Rory Hearne (Dublin North-West, Social Democrats)
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The figures released by the HSE this week to my colleague, Deputy Quaide, reveal a truly shocking level of waiting times for essential primary care services for children. My constituency of Dublin North-West has recorded the longest waiting time in the country for psychology services for a child, with one waiting 706 weeks, or 13 and a half years, for psychological care. I cannot understand how a child whose parent probably contacted the HSE and was probably referred by a GP in need of psychological supports, be that for mental health trauma or developmental need for intervention, has been left waiting for 13 and a half years for that support from the State.

The longest wait time in the country for speech and language therapy is over six years, or 313 weeks, also in my constituency of Dublin North-West. What is going on here? Everything we know about children and psychology is that early intervention is absolutely key. From speech and language to behaviour to dealing with trauma, early intervention in children is absolutely essential so they can develop and grow and reach their potential and the issue they face is addressed and does not leave lifelong impacts.

I am not surprised by these figures because I have been contacted by many parents in my constituency who have children with additional and developmental needs. While working with them, they have told me they have been stuck on waiting lists for primary care supports, therapies and interventions. They have told me about the stress and anguish they face, their frustration and experience and the negative impact on their children of being unable to get the vital services they need. One particular case in my constituency concerns a mother who contacted me about her young son. He received an autism diagnosis in April 2024 and the diagnosis report indicated that follow-on psychology, occupational therapy and speech therapy were required. When looking for these services, however, she has been left utterly heartbroken by the lack of availability of services. Over a year later, she has not been able to secure any therapy for her son, particularly occupational therapy, which she was advised he would need and from which he would really benefit. Like so many others, she has had to pay privately for speech and language therapy. Many children are being impacted by this in my constituency and across the country. They are being denied the right to see therapists and get speech and language therapy, occupational therapy and psychological support when they need it most.

The crisis is one of a lack of staffing. There is a number of reasons for this, particularly the HSE primary care strategy known as pay and numbers, as well as the recruitment embargo, but also issues with retaining and attracting staff and Dublin is a particular issue. We know the cost of housing is a major issue, but other issues raised with me by staff in these services include childcare and a lack of maternity care. We do not see staff being replaced. Will the Minister of State explain why the waiting lists for psychology and speech and language therapy in my constituency of Dublin North-West are the highest in the country? What is he going to do to ensure these wait times are reduced and that children and their families have access to the primary care services they urgently need?

Thomas Byrne (Meath East, Fianna Fail)
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On behalf of the Minister for Health, I thank Deputy Hearne for raising this issue. It gives the Minister the opportunity to update the Dáil on this important issue. What the Deputy has set out is not acceptable.

Primary care services, including primary care psychology, play a central role in providing care and treatment to both children and adults in the community. Per the implementation of the national policy on access for children and young people with a disability or developmental delay, children and young people with complex disabilities are seen within the children’s disability network teams, whereas those with less complex needs are seen within the primary care services. The HSE has advised that increases in the numbers of referrals and an increase in the complexity of presentations requiring more intensive interventions have resulted in increased pressure on primary care services, including primary care psychology.

As the Deputy outlined, primary care services are facing staff shortages and ongoing recruitment challenges for health and social care professionals working in general and specialist services in the community. These factors have all contributed to an increase in waiting lists for services across the country, including Dublin North-West.

This Government recognises, however, the central role that primary care therapy services play in offering the opportunity for early and cost-effective interventions for children and young people.

In budget 2025, the Government continued its investment in initiatives aimed at addressing long waiting times for children and young people, including in child psychology. This year, funding of €4.75 million to continue this initiative will target the removal from the waiting list of 2,933 people under the age of 18 who have been waiting longer than 52 weeks to access the service, with almost 900 people already removed at the end of the first quarter of this year. The Minister for Health fully acknowledges there is an urgent need to reduce waiting times and waiting lists for primary care services and to improve consistency of patient experience regardless of location.

In line with the programme for Government commitment to build capacity in primary care therapy services, a programmatic approach to address primary care waiting lists has been developed jointly by the Department of Health and the HSE. The aim of this programmatic approach is to put in place considerable standardised infrastructure to support systematic responses to primary care waiting lists and to facilitate a greater understanding of the scale of demand, which we all know about and the Deputy has outlined, as well as the drivers of demand and to allow for more timely access, improved planning, interventions, investment considerations, enhanced productivity and the most efficient use of capacity.

This approach involves three main workstreams which aim to improve access to primary care therapy services by analysing activity and maximizing capacity, developing national measures to reduce long waiting times, and creating a consistent management protocol for referrals and waiting lists to these services.

Rory Hearne (Dublin North-West, Social Democrats)
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I thank the Minister of State for that. I appreciate the Minister for Health, Deputy Carroll MacNeill, is responding by saying she will address this and take action. I am disappointed there was not a specific response to the constituency of Dublin North-West or the rationale for why that area in particular has such high lists. The Minister of State might take that back to the Minister to ask what specific interventions will be addressed for this in my constituency. Again, that length of time is truly shocking when we think that the child in question, who is waiting for responses and services, must have been two or three years of age and now would be 16 or 17 years of age. It is absolutely unacceptable.

I did not hear or read in the response any increase in recruitment of staff. Again, this is a key issue. The lack of staffing is clearly identified. The Minister of State identified in his statement the increase in complexity of need and number of referrals so clearly there is an increased need for staff. Existing staff cannot cope with that increase in either. References to workstreams, analysing capacity and aims of developing plans do not say recruitment of staff. I would like the Minister of State to address that in his response. What is the Department going to do to increase the number of staff so it can provide the services needed? Even producing these high-level waiting times does not address the other issue of people waiting six months, a year or two years. This issue, in a matter of weeks and months, has lifelong impacts on children.

Thomas Byrne (Meath East, Fianna Fail)
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We fully recognise the frustration of people in the Deputy's constituency with long waiting times for certain services. Much more needs to be done, particularly to fill vacancies, as he has said, to address waiting lists and to ensure consistent, equitable and timely access. As I said, we have a child psychology waiting list initiative alongside a joint Department and HSE programmatic approach. We are committed to building capacity within primary care, particularly by recruiting additional staff numbers, promoting advanced practice roles in the community for health and social care professions and increasing - this is critical and goes to the Deputy's point - the number of college training places for health and social care professions.

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 number. This gives them more power and control to focus resources where they are needed and informs decision-making at a local level regarding prioritisation and filling of waiting lists. There are challenges, particularly with local vacancies, which the Deputy has outlined and these are impacting on waiting times.

Each of the health regions now has its own budget. The leadership team with responsibility for local decision-making continues to work towards the Sláintecare objectives. The Government remains committed to the development of the primary and community healthcare services as outlined in the programme for Government and we will certainly take those points the Deputy has raised here in the Dáil back to the Minister.