Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister of State for coming to the House to address this issue. I apologise that I was not able to get back into the House the other night due to a roads diversion.

This issue has been aired many times over the years. I happened to be on a programme with a journalist recently who had to face that particular problem. He and his spouse found all the obstacles put on the course. I was thinking about it afterwards and I discovered that we all try to resolve those issue on a case-by-case basis. There does not seem to be a regime to kick into place as soon as the diagnosis is received. Early diagnosis is hugely important for children with autism and similar complaints but it should follow that the necessary treatment is available. Speech and language therapy, physiotherapy, occupational therapy or whatever is required, needs to be put in place immediately. Any delay will cause further issues at a later stage and further consequences for the child.

Invariably the parents go to the ends of the earth to help their child out. They make huge sacrifices such as going for costly private assessments to get the thing moving and they do it again and again. We have all dealt with the cases when an assessment is taking place, whether it be a mild, severe or profound diagnosis. There is a big difference between them. In many of those cases, there are situations where the parents have provided almost a hospital environment in their homes and the ways and means of catering for their child on a 24-7 basis. It has to shock us the degree to which those parents have to commit themselves. As one woman said to me some time ago "I have been at this for 25 years"; 25 years is a long time, albeit with some respite. Sometimes, there is no respite. For example, there is no maternity cover for speech and language therapists in that kind of situation. The child is then put under further pressure because they have to catch up at a later stage.

Looking at it again, I think it is necessary to put in place a sequence of events that kick in from the moment of diagnosis. Depending on whether a diagnosis is mild, severe or profound, the appropriate backup services should be made available to the parents and the child to minimise the delay. We should try to make sure the child's future - insofar as we can - is in someway guaranteed or helped so that they will at least be confident enough in the time ahead to be able to live their lives in society in the best way they can. It is important we do this now and that we recognise it. It is unfair to the parents and the children in question to have to go over the same performance repeatedly and come to the same spot. I have seen situations, as everybody has, where children have seriously injured themselves and have had to go to hospital. They have had to sit all day on a waiting list in the hospital with everybody else. There should be a system where there would at least be a recognition of the child's predicament and that the child would be removed from the queue, dealt with and the family sent home. Those are just a couple of the things that come to mind and I am glad to be able to ask the Minister for a reply.

Mary Butler (Waterford, Fianna Fail)
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On behalf of my colleague, the Minister of State, Deputy Rabitte, who has responsibility for disabilities, I thank Deputy Durkan for raising this important issue and for offering us the opportunity to respond. The Government and the HSE are fully committed to delivering real and tangible solutions to enhance services to better support children with disabilities in Ireland. The progressing disability services roadmap 2023 to 2026 focuses on the ongoing development of children's disability network team services to meet current and growing demand. PDS is a needs-led model of service where a child does not require a diagnosis to access services and the CDNTs provide a multidisciplinary assessment of individual needs and strengths as well as therapy supports. The current delays in accessing assessments of need and therapy interventions are acknowledged and work is ongoing by the HSE to maximise the capacity of CDNTs via recruitment campaigns and other measures, including sourcing assessments through private providers.

The HSE advises it is receiving approximately 10,500 applications annually, with around 3,400 assessments of need completed each year. Under budget 2024, record funding of €2.9 billion has been provided for specialist community-based disability services. This 10.6% increase is supporting the HSE in seeking to meet demands in respect of the provision of therapies to children and to also meet the legislative demands of the assessment of need.

On 21 May this year, the Government announced a decision to finance an assessment of need waiting-list initiative through the procurement of private assessments for long-wait families. The waiting list initiative targets those families waiting longer for assessments of need, with the HSE reimbursing clinicians directly through the procurement of capacity from approved private providers. Targeted funding of €6.89 million will allow the HSE to procure up to 2,500 additional assessments of need, with delivery targeted over the next three months, and will target those families waiting longest. Information received from the HSE areas indicates that under this targeted initiative, in the order of 1,100 assessments of need were commissioned from private providers during the months of June, July and August at a total cost of €3.5 million. In the first half of this year, 1,841 assessments of need have been completed, which is a 28% increase on the same period last year. This increase is due, in part, to the new targeted waiting list initiative that commenced.

The HSE continues to seek to recruit therapy professionals to the respective teams in order to enhance capacity. Funding has been allocated by the Government for that purpose as well as private sector bolstering of overall capacity. I also point out that this was one area that was not affected by the moratorium last year. Recruitment continued the whole time. However, while the HSE continues to maximise the capacity of the private sector to support both assessment of need and therapy provision, in keeping with the difficulties in recruitment of health and social care professionals, the HSE reports that private sector capacity is becoming increasingly limited. I am assured by my colleague, the Minister of State, Deputy Rabbitte, that this remains a matter of extremely high priority for her as well as for senior leadership within the HSE.

Bernard Durkan (Kildare North, Fine Gael)
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I thank the Minister of State. I compliment her good self and her colleague, the Minister, Deputy Rabbitte, for the work they continue to do in the whole area for which they have responsibilities. I note that they, and several others, are busy Ministers. That is what one has to be.

It is also worth mentioning that the struggle does not stop just there. It continues. There is a domiciliary care allowance on which a different Department adjudicates. There is usually a battle. First, it gets refused on the basis that - as quoted in countless cases - the child does not need any greater attention than any other child of a similar age. I am sure the Minister of State has read that report many times. This is wrong. The people who make the assessment come to this conclusion, whichever category the child may be in. The children need support now, not in ten or 15 years' time. We have all dealt with cases where the child grows to a teenager and then a young adult and never gets any services, recognition or payment.

We have all dealt with cases where the person with the particular problem, who was diagnosed all those years ago, could be 40 years of age before there is any recognition of their predicament in terms of participating in the workplace. I reject the notion that is sometimes put forward that the child needs no more attention than any other child of similar age. In many cases, they have been left to make their own way in the world and have got into difficulty. That should not be happening. We are supposed to be a caring society. We are a caring society and we have many caring people in our society. The time has come to do something urgently about this.

It was referred to on the television programme that the Minister of State, Deputy Rabbitte, was refused a meeting with the HSE. I do not know how that came about but it should not happen under any circumstances. If we can find out the details of that, it needs to be dealt with.

Mary Butler (Waterford, Fianna Fail)
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I was watching the programme that night. Once again, I thank the Deputy for raising this important issue, which the Minister, Deputy O’Gorman, and the Minister of State, Deputy Rabbitte, are extremely involved with. Indeed, the whole of the Government is highly conscious of the need to address the situation.

It is important to reiterate that, as part of the CDNT model of service, a child does not require an assessment of need or a diagnosis to access health services. I acknowledge that CDNTs are currently providing services and supports for over 46,000 children, with 93 dedicated teams across the country. These teams are also providing strategies and supports for urgent cases on the wait-list, where staffing resources allow.

In recent years, the Government has provided funding for additional posts to enhance the capacity of CDNTs and shorten the waiting times. The 2023 CDNT staff census noted an average vacancy rate of 36% across CHOs, a 2% increase on the previous year. However, while an analysis of the data from 2022 to 2023 demonstrates an increase of 152.52 whole-time equivalents in the approved posts, this only reflected a 3% increase in the CDNT workforce, which I find strange.

Detailed engagement continues between the Minister, Deputy O’Gorman, and the Minister of State, Deputy Rabbitte, their officials in the Department of children and the HSE to seek practical and implementable solutions to address the AON issue. I assure the Deputy that the matter is receiving the most urgent attention. As somebody who works very closely with the Minister of State, Deputy Rabbitte, I know she puts her heart and soul into this every day of the week to try to find solutions, and they are not always easy to find.