I raise the child disability network teams and the chronic situation regarding their staffing. There are vacancies across the State. They run between 22% and 29% according to replies I have received from the HSE. In County Laois, however, the situation is far worse. I will read the figures for the shortages: occupational therapy in network 12, which covers most of the county, is 33% staffed; speech and language therapy is 46% staffed; physiotherapy is 50% staffed; therapy assistants and dietetics are zero staffed. In network 11, which covers the north of the county and part of Offaly, the situation with dietetics is the very same. Therapy assistants and behaviour therapists both have zero staffing. For families with children on the autism spectrum, or with ADHD, dyspraxia or similar conditions, trying to get an assessment is a problem but trying to get the therapies is a bigger problem. This has to be sorted. The programme for Government says on page 92 that the Government will “increase staffing, train more therapists and prioritise children’s disability teams”. I welcome that commitment but the Taoiseach has been in government for most of the last 30 years. The Taoiseach was Minister for Health at one stage and I have to bring it to his attention that right through that period, this crisis has pertained. I remember during the boom of the Celtic tiger, parents coming to me as a county councillor who were desperately trying to get services. It goes back to that boom in the late nineties. Then we had the crash and then the uplift in 2014 and 2015 and we are still in the same situation. This has to be sorted out. Children are missing out at crucial periods in their development. We know, as does the Taoiseach and everyone who looks at these issues, that early intervention is key, but it is not happening. This is putting enormous pressure on parents and families. They are coming to TDs and when they have to come to TDs, councillors or anyone else, the system is failing and we must address it.

Some voluntary organisations such as Laois Offaly Families for Autism are trying to plug that gap by providing therapy and assessments but they can only do so much because they are voluntary organisations. As an Oireachtas, we have a responsibility – the Opposition and the Government – to sort this out. We have to increase the pipeline of staff coming into the services. The programme for Government includes the commitment I have mentioned, but there are immediate actions that can be taken on that.

I thank the Deputy for raising this issue which is very serious. I would make the overall point, and I do not want to go into the history of provision, that there has been dramatic exponential growth in the level of investment and provision both on the education side, in terms of special needs, and on the health side. On the education side, it is much more clearly to be seen in the transformative impacts over 20-odd years with investment in special education. Back in the late nineties and early 2000s we had no special classes or special needs assistants. That only started in the late nineties. Over the past five years alone the number of pupils attending special classes has gone from 9,000 to 19,000. Those attending special schools have gone from 7,800 to 9,000. The number of special classes has doubled and there will be further increases in that.

That is 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 for CDNTs more generally. In the 2022 census, about 13% of children were identified as having a disability. Huge money has been allocated on both sides but people are not interested and rightly so because people are interested in a service for their child and they are not getting access to therapists in particular. Recruitment is under way. There is an issue with the assessment of need which the Government is examining. That is drawing down a lot of resources following that High Court decision which means an awful lot more is going into the assessment and not the delivery of services. Our Government will bring forward legislation on that. It will be challenging - I have no doubt it will be debated in this House – but that nettle has to be grasped because it has to be dealt with in order to have a more efficient and effective assessment of need and to make sure that from day one, children get the services they require. Second, recruitment continues. There had been issues in the HSE around the recruitment of therapists. Those were not funding issues but recruitment and retention issues. The vacancy rate was as high as 29% in 2023. That has come down to 21%. The posts are approved and funded but the recruitment issue has been a factor. The CDNT workforce has grown by about 17%, with an additional 272 posts having been filled, but it is still nowhere near optimal. That is why we have decided as a Government to pursue a therapy in education approach, particularly for special schools - we want them to be in a position to have multidisciplinary teams separate from the health service itself for the children with the most profound special needs.

I thank the Taoiseach for his reply. Yes, the education situation has improved over the last two and a half decades. I accept that. We have more to do there but we were starting from zero where we had nothing. However, in the HSE overall, there is a great problem between budget and services. No one will dispute that a considerable budget is going in. Certainly, I will not argue with it. There is a problem at the other end when we see what comes out in terms of services. There is a fog in the middle. Where does the money go? There is a question mark around that. It is the same with these therapies.

When the Minister for Finance was deputising for the Taoiseach here a few weeks ago, he told me that the Taoiseach was chairing a Cabinet subcommittee on this. I would say three small things to the Taoiseach. First, he needs to expand the number of training courses in speech and language therapy, occupational therapy, physiotherapy, psychology and therapy assistants and dietetics. Second, he needs to recruit people for full-time positions and retain them in the services. Third, the Taoiseach mentioned the gaps in services. The gap is 100% in those therapies in networks 11 and 12. Someone needs to look at this. This should not be the case. There are no services in some of those therapies in Laois.

I do not disagree with the Deputy at all. I agree with him that there is an issue with the budget going in and the services coming out. That needs to be constantly interrogated. There is no question about that. I am chairing a Cabinet subcommittee meeting on disability and we are establishing a disability unit in the Department of An Taoiseach to work hands-on with all the various Departments and get a co-ordinated approach in every single Department towards the disability issue.

On therapists, in July 2024 funding was provided to boost training places in speech and language therapy, occupational therapy and physiotherapy. This will lead to a 35% increase in student places this September. New student places were launched in September in Galway in speech and language therapy, occupational therapy and podiatry. We have 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 must be followed and paralleled with an increase in clinical training places for them. We are also engaging with CORU about registering qualified people from overseas much more quickly than is currently the case.