Brian Stanley warns of crisis in child disability services

The issue I'm raising with you Taoiseach is the child disability network teams and the chronic situation regarding the staffing of these. Across the state there are vacancies, the vacancies run between 22 and 29 per cent according to replies I got from the HSE. In County Leash however the situation is actually much worse, far worse and there are gaps, there is shortage there of spaces and I'll read you their figures. Occupational therapy in network 12 which covers most of the county is 33 per cent staffed. Speech and language therapy is 46 per cent staffed. Physiotherapy is 50 per cent staffed. Therapy assistance zero staffed. Dietetics zero staffed. That's in network 12 and in network 11 which covers the north of the county and part of Offaly. The situation with dietetics is the very same and for therapy assistance there's zero staffing in that area. Behavioral therapists, imagine that, behavior therapists zero. And families with children who are on the autism spectrum and or who have ADHD or dyspraxia or any of those conditions, trying to get in for an assessment is a problem and trying to get the therapies is a bigger problem. So this has to be sorted and in the programme for government it says here on page 92 that the government will increase staffing, train more therapists and prioritise children's disabilities and it goes on and I welcome that commitment. But you have been in government you know for most of the last 30 years and we're in a situation and I have to say this to you and you were Minister for Health at one stage, you know I have to bring this to your attention that right throughout that period this crisis has pertained. You know we had we had the boom of the Celtic Tiger and I remember parents coming to me at that time as a county councillor they were desperately trying to get you know trying to get services. So it goes back right into that boom the late 90s the Celtic Tiger boom then we had the crash then we had the uplift in 2014 and 15 and we're still in the same situation and this has to be sorted out. Children are missing out at crucial periods in their development and we know and you know and everyone that looks at these issues know that early intervention here is key and that's not happening. It's putting enormous pressure on parents and families and they're coming to TDs and when they come to TDs or councillors or anybody else the system is failing and we must address it and some voluntary organisations such as Lee Shoffley Families for Autism are trying to plug that gap and providing therapy and providing for assessments as well but they can only do so much because they are voluntary organisations and as an Oireachtas we have a responsibility opposition and government to sort this out. We have to increase the pipeline of staff that's coming into the services and you do say that in the programme for government but there's immediate actions that can be taken in relation to that you know and I'll come back in on that in a second when I have a chance. Well I thank the Deputy for raising this issue and it is a very serious issue but I just want to make the overall point I don't want to go into the history of provision but it has dramatically and exponentially grown in terms of the level of investment and provision both on the education side in terms of special needs and on the health side. I think in the education side it's much more clearly to be seen in terms of the transformative impacts over 20 odd years in terms of investment in special education because back in the late 90s early 2000s we had no special classes we had no special needs assistance only started in the late 90s. Now over the last five years alone the number of pupils attending special classes has gone from 9,000 to 19,000 in five years and special schools attending 7,800 to 9,000. The number of special classes has doubled and there would be further increases in that. Now that's on the education side. I accept fully the CDNT situation is not at all satisfactory and the absence of fully staffed multidisciplinary teams is a huge issue in terms of the CDNT teams more generally. In the census of 2022 about 13% of children were identified as having a disability. There's huge money allocated on both sides but people are not interested in a service for their child and they're not getting access to therapists in particular. Now there is recruitment underway. There's an issue with the assessment of need which the government is examining because that is drawing down a lot of resources following that High Court decision which means there's an awful lot more going into the assessment not in the delivery of services. The government is going to bring forward legislation on that. It will be challenging. I've no doubt it will be debated in the south but that nettle has to be grasped because it has to be dealt to it in terms of having a more efficient and effective assessment of need but at least making sure that children from day one get the services that they require. Secondly recruitment continues. There had been issues within the HSE in terms of the recruitment of therapists. Not funding issues but actually recruitment and retention. So the vacancy rate was as high as 29% I think in 2023. That has come down to 21% vacancy rate. So the posts are approved and funded but the recruitment issue has been a factor. The CDNT workforce has grown by 17%. That's an addition to 272 posts being filled but it still is nowhere near optimal and that's why we have decided as a government to pursue a therapy and education approach particularly for special schools that they would be in a position to have multidisciplinary teams, if you like separate from the health service itself. Thank you, Tisha. For the most severe and profoundly children with special needs. Thanks, Tisha for your reply. And yes, the education situation has improved over the last two and a half decades. I accept that and we have more to do there but we were starting from zero where we had nothing. But I have to say to you that in the HSE overall there's a huge problem in the HSE between budget and services. You know, there's considerable budget going in and nobody here I think would argue with that and I certainly won't argue with it. But the problem is that at the other end, you know, when it comes to actually seeing what comes out the other end in terms of services, you know, there's a fog in the middle. Where does the money go? There's a question mark around that and it's the same in relation to these therapies. I want to say to you that the Minister for Finance informed me here a couple of weeks ago, I was deputising for you, that you're chairing a cabinet subcommittee on this. And I would say three small things to you. One is you need to expand the number of training courses in speech and language, occupational therapy, physiotherapy and psychology and therapy assistance and dietetics and recruit people for full-time positions and retain them in the services. And you mentioned about the gaps in services. It's 100% in those therapies in network 11 and 12. And somebody needs to look at this. This should not be the case. There's no services on some of those therapies. I don't disagree with you at all. I agree with you in terms of there is an issue in terms of the budget that's going in and the services that are coming out. There is a, that needs to be constantly interrogated. No question about that. I do, I am chairing a cabinet subcommittee meeting and our subcommittee on disability and we're establishing a disability unit within the Department of Antioch to work for, you know, hands-on working with all the various government departments to get a coordinated approach in every single department towards the disability issue. And then under therapists, in July of 2024, there was a funding provided to boost training places in speech and language, occupational and physiotherapy, leading to a 35% increase in student places this September. And the new student places were launched in September in Galway in terms of both speech and language and in terms of occupational and in terms of pediatric, podiatry, sorry, places. But I know we've instructed the Minister for higher education to go back to the universities for the next academic year to have a substantial increase in the number of places for therapists. But that has to be also followed and paralleled with an increase in clinical training places for them. And we're also engaging with KORU in terms of registering, for example, qualified people from overseas much more quickly. Thank you, thank you.