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

I thank Senator Clonan for the opportunity to come here this evening. Good evening to him and to his family who are present. I know more than Senator Ruane, yet I too find it all confusing. I will bring Members to where some of this confusion has come from and then I will address the Bill.

I have spent the past two and three quarter years trying to get out of the Department of Health. I am now in the Department of Children, Equality, Disability, Integration and Youth for the last three months. To be fair to the Minister for Health, Deputy Donnelly, he let me operate a little bit on my own within the Department of Health because he knew I was going out the door. Therefore, whenever I went before committee, the Minister, Deputy O'Gorman could not attend because he did not have the transferred function powers. Now I am transferred. Now I am actually working with the Minister, Deputy O'Gorman, in a very close capacity. Up to this I probably had freer rein. I am the Minister of State and I am here this evening. Senator Ó Donnghaile asked me to lay out my stall as to whether I was tabling a timed amendment. That is what I am going to do, to lay out the stall.

I am supportive of the timed amendment but I want to explain why because it is important Members hear why. I was here the day of Senator Clonan's maiden speech when he said he actually wanted to do good, wanted to make friends and wanted to learn. I, no different from him, wanted that in 2020 but it has taken me a while to understand the dynamics and the reasons the system does not work. There are numerous layers as to why the system does not work. Six weeks ago, I took a flyer on the floor of the Dáil and that was my first step towards breaking the system. I made a commitment to families and to children that if they could not get an assessment of need and if the regional assessment hubs were not stood up on 1 August, I would ensure that they could access it through private therapists and be refunded. I still stand over that. The HSE is pedalling really hard to deliver on my six regional assessment hubs. Why is that? It is because the two parts of the HSE do not work at the moment. They cannot do assessments or interventions. They can do one or the other but not both, so we need to take away that which is their legislative requirement. That function cannot be taken from it because it is still legally charged with it. We need, therefore, to stand up the regional assessment hubs. We need to bring private capacity into that in six regional centres. So far I have between six and seven stood up. I have one in CHO 8 being stood up and there is work being done in CHO 2. That is three of them and today is 11 July. I have achieved a fair bit since we started about three weeks ago. That needs to be done so that as children are assessed they can go to a regional assessment forum. This should all happen seamlessly. They can then go back onto their CDNT and get direct intervention. The CDNT manager managing the 91 teams throughout the country is doing only one thing and that is delivering therapies and interventions. That needs to happen. It is not happening. Everybody is moving the bit of paper. One of the Senators talked about how 11 hours a week of a 35-hour working week is spent on direct therapy interventions. The rest is spent on paperwork. The rest is spent on setting up the case and liaising back. We are doing that.

The next part that we spoke about is, "What else do I need to do?" That is the regional assessment hubs. I am now on the PDS roadmap and it is going before the HSE board for approval within the next two weeks. I have spent the past year trying to get this right. I am not saying I am going to have it all right but if it is 80% of the way that is a hell of a lot further than where it is today. The biggest part for me was adding capacity to the teams, the 34% vacancy rate of which Members spoke.

I have a proposal and I have no problem in sharing with Members. I am looking for master's and postgraduate students to be added on to my teams. We all know the class of 2020 never got to sit the leaving certificate but many of them ended up doing science. Others did science too and I want them to pivot into physiotherapy, speech and language and occupational therapy. The HSE pays for those spaces on their master's programme. I do not mind if they pay for the postgraduates. The Psychology Society of Ireland, PSI, has been saying for the past number of years, since I came in here, that we need to do the postgraduate for psychologist places. I have asked the HSE to fund 30-30-30 because 30 is a third of the number of our teams. If I did 30 of all of them this year, and 30 again, then two-thirds of it will be done by the time the timed amendment Bill brings me in here to say where I am at. That is the piece I am trying to do. That is a direct intervention. I am not asking the Department of Further and Higher Education, Research, Innovation and Science to do it. We have to do it ourselves within the Department of Children, Equality, Disability, Integration and Youth, working with the HSE. That is what has to happen. If we got that, we would have more clinical governance. Then I need to work with the Department of Further and Higher Education, Research, Innovation and Science on the actual development of the assistant therapy grade. This is no different from the SNA grade. They would go into our special schools and into our education system, not just special schools, because we have classes in all our schools. It should be a whole-of-community approach by developing our assistant therapy posts in occupational therapy, physiotherapy and speech and language. Only six of our ETBs at the moment are providing therapy supports or developing FETAC level 5 or FETAC level 6. The Cavan-Monaghan area has been a leader in this. Last year, between level 5 and level 6, in physiotherapy we produced 75 assistant grade therapist posts. We provided 18 in occupational therapy. We now need to get that stood up further. That is a game changer.

