Joe O'Reilly (Fine Gael)
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I thank the Cathaoirleach for selecting this Commencement matter, which is important to the people I represent. I thank the Minister for coming in to take the question in person and give it the seriousness it deserves.

I have lived in the Bailieborough area for more than roughly 30 years and in all of that time, there has been a speech and language service available to parents in Bailieborough, Shercock and Mullagh. I understand that this would have been the case in most areas throughout the county. It is my understanding from parents in this area that the service has been abandoned, and families are now asked to attend the service in the town of Cavan. In other words, it is centralised. Not all of the families have transport. It is difficult to overcome this, and the costs are big as the Minister will appreciate.

In an area like Cavan, while huge strides were made in public transport during the previous Government, which is outside this debate, and there are much improved bus services, there are still not trains. Using the buses to go to Cavan town involves quite a chunk of a day and it is expensive. For many families, the time involved in getting to Cavan town and back is not available to them either because of work or having other children to care for. This repeats itself in areas like Ballyconnell and others. The extra time involved will greatly damage their schooling. The children are not attending school if they are travelling to get there and presumably there are all sorts of diversions the children will insist on when they get to Cavan town. They are, therefore, losing out on schooling.

I am aware that the non-attendance policy takes them out of the service quickly. In other words, if somebody is due to attend and they miss one or two, then they are struck off and go off the service for non-attendance. This will greatly increase non-attendance. That is a huge part of it in my view, and there is anecdotal evidence to support that. If I understand properly the values of Sláintecare or what it seeks to achieve, this totally contravenes it. There are many vulnerable families in the area I am discussing and in other areas in the county.

I understand that in the case of cancer services and other clinical needs, there are cases for centralisation on the grounds of not losing excellence, etc. Those arguments have been well rehearsed. However, I am a teacher by background, and I cannot see how speech and language therapy delivery is improved by moving its location. It is a one-to-one thing with very little resources. It is mind-bogglingly stupid unless I have been misinformed.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Senator O’Reilly for raising this matter and for the opportunity to discuss this very important issue for Cavan but for people more generally.

As we know, at a higher level, primary care therapy services generally, such as speech and language therapy, play an absolutely central role in enhancing the health and well-being of both children and adults in the community. However, the Senator and I are both aware and have discussed separately the very important early intervention measures that speech and language therapy can provide.

I am doing everything I can, working with the Minister, Deputy Lawless, to get more speech and language therapists with regard to the number of training places. In the past number of days I have met with officials from CORU about the speed of registrations and how we might do that better to get more people onto the register to be able to serve our community.I met with the national clinical directorate for disability yesterday on the same point about making sure that as many speech and language therapists, and indeed therapists more broadly, are available in our system to be able to provide services to everybody who needs them but, in particular, as the Senator correctly identified, and as the Sláintecare principle goes, as close to home as possible.

We are not there yet, however, and we have to organise services in a way that maximises our ability to get the most out of the good training and the good experience of every therapist. I am aware that recent increases in the number of referrals as well as an increase in the complexity of presentations require many more intensive interventions that have put more pressure on many primary care services, including speech and language therapies. Furthermore, a number of primary care services face staff shortages and we have ongoing recruitment challenges. Combined, these factors have increased the waiting lists for services across the country. I fully recognise the frustration of people in Cavan who have to address both long waiting lists and the geographical proximity of the services available to them. I want to make sure they have timely access to therapeutic services.

On do-not-attends, it is very important that people attend their appointments because every appointment that is not fulfilled costs somebody else the opportunity. We have to take a strong approach to do-not-attends generally in order that we can continue to get the best for our all-too-scarce-yet services, particularly in disability.

I am committed to building capacity in primary care, recruiting additional staff and promoting advanced practice roles in the community for health and social care professionals. The Government is committed to increasing the number of college training places for health and social care professionals. Cavan community healthcare network speech and language therapy services, as I understand, are currently delivered in Cootehill; Breffni Care Centre, Ballyconnell; and Cavan town in line with the current staffing resource that is available. That is our big challenge: making sure we have enough therapists to be able to deliver the service to the people who need it as close to home as possible. We are not there yet, and I appreciate the Senator raising the complexity of this intersection for the people in his area. I hear him very clearly in that regard. All I can do is try to increase the number of therapists insofar as possible, expedite recruitment where we can and make sure that the therapists and the services are delivered as close to home as possible.

In the meantime, until we reach that, we have to do this as efficiently as possible to get the best for every therapist and every therapeutic service and to make sure they are seeing as many people as possible, recognising the increased number of presentations and the increased complexity of those presentations. I hear the Senator very clearly about the needs of the people of Cavan.

Joe O'Reilly (Fine Gael)
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I thank the Minister for that. I accept her bona fides and accept that she is doing everything possible to increase the number of speech and language therapists. The issue here, however, is that this has been centralised and moved from the villages and the small towns. The Minister might say that is because of a lack of speech and language therapists. There are enough there at the moment to deliver the services. It will take the speech and language therapist, unless he or she is walking, only a short time to commute from one town to the other and provide the service locally, so this is an absurdity. If we had a map of Cavan here, and if you take the service out of the towns of Mullagh, Virginia, Bailieborough and Shercock and move it to Cootehill, Ballyconnell and Cavan, we would see there is no logic to this, only disturbing parents. I take the point about domiciliary care for adults, but this is no good to children. It is right that that is there for adults, and of course I am in favour of it, but for children this does not deal with it. A child in Shercock or Bailieborough, say, where I live so it is easier for me to talk about it, will now spend four or five hours of a day going to Cavan town for a service. They are taken out of the primary school, the parents are discommoded and other children suffer. It is madness. I ask the Minister personally to look at this specifically because this does not arise from a lack of speech and language therapists. Of course we need more of them, but there is no logic to this. The speech and language therapists can commute in 20 or 25 minutes from, say, Bailieborough to Cavan in a car. The parents take four hours, and there are multiple parents. It is crazy stuff. I ask the Minister to look at it.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Of course we will look at the organisation of services more generally. It is very important to me that every hour a therapist works delivers therapeutic services. I do not want to see therapists in cars. That is one of the reasons the Minister, Helen McEntee, is doing such strong work to make sure there are therapists based in schools, where they can have the most effective and efficient use of their time. I appreciate that is a transitional period at the moment as she moves to do that and provide services in special schools in the first instance. There will be a measure of travel if we are going to get the best out of every hour from every therapist who wants to do therapy work. I hear the Senator about the geography and I will reflect on it. It is a matter for the local area to organise its services, but we need therapists doing therapy.

Alison Comyn (Fianna Fail)
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Thank you, Minister, for coming in to answer those Commencement matters.

I would like to welcome some of our groups here. I feel like I am in the ballroom of romance; we have the ladies on one side and the gentlemen on the other. We have guests of Senator Chris Andrews, the Ringsend and Irishtown golden girls group. You are all golden girls and fabulous blondes. We do have more fun, do we not? We also have the Terenure Men's Shed. I hope you are both enjoying your trip to the Seanad today and that perhaps you will convene and have a cup of coffee together. It might really be the ballroom of romance here this morning. Thank you and enjoy the rest of your stay.