Dáil Éireann díospóireacht -
Tuesday, 25 Feb 2025

Vol. 1063 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Hospital Services

Deputy Donna McGettigan

I thank the Leas-Cheann Comhairle and congratulate him on his position.

There are no dedicated public inpatient beds for adults with anorexia or other eating disorders in the mid-west region. Nationally, only three public inpatient beds exist for these patients, all of which are located at St. Vincent’s hospital in Dublin, serving local catchment areas. The HSE introduced a national model of care for eating disorders in 2018. This included the appointments of 16 specialist teams and 23 adult inpatient beds across the country. Only 11 of those specialised teams have since been established. This does not include the mid-west region.

In addressing this gap, the HSE has been purchasing inpatient beds from private units. Additionally, the treatment abroad scheme has been utilised since 2020.

In December I was contacted by a distressed mother of a very seriously ill 15-year-old daughter who is an anorexia patient with a history of self-harming. When she brought her daughter to UHL in December she found her daughter in bed covered in blood, having deeply severed her wrists and having left suicide letters. This young girl was discharged after two days under the care of CAMHS Ennis with a referral to the Galway adolescent mental health inpatient unit. However, at the time there was no bed for her. This is simply unacceptable.

Due to these shortages, individuals like this young girl who is a constituent of mine cannot access specialised inpatient care for eating disorders. As a result, some patients are forced to find treatment abroad through the HSE treatment abroad scheme, TAS. Between 2022 and 2024, the HSE spent more than €12.7 million to facilitate inpatient care for adult patients with eating disorders via this scheme. Yet, no funding has been provided over the past six years to solve this issue here and provide eating disorder treatment beds. Ireland has just three public beds in the entire country offering specialised treatment for these patients. What happened to the commitment by the Minister of State's Department to open 20 new beds by 2023? Patients impacted by eating disorders outside these catchment areas in Dublin are normally referred to general psychiatric units, where they often do not receive specialised care. A thejournal.ie report into this crisis gives some very stark figures in relation to this and noted that in 2022, there were 210 hospital admissions for eating disorders, the vast majority of whom were women. This was the highest level of admissions in a decade.

Last year, Sinn Féin spokesperson on mental health, Deputy Mark Ward, noted that the reports from the eating disorder charity Bodywhys state that the number of people presenting for treatment with eating disorders has increased over the past few years. In 2023, 4,809 people accessed support through the charity, which was a significant increase of 19.5% over the previous year. The HSE’s model of care, planned to modernise the country’s eating disorder services between 2018 and 2023, inclusive, did not receive any funding. Sinn Féin’s mental health spokesperson, Deputy Mark Ward, raised this issue before and we are still here asking why this has not been fulfilled. The HSE's 2025 national service plan states it plans to continue to roll out the national clinical programmes for ADHD for adults and eating disorders. I would like to ask the Minister of State how the Government is meant to achieve this with the severe lack of beds, let alone any sort of specialised treatment care. Will she provide us with an update on the recruitment process for consultant psychiatrists and dieticians please?

Minister of State at the Department of Health (Deputy Mary Butler)

I thank the Leas-Cheann Comhairle and from the outset I congratulate him on his recent election to Leas-Cheann Comhairle. It is great to see him in the Chair.

I thank the Deputy for her forbearance. Last Thursday I was not in a position to take the question. I thank her for agreeing to have the debate tonight.

I thank the Deputy for raising this important matter in the House this evening. While I cannot discuss the details of an individual case here, I acknowledge what the Deputy has told me and am sorry to hear about this experience. As Deputies will be aware, eating disorders occur in approximately 5% of the population and have long been recognised as one of the most severe of the mental health conditions. We also know that it disproportionately affects adolescents and women. While some people benefit from more intensive treatment through day programmes or inpatient care, research shows the most effective treatment setting is in the community, and this has been the area of focus for recent new investment in eating disorder services. Some 90% of people with an eating disorder are being treated in the community. Enhancements for specialist mental health services such as the national clinical programme for eating disorders is a key priority for myself as Minister of State, the Government as a whole and the HSE.