Another piece in the roadmap has to be a clinical specialist within our CDNTs. There is no point having assistant therapist grades if I do not have that senior post in order that there is a pathway for development, to write the framework to work with a number of schools, and not just special schools. However, I believe we need to put back into special schools what we took out. We levelled down with the PDS roll-out and that reform piece. The assessment of need clinical guidance is about to be signed off. It is finalised with the legal guidance back on it now. We know that back at the start the assessment of need was not working. The PDS then came in January 2020, six months before I became Minister of State. We had the High Court ruling last year where it was not successful. I have now worked with the HSE and all the clinical leads and have final clinical guidance which I have tested. However, I am sure it will be challenged with the legal system. We know that 90 minutes was wrong but we know that not every child needs 34 hours. It should be a range. We are doing that piece. That will be within three weeks.

Finally, the disability capacity action plan, which will fund my budget this year, sets out the roadmap from 2024 to 2026. Officials are meeting with the Department of Public Expenditure, National Development Plan Delivery and Reform at the moment on the negotiations on that. We do not just look at children's disability services. Young adults and older people need therapy and interventions. It has to be looked at in the round, not just for children. Children transition into young adults who transition into older people. This will ensure there is therapy and intervention within all ranges. It is also to ensure that we have adequate housing, respite and personal assistant, PA, support. The disability action plan is about funding that range. I have prioritised three parts of it, respite, residential and PA. They are the three levers I want front-loaded for the next three years. I want the Department of Public Expenditure, National Development Plan Delivery and Reform to give me a funding percentage for the next three years so that I know the disability service providers can actually build capacity.They cannot do so from year to year because they do not know what funding is coming next year. I want to front-load it now so that they can build and add capacity.

Senator Ó Donnghaile, who has left, was right to ask me to set out what actions we are taking. The time for action is now. I am taking action. I apologise to the families who have waited this long. It has taken me this length of time to crack the nut and get all Departments to play their role, as they are now doing. It has taken me this length of time to change the culture of pushback, which is one of the greatest challenges I have met in all of this. I am not a clinician or a parent of a child with lived experience. The cultural pushback and lack of communication, understanding and willingness to change I have experienced have been unbelievable. l have experienced the frustration parents and families must feel on a daily basis for the oast three years. There is no longer any point in having officials from the Department come into a room; I bring the providers into the room. I want to hear what they are doing or not doing. I want the HSE in the room because I need to understand what parts of the cog of the wheel are not working. What I have discovered within the Department in Health and then the Department of Children, Equality, Disability, Integration and Youth is that everybody is willing to change but when we leave the meeting room, the application of that change does not happen.

I am glad to hear of the experience Senator O'Reilly from Cavan-Monaghan had last week. That is the only way I can make change and provide accountability. That is how I am doing my business from now on. I ask Senator Clonan, Senator Chambers and my colleagues on this side of the House to hold me to account over the next 12 months. What I have said here is on the record. I have no fear of coming into the House but I ask Senators to at least give me the chance to make that change. It has taken me three years to get movement. Let me be accountable for the change over the next 12 months.

I commend Senator Clonan on what he has done. He is challenging me further on intervention but if the regional assessment hubs are working, intervention should be happening and we should be hearing that. Let us see if the Senator can afford me that time. If 12 months is too long, hold me to account on a quarterly basis. I am more than willing to come before the Seanad for that reason.

To respond to Senator Ruane, I am taking total ownership of all of this. I have no problem with being accountable to anyone. I have a good working relationship with the Minister for Children, Equality, Disability, Integration and Youth, Deputy O'Gorman. He has been more than supportive, as has the Minister for Health, Deputy Stephen Donnelly. They have helped me move the dial, as has Senator Ruane in her engagement with me since becoming a Senator. She has told me many times where I needed to focus my energies and how to change. I have taken that advice on board. For this reason, the role of personal assistants is one of my main points in the framework coming forward on the disability action plan.