Pauline Tully (Sinn Fein)
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Every week, I am contacted by people either coming to see me or through emails and phone calls who are worried about their child because they have identified an additional need but no services are available for that child in the foreseeable future. I will give an example of one set of parents who contacted me last week about their son James, who is five years old and has just started school. He was referred for occupational therapy, OT, at a four-year check-up by his public health nurse because both the public health nurse and indeed the parents had concerns about his fine motor skills and gross motor skills, but he was refused access to OT and told that because he was already on the physiotherapy list, since, as a baby, he received physiotherapy for a totally unrelated issue, he had to go back to physiotherapy. The physiotherapy team said it would take him in and assess him, which it did, and it referred him to occupational therapy.

It was vital that the issues with his fine motor skills be addressed, as he was about to start school. In the meantime, he has started school and it has identified the issues too. While people at the school are very supportive, they are not therapists and do not have the knowledge or expertise to assist him to the extent that he needs. While doing the speech programme in school, he was identified as having a significant speech delay too.He had been referred to speech and language therapy by the age of two because he had not spoken at that stage. He waited two years for speech and language therapy and by the time he was accepted onto the list, he had started talking and they said he was fine and left him. Had they addressed the issues then, he would not have speech delay at this stage. Now, he is being referred back to speech and language therapy. The parents are most concerned about the need for occupational therapy. The occupational therapist came back to them and said she would accept him onto her list but it would be up to three years before he was seen. They actually cannot say that that is definite because it is dependent on resources, that is, staff. He will potentially be eight before he is seen by an occupational therapist. He will have missed out on so much in that time. The parents could pay privately but they cannot afford to. Even if they could, it is very difficult to access a therapist. Many people I know are getting into debt having to pay out the money for therapists that they should be receiving from the State.

Another little girl, Méabh, is almost three years old. She is deaf in one ear. She urgently requires speech and language therapy. She is on a waiting list for over a year. She was referred for speech and language therapy in September 2024. When I contacted primary care, I was told it would be early 2027. We are talking about two and half years in total that she will be waiting. Again, Méabh's parents cannot afford to pay privately but they say she requires the early intervention to prevent her from experiencing developmental delays. I looked at the lists in Cavan-Monaghan for the end of last year and there were 810 waiting for a first-time assessment with occupational therapy, and more than 500 of them had been on that list for over a year. Speech and language therapy was the longest list. There were 1,604 awaiting an initial assessment for speech and language in Cavan-Monaghan. That is not including initial therapy or those waiting for further therapy. The HSE has compiled extensive data on this. It knows there are extensive delays.

I know this relates to a different Department but the children's disability network teams, CDNTs, also have a huge waiting list for both assessment of need and for services and therapies. The staffing in Cavan CDNT was a huge issue of concern. It has improved and there are only a small number of vacancies, but there is a huge waiting list. Even with a full team complement, which it now has, I do not know how it is going to address all of those who have been on the waiting list since the time it did not. I am not even sure the team is actually big enough when it is fully filled to address the need that is there.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I extend my gratitude to the Senator for raising these pertinent issues and, in particular, bringing light to the cases of James, Méabh and their families. As the Senator will know, the relevant Ministers are currently in the Dáil answering oral parliamentary questions, which is why I am here.

The Government fully recognises the importance of early intervention for children with disabilities in Ireland, including those living in Cavan. In early 2023, the specialist disability function transferred from the Department of Health to its current Department. This ensured appropriate focus was given to the challenges being faced by people with disabilities. Under the programme for Government, the Government is committed to ensuring children and their families who need early intervention and therapy input can access that support in a timely way.

Under the roadmap, children’s disability network teams continue to deliver supports for almost 45,000 children with complex needs, and despite increasing demand for services, the total number of children awaiting services has continued to fall nationally. Since the implementation of the roadmap was approved, this national CDNT waiting list has reduced from circa 16,500 to closer to 10,000 children at the end of September of this year.

Children’s disability network team staffing remains a key priority. The most recent CDNT workforce survey conducted outlines 2,009 posts filled in CDNTs and 445 posts vacant as of April. This survey outlines continued growth in staffing in all regions and a corresponding reduction in vacancy rates. There is an overall national increase of 8% in staffing in the CDNT workforce compared to the workforce as of the last survey in October 2024. This means there is an overall reduction in unfilled posts from 29% in October 2023 to 18% in April 2025, and an overall growth in the workforce of 415 whole-time equivalent staff since October 2023. The Government has continued to make funding available in 2025 for children’s services.

Speaking on Cavan specifically, the HSE has advised that the total number of children receiving services in a CDNT at the end of November stood at 380. The number of children on the waiting list at the end of November stood at 194 children, with 172 of those waiting over 12 months. To tackle these challenges, waiting list supports and initiatives have been put in place in CDNT services in Cavan, such as: diagnostic assessments, cognitive assessments and discipline-specific assessments outsourced to private providers; use of therapy assistant posts to support clinicians in service provision; and the use of recruitment agencies to source staff where Enable Ireland’s normal recruitment pathways have been unsuccessful. The HSE has also advised that staffing levels have improved in the last 12 months, and the local team is systematically working through the longest waiters on the waiting list. The Senator acknowledged that in relation to staffing. The Minister does reaffirm, however, that the Government, the HSE and its funded agencies remain committed to the delivery of appropriate services for children with disabilities and their families and to continue advancing services that meet their needs.

I provide this reply not in any sort of political or combative way but to try to say that the Senator outlines very real and stark concerns about the upper-end waiting times that these poor children, whose cases the Senator has raised in the Chamber, may be facing into. I wanted to provide the real context and say we were aware of that and were acknowledging it. We are committed to, and are, putting the resources in, which we hope will reduce those waiting lists and, more importantly, make sure those children are seen a heck of a lot sooner than is perhaps thought at the moment.

Pauline Tully (Sinn Fein)
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I thank the Minister of State. The two examples I have raised relate to primary care, but there are waiting lists for both primary care and CDNT. There is actually a lot of frustration and confusion even when children are referred from one team to the other. I know these matters fall to two different Departments, but they are all matters for the HSE, or the HSE with Enable Ireland.

Regarding the CDNT, the staffing levels have improved but there is considerable frustration from parents still around the lack of assessment. There are a lot of courses being run for parents on how to support their children. Parents are more than willing and able and are happy to do those courses but they are saying the children need the contact with the therapists and that that is not happening to the extent it should be. Some children have had no actual engagement at all with a therapist, or very limited engagement, and the parents are watching the children struggling. The same happens with primary care. The primary care lists are extremely long. What plan does the Government have to try to address this? There needs to be a workforce plan to put in more speech and language therapists, occupational therapists, physiotherapists and so on. I could go on. I raised two examples but I could have raised any number of examples of different children in similar circumstances.

Neale Richmond (Dublin Rathdown, Fine Gael)
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It is important to recognise that, while those two specific cases were very clearly brought to this Chamber, I know they are representative of a much wider cohort, not just in Cavan, but around the country. The Senator is right to ask what the workforce plan is and what the solution is to make sure that those children do not just get assessed in time but get that one-on-one contact with the therapists they need. Budget 2026 has provided €20 million for the delivery of some 6,000 clinical assessments to the targeted waiting list and a further €8 million has been secured in the budget to allow for the funding of 150 additional posts to the children and disability network teams. Over the last five years, the disabilities workforce in the HSE and section 38 providers has grown by over 21%. This is the key issue and it is mirrored in relation to additional places in our third level institutions. We need more staff. The more staff we have, the more people will get their assessments and therapies. We are working on a concrete plan to make sure that is rolled out in a timely manner.