Denis O'Donovan (Fianna Fail)
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I welcome the Minister of State. Tá fáilte romhat, a Aire-Stáit agus gabh mo leithscéal.

Finian McGrath (Dublin Bay North, Independent)
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Go raibh maith agat.

Denis O'Donovan (Fianna Fail)
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Anois I call on Senator Martin Conway who has four minutes to outline his case.

Martin Conway (Fine Gael)
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Go raibh míle maith agat, a Chathaoirligh, agus tá fáilte romhat, a Aire-Stáit. I acknowledge that the Minister of State, who has responsibility for disabilities, has come here to take this important Commencement matter.

World Down's Syndrome Day was last Thursday and we all wore odd socks. This Commencement matter arose as a result of an engagement I had with the parent of child who has the condition on World Down's Syndrome Day. We spoke at length about the challenges that children with Down's syndrome come up against. One of the significant challenges is in terms of communication and speech. The Minister of State will be fully aware of the unique set of challenges that children with Down's syndrome in particular encounter when it comes to speaking. Every one of us, as a result of our involvement in the business of politics, appreciates the value of being able to communicate. If one is in a situation where one cannot articulate properly as a result of difficulties with speaking due to having Down's syndrome, then the basic premise of communication is compromised.

Down's syndrome children are beautiful and have a huge amount to offer. We have a responsibility to assist them and provide the necessary supports to enable them to develop their communication skills. It is one thing if one will never be able to communicate but if one can communicate with proper interventions and supports, then that is where the State needs to step in. Last week, I was informed by the parent to whom I refer that the State only provides six sessions of speech therapy a year. The child involved had six sessions of speech therapy in 2015, 2016 and 2017. In 2018, there were still six sessions even though our economy has benefited enormously from a recovery and despite the fact that the Government has prioritised the issue of disability and support structures for people with disabilities. In 2019, the allocation still is six sessions.This parent, through hard work and dedication, is funding speech therapy privately for her child. The child gets two sessions a month. That works out at about 24 or 25 sessions a year. That parent uses the six sessions available from the State to complement these. We need to do more and we need to do better. Perhaps there is a mechanism whereby this can be improved. Perhaps there is a plan. The provision of speech therapy is a critical intervention for children with Down's syndrome because of the unique challenges such children face and because speech therapy has been proven over and over again to be successful and to work. All children with Down's syndrome in our society and our State should be able to reach their potential in terms of communicating. Through hard work, the parent with whom I engaged has the resources to provide speech interventions and therapy privately, but what about the parents who cannot?

Finian McGrath (Dublin Bay North, Independent)
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I thank Senator Conway for raising this very important issue. I totally acknowledge his own great work in pushing and campaigning for all children with disabilities and, in this debate, for children with Down's syndrome in particular. I thank him again for raising this very important issue. I absolutely agree with most of the sentiments he expressed. I accept the point that we need a plan, but we have a plan. I will deal with that in my response.

Timely access to speech and language therapy services is important and I understand that delays in accessing the service are a source of concern for patients, their parents and their families. The Government is committed to improving access to services through investment and improvements in how services are provided to enable children to reach their full potential. In 2019 we are going to spend €1.9 billion on disability services under the HSE service plan. That is an increase of 7.5%. Anybody who comes into this House to say that cuts are being made to services should look at the statistics and information and get his or her facts right.

The overarching principle governing the planning and delivery of health services and supports for adults and children with disabilities is that they should be integrated, as much as possible, with services and supports for the rest of the population. The Government’s agenda, and mine, in this regard is clearly set out in the national disability inclusion strategy, the steering group of which I chair. The strategy is based on a non-condition specific approach to the delivery of public services and the mainstreaming agenda. I take the Senator's point. I did a number of events myself on World Down's Syndrome Day. I spent a lot of time with parents and talking to children on that day.

As Senators will be aware, speech and language therapy is mainly provided through the HSE’s primary care service. Overall funding for primary care has increased in the HSE’s national service plan for 2019, with more than €50 million in additional funding being made available. An extra €50 million is being put in in 2019. This represents an increase of 6% on primary care for 2018. I make that point very strongly. Of course, we also have to look at individual cases. Each individual that presents to the HSE’s speech and language therapy service has an initial assessment to determine the individual’s presenting need and requirements for therapy. The therapist, in conjunction with the parents or carer, will then determine the severity of the individual’s difficulties and prioritise for therapy accordingly. The level of intervention is in line with clinical policy, age and presenting need according to diagnosis. The waiting period for intervention is dependent on the nature and severity of the disorder following assessment. The HSE aims to ensure that the resources available are used to best effect, in order to provide assessment and ongoing therapy to children and adults in line with their prioritised needs.

Speech and language therapy staffing levels in primary care have increased significantly in recent years with an additional 76 whole-time equivalents appointed between January 2015 and January 2019. Further increases are anticipated in line with funding in 2019. I accept the Senator's point; we need to increase and expand services further, but we have started. The HSE anticipates that almost 280,000 speech and language therapy patients will be treated in primary care in 2019. That is a lot of speech and language services. In addition to this increase in staff numbers, the HSE has established service improvement groups to develop new standardised models of service provision for speech and language therapy and other therapy services to support service delivery. We accept the point the Senator raised in his introduction. We are increasing staff numbers to expand this service. Measures under these models include providing structures, training and support to parents or carers so that they can work to help improve the individual’s speech and language. In addition, therapy is delivered in group settings where appropriate.

The HSE and I are committed to working in partnership with other service providers to achieve maximum benefits for children and adults requiring therapies and aim to ensure that the available resources are used in the most effective manner possible. On the Senator's general point, we have started the work and the reforms, but we have a fair distance to go yet. I accept that argument, but we have started, we have increased spending, and we are expanding the services. We have to make sure that every child with Down's syndrome has access to proper speech and language therapy. That is the objective of my plan under the national disability inclusion strategy.

Denis O'Donovan (Fianna Fail)
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I accept this is a very worthy cause. I have a grandchild with Down's syndrome of whom I am very proud. I am also the godfather. I will give Senator Conway 40 seconds to conclude.

Martin Conway (Fine Gael)
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I thank the Minister of State for his response. I agree with him in respect of the increased resources but I would like to see these increased resources orientated specifically towards speech and language therapy for children with Down's syndrome. Perhaps there could be a greater level of increase for that specific group of our citizens for 2020. It is probably too late for 2019 at this stage. Perhaps the Government could direct the HSE to ring-fence the great majority of whatever increase in funding is provided for speech and language therapy for 2020 for children with Down's syndrome. At the end of six sessions over a year there will be an obvious improvement in the child but can the Minister of State imagine what would happen if the number of sessions were to be doubled and if the child was to have an intervention of 12 sessions? I know it is a doubling of resources but perhaps the Government could look at a specific increase in funding for speech and language therapy for 2020 as a once-off intervention for children with Down's syndrome.

Finian McGrath (Dublin Bay North, Independent)
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I will make three short points. First, I recognise what the Senator has said about delays in accessing speech and language therapy being a source of significant concern for parents. We are trying to act on that. Second, as Senators including Senator Conway may be aware, funding for additional therapy posts for children's disability services was announced in budget 2019. As I speak, these posts are being rolled out. These posts will support the completion of the assessments of need and will increase the number of therapeutic interventions provided. I am confident that the additional resources committed by Government and the HSE's reform programme will lead to significantly improved services for children requiring speech and language therapy. However, I cannot isolate one sector of society, even though I am a parent of a daughter with Down's syndrome and was chairperson and treasurer of the Dublin branch for many years. We have to treat everybody, right across the disability sector. People with speech and language difficulties should be given priority.