Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I agree with most of what Senator Cullinane said, but it is important to read out his exact question, because what he said in his contribution is not exactly what he asked in writing, so I do not have the entire answer to the issues raised. The Senator inquired about

the need for the Minister for Health to outline how many speech and language therapist and clinical psychologist posts exist in the public system in Waterford city and county, how many are vacant, how many of the 80 posts announced last year were allocated to Waterford and how many of the additional 120 posts will be allocated to Waterford and to outline waiting times for assessment for children referred with a mild to severe intellectual or physical disability.

There is no reference to the other areas of psychology to which he referred in his contribution. That is by way of explanation, because I do not wish Senator Cullinane to say subsequently that I did not answer the entire question.

I thank Senator Cullinane for raising the issue. The Government is committed to the development of therapy services for children with a disability, including speech and language therapy and psychology services. Health-related therapy supports and interventions for children with a disability can be accessed through both the HSE's primary care services and its disability services, depending on the level of need. Speech and language therapy services in Waterford are provided by HSE teams in primary care and disability services, as well as by the Brothers of Charity and the Central Remedial Clinic regional service. There are currently 15 approved speech and language therapists, or 14.81 in whole-time equivalent terms, in the Waterford service overall. Six speech and language therapists provide services to the general population of children in primary care. Five speech and language therapists are assigned to the children's specialist disability services in Waterford. The remainder look after adults, mental health and other needs.

In addition to these dedicated posts in Waterford, the Central Remedial Clinic regional service provides more specialised speech therapy for particular children with physical and sensory disability across the whole south-east region. I understand three of the 15 speech and language posts are vacant at present in Waterford. The filling of a permanent replacement post has been approved and a new post holder is due to take up duty next month. The local HSE community health organisation management in Waterford has prioritised the filling of the other two posts which are temporarily vacant due to maternity leave. I understand, however, it has proved difficult to secure appropriately qualified staff to take up these temporary positions.

I also understand there are currently three psychologists employed in Waterford disability services. In addition, a number of psychologists are employed in child and adolescent mental health services, CAMHS, and in primary care services in Waterford. The HSE has advised that 13 assessment of need applications under Part 2 of the Disability Act 2005 were received in Waterford for the first quarter of 2015. A total of 12 of those were commenced within the statutory timeframe. A total of 22 applications, which have been on hand for over six months, are overdue for completion in Waterford. On this point, I wish to stress that while any delay in the assessment of a child is not desirable, the assessment process under the Disability Act can take place in parallel with any interventions deemed necessary, and guidance to this effect has been issued to front-line staff. I would be interested to hear from Senator Cullinane whether that is happening. I will explain the situation in a little more detail later. Importantly, the HSE has commenced the reconfiguration of children's disability services into geographically based children's disability network teams as part of the Progressing Disability Services for Children and Young People programme. The objective of the programme is to provide one clear referral pathway for all children from zero to 18 years old, irrespective of the nature of their disability or where they live or attend school. The transition to this service delivery model is governed by a consultation and engagement process with all stakeholders, including service users and their families. A number of HSE community health care organisations are successfully implementing this programme, which requires significant preparatory work in engaging with families, schools and local communities. It also involves implementing new policies, procedures and protocols in respect of multidisciplinary and multi-agency working. Once this preparatory work has been completed, additional posts will be provided to support the implementation of the new model of service. Waterford, which has been working with the other counties in the local HSE community health organisation area, has put in place the required governance structure to allow for the provision of additional posts in 2015. Additional funding of €4 million has been allocated to the programme in 2015, equating to €6 million in a full year. In all, 120 new therapy posts will be provided across the country in 2015 and work on finalising the specific allocation of these posts is nearing completion. The HSE has informed me that, in this context, Waterford and the south east are being prioritised for therapy posts in 2015.

I will explain the reason for the parallel operation of services that sometimes occurs. Strict compliance with the law would require a diagnosis before an intervention may take place. It has been made clear to front-line staff - I have stated this several times in this Chamber and elsewhere - that intervention at an early age should not be delayed because a diagnosis has not yet been provided. When a child has a difficulty with speech it should not be necessary to wait for a diagnosis before speech therapy services are provided. Similarly, physiotherapy services should be provided to a child who lacks balance or cannot sit up. I could rattle off a list of difficulties children may experience but it is not necessary to do so. The necessary interventions should not hinge on the provision of a diagnosis, as occurred in the past.

The progressing disabilities programme for children aged from birth to 18 years has been rolled out in several areas. It is an incredible programme which does exactly what I have described. For example, children are not required to be signed up for a specific service or visit a particular service provider and intervention takes place in the community.

Once the 120 posts in this year's allocation have been provided, we will identify gaps in services and assess what further supports are needed to fill these gaps. We have already done this in the area of mental health. While no one denies that we are still far from where we should be, we should be able to do things better and in a more smooth manner. The progressing disabilities programme is the way forward in this regard. I fully agree with the approach of ensuring governance is in place before assessing which areas have the greatest need. In that context, Waterford has been prioritised.