Kathryn Reilly (Sinn Fein)
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I welcome the Minister to the House and thank him for coming here this morning. This morning's Commencement matter follows one I raised on 12 November with regard to disability services in Cavan and Monaghan. That matter concerned waiting times for joint physiotherapy and occupational therapy assessment in the HSE. Since then I have been inundated by parents contacting me with their own experiences and stories of the disability services for children and young people in Cavan and Monaghan. Their stories tell of despair, concern and, in some cases, anger at what they feel is a system that is failing their children's needs.

My office is contacted weekly by parents of children who have great difficulty getting answers from the HSE with regard to diagnostic assessments or access to therapies for their children. Many of those waiting on those appointments are in their formative years. It is not just the odd case; it is becoming the rule rather than the exception. Many of the problems I hear of stem from what happens once children transfer from Enable Ireland to the child development team. Instead of just taking my word for it, I will read some accounts into the record. One parent said:

My experience is one of a child already diagnosed transitioned from enable Ireland to CDT 2006, put on a waiting list for over two years for OT and SLT. The result - regressed so severely - now in a residential therapeutic assessment center. The progressing disability is a result of initial poor services. Presently my child’s care and therapies are costing the government a lot more had they addressed the needs earlier.

Another parent wrote:

6 year old transfers from enable Ireland to Child development team and has to rejoin the nearly 3 year waiting list for OT!!!! This child is diagnosed and recurring treatment since he was 2! He will be nearly 9 before he sees someone again!!! It's just horrendous!

Another parent wrote:

Our son was referred from Enable Ireland to the Child Development Team in Cavan in July 2014 and have recently been informed by the HSE that he won't have access to Joint Physiotherapy/Occupational Therapy Assessment till MARCH 2017. We have a Physiotherapy Home Plan dated 2012 - we are left on our own with no support.

Another wrote:

6 year old son is autistic and was transferred from enable to the child development team in June 2015. We have just received our first speech and language session however I'm told that the wait for Occupational Therapy will be 2 years 11 months.

When the Minister of State at the Department of Health, Deputy Kathleen Lynch, was in the House last, she noted:

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.

Furthermore, she advised that "Cavan-Monaghan is restructuring its services in line with the national programme for progressing disability services for children and young people." She continued:

The Cavan-Monaghan implementation plan for progressing disability services for children and young people proposes the establishment of a network of 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.

An implementation plan that will ensure therapy services for children are more accessible and are available within accessible timeframes is welcome. I welcome it. This plan should be rolled out as a matter of priority. Saying that there is a plan and advising that there are proposals in place will not alleviate the burdens of assessment and waiting times in the short term.When parents tell me and those who operate the system that the lack of interventions and therapies at an early stage, as a result of waiting lists, is causing their children to regress, this becomes a serious issue of concern for us all.

I have a few questions on the specific services that are being restructured and proposed in Cavan-Monaghan. While the Minister of State may not be able to answer them this morning, I would be appreciative were he to refer them on for a response. Can a timeframe be provided? In addition, for those interested parents and families affected directly by this issue, can the Minister of State advise how the plan can help their children? Essentially, how will this plan help those children on the waiting list at present and those who are being put on it and who may be in the middle of a long wait for assessment or services? Will it mean availability and access will be facilitated in the next month, three months, six months or a year? Alternatively, will it only help those who will be referred in the future? In the last contribution, when I asked when the networks were to be established, the Minister of State, Deputy Kathleen Lynch, advised the process would take time. I accept that change takes time and that overhauling or implementing a new system cannot happen overnight. However, as the Minister of State noted, the demand for services is growing, as evidenced in the surge in referrals. I would welcome the indication of a timeframe as to how this change is to happen, when or how the network teams are to be built up, when gaps are identified and when posts will be allocated. It would go some way to allaying the concerns of parents who truly believe their children are being lost in the system.

Joe McHugh (Donegal North East, Fine Gael)
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Gabhaim mo bhuíochas leis an Seanadóir as an gceist. Toisc go bhfuil an tAire Stáit, an Teachta Lynch, as láthair inniu, tabharfaidh mise an freagra a bhaineann leis an ábhar fíor-thábhachtach seo.

The Government is committed to providing and developing services for children with special needs and to improving access by these children to therapy services, in so far as possible, within available resources. As the Senator will be aware, health-related therapy supports and interventions for such children can be accessed through both the HSE's primary care services and its disability services depending on the level of need. Significant additional resources have been invested in recent years in the State's primary care and disability services with a view to enhancing therapy service provision. For example, in 2013, additional funding of €20 million was allocated to strengthen primary care services and to support the recruitment of prioritised front-line posts. The HSE also has recognised that its early intervention services and services for school-aged children with disabilities must be standardised. To this end, a major reconfiguration of therapy resources for children with disabilities aged up to 18 years is currently under way. This involves pooling the resources of all service providers in defined geographical areas. The HSE's national programme on progressing disability services for children and young people up to 18 years of age aims to bring about equity of access to disability services and consistency of service delivery, with a clear pathway for children with disabilities and their families to services regardless of where they live, what school the child attends or the nature of the individual child's difficulties. Implementation of this programme is taking place on phased basis in consultation with stakeholders, including service users and their families. It is a key priority for the executive's social care directorate. An additional €4 million was allocated in 2014 to assist in implementing the programme, equating to approximately 80 additional therapy posts. Further investment of €4 million, equating to €6 million in a full year, has been provided this year to support its ongoing implementation. Full implementation of the programme is expected before the end of 2016.

Reconfiguration of disability services in line with this programme is already under way in Cavan-Monaghan. I understand that four additional therapy posts have been allocated to the region to date to assist in this process, comprising two speech and language therapy posts, an occupational therapy post and a social worker post. To date, two early intervention teams are being operated by Enable Ireland in line with the programme's policy and two school-age teams in the area are due to be reconfigured by the end of this year. It should be remembered that moving to this new service model is complex and requires considerable preparatory work on the part of the multi-agency local implementation group, in collaboration with all key stakeholders, to ensure as smooth a transition as possible. Clear integrated policies, procedures and protocols must be developed, together with a clear governance structure for the newly-formed multi-agency and multidisciplinary teams. While the HSE is facing challenges in some areas in meeting the statutory timeframes that apply to the assessment of need process under the Disability Act in light of the number and complexity of current cases, I understand there are no particular problems at present in Cavan-Monaghan and that assessments are being carried out in a timely fashion. Research conducted by the National Disability Authority into the statutory assessment of need, AON, process has found that where services are reorganised on an integrated basis, such as under the model advocated by the progressing disability services programme, the statutory assessment process works more smoothly.

I assure the Senator that improving access to therapy services for children in primary care and in disability services is a particular priority for the Government. In this context, further funding of €8 million is being provided in 2016 to expand the provision of speech and language therapy through primary care services and to support the re-organisation and expansion of speech and language and other therapies under the progressing disability services programme.