Conor Sheehan (Limerick City, Labour)
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I add my congratulations to the concerto of congratulations. I thank the Minister of State, Deputy Butler, for coming to the House this evening. I am sorry to subject the Minister of State to this at this ungodly hour but let it never be said that she does not work hard.

I rise tonight to raise the issue of the lack of a consistent and permanent full-time speech and language therapist, SLT, at King's Island primary care centre in my constituency in Limerick. I do this on the basis that there are 1,257 children in CHO 3, specifically in Limerick, who are waiting two years for speech and language therapy. King's Island is a wonderful community that I am extremely proud to represent, previously as a councillor and now as TD for Limerick City. Like all proud working-class communities it has huge deprivation and many issues. King's Island is considered to be extremely disadvantaged - it is widely acknowledged as one of the most disadvantaged communities in Ireland - and has a deprivation index score of minus 31.9, but the King's Island primary care centre does not have a paediatric speech and language therapist and has not had one for a number of years. This lack of essential support is having a devastating impact on the most vulnerable children and families in our community, many of whom are already facing significant social and educational challenges. The situation is now so dire that the local school principal, Eoghan O'Byrne, has been forced go on local radio and literally plead for this post to be filled. This is simply unacceptable for any child but especially for children from poorer backgrounds who cannot access private therapies. This early intervention is critical and yet children who attend his primary school, St. Mary's National School, are being left behind. This wonderful school in many ways is a victim of its own success with a population that has grown by 70% in three years. With a growing population, however, comes an even greater need for this vital service. The longer this continues, the more children will fall through the cracks and the more issues they will have as they get older.

I will give the Minister of State and the House some context. Some of the figures that pertain to the junior infant pupils are quite stark. If one uses the Renfrew action picture test the class average is 34%, the whole class scored below the 75th percentile, and 85% of the class scored below the 50th percentile. I urge the Minister of State to ask the HSE to prioritise the deployment of a speech and language therapist to this community as a matter of urgency. These children and their families deserve equitable access to the supports that are essential for their development and future success. The absence of a consistent SLT service in King's Island for over three years has had significant and far-reaching implications on the children in this area.

Speech and language therapy is a critical component of early childhood development and for supporting communication skills that are essential for learning social interaction and emotional regulation. The lack of consistent SLT services means that teachers are left without the necessary professional supports to implement effective classroom strategies for these students. The emotional well-being of children in this community is another area of concern. Language difficulties can contribute to frustration and anxiety especially when children cannot express their needs or feelings effectively. We urgently need a full-time speech and language therapist in King's Island primary care centre. This post has been vacant for over three years. The HSE pay and numbers strategy is having a direct negative impact on the provision of primary care services in the mid-west. While approval may have been given to fill this post, will the Minister of State guarantee that the post will be filled before the end of March? In the interim, will the Minister of State please instruct the HSE to ensure that an agency paediatric speech and language therapist will be allocated to King's Island on a full-time basis?

Mary Butler (Waterford, Fianna Fail)
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I congratulate Deputies Sheehan and Quaide on their recent election to the Dáil and I thank them for their interest in all health matters.

The Minister for Health has asked me to thank Deputy Sheehan for raising this important matter and for the opportunity to update the Dáil on it. Primary care therapy services, such as speech and language therapy, play a central role in providing care and treatment to children and adults in the community. There have been persistent challenges in recruiting certain grades of health and social care professionals to meet the demands for primary care therapy services and other community-based services, in part due to the lack of availability of suitably qualified candidates. In July 2024 we saw the lifting of the HSE recruitment pause. Each of the six health regions and each national service has been provided with a specified number of whole-time equivalents and can replace, recruit and prioritise staff within that approved number. This has given the health regions further control to focus resources where there is the greatest need and it informs decision-making at local level on the filling of available posts.

