Seanad debates

Thursday, 12 November 2015

Commencement Matters

Services for People with Disabilities

10:30 am

Photo of Paddy BurkePaddy Burke (Fine Gael)
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I welcome the Minister of State, Deputy Kathleen Lynch.

Photo of Kathryn ReillyKathryn Reilly (Sinn Fein)
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I thank the Minister of State, Deputy Kathleen Lynch, for coming to the House. I am raising this matter because of responses received by several families in the Cavan-Monaghan area about physical and occupational therapy assessment waiting lists. One particular letter, dated 4 November, advised that the waiting time for these assessments was 29 months. Owing to these backlogs in assessments, parents whose children need urgent assessments for therapies and treatments are being forced, at great personal cost, to go private. This is a serious financial cost just because their children cannot access services which are often abridged to other services such as resource teaching hours and special needs assistants.

The primary care services very much act as gatekeepers to those vital assessments that unlock around the resources children need to live, function and fulfil their potential. While they are the gatekeepers, parents believe they have to jump through hoops to access what are basic necessities and rights for their children. Many of the children waiting for assessments are in their formative years. It kills me to hear the desperation in the voices of mothers and fathers who just want their children to be assessed. My office is contacted weekly by parents of children who have great difficulty in getting answers from the Health Service Executive on diagnostic assessments for their children.Unfortunately, this is fast becoming the rule rather than the exception. My office receives at least a couple of representations of on this issue every week. For example, the parents of a child was who was referred in March of this year for multidisciplinary assessment were informed by letter dated 4 November that the waiting list for joint physiotherapy and occupational therapy assessments is approximately 29 months. This means the child cannot expect to be seen until August 2017, during which month the child will be nine. In the absence of the assessment, necessary interventions and assistance may be unavailable, which might impact his ability to access other important services. Is this the Government's vision for children?

It must be remembered that many of the children referred to these services, particularly the child development teams, have complex needs, including speech and language difficulties, emotional and mental health problems, autism and other issues. For parents and their children to be told upon referral to these services that the waiting lists extend to over two years leads them to question the concept of early intervention. How is forcing a child with special needs to wait for years for even a basic assessment of his or her needs deemed early intervention?

We all know that the longer children are forced to wait, the harder it is to tackle their issues and give them the skills they need to live happy and successful lives, both at home and at school. A waiting list of 29 months is unacceptable. We, particularly the HSE, need to start providing a continuous pathway for children requiring specialist interventions to have access to assessments in an acceptable timeframe. Children who experience significant gaps between their assessment and treatment can regress. They are being disadvantaged by the current situation. I know from talking to families that delays can cause a phenomenal amount of stress for parents and children. I know of parents who have indebted themselves to get money to pay for private services but they are not complaining. Parents do not complain. They want to provide for their children and to ensure they have the best start in life. In my view, current waiting lists in this area are hindering them in that regard. Identification of need at a young age and the mapping out at that time of an appropriate care plan leads to a child having a much better chance of a quality life.

Last year a report entitled, The Case of Speech and Language Therapy, was prepared on behalf of Inclusion Ireland by researcher, Pauline Conroy, aided by Simon Noone. It uses figures from the CSO and elsewhere to highlight the shortage of services. One of its most interesting points it makes is that extensive waiting lists for treatment and assessment, coupled with the trend of parents accessing private speech and language therapy services, are indicative of a system that cannot cope with demand. This is evident across the board in terms of some of the child development teams. There is a great demand for services. A 29 month waiting list is not acceptable. We need action in this area as a matter of priority.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I thank Senator Reilly for raising this issue as it provides me with an opportunity to update the House on it. Significant additional resources have been invested over the past number of years in the State’s primary care and disability services, with a view to enhancing therapy service provision. For example, additional funding of €20 million was allocated in 2013 to strengthen primary care services and to support the recruitment of more than 260 prioritised front-line primary care team posts. This included 48 physiotherapist posts and 52.5 occupational therapist posts, all of which have now been filled. The HSE’s primary care division has commenced a national caseload capacity review in support of overall performance and optimum resource utilisation and is trialling a software system to assist in reducing the administration tasks of allied health professionals, thus increasing capacity for direct client contact time.

