Brendan Smith warns of therapy delays in Cavern and Monaghan

Minister, I had the opportunity to mention to you before my serious concern about the ongoing delays in children with additional needs accessing therapies in Cavern and Monaghan. It is absolutely unacceptable of the delays that are occurring, some children being assessed and not getting follow-up therapies, and even delays in getting assessments. We need more clinicians in the Cavern and Monaghan area, and I sincerely hope that additional efforts will be made to recruit more clinicians across particular therapy areas for those two counties. I agree. While in 2024 nearly 1.4 million people accessed therapy services across the disciplines, including physiotherapy, speech and language therapy, occupational therapy, dietetics, psychology, podiatry, all of that, in many cases waiting times are just wholly unacceptable. And to tackle this, the Department of Health is working closely with the HSE on a targeted programmatic approach to managing therapy waiting lists in primary care in particular. As well as looking at the longer-term changes that are needed, we are trying to do what is possible right now. I have asked the HSE CEO to now put in place measures to address physiotherapy, occupational therapy and speech and language therapy waiting lists to reduce the waiting time for these three therapies to less than 10 months, which I hope will be achieved. That would be a massive improvement on where we are now. It would remove 60,000 people from the waiting lists across these three therapies into actually getting therapeutic services. Deputy, that is a challenge, but unless we set a direction and a target, and I have very clearly given that to the HSE CEO, I am concerned that nothing will change without some direction and the resources and the support to do that. Now, I do acknowledge that we have global workforce challenges, the same as everybody else in health care. We are trying to advance initiatives to retain and recruit the skilled professionals that we need. Recruitment efforts include offering permanent roles to all Irish HSCP graduates, streamlined registration with Carew, which has improved enormously over the last number of months, and the introduction of 320 new training places via the CAO. You will be aware that since January 2020, 5,019 additional therapists have joined the HSE, a 30 per cent increase. Indeed, in that time, 40 additional therapists have been recruited to Calvin Monaghan, bringing the total to 177. You are aware that that includes 12 new occupational therapists, 14 physiotherapists, seven dieticians, three speech and language therapists, demonstrating our commitment to strengthening frontline capacity, but I still acknowledge that your concerns are raised and that I remain committed to targeted reform in the way that I have given the direction to the HSE CEO. The Minister, I very much appreciate your determination to get this issue dealt with once and for all. Last Friday night at clinics and last Saturday, I had a number of young parents with me who had children who have not got assessments, they have not got therapies. One parent spoke to me about her son getting a speech and language therapy appointment in June 2021, none since. That child got an occupational therapy appointment 22 and 25. Another child, that young mother has been assessed for the past 18 months and still no assessed and diagnosed and still no follow-up therapies. Minister, there is an opportunity, I believe in the Cavan area in particular, to outsource more therapies. Assessments are being outsourced. I know that is not the answer to all our concerns. Minister, back a few years ago we discussed with your predecessor Stephen Donnelly in this house one night during question time. It was in relation to the introduction of the development therapy assistance. Now, speaking to clinicians, I believe that that can help speed up the number of people delivering therapies and delivering services. And I know that some of the colleges of further education do an initial course which enables those students go on then to a university or an institute of technology to pursue courses across different disciplines, including occupational therapy and others. So, Minister, if that may not be included in your brief, but I think it's an area that we should pursue and make more progress in that area of therapy assistance. Minister. Thank you, Deputy. Yes, and you might allow me to reflect on that and discuss that with my officials further. I think this this three – what we are trying to do to build capacity in primary care therapy services is this three-part national programme, and I might just lay it out for you. Workstream one is an analysis of the regional productivity to optimise current therapy care to maximise capacity within existing resources. Frankly, there is variation between regions, and we need to understand specifically what that variation is, and have a national response that prioritises patients waiting over one year for therapy access. And then we will be developing and are developing a primary care therapy waiting list management protocol, which the purpose of which is to ensure consistency and transparency during referral, waiting list management and discharge across all primary care in the different regions to improve overall patient experience. We have seen this used in other areas to good effect, and it's now time for this to be properly used for primary care therapy. Thank you very much, Minister. One other area of difficulty for us in Calvin is that the CDNT in County Calvin is led by Enable Ireland. We know that they have difficulties in recruitment and retention of staff because of the Section 38, Section 39 issue. I know that's a broader government issue, but it's one that needs to be addressed. Also, Minister, have the universities and colleges, have they made enough places available to ensure that we have the professionals to deliver healthcare and that we meet the ongoing demand and indeed increasing demand for different healthcare services across our country. My understanding is that there's still a big shortfall in regard to the numbers graduating vis-a-vis those retiring and add on the increased demand as well. One issue was brought to my attention at the weekend as well, and it may not be absolutely accurate. But apparently for speech and language occupation therapy and other therapy studies in Britain, it's a form of an apprenticeship rather than the traditional university or college route that we have. So there may be a financial incentive there for some students from our state to go to those colleges in Britain. So, Minister, I appreciate that. It's just an area that you, your department at the HSEMA and our colleges would want to keep a tight eye on because we don't want students withdrawn away from our state because it may be a monetary attraction in pursuing a specific course in a British college. There is an additional 320 new training places via the CEO in the different colleges, which is a very significant expansion. I will speak to my good colleague James Lawless in the Department of Further Higher and Education. My responsibility on that side is the clinical training places that have to go alongside the academic piece. We did move from an apprenticeship model in nursing to an academic degree model, and that is to try to lift standards and lift expertise as far as possible and enable the sort of advanced practice that we want to see right across the specialisms. We are trying to do that now with health and social care professionals as well. I have met Kourou in relation to their registration processes, which frankly had been too slow. They have had an enormous improvement on their registration processes, and I have met the different professions to signal very clearly that we will be aligning ourselves to the European standards to enable even greater numbers of people to come and to work in Ireland from different parts of Europe, where that hasn't necessarily happened at the rate that I think we should have seen in the past. But it is also Kourou are working hard with the professions to make sure that the clinical training places are available, not just in acute hospitals, but in primary care and in other areas as well. Thank you. Deputy Borland.