Specifically, to address the Deputy’s question, primary care speech and language therapy services are provided for the community of King’s Island and the surrounding areas in Limerick from King’s Island primary care centre. I note the Deputy's comments around the area being disadvantaged and the challenges in the local national school. The HSE has advised that the staff grade paediatric speech and language therapist post in King’s Island primary care centre has been vacant since January 2024 due to the resignation of the post holder. Since this post became vacant last year, all new referrals have been and will continue to be triaged by senior speech and language therapists within the north Limerick city network. However, I do have some good news that I am happy to report.

Approval has been given for the permanent backfilling of the vacant speech and language therapist post in King’s Island Primary Care Centre. The HSE has advised that this post has been recently accepted from the national staff grade speech and language therapist panel.

The HSE has further advised that it will be a number of weeks before the speech and language therapist is in post. However, as an interim measure, it has been agreed that a new graduate grade paediatric speech and language therapist employed through an agency will provide a level of cover at King's Island Primary Care Centre until the post is filled permanently.

The Minister fully acknowledges the frustration of those who are impacted by the vacancies in primary care therapy services and agrees that much more needs to be done to address the gaps in staffing and the waiting lists for these services, including speech and language therapy. In that context, it is welcome news that progress has been made to fill this specific post in King’s Island Primary Care Centre. We are all very much aware that early intervention is crucial and I am glad to see that there is a pathway here with both a long-term solution and a short-term solution.

Conor Sheehan (Limerick City, Labour)
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I thank the Minister of State for her reply and I welcome it. The community needs complete certainty as to when exactly this post will be filled because there has been a lack of faith here because the post has been vacant, as I have outlined, for more than three years. It is very clear that the HSE's pay and numbers strategy is not working. Officials in the HSE have told me that they were severely impacted by the moratorium before it was lifted and now, because of the pay and numbers strategy, they are simply unable to fill the vacant posts they have, whether that is due to maternity leave, resignations, etc. We know that with the pay and numbers strategy, that posts are essentially disappearing as if into thin air and that clinical staff are being poached by the private sector. I know of a local speech and language therapist who went to Australia on a career break and could not resume her post when she returned due to the pay and numbers strategy.

Last year, the HSE facilitated a group of parents in this school. One parent from Thomondgate, just across the river from King's Island, spoke in glowing terms about the relationship she and her kids had with the speech and language therapist in Ballynanty Health Centre a kilometre away. All of her children had been seen by the same speech and language therapist for over a decade and have now been discharged. A parent who lives in King's Island, across the river, as I outlined, said that her children had yet to see the speech and language therapist, not to mind develop a meaningful relationship with one. We need to see a change here with regard to the pay and numbers strategy to ensure that this type of situation does not occur again.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy. We have had the change from the nine community healthcare organisations, CHOs, to six individual health regions. Each of the six health regions and each national service has been provided with a specified number of whole-time equivalent staff members that they can hire. They can replace, recruit and prioritise staff within the approved numbers they have. By the end of this year, there will be 133,000 whole-time equivalent staff members working across the HSE. That is an increase of over 20,000 staff in the past four years. The health regions have further control to focus resources where there is the greatest need and this informs decisions made at local level on the filling of available posts. They have informed us, which is very good news, that they have given approval for getting the permanent backfilling of the vacant speech and language therapist post. When a post becomes available and the post of the person moving into that post is not backfilled, nothing happens. It is really good news that that post is being backfilled and, in the short term, an interim measure has been agreed that a new graduate grade paediatric speech and language therapist employed through an agency will provide a level of cover at King's Island Primary Care Centre until the post is filled permanently.

It is really important that I reiterate that recruitment and retention of these very specialised, dedicated staff has become very difficult. Retention is also an issue. It is a full-time post and it is very welcome that the other post is being backfilled. The HSE is confident that the new person will be in place in a number of weeks. That is very positive and we will keep a close eye on this matter for Deputy Sheehan because it is very important that those children have those vital interventions.