Tuesday, 4 October 2016
Commencement Matters (Resumed)
I welcome the Minister of State to the House. She has been a frequent visitor since her appointment. I wish to raise the issue of psychological services in west Cork, in particular child and family psychology services. Recently, I was told by the HSE that there is a 22 month delay for a child to receive these services. I was very shocked to learn there is a wait of 22 months in cases where early intervention is required. The case I dealt with involved a very young child and 22 months is almost one third of that child's life. Issues such as dyspraxia need to be dealt with at a very early stage. Issues arise if we do not intervene early.Research has shown that for a child's quality of life, physical and social well-being and economic potential into the future, early intervention is important. There has been a major cut in this service in the past few years, the restoration of which is vital. A scheme has been put in place under which nurses are offered €1,500 to return home. What initiatives are being put in place to improve psychological services in Cork? This is an emotive issue in that we are speaking about children, in particular. Mothers and fathers are concerned about their children not having an appropriate start in life and every delay of one week is a major worry for them. That parents have to wait 22 months for a first response from the HSE is shocking. I hope provision will be made in the budget to ensure parents will not have to wait almost two years to have a child assessed. Even at that point they are only getting a foot on the ladder in that the child will be the subject of an assessment but there will be no delivery of a service. This is a major concern.
I hope the Minister of State will use her powers to ensure this issue is addressed. If it not addressed, it will impact on society. While the development of mental health services is important, this, too, is an important issue. With proper funding, we can address this and other mental health issues and, I hope, provide the service the people of Cork, west Cork in particular, deserve.
I thank the Senator for raising this issue which I am taking on behalf of the Minister of State, Deputy Helen McEntee, the Minister of State directly responsible for this area who is unavoidably engaged elsewhere.
The primary care psychology service in the Cork and Kerry Community Health Care Organisation, CHO, area is a community-based service for children aged 18 years or under with social, emotional or behavioural problems. In addition to delivering interventions to service users with a wide range of clinical presentations and across different organisational environments, the service provides advice for other primary care service providers, including GPs. The majority of referrals to the child adolescent and family psychology service are from GPs and primary care and community-based referring agents. An increase in the number of priority referrals in primary care services represents the complexity and severity of concerns being referred for psychological input. Some are re-referrals to the service, in respect of which assessment and intervention have been offered but difficulties have returned or are of significant complexity and impact as to require repeated blocks of intervention. Other priority referrals relate to severity of impact on the day-to-day functioning of the child or young person and may indicate that difficulties pose a risk to his or her development, social, emotional and behavioural functioning.
The total number of patients on the primary care psychology service treatment waiting list in August was 1,124, of whom 523 had been waiting for longer than 52 weeks. The CHO has an approved complement of 12 whole-time equivalent staff. There are eight whole-time equivalents in place and recruitment of the remaining four whole-time equivalents by the HSE's national recruitment service is awaited. A number of actions are being undertaken within the psychology service to try to reduce the waiting list, including providing drop-in clinics which result in people not joining the waiting list; maximisation of the input of training psychologists and facilitating group work and staff training in so far as possible. Notwithstanding such actions, the increased complexity of cases has resulted in the rate of referrals significantly exceeding the rate of discharge, leading to increased waiting lists.
The HSE considers that the current referral rate may not truly reflect psychological need in the community. This raises a concern that the absence of intervention at the earliest possible opportunity is likely to result in children and adolescents requiring long-term more complex intervention. Local management is liaising with the national primary care office on further initiatives to reduce waiting times and numbers, including examining the potential recruitment of additional psychology staff for a period of 12 months to address the waiting list for those waiting longer than 26 weeks. Separately, clinical psychologists in child and adolescent mental health services within the CHO work across eight multi-disciplinary teams.Recruitment to CAMHS in the past 12 months with a specific remit for reducing the teams' waiting lists has successfully reduced waiting lists to fewer than 12 months in many sectors.
I can also advise the Senator that the HSE's national service plan 2016 provides dedicated funding of €5 million to address psychology services in primary care through the development of early intervention and counselling for young people. A revised model of care, focusing on facilitating better access, has been developed collaboratively by the primary care and mental health services in the HSE and is being considered by the Department of Health.
I thank the Minister of State for her very in-depth response. This all comes down to staffing, which is probably the key issue in this debate. I would like to welcome the Minister of State's statement regarding the 12 whole-time equivalents. However, four are still to be appointed. The actual issue is similar to the nursing issue, namely, whether we have the correct quality of workmanship and staff available. When we are trying to recruit staff to the sector, do we have to go abroad? What incentives are in place to bring those living abroad here to work?
The Minister of State previously stated during another debate that the State is trying to entice nurses home by paying them an extra €1,500. Are we going down that road in order to try to entice people to fill these roles? It is to be hoped that if staff are recruited services can be delivered. I again thank the Minister of State for her kind response.