Rose Conway Walsh (Sinn Fein)
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I wish to raise the lack of physiotherapy services to meet the needs of children in the west. It is timely that this Commencement matter is being heard today after last night's programme on RTE. I commend RTE on the programme and on highlighting what all of us know has been happening for many years, which is that people are suffering in pain while they wait for vital treatment. I hope the focus on the issue in the RTE programme will provoke consciousness among those making decisions in this area. This morning the Minister said it was unacceptable and it is certainly unacceptable to those waiting in pain. It is also unacceptable for those waiting in pain every day for physiotherapy services.

Notwithstanding the numerous representations I receive from parents all over County Mayo, I was prompted to raise this case by a particular woman in the county. She is called Karen and she has an eight year old son, Jack, who has cerebral palsy. Four years ago Jack had surgery, without which he was facing life in a wheelchair. It was not available in Ireland so he had it in the United States after fund-raising €70,000 in the local community. On returning, and on the advice of doctors in the US, Jack began a physiotherapy programme at First Step therapy in Patrickswell in County Limerick, the only place other than Dún Laoghaire where this particular physiotherapy, called spider cage and lokomat therapy, was available. The complex surgery that was carried out in the USA requires this specific type of physiotherapy in order to get maximum benefits. The therapy that Jack receives through the HSE is just 45 minutes, twice a month, which is inadequate in terms of both the amount he needs and the type of physiotherapy he requires. The therapy is paid for entirely by the family with no support from the HSE. He attends this centre every second weekend for two hours, on a Friday evening and again on a Saturday morning, and all of it is self-funded with Karen footing the cost for the diesel and fund-raising for the cost of accommodation and the therapy itself. This works out at between €400 and €500 for each trip. Why should parents like Karen have to depend on charity fund-raising to provide this vital treatment to keep her son from being wheelchair bound? Without the follow-up care the surgery becomes less and less effective. The physiotherapy is not an optional extra but essential for Jack to have any quality of life to alleviate his pain.

I have travelled to Limerick with Karen and Jack to see the great work being done by the First Step rehabilitation centre, which was opened several years ago by then Minister for Health, Mary Harney. I am asking for two things from the Minister today. Jack is not the only person in this situation and I am only using him as an example of what children have to go through when they do not have this vital physiotherapy available to them in their local areas, by which I do not mean their own parish or county but their region. Is it possible for the HSE to put in place a funding mechanism that would help Karen and other families pay for travel, accommodation and the therapy which is needed for their children? Can he instruct the HSE to carry out a full cost-benefit analysis on the setting up of similar physiotherapy centres in each province to meet the needs of children?

Finian McGrath (Dublin Bay North, Independent)
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I thank the Senator for raising this very specialised issue relating to physiotherapy. I welcome the opportunity to outline the current position on the matter.I agree with her introductory remarks on the programme last night on RTE. I find it totally unacceptable and I agree that we have to do something about it. That is the reality of it. Children, or anyone in pain, should not have to wait around like that. We have to deal with the waiting lists. The Minister, Deputy Harris, has been very proactive over the last couple of hours in dealing with it through the hospitals and the HSE. However, it is unacceptable that people are in that situation.

In regard to the Senator's matter, the HSE funds a range of community services and supports to enable each individual with a disability to achieve his or her full potential and to maximise independence. Services are provided in a variety of community and residential settings in partnership with service users, their families, their carers and a range of statutory, non-statutory, voluntary and community groups. Voluntary agencies provide the majority of services in partnership with, and on behalf of, the HSE. The HSE works very closely with a number of voluntary service providers that specialise in the provision of services to children with cerebral palsy, offering a number of therapy services, including physiotherapy and gait analysis. These include Enable Ireland and the Central Remedial Clinic, CRC. In 2005, the CRC commenced the provision of a range of services to people in the mid-west region, including the world's first gait laboratory. Significant resources have been invested by the health sector in disability services over the past number of years, including an additional funding of €31 million last year. This extra €31 million is also available for the social care and disabilities service plan 2017.

The First Step Therapy Centre is a private company based in Limerick that offers intensive physiotherapy programmes for children and adults with neuro-muscular disorders. The HSE acknowledges that service users may choose to access privately provided therapy services. However, it is not generally the policy of the HSE to fund private therapy sessions. I have set up a task force and I met with it in the last couple of days. It is looking at the idea of personalised budgets. This could be a situation where people might be given a certain amount of funding to access physiotherapy services. Karen and Jack's case could easily fall under that.

The HSE is working closely with all the service providers to ensure available resources are used in a creative and flexible manner in order to be responsive to the needs that present. However, the health service as a whole has to co-operate within the parameters of funding available to it, and given the current economic environment this has become a major challenge for all stakeholders, including the HSE, the voluntary service providers, service users and their families. Physiotherapy services for adults and children are generally delivered through the primary care teams, community therapy services, specialist disability providers or early intervention on children's teams from zero to 18 years of age, which continue to be developed under the progress and disability service for children and young people zero to 18 programme.

The HSE also provides assist devices to people with disabilities to enable them to maintain their health, optimise functional ability and facilitate care in the primary care setting. In addition, access to rehabilitation equipment is also provided where appropriate. The issues raised are very important and we have to look at some creative ideas to deal with situations like Karen and Jack case raised today.

Rose Conway Walsh (Sinn Fein)
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I thank the Minister of State for that. I welcome the fact that a task force has been set up, but the crux of it is that the money be used to meet the needs of the individual patient, because the same treatment is not suitable across the board. I disagree with the Minister of State in terms of the picture he paints of children being able to access physiotherapy when they need it. That is not the case. It is not my understanding, or experience, of it. Physiotherapy twice a month for a child like Jack is absolutely unacceptable. There should be an examination of where the money is going and we need to ensure the supports and services provided to children reach the areas where it is most needed.

Finian McGrath (Dublin Bay North, Independent)
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I take the Senator's point on physiotherapy. When I took over as Minister of State with responsibility for disability, I inherited a situation whereby there had been seven or eight years with no investment whatsoever. We had to start reinvesting and reforming services.

The Senator raised an important point, namely, that a cost-benefit analysis should be carried out. I will bring that point to the HSE, in particular those directly involved with disability services. Something must be done. If we are providing millions of euro for the reform of, and investment in, services, we need to ensure the money goes to people such as Jack. I want to focus on such cases.

The Senator referred to access to physiotherapy services. I have had the same experience as she has had, in particular in recent years. There is a major crisis. Most people on the front line accept that there is a crisis in speech and language therapy and physiotherapy services. I hear the same from people in Waterford, Wexford, Mayo, Galway and across the north side of Dublin. There is no point denying that is the reality.

My objective is that no matter what budget we have, we prioritise people and ensure that a person with a disability receives services. People may not know that €1.688 billion will be provided for disability services in 2017, an increase of €96.3 million, or 6%. People like the Senator also demanding other things. People are asking why, if that level of funding is available for services, children are on waiting lists. That is my job. We are going to try to reform the system.

The cost-benefit analysis and access to physiotherapy are issues I will bring to the attention of managers in the HSE.