Joe O'Reilly criticises centralisation of speech therapy services

At the outset, thank you for selecting this matter, which is important to the people that I represent. Also Minister, thank you for coming in to take the question yourself in person and giving it the seriousness it deserves. First of all, I have lived in the Bailey-Burr area for more than the past 30 years, roughly 30 years, and in all of that time, there has been a speech and language service in Bailey-Burr, Shercrooke and Mullagh available to parents there. I understand that this would have been the case in most areas throughout the county. Now 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 Cavern, otherwise it is centralised. Not all of the families have transport. It is difficult to overcome this and the costs are big. Now, as you would appreciate, Minister, in an area like Cavern, while there were huge strides made in public transport, which is outside this debate during the last government, and there are much improved bus services, there are still not trains, buses. Using the buses to go to Cavern Town involves quite a chunk of a day, and it is expensive. For many families, the time involved in getting to Cavern 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 Ballyconnel and others. The extra time involved will greatly damage their schooling. The children are not attending school if they are travelling and going there, and presumably all sorts of diversions that the children will insist on when they get to Cavern Town. So they are losing on schooling. I am aware that the non-attendance policy takes them out of the service quickly. So in other words, what I am saying here, Minister, if somebody is due to attend and they miss a couple of, I think it is one or two, then they are struck off and they go off the service for non-attendance. This will greatly increase non-attendance. So that is a huge part of it in my view, and there is anecdotal evidence to support that. If I understand it properly, Minister, understand the values of Sláinte care, or what Sláinte care seeks to achieve, I think this totally contravenes it. Now, there are a lot of vulnerable families in the area I am discussing, and in other areas in the county. Now I understand, Minister, that in the case of cancer services and other clinical needs, there are cases for centralisation on the grounds of not losing excellence, etc., etc., and those arguments are well rehashed. But there is no case for how – and I am a teacher of my background – to see how speech and language therapy delivery is improved by moving its location. It is a one-to-one thing with very little resources. So I think it is mind-bogglingly stupid unless I have been misinformed. Thank you, 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 health and wellbeing of both children and adults in the community. You 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 to get more speech and language therapists working with Minister Lawless in relation to the number of training places. In the last number of days, I have met with Carew 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 there are as many speech and language therapists and indeed therapists more broadly available in our system to be able to provide services to everybody who needs it, but in particular, as you correctly identify, this lunch care principle is as close to home as possible. But we are not there yet. 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 and also increase in the complexity of presentations do require many more intensive interventions that have put more pressure on many primary care services, including speech and language therapies. Furthermore, there are a number of primary care services that are facing staff shortages and we have ongoing recruitment challenges and combined they have increased the waiting lists for services across the country. I fully recognise the frustration in people in Kevin who both have to address long waiting lists and also the geographical proximity of the services that are available to them. What I want to make sure is that they have timely access to therapeutic services. On the do not attend piece, 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 attend generally so 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, I am committed to recruiting additional staff numbers, I am committed to promoting advanced practice roles in the community for health and social care professionals and the government is committed to increasing the number of college training places for health and social care professionals. We have Cavan Community Healthcare Network speech and language therapy services, as I understand it, are currently delivered in Coote Hill, Breffney Care Centre, Ballyconnell, Cavan Town, in line with the current staffing resource that is available. That is our big challenge, making sure that we have enough therapists to be able to deliver the service to the people who need it as close to home as possible and we are not there yet. I appreciate you raising the complexity of this intersection for the people in your area, I hear you very clearly in relation to it and all I can do is try to increase the number of therapists as far 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 it as efficiently as possible to get the best for every therapist, every therapeutic service, to make sure they are seeing as many people as possible, recognising the increased presentations and the increased complexity of those presentations. But I hear you very clearly about the needs of the people of Cavan. Thank you Minister for that and I accept your bona fides and I also accept that you are doing everything possible to increase the number of speech and language therapists. But the issue here, Minister, is that it has been centralised and moved from the villages and the small towns. Now you might say that that is because of a lack of speech and language therapists. There are enough there at the moment to deliver them and it will only take the speech and language therapists, unless they are walking, a few minutes, a small number of time to commute from one town to the other and provide the service locally. So it is an absurdity, Minister, to say to take, if you had a map, if I had a map of Cavan here, take Muller, Virginia, or Muller, yeah, Virginia, Bailey versus Sherkirk and take those towns and take the service out of them and move it to Goodhill, Ballyconnell and Cavan. There is no logic to this, only disturbing parents. I take the point of a 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 that, but for children this does not deal with it. So what you have now, you take a child in Sherkirk, you will have them or Bailey Bursay, where I live, easier to talk about it. They will now spend four or five hours of a day going to Cavan town for the service. They are taken out of the primary school, the parents are discommoded, other children suffer. It is a madness. I would ask you personally, Minister, 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, they can commute, I am finishing now, they can commute in 20 minutes, say from Bailey Bursay to Cavan, 25 in a car. The parents take four hours and there are multiple parents. It is crazy stuff. So Minister, please look at it, thank you. Thank you Senator and of course we will look at the organisation of services more generally. I just would make the point that it is very important to me that every hour that a therapist is working is delivering therapeutic services, I do not want to see therapists in cars. That is one of the reasons why Minister Helen McEntee is doing such strong work about making sure that they are therapists based in schools where they can have the most effective and efficient use of their time and I appreciate that that is a transitional period at the moment as she moves to do that and provide services in special schools in the first instances and there is going to be a measure of travel if we are going to get the best out of every hour from every therapist who wants to be doing therapy work. But I do hear you about the geography and I will reflect on it of course, it is a matter for the local area to organise their services but we do need therapists doing therapy.