I also extend a very warm fáilte to our friends and guests. They are most welcome.

I recently met with 12-year-old Cara Darmody from Tipperary. I know the Taoiseach also met Cara in July. Cara is an amazing young person who campaigns tirelessly for better autism services for her brothers Neil and John and for so many other children failed by the system. Cara spoke to the Oireachtas committee two weeks ago. She said:

My brothers Neil and John have been treated disgracefully and I am here to stand up for them. I am also here to stand up for the almost 18,000 children who have been left to rot on waiting lists.

Cara’s family has been through a nightmare, fighting to get proper services for her brother, Neil, in particular, an experience her father, Mark, describes as “horrific, humiliating, and inhumane.” Neil is ten years old. In 2016, he was diagnosed as having a mild to moderate autism spectrum disorder. In 2020, with little progress or development, Neil was referred to a HSE child psychiatrist who was adamant that his disability was, in fact, severe. The psychiatrist’s recommendation was that Neil be re-assessed. Despite this recommendation being sent to three separate HSE managers, it was never actioned. Two years on, Neil has still not been re-assessed and has not received the services he needs.

Mark says he was told that Neil will be on a waiting list “indefinitely” but the local children’s disability team refused to put that in writing. No explanation has been given. Mark has made numerous complaints to the HSE but he has been stone-walled and the family is being ignored.

The impact on Neil’s development has been catastrophic. He bites and punches himself all day. The child is non-verbal. He needs to be brought on long drives to calm down. He has to sleep with his parents every night. Mark, his dad, says the lack of intervention has done his son irreparable damage. By contrast, his brother John has shown real progress. John received earlier intervention after the Darmodys paid for him to be assessed privately.

The pressure on this family is immense. Both children need full-time care, which has resulted in the loss of employment for both parents.

Ní hamháin go bhfuil Cara Darmody ag seasamh suas dá deartháir, Neil. Tá sí ag seasamh an fhóid do na mílte páiste atá ar liostaí feithimh míchumais.

Neil’s story is shocking but it is not unique. In fact, I spoke to families in Waterford last night who are in a very similar situations. As Cara said, there are more than 18,000 children on waiting lists just for initial contact with a children’s disability team. Thousands more are going without the services they need. There are 2,500 children whose assessments are overdue. More than a quarter of children’s disability posts are vacant, equating to over 480,000 lost therapy hours. This is a result of a failure to plan and invest in the specialised workforce and in services for children with disabilities.

Cara told the Oireachtas committee: “I am sick of adults who just talk. Why can you all not do something about this and stop the damage being done to children with disabilities?” What Neil urgently requires is a psychometric assessment, as recommended by his consultant psychiatrist. This is necessary to ensure that he is in the right school and that he gets the health and educational services he needs. When will Neil get his assessment?

First, I did meet with the Darmody family and with Cara some time ago. We had a good, frank and very useful discussion in terms of services for children with additional needs, in particular children with autism. I have been very clear on two fronts as there are two aspects to this, the education dimension and the health dimension. I am not satisfied and not happy with the services provided through the HSE in respect of children with autism. It is not at a scale and level that it should be at. It is not a funding issue as the resources have been allocated. The HSE is saying it is a recruitment issue.

When I came into government, I would have had issues with the progressing disability programme, which has been advanced by the HSE now for over a decade but has really only come into additional resources in the last four to five years. I have met with many disability organisations, both service providers and users, to try to get to the bottom of this progressing disability initiative. My view, which I made very clear, is that progressing disability – the Deputy will know this from her own constituency - took therapists out of the special schools to have a general pool available, diluting the service. We made it very clear that we wanted the therapists back working in the special schools as a first step, and that has been agreed, although we are following through on the implementation of that with the HSE. There has been resistance. There are different perspectives on this but I am very clear that in special schools, the multidisciplinary approach is best. I want the therapists in the special schools.

On the education front, over the last two years we have made rapid progress on education in terms of additional special schools, additional special classes and additional resources. We have more to do. We have also legislatively placed an obligation on every single school in the country to do its bit in respect of special needs, and schools have to be fully inclusive in terms of children with special needs and there can be no refusal of children with special needs regarding access to schools. That is also being worked through by the Minister for Education and there is very clear progress to be seen.

The availability of therapies is not satisfactory. I have spoken to different service providers. I want to be balanced here. In some areas, progressing disability seems to be working because there is a lower catchment or a lower number of children or young people being covered by a given area, and the workload seems to be manageable in respect of some CHO areas. In other areas, the load seems to be excessive. The key issue that the HSE raises is the capacity to recruit. I know that is of no consolation to children and families trying to access services.

If we look across the HSE, it has had far greater success in recruiting therapists for a whole range of other services, such as enhanced community care. Indeed, I was at a stroke unit the other day and there was no issue in recruiting therapists for speech and language, physio and so on. In terms of children and the progressing disability area, there seems to be a particular difficulty in recruiting and, indeed, retaining therapists across the board. That is a key issue. I have convened two meetings so far with all of the Ministers responsible for special needs to deal with this issue.

In the interim, we have to develop more accelerated means in terms of assessments of need, both on the clinical side and the services. In the case of Neil, the individual child here, it is a matter of services. The key issue is recruitment of a sufficient number of therapists to provide not just assessment, but interventions for children who require them on an ongoing basis.

There is undoubtedly a big problem in recruitment and retention of those therapists and specialists, as the Taoiseach stated. Much of the difficulty is self-inflicted by the Government and the HSE. If they are not prepared to pay and reward people in terms of their take-home pay and their pension entitlements in line with statutory standards, they will have a problem recruiting and holding onto staff.

I asked the Taoiseach about Neil specifically. He has given me a general and global picture. I know how bad it is out there. My God, every family dealing with this knows how deep the nightmare and the quagmire are. I asked him about this ten-year-old child, however. Two years ago, a consultant psychiatrist said the child needs to be reassessed because he is not on the mild spectrum; he is, in fact, profound and severe. He bites himself all day. The household is chaotic. The child needs constant care and is not getting the services he needs but he has not even been reassessed and the HSE is stonewalling the family. That is a fact. I asked the Taoiseach when will Neil get his assessment. I would like an answer to that question, particularly since as the Taoiseach stated, he met the family directly last July.

In fairness, I am not going to individually get involved in every case that comes before us in respect of services, such as the need for the HSE to provide services to Neil, for example. We will make representations and speak to the HSE in respect of the case but other children also require access to services and assessments. A recent legal case has impacted the model of assessment-----

The Government broke the law.

The Government was breaking the law.

------that was ongoing at that time by the HSE, which has to be-----

The HSE was breaking the law.

-----factored into how we deal with that. Suffice to say the resources have been made available in terms of the recruitment of all the clinicians and therapists. It is not about pay and conditions, in my view, in terms of------

It is for non-HSE staff.

Sorry, in many instances there are. There has been recruitment but there needs to be far more recruitment of therapists, particularly in respect of special needs, through the HSE. As I said, in education we have made very good progress.

Neil has not had his reassessment.

This area of access to therapies is a key area where we need far more significant progress than we have had.

The child has not been reassessed.