Matt Carthy (Cavan-Monaghan, Sinn Fein)
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I thank the Minister of State for being here. Last week, the Dáil debated the motion in respect of the assessment of need scandal, as I would describe it, where Government is flagrantly breaching the law on a daily basis in terms of providing assessment of need for children with disabilities in particular. What might have got lost in that scandal is that for many families of children who have received assessment of need, their battle only starts there. In Monaghan and Cavan we have CDNTs that are at crisis point. In March, in a response to a parliamentary question I received from the HSE, it was confirmed at least 12 posts were unfilled. These ranged from social workers, speech and language therapists, psychologists, OTs and across virtually every discipline. Although I have not received the information, I suspect the situation is worse in County Cavan because the numbers of parents who are contacting my office at absolute crisis point is increasing all the time. In County Monaghan this is an issue that has been getting steadily worse in respect of the length of time people are expected to wait for appointments and then the routine in which appointments are offered. There is a pattern with many families who contact me; I am sure it is the same for other Deputies and elected representatives. The families contact us to let us know they are waiting on OT, speech and language therapy, physiotherapy or other appointments in some cases for years without hearing a dickey bird. They contact our office and we contact the CDNT. In some cases, an appointment is offered fairly quickly and there is a pattern of a number of appointments within a short period of time. Then it all starts again; radio silence. Of course, that is because the CDNT is under huge and immense pressure and it is trying to juggle all of the competing demands of families who are in very stressed situations.

My call on the Minister of State this morning is to ensure there is a direct intervention at every CDNT level. First, to decide whether the structure of the current CDNTs within each region is fit for purpose, whether the level of service delivery is up to the standards any of us expect and that those families would deserve and, second, to ensure adequate resources are within each CDNT. I mention particularly the issue of staffing allocations because there is clearly a problem. I do not know if this is across every CDNT but certainly in the two of which I am aware there are huge and substantive gaps that are resulting in a situation that means even if the posts were to be filled tomorrow we would have backlogs that would last for years. There is a need for direct intervention from the Department and the HSE to ensure those blatant gaps are addressed. I do not think it is fair to expect CDNT managers, who are dealing with all these families while at the same time trying to fill staff gaps when they emerge, to also have a holistic eye to the long term which is what is required if we are going to get a handle of this situation.

Hildegarde Naughton (Galway West, Fine Gael)
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I thank the Deputy for raising this issue. He can be assured when I came into this role our CDNTs and that step change in disabilities service are an absolute priority. As he will know, we are working on a national disability strategy at the higher end where every single Department will have to feed in what they are going to do. Whether it is the Departments of Justice, Health, Social Protection, transport, or enterprise, that step change will be required right across Government. Regarding the issue of assessment of needs, which the Deputy raised, we can all acknowledge it is currently not working. The waiting lists are far too long. There is an issue around therapists. We are doing our recruitment drives at a domestic and international level. Last year, my colleague, Deputy O'Donovan, when he was Minster for higher education, put in place an extra 150 therapy places through our higher education institutions and we will be doing at least that again this coming September. We are also looking at therapy assistant posts and how they can support our CDNTs to ensure our children and adults are getting the therapies they deserve and need. As the Deputy will know, I am also working my colleague, the Minister, Deputy McEntee, regarding therapies going directly into our special schools and eventually into special classes in mainstream schools. That will also help to ensure that those children most in need - or some of them - are getting access to therapies. I found instances in my last brief in special education going into special schools where a child would not have seen a therapist. That is just not acceptable. Those measures are part of it. We have an extra 272 whole-time equivalents within our CDNTs across the country. That is more than a 20% increase but we need to do much more. I am certainly open to suggestions as to how we can ensure we have a greater supply of those therapies be it occupational therapists and speech and language therapists.

I am engaging with the HSE, including Mr. Bernard Gloster, and the Department on what else we can do about the assessment of need process. I am sure the Deputy has found in his own area that it is not just about getting the assessment of need. Sometimes when someone gets one, he or she is still waiting to get access to those therapies. These issues are a top priority for me to make sure that adults and, in particular, children get early access to the therapies they need. We are spending €3.2 billion on disability under the previous budget. We want to see the expansion and reform of our disability services in order to maximise people's independence and to help to support them to live the lives they so wish. There will continue to be significant investment in this area.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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I thank the Minister of State. The truth of the matter is that disability services in my constituency are an actual embarrassment. I am embarrassed, as an elected representative, when dealing with parents who are at their absolute wit's end trying to be all things to their children. As well as being parents, they are also expected in some cases to be teachers. They are absolutely expected to be OTs, speech and language therapists and physiotherapists.

There is a clear problem in getting appointments. There is also a clear problem that, when people have no choice, have reached their absolute limits and seek private care for their children to access those services, they are substantially financially impacted, yet the Department has not made any supports available to families in those instances.

There are a number of points in the Minister of State's written response that I will deal with. The interim respite centre for children in County Monaghan is very welcome. I know that interim centre was put in place pending a permanent respite centre. Will the Minister of State give an update on the permanent respite centre? I suggest that, when that permanent centre is opened, the interim centre also be made permanent because the demand is of such a level.

The Minister of State mentioned the Errigal Truagh Special Needs Centre. It is a hugely impressive centre started by a group of volunteers in north Monaghan. They have made applications for capital funding to the Department in order to expand their services and I encourage the Minister of State ensures that happens. Likewise, Steadfast House in Carrickmacross provides crucial supports for people with disabilities. It also has plans to expand its services. Will the Minister of State give assurances that she will ensure these applications are dealt with quickly and positively?

Hildegarde Naughton (Galway West, Fine Gael)
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The Deputy's first question veered into another area, so the response to that is in the written reply.

I am having pre-Estimate discussions with the Ministers for public expenditure and Finance for the upcoming budget. What we all need to see is an increase in the budget and support for our day, respite and residential services right across the country to ensure that there is a good geographical spread and that, no matter where one is living, access to the disability services one requires is not based on a postcode lottery. That will require capital and current spending.

Regarding the CDNTs, we are examining recruitment and retention and means to incentivise therapists, for example, to work within our CNDTs.

The Deputy mentioned a number of projects within the Cavan-Monaghan area that were referenced in my reply. This is about ensuring we are dealing directly with the HSE but also with service users and those with lived experience on the ground to ensure they get access to respite and day services. Some of these projects will take time, and perhaps a phased basis, but the Deputy can be assured of my commitment to rolling this out. I look forward to working with him on these projects.