Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The second item I have selected comes from Deputy Éamon Ó Cuív, who wishes to discuss the need to provide a full range of services based on children's needs to children's disability network team 4, CDNT 4.

Éamon Ó Cuív (Galway West, Fianna Fail)
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The first comment I have to make is that I found out there is more than one CDNT 4 in the country. It is a funny way of naming things. The one I am talking about is in Connemara and covers all of Connemara. It is based in Spiddal and Connemara is as big as most counties on its own. It is a huge geographic area, particularly when you have to drive around the inlets, bays, mountains and hills.

We all know that early intervention is really beneficial for young people and children. The earlier the intervention and the more thorough it is, the better. Giving excuses about why it is not happening is not any good for those children for the rest of their lives. We are talking about affecting people's future permanently. In the long term, it is also imposing a significant cost on the State, with more intervention being needed. As they say, a stitch in time saves nine.

I am not going to mention who is involved in the case. It is the case of a young person. I raised the issues of physiotherapy, occupational therapy and speech therapy. I understand there is a physiotherapy appointment about every three to four months. I love the terminology in what I am told, which is that the child is wait-listed for individualised team intervention from speech and language therapy and occupational therapy, but unfortunately, CDNT 4 is not in a position to identify timeframes for children to be taken off the waiting lists. This child went on the waiting list in October 2021. It goes on to say that CDNT 4 continues to have recruitment challenges and is making efforts to recruit. That does not wash with me because as I was sharply told one time when I started giving excuses, excuses do not get the job done.

I am highlighting it today because we have often seen in the State that when a thing becomes urgent and it is seen that people are not going to lie down and just accept this second-class service, suddenly, miraculously, ways are found of getting, procuring and providing the service. I have, on behalf of many people, chased down the lack of services in CDNT 4, otherwise known as the Connemara children's disability network team for a long time. What I need to know today is quite simple. The problems that the CDNT has are HSE problems. That is not my business. My only concern is when these children will get a service. When will they get the service when they need it? When will we adhere to the principle of early intervention and a stitch in time saving nine?

Ossian Smyth (Dún Laoghaire, Green Party)
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My colleague, Deputy Anne Rabbitte, the Minister of State with responsibility for disabilities, is fully committed to the continued development and enhancement of our children's disability services through the CDNTs, as they seek to ensure equitable access to services for all children with complex needs. I acknowledge the difficulties faced by children and their families seeking to access the services of children's disability network teams in CHO 2, and in this particular instance, CDNT 4. The Minister of State, Deputy Rabbitte, wishes to reiterate her unhappiness at this situation and her commitment to addressing the underlying issues.

The children's disability services in community healthcare west, CHW, were reconfigured into children's disability network teams in January 2021. There are nine CDNTs in CHW, including CDNT 4, which broadly covers the west Galway-Connemara area. Recruitment of staff to reduce waiting lists has been an ongoing issue, especially in this region. There are significant challenges both nationally and globally regarding the recruitment and retention of health and social care professionals, particularly to children's disability services. Following an intensive national recruitment campaign, we have recruited nearly 30 staff in the CHW region to date in 2024. While CDNT 4 has only been able to fill one post from this campaign, further campaigns are being run in an effort to attract suitable candidates to this area. While funding has been allocated, vacancy rates in CDNTs unfortunately remain high. On CDNT 4, the HSE advises that the vacancy rate currently stands at 50%, with six staff in place and six posts vacant.

CHW is fully committed to providing a quality service to the CDNT 4 cohort of clients, and every effort will be made to increase staffing numbers to support this during the remainder of 2024. These efforts are ongoing, both through the HSE's national recruitment service and HSE HR at a local level. Additional measures are also being progressed under the progressing disability services roadmap to increase capacity on CDNTs. These include student sponsorship programmes for health and social care professionals, HSCPs. There is a target of 175 therapy assistants to support HSCPs in delivering most effective and efficient services in environments appropriate to each child's needs. There is dedicated work on marketing CDNTs as a workplace of choice.

