Seanad debates
Tuesday, 17 May 2022
Nithe i dtosach suíonna - Commencement Matters
Disability Services
2:30 pm
Joe O'Reilly (Fine Gael)
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I thank the Cathaoirleach. At the outset I welcome the Minister of State, Deputy Rabbitte, to the House and I acknowledge her ambition and that of her Department. That is why I feel confident that we will get results from this discussion. I also acknowledge her recent visit to my own constituency.
I propose to address this issue, in the first instance, by moving from the more particular standpoint to the more general. I met an informal group of parents in Cavan recently, all of whom were parents of children with disabilities and they made a number of points to me. I will deal with those and will then deal with the broader objective evidence. That is not to suggest that these initial points are not also objective but I will deal with the other issues then. One’s heart would be moved by meeting these parents as they are very good people who are concerned for their children and, in some instances, are very distraught. I spent a good two hours with them. It was a very moving experience and it would be a disgrace if I was not doing what I am doing now.
Their first point was that for an initial appointment with Enable Ireland one could be waiting anywhere from six months to two years. The younger children are seen more quickly in respect of an assessment of needs and are prioritised. However, if one has an older child in the new progressing disability services for children and young people programme, one could be waiting for three years for any intervention if that child has received a private diagnosis. The parents made the point, which I distinctly remember, that there was a particular problem if one has had a private diagnosis done, where one might not then get an assessment of needs. That would be bizarre.
There is no clear pathway apart from an assessment of needs in order to get the services. One of the parents said to me that their non-speaking child is waiting nearly three years for a psychology assessment and that their other son is waiting four years in primary care for autism spectrum disorder and occupational therapist assessments. The child should be seen within three months for initial paperwork and a complete diagnosis should take from six to nine months, if they have the necessary paperwork, for an assessment of needs.The parents referenced that a pay gap of €3,000 to €5,000 exists between those who work in Enable Ireland and the voluntary services, though I know they are section 39 organisations funded by the State, and those in the mainstream HSE, in primary care centres and so on. The pay anomaly is huge. We referenced it at a health committee meeting but I want to hear about it today. Under the Haddington Road agreement, Enable Ireland staff are paid less than HSE staff. A new deal was sorted for HSE staff but Enable Ireland did not receive the same, as per the manager in Enable Ireland. Enable Ireland staff do not have the same maternity leave and pension contracts and it blames HSE funding for lack of recruitment. It states there is a lack of recruitment and there should be international recruitment. It blames the HSE for that. The day the Minister of State was with us in Cavan, this and some of the other points came up. The HSE takes months to approve advertisement of vacancies even when aware beforehand that a post needs to be filled. There is huge bureaucracy that is ridiculous and should not be the case.
I move to some of the surveys and studies. Inclusion Ireland did a report that scarily stated 85% of children wait for more than a year for appointments and assessments. Some 1,000 families were surveyed for that. Down Syndrome Ireland conducted a survey of their parents and 30% of them or 400 families, of whom 44% wait similar lengths of time. The Ombudsman for Children, Dr. Niall Muldoon, said 4,000 children are awaiting an assessment. All of this makes for a horrendous story. I am aware of the standard operating procedure that is obviously not implemented yet and of the UN convention. It is something we could discuss for hours, but neither I nor the Minister of State has the time. I look forward in her response to getting hope so that I can go back to the parents and tell them she told me this and it will make a difference.
Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Deputy for tabling this Commencement matter and keeping it on the agenda. It was fantastic to meet him when I was in counties Cavan and Monaghan. I commend the teams I met with, both the Enable Ireland team and our HSE team on the ground. Both gave their time willingly to discuss the issues the Senator has eloquently raised and both said the same.
