Paddy Burke (Fine Gael)
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I welcome to the House the Minister of State at the Department of Health, Deputy Kathleen Lynch.

David Cullinane (Sinn Fein)
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I thank the Cathaoirleach and welcome the Minister of State to the House. I tabled this Commencement motion last week and coincidentally, there was a report on Newstalk this morning by Kieran Cuddihy, who obtained figures through a freedom of information request regarding national waiting times for children with mild to profound intellectual or physical difficulties who were waiting for assessment. They showed that 12,650 children nationally are waiting for assessments of whom 3,300 are waiting for longer than the three months that is the Health Service Executive, HSE, and the Government's own benchmark. As for children waiting for treatment, 4,500 are waiting for longer than three months, while 7,908 are waiting for treatment.

At present, I am dealing with a number of families and I wish to give the Minister of State a flavour of their stories, because each individual case has its own personal story to it. These are parents who are battling to get services for their child, who may suffer from a mild to a severe disability, be it intellectual or physical. One such story concerned a child called Harvey, whose general practitioner, GP, referred him to the early intervention team in September 2013. On 19 September 2013, the parents received a letter from the speech and language therapist regarding the referrals with a questionnaire attached. On 29 November 2013, Harvey was assessed by the speech and language therapist and the conclusion in her report pertaining to autism stated that Harvey was demonstrating some clinically significant markers for autism, that this would be monitored in subsequent sessions and onward referral would be made to the autism team, as required, and with parental consent.

The occupational therapist's report, which was based on an assessment carried out on 11 March and 14 April 2014, again referred Harvey on to the autism spectrum disorder, ASD, team for a diagnostic assessment. The family was told this would happen in February or March 2014 but that date came and went. It is now approaching June 2015 and the family still awaits that diagnostic assessment. It had a private assessment carried out, which is accepted by the Department of Education and Skills but not by the HSE, which is the provider of the child services. I have to hand another e-mail from other parents stating their child did not get proper support due to a significant delay in diagnosing and assessing their child. Their son has ASD and received a private diagnosis when he was two. While he receives appropriate resources in school, he is almost seven and the HSE only diagnosed him this year after a long road and battle.

As Members are aware, early intervention is hugely important and these children have complex needs and need multiple therapies. The question I specifically asked the Minister of State, because this is also relevant to where I come from in Waterford and is a national issue now it has been highlighted, is how many speech, language and occupational therapists are in the public system in County Waterford? How long are children with mild to profound intellectual or physical disabilities in Waterford city and county waiting to be assessed? There appears to be a problem with assessment waiting times and these are stories from parents of children who do not deserve to be obliged to battle the State to get support for their children. They simply do not deserve that, as these resources should be provided as quickly as possible and under the timeframes to which the Government itself has committed. Consequently, I raise these issues on their behalf as they have asked me to so do.

Last year, 80 speech and language therapy posts were announced, not all of which were filled and none of which went to Waterford. As another 120 further posts are to be announced, how many of those posts will be delivered in Waterford? It is not just therapists as there also is a need for both child psychiatrists and clinical psychologists, as this is a joined-up system.

The final point I will make is I visited the Sacred Heart Centre in Waterford city, where the staff provide fantastic support. It is a joint venture between the Department of Education and Skills and the HSE but the building is dilapidated.The children have complex needs and the building is not fit for purpose. There is a real need for resources to be put into this area. Unfortunately, due to waiting times and the lack of therapists, staff and capacity in the system, children are waiting longer than they should. The children in question have complex needs and we should not fail them. We should provide parents with every possible support because, as the Minister of State and I are well aware, early intervention is critical.

Kathleen Lynch (Cork North Central, Labour)
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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.

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.

David Cullinane (Sinn Fein)
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I welcome the Minister of State's response and the decision to prioritise Waterford city and county once the 120 new posts have been delivered. I am concerned, however, that 22 applications have been on hand for more than six months and their completion is long overdue. Perhaps some of the cases I cited are among this group of 22. If I may, I will forward to the Minister of State e-mails I have received asking questions and expressing concern as they provide evidence of the heartbreaking struggle of parents. They would also allow her to make up her mind as to whether children are receiving the treatment they need while assessments are ongoing. From my contact with parents, including e-mails I have received, it is clear that this is not always the case on the ground.

I do not wish to make a political football of this issue. My only objective is to ensure the necessary capacity and posts are in place and the children in question receive the supports they need. When people contact with me to tell me these types of stories I have a duty, as a public representative, to raise the issues directly with the relevant Minister.

I appeal to the Minister of State to consider the case of the centre in Lady Lane, Waterford, which provides a fantastic service for children. My view, which is one shared by many parents, is that the building in which the service is located is not fit for purpose and a new, state-of-the-art facility is required. I am informed that children receive early intervention and support until the age of six years, at which point they lose their supports. A holistic review of services is required and the centre in Waterford should be replaced with a state-of-the-art facility to ensure children have all the resources they need in the best possible setting.

Kathleen Lynch (Cork North Central, Labour)
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I will examine any information the Senator forwards to me.I am not in the habit of making promises which, I suppose, the Senator knows. The progressing disability services programme is genuinely for people aged 0 to 18 but if it does not have proper governance, it could go the way of all others. That is why we are insisting that the type of preparatory work necessary to make sure it works should be put in place and I believe Waterford is in that position and that is why we will move on in terms of prioritisation. If the Senator wants to send me the information, I will consider it.