While recruitment measures are ongoing, I can advise that the HSE is driving forward several initiatives to reduce waiting times and strengthen services for children waiting. These efforts include sourcing assessments from private service providers. A new waiting list initiative with a total fund of €6.9 million will target those families waiting longest for assessments of need, with the HSE reimbursing clinicians directly through the procurement of capacity from approved private providers. This initiative will be progressed through the existing framework of providers procured by the HSE and is expected to provide an additional 2,500 assessments over a six-month period. While recruitment and retention of staff to CDNTs remains a considerable challenge, the Minister of State, Deputy Rabbitte, wishes to reaffirm her commitment, as well as that of the HSE and Department to exploring all avenues to improve access to CDNTs for children and their families in CDNT 4 and across the country.

Éamon Ó Cuív (Galway West, Fianna Fail)
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The one answer I did not get is the only answer I want. When will this child and all the other children get a service? If what is being done is not tackling it fast enough, what will the services do to tackle it faster? They have not got through the 2021 list yet. There is always a way. Do they need to pay more money? I do not know what they need to do. There is one thing they could do. I know one person from the area with one of the named skills who came home to live here. That person worked for the NHS in London and is fully qualified.

It has taken them a year to register with CORU. Mutual recognition of qualifications between Ireland and Britain and Ireland and the European Union is needed along with a quick transfer. The accreditation authorities seem to hold these things up forever when it is obvious that if somebody is good enough for the NHS, then, no disrespect, they are good enough for the HSE. We would take severe umbrage if someone in the NHS said somebody good enough for the HSE and qualified here properly, with degrees and all the rest, was not qualified to work in England. I am not satisfied that the recruitment processes in the HSE are adequate nor that this problem is being taken seriously enough. There is a need for crisis management. It seems that when it gets to the point of recruiting and doing interviews, it can take six or nine months to make an appointment. What kind of world are we living in? In the old days, you did an interview, provided the paper versions of your qualifications to guarantee that you had them, provided references, which were checked, and you had a job within three weeks. I do not know what we have done because nothing seems to work or move forward. All we get is excuses and children without a service. I hope the Minister of State carries back to the line Minister my frustration with this issue and my determination to keep advocating for those children who should get early intervention but are not.

Ossian Smyth (Dún Laoghaire, Green Party)
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I will communicate to the Minister of State, Deputy Rabbitte, Deputy Ó Cuív's frustration at the situation. I will ask for her projection of when the services will be delivered. The Deputy can see from the answer that the problems seem to stem from a lack of staff - half of the positions in CDNT 4 are currently vacant. The HSE has turned to private service providers and has an allocation of nearly €7 million to provide an additional 2,500 assessments over the coming six months. Clearly, it is trying other options. The Deputy suggested that we look into faster mutual recognition of qualifications from jurisdictions such as the UK in order that we can recruit staff more quickly. I will suggest that to the Minister of State.

The HSE launched its first nationwide CDNT campaign in January 2024. Following a further validation and engagement process by the lead agencies, the HSE advises that as of June 2024, 145 job offers have been made to successful candidates, with about 53 in the final stages of the recruitment process. A second recruitment campaign applying learnings from the first will start shortly. I reassure the Deputy of the Minister of State's commitment to working with the HSE to enhance CDNT capacity, find effective solutions to reduce wait times and to ensure children and young people with complex needs have timely access to services in CDNT 4 and, of course, across the country. I will communicate to the Minister of State the Deputy's concern.

Éamon Ó Cuív (Galway West, Fianna Fail)
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Will Deputy Smyth ask how many on the shortlist are for CDNT 4? It seems peripheral areas were once again left out.

Ossian Smyth (Dún Laoghaire, Green Party)
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Does Deputy Ó Cuív want to know how many of the people recruited are for CDNT 4?

Éamon Ó Cuív (Galway West, Fianna Fail)
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Yes.

Ossian Smyth (Dún Laoghaire, Green Party)
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I will ask that.