With particular reference to Cavan-Monaghan, all children there who require physiotherapy and occupational therapy are currently assessed in the children’s disability services, which I know the Senator is aware of. The referral rates to the paediatric physiotherapy and occupational therapy service have increased steadily over the past number of years. Between 2010 and 2014 there was a 32% increase in referrals of children to the physiotherapy and occupational therapy service in Cavan-Monaghan. In 2010, there were 221 children referred for assessment. This figure increased to 292 in 2014.

All children referred to the child development teams are prioritised based on clinical need according to an agreed prioritisation system. Where a joint physiotherapy and occupational therapy assessment is required, the child is placed on the waiting list in accordance with the agreed clinical prioritisation criteria. Cavan-Monaghan operates a group intervention programme and caseloads are validated on a monthly basis. There has been a recent review of all staffing in the children’s disability teams nationally and this will support the allocation of all therapy posts in 2016. I will explain this further later.

Cavan-Monaghan is restructuring its services in line with the national programme for progressing disability services for children and young people. An underlying principle of progressing disability services for children and young people is that children should be seen at primary care level. A child presenting with complex needs will then be referred to the children’s disability network team. The Cavan-Monaghan implementation plan for progressing disability services for children and young people proposes the establishment of network paediatric teams at primary care level as this will facilitate children with non-complex needs accessing services in primary care, as appropriate. The establishment of these teams at primary care level should ensure that therapy services for children are more accessible and available within acceptable timeframes.

The Cavan-Monaghan area divisional management team has agreed to upgrade five existing allied health professional posts to support the progressing disabilities agenda. Furthermore, a recruitment process is currently under way to ensure that this service is staffed by senior clinicians with specific paediatric training with a view to being operational before year end. Additional allied health professional posts are being considered in the context of the HSE’s national service plan for 2016 in order to address waiting lists.

Local services have also indicated that they will further review waiting times. I hope this reply has been of assistance to the Senator.

Photo of Kathryn ReillyKathryn Reilly (Sinn Fein)
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I thank the Minister of State for her reply. When will the national caseload capacity review be concluded and what actions are likely to be taken arising out of its conclusions? Also, the Minister of State mentioned that the Cavan-Monaghan implementation plan for progressing disability services for children and young people proposes to establish a network of paediatric teams at primary care level which, it is hoped, will result in therapy services being more accessible and available within acceptable timeframes. When are those networks likely to be established? Is it anticipated they will be in place by the end of this year or the end of next year?

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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In response to the Senator's first question, it is anticipated the review will be completed by the end of this year. On the second question, network teams will be put in place in relation to the progression of disability services. Progressing disability services is about reconfiguring the entire service in this area. Up to about two years ago, funding was provided to various organisations to deliver the service. They then delivered the service to children who had signed up to their services. In the context of progressing disability services, we are now developing network teams in the communities such that children and their parents no longer have to sign up to a particular service, although they may do so if they wish. This process will take time. We need to first identify the areas in which the gaps are greatest and to then allocate posts to areas of greatest need. The network teams will be built up over time and will be able to deliver a service at community level for all people with disabilities rather than, as was the case in the past, only those who had signed up to a particular service.

If we are serious about main-streaming this is the way we need to go. Progressing disability services is not as advanced in some areas as it is in others. The Senator will note from my earlier reply that Cavan-Monaghan is currently building such a structure. In terms of Government policy in this area, this is the route we are going. Not only is this Government policy, there was no opposition to it when initially presented. Cavan-Monaghan is in the process of building that structure.Where it is in operation and working well, it is working extremely well. I am very hopeful for the future.