One of the issues related to pay, the variation between teams and how difficult it is to recruit into those teams. The Senator is correct that there is a gap between section 39 workers and section 38 and HSE workers. It will have to be addressed because if it is not we will not be able to recruit to those teams. We have teams that have not been fully populated. That can be seen in Cavan and Monaghan, where there is a 25% vacancy rate. Pay is part of the reason for that vacancy rate. It is not the conditions because the conditions include that it is a lovely part of the world to live in. There are reasons to choose to go there, including purchasing of properties and everything else, and the choice that is available. At the same time, those people still have to go for a mortgage and are €5,000 down in their pay grade. They could be on a team with people from the HSE and section 38 organisations who make an extra €5,000 and are sharing the same canteen room. Of course it is a concern and that is not wasted on me. I am trying my best to address that matter. I am addressing it with the National Federation of Voluntary Service Providers Supporting People with Intellectual Disability, FEDVOL, and recently had a meeting with Alison Harnett, who represents many section 39 workers.
The Senator mentioned long waiting lists being experienced in the Cavan-Monaghan area. What are we going to do about it? We need to address international recruitment. Where the Senator is located on the Border, international recruitment means looking to our neighbours in Northern Ireland and to the qualifications they have for speech and language therapy. I keep talking about speech and language because it is done in Derry, yet we cannot recruit people qualified in speech and language therapy in Northern Ireland to southern Ireland because there is a component there that CORU does not recognise.This is an issue I am addressing. The reason I am addressing it is that perhaps we can recruit and give training on the ground in the piece that is missing. This could ensure the requirements of CORU are met and at the same time there is on-the-ground training. This is an open and very live conversation with the HSE. As I said, international recruitment, along with efforts to increase the HSE's reach into the broader domestic supply market for the non-regulated healthcare workforce, is being used as an approach. However, there are limitations to international supply as Ireland is a signatory to the WHO global code of ethical recruitment of health workforce.
Technology to support the recruitment process should be used also. We do not need to go on big trade missions. We can do a lot on LinkedIn. We can manage our time very well. The Senator mentioned Enable Ireland. The section 39 organisations are far more fruitful in their recruitment. They have a quicker turnaround. They can recruit more quickly. Their process is more streamlined as opposed to taking eight months with the HSE. It can be done in six to eight weeks in organisations such Enable Ireland. We need to see why we cannot do it better in the HSE. If the section 39 organisations are able to recruit so much faster, we should release the posts to them as opposed to having 555 vacant posts nationally as I stand here today.
Joe O'Reilly (Fine Gael)
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I thank the Minister of State. I am very happy to know she is addressing the pay disparity. It is a big issue. These parents chatted to the professionals before speaking to me. This debate will be repeated because they have also chatted to other Oireachtas Members. This will also be raised in the Dáil. I am happy about the recruitment. The parents feel international recruitment is very important. The Derry issue, which the Minister of State cited, is very important. It would be great if we could correct this and if the CORU rules could be adjusted. These are the fundamental points that parents raised. We cannot raise new issues in a debate such as this but they were also concerned that there is a bureaucracy with regard to establishing parentage. The guardian of the child is the guardian of the child. It is a bit archaic and arcane that they are asked to present evidence they are the parent of the child. I ask the Minister of State to note this.
Anne Rabbitte (Galway East, Fianna Fail)
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I will of course.
Joe O'Reilly (Fine Gael)
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Surely if somebody is looking after a disabled child on a full-time basis and presenting them, one would hardly want to question their bona fides. The other points are significant and I thank the Minister of State. The recruitment and the salary are major issues, as are the waiting lists.
Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for his contributions and concern. Progressing Disability Services for Children and Young People is the policy underpinning children's disability services. The Minister, Deputy O'Gorman, and I met the CEO of the HSE, Mr. Paul Reid, and senior officials on Wednesday to discuss a number of disability issues, including Progressing Disability Services for Children and Young People. An agreed outcome of the meeting was that a plan would be developed in the coming six to eight weeks with a number of actions to support the roll-out of Progressing Disability Services for Children and Young People. I hope this will address some of the matters the Senator has raised. It is important to note the Government has provided significant funding to the HSE for new posts in recent years to strengthen the capacity of the children's disability network teams throughout the country, including in Cavan and Monaghan. Since 2019, almost 500 additional whole-time equivalent posts for children's disability services have been allocated. I will continue in my efforts at local and national level to address the obstacles that exist in recruitment and other important issues. I will take on board the issue with regard to parentage.