at dealing with that backlog of cases. They are far above what is acceptable for those who need access urgently to those services in the public system.

I am taking this matter on behalf of the Minister for Health, who has asked me to thank Deputy O'Connor for raising it and giving him the opportunity to update the Dáil on this important issue.

The Minister recognises the central role that primary care therapy services, and specifically speech and language therapy, play in offering the opportunity for early and cost-effective interventions for children and young people. The Minister acknowledges that the increasing waiting lists for primary care services, and particularly those waiting for a long time to access services such as primary care speech and language therapy, is a source of real concern for clients and their families. The HSE has advised that an increase in referrals has resulted in increased pressure on primary care services. For example, the implementation of the national policy on access to services for children and young people with disabilities and developmental delays now means that more children and young people with non-complex disabilities and developmental needs are being referred to primary care services. Coupled with this additional demand has been increasingly complex presentations in primary care requiring more intensive interventions.

Notwithstanding the current HSE recruitment pause, there have been also persistent challenges in recruiting certain grades of health and social care professionals to meet the demands of primary care therapy services. Indeed, the shortage of such professionals has an impact across several service delivery pillars in the HSE, with competing demands for physiotherapists, occupational therapists, speech and language therapists, dieticians and psychologists across both general and specialist services in the community.

In summary, increased referrals combined with the challenges being experienced in recruiting therapy professionals in the HSE, has resulted in an increase in waiting lists for services across the country. In 2023 waiting list action plan funding of €3.5 million was allocated to primary care therapy services which saw more than 5,000 long waiters removed from the waiting lists nationwide. The HSE continues to work to address these challenges, with several initiatives underway including validation of waiting lists to drive increased productivity and ensure effective management of therapists’ time and a focus on reducing the numbers of long waiters. A significant programme of work is also currently underway between the Department and the HSE to develop standardised infrastructure and protocols to support systematic responses to primary care waiting lists. These are in line with similar protocols developed by the NTPF for hospital outpatient waiting list management. This programmatic approach is aimed at ensuring consistency at a national level to waiting list management in primary care, improved access to services regardless of location, as well as a greater understanding of the scale of demand, the drivers of demand and to allow for improved planning, interventions, investment considerations, enhanced productivity, and the most efficient use of capacity.

What the Minister is saying is that there is a challenge in relation to the increase in referrals and the difficulties in recruiting the staff that are needed for these services.

James O'Connor (Cork East, Fianna Fail)
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I thank the Minister of State for his reply. However, the reply given in the House this morning makes no reference to the location affected. Considering that the location is in the title of the question asked, that is not acceptable. I ask the Minister of State to bring that back to the Department of Health. When a Deputy comes in here from a constituency and asks a question about an area, the fact that there is not even a reference to the area in the response is quite poor, to be frank.

That aside, I acknowledge that work has been done by the HSE to address backlogs and waiting times. I acknowledge the allocation of resources to this and the fact that there are areas where this has worked out quite well. However, we now have people in the Midleton area who have been waiting for up to two years for services. This is not the fault of the incredibly hardworking professionals that provide those services and I want to be absolutely clear about that. The issue is that the services are just not being resourced at a local level. Even before anybody vacated the Youghal position, there was a problem. That role in Youghal is now lying empty, unfortunately, because of the embargo and the person who left cannot be replaced. The caseload from Midleton has now been combined with the caseload from Youghal. These are two major towns. Midleton is one of the biggest towns in County Cork and Youghal is not a small town either. Both caseloads have been lumped into one office which means, unfortunately, that people are waiting for up to two years when the recommended timeline is 16 weeks. This is so wrong. It is wrong because of its impact on the young people who desperately need these services. These are people who need help to be able to speak and be able to swallow, two of the most basic functions in life. The people who are in the position of needing that assistance from the State need to be taken more seriously by the HSE. I also have an issue with HSE estates management with regard to its prioritisation of projects in that region of the country. There are lots of projects that are well overdue and that need to be addressed. On this issue, it is sinful to leave these roles empty. The embargo needs to be looked at urgently and ended.

Colm Burke (Cork North Central, Fine Gael)
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I note what the Deputy says in relation to the specific vacancy in Youghal and I will take back his concern to the Minister.

The Minister fully acknowledges the frustration of those waiting too long to access vital primary care services and that of their families. He agrees that much more needs to be done to address waiting lists for speech and language therapy in addition to other key primary care services. This Government is committed to delivering increased levels of healthcare, with service delivery reoriented towards general practice, primary care and community-based services, as demonstrated through the €195 million in recurring annual funding allocated to the enhanced community care programme. Ultimately, a total of approximately 3,500 whole-time equivalent staff will be recruited into the enhanced primary care programme, with a particular focus on clinical staff such as community therapists and nursing staff. These are being recruited to enable the implementation of 96 community healthcare networks along with community specialist teams for older persons and chronic disease management across the country. In addition, following budget 2024, the Minister, in the preparation of the national service plan for 2024, highlighted the urgent need to ensure a consistent approach at national level to primary care therapy waiting list management. In 2024, a pragmatic approach is being rolled out to put in place considerable standardised infrastructure to support systematic responses to primary care therapy waiting lists. To this end, the Department of Health is engaged in ongoing dialogue with the HSE to advance that programme of work to both develop short-term strategies and to address the longer-term management of waiting lists for primary care therapies. Ultimately, it is expected that this work will ensure consistency of access to primary care therapies irrespective of location and in a much more timely manner than is currently the case.

I take on board the Deputy's concern about the vacancy in Youghal and I will convey that to the Department. The Deputy is correct in saying the departmental reply does not specifically deal with that issue. I will take it back to the Department on his behalf.