Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the Leas-Chathaoirleach and everybody who took the time to contribute to this debate. The contributions were fantastic and spread right across the country. Every CHO was represented and I was just checking that aspect as we were going along through the debate.

It is important to recognise we are all on the one page in that we all want to ensure we assist families, we do not want the fight to continue, and we need to ensure families have fair and equitable access to services. That is exactly what progressing disability services for children and young people, PDS, was always supposed to be about, which was fair and equitable access to services regardless of geographical location. Sometimes when you come from the west, you always think people on the east coast have more access to services.

This is the whole idea of PDS, in that we will have 91 teams throughout the country. I know Senator Warfield is gone from the Chamber, but at this time we have reconfigured 80 of those teams. By the end of this month we will have 91 done. The last three are being done in Mayo, where we are recruiting the managers there as we speak. From there, it is hoped, the system will start to settle because what the Senators are receiving in their emails and constituency offices is the state of flux of the transfer that is taking place at the moment.

I said at the beginning that much of this is paper and not technology-based, and where there is the configuring of the various lead organisations and team members working together who have never worked together before, this means staff have had to uproot as well make all this happen. At the centre of all this is the young people and their families and giving them that access to service. I pay tribute to the staff who have put in an inordinate amount of work. We heard from Senator Warfield that we had 40 teams in May and now we have 80. We have come a long way in that space of time, and by 1 December we will have the 91 teams. Great strides have been made and a great deal of work has been done by all of the staff working right across the country.

In my remaining time here I want to share with Senators what I expect from the HSE for the next 12 months, and perhaps when the House calls me back here again in a year’s time, I would like to be held to account, and not just me but also the HSE. We are funding this service so I have to hold it to account. As Senators Kyne and Carrigy and others have said, parents are tired of battling. I see my role as the advocate for that child and parent to ensure they have fair and equitable access to the service because that is the vision and the model we are funding. That is the expectation, so what I want to do is to hold the HSE to account.I will share this with the House. Some Members might be hearing this for the first time tonight. From the start, on 1 December, every week I will be meeting with CHOs. I will meet three CHOs in the first week, three CHOs in the second week, two in the next week and so on. That is how I am going to do it. Then, in the final week I will meet with the HSE director of services and all of the leads. That is how it is going to be done every single month, month after month. After that I will have met with the likes of Dr. Colm Henry.

In answer to the Senator's question of what is an acceptable key performance indicator when one has a team, we will look at how many speech and language therapists and how many children should be seen across all of the teams and what this means with regard to input, output and access to services. We will ask what parents should be expecting and what I should see in the figures. If 100 children are coming in, should a team be seeing 100 children or is that too much to be expected? When we consider the team in Cork that went from 800 to 1,800, we must ask if it is a fair workload on a team when there are so many? Is it a case of just putting people onto a team and they are never going to access services? I genuinely cannot put people onto a team and send out letters saying that they will see somebody in five years' time. That is not acceptable to me, nor can I stand over it. I would not expect any of the lead agencies to stand over it, nor the HSE.

At this stage, I believe the HSE needs to be run like a business in relation to progressing disability services for children and young people, PDS, which is the reform piece within it. Every time they have an assessment, parents should be able to expect that the assessment should be an intervention. We need to move away from the practice of "we are all on an assessment". Everything should be an intervention. When a child or young person first goes in front of a therapist, that first meeting should be an assessment, as opposed to what the child is diagnosed with. If there is a need for speech and language therapy or a need for occupational therapy, we must get on with that while the team is still working out what the diagnosis piece is. Senator Ardagh spoke about this. The family just want the intervention, be it speech and language therapy, occupational therapy, physiotherapy or behavioural management. While we are working on the complex piece to put a name on the diagnosis at the very end, let us be getting on with the intervention.

I refer back to my opening contribution. I will be honest with the House that I was very disappointed when I saw what was laid before me in the last week. I was very disappointed. Members will see that in what I have circulated. I cannot accept that for three months in some CHOs in the State not only were no assessments done, but there were also no interventions. That is not acceptable. I will not stand over that. I do not expect anybody working in the HSE to think it is acceptable. I am not apologetic in relation to it. I absolutely believe the culture has to change. The culture needs to move from the assessment to that intervention piece.

Senator Cummins spoke about communication. Communication is absolutely appalling within the HSE. How we communicate en bloc, in a cut-and-paste manner, to parents is not acceptable. We need to tell parents the truth, but there is a way in which one tells them the truth. There is a way in which we bring people with us. It is not acceptable to tell a parent who is wondering whether his or her child's speech and language therapy is going to be delivered that he or she is not going to hear from the HSE for four years. If that is what the waiting list is when I get the final figures in the next couple of weeks, I will have to look at alternative methods of delivering service and intervention. In the budget this year, the Minister for Public Expenditure and Reform. Deputy Michael McGrath, gave me €10 million to spend on waiting list initiatives. I must first get all of my figures to see how we are going to do that. I am open to every suggestion around delivery. When we did this with the assessment piece, and with €7.8 million, we were able to clear a backlog of 6,000, and 92% was cleared in 12 months. I believe we can do something similar with speech and language therapy, operational therapy and physiotherapy services. It is a bigger challenge. If we have to rise to it, then it has to be done. Senator Carrigy has said that we have done massive development projects in this State but we still need to invest in our young people. We need to give them the intervention required to give them the best chance in life and the opportunities to be the best they can possibly be.

We also need to work closer with education. The Minister of State, Deputy Madigan, has a very good pilot project around the school inclusion model. We need to see how that model can work with my PDS to ensure that children have access to therapies, whether they are closest to home, closest to the school or in the school. Whatever works needs to be worked on. This is a fresh model that needs to be given every single chance to be rolled out. This is why we have 91 of them, so they are very close to all of our primary care centres.

As I said earlier, 12 months ago people were telling me that the standard operating procedures would mean I would never have another waiting list again, and I would be getting straight into my interventions. Needless to say, having seen where we are in the past couple of days with the figures, I am open to all suggestions. I am prepared to break it and fix it and break it and fix it until we get it right, as opposed to saying we will wait for it to work out. That is not how we can work with children's lives. That is not how we can work when a child needs speech and language therapy, occupational therapy or physiotherapy. Parents are tired of fighting. They are tired of the repeated fight to get access to a diagnosis, to get access to an intervention and to get the supports they need within schools. It goes on and on.

The Leas-Chathaoirleach asked me a particular question on residential adult spaces. There is always a shortage of residential adult spaces. At this moment in time, there is emergency and critical emergency. Between emergency and critical emergency, there could be 800 people waiting at this minute for access to residential places in the State. I believe that the way the model has been to date needs to be reviewed. Sometimes the key performance indicators for accessing the service seem to require the death of a parent or a sibling, which is the wrong model to be working on. We need to do early intervention a lot sooner so we can support people to have supported independent living and accommodation. We must move away from this idea of being reactionary so we can plan for building capacity into it. The good news in the budget this year is that I have also created respite places for eight houses for children and eight for adults to start building up back that capacity.