Dedicated investment in eating disorders continues. Last year, the HSE spent over €9 million on eating disorder services under the clinical programmes. It is factually incorrect to say that money is not being spent. The previous year the spend was €8 million. It is ring-fenced funding that has been built on, year on year. Approximately 100 posts are funded under the programme including ten consultant psychiatrists now treating people with eating disorders across the country. The national clinical programme is being implemented by multidisciplinary teams on a phased basis. There are now 11 teams in place, as the Deputy said, six adult teams and five child and adolescent mental health services, CAMHS, teams. Funding was secured for an additional two teams under budget 2025. I also secured the funding for the 14th team last year when there was an announcement of €10 million last February. This means that 14 of the 16 teams envisaged under the model of care are now funded. It takes about a year and a half to stand up a multidisciplinary team. I am delighted to say that one of them, a CAMHS team, is on the way to the mid-west, in Limerick. These are very specialised services.

To stand up the team takes some time. It has to be led by a consultant psychiatrist. That means we will have a new CAMHS eating disorder team for the mid-west, bringing the total number of eating disorder teams nationally to 14 out the 16 teams under the model of care. In addition, HSE data indicates that, as the national clinical programme is rolled out, fewer people are needing to access eating disorder services abroad via the treatment abroad scheme. For example, I understand from the HSE that no child under 18 has had to be sent to the UK for treatment of an eating disorder since 2019. We have four different inpatient facilities for eating disorders for those under 18, namely, Eist Linn in Cork, Merlin Park in Galway and Linn Dara and St. Vincent's in Dublin.

I am also aware the HSE funds patients in private facilities based on individual clinical need, as assessed by the local mental health team, and the prioritisation of available funding. I will address the beds in my supplementary reply.

Deputy Donna McGettigan

While there has been a steady increase in the number of treatment hubs, there is still no funding for new inpatient beds. For people with eating disorders, it is usually for an extended period in an inpatient facility, which can be very difficult for the person. This treatment can be expensive and the process to get a bed can be so long that it means the person ends up needing more care.

The HSE spent more than €4 million sending seven people with eating disorders abroad for treatment in 2023. We need to stop sending extremely sick people abroad and put the much-needed money spent on the treatment abroad scheme into services here at home. People with eating disorders end up being referred to a general psychiatric unit, meaning they do not get the specialised care they need. Consistent funding is needed to provide much-needed beds, while more specialised teams are brought on board. It is a positive step in the right direction. Across the system, awareness and education has improved.

It is simply not enough. We need more investment and more beds now. However, I welcome a Limerick team coming into effect.

Deputy Mary Butler

The new CAMHS eating disorder team will transform the experiences of adolescents with eating disorders in the mid-west, giving them earlier and enhanced supports and reducing the need for hospital admissions. As I said, there are currently 20 dedicated eating disorder beds across the four CAMHS inpatient units. The Deputy is right to say there are only three adult beds in St. Vincent's hospital. We have done a full bed capacity review of all mental health beds across the whole country.

I have asked the HSE to conduct a full review of the national clinical programme. When it was established in 2018, at the time there was an indication that there may be 60 people who might need access to eating disorder extensive supports. I am meeting the lead on eating disorders this week. Last year, the figures show there were 894 referrals. We have seen the issue regarding eating disorders grow exponentially over the past four to five years, especially among young girls aged 15 and 16 with anorexia nervosa. When the model was put in place in 2018, it was envisaged that the best care for young people like that is in the community. A decision was taken at the time to try and put supports across every single community. When I became a Minister of State in 2020, we had one eating disorder team in place. We will have 14 by the end of this year. I have built on it year on year, securing the funding and getting the multidisciplinary teams in place. We will do the next two teams next year, and that is the 16 under the model of care. Notwithstanding that, our focus has to turn to the beds. I would like to see a geographical spread of the beds, not just in the large cities. I met with my HSE officials last week to discuss it.

Ambulance Service

Deputy Michael Murphy

I begin by offering my congratulations to the Leas-Cheann Comhairle on his elevation. I hope his new role does not distract him from continuing to represent my in-laws in Kilkenny city, namely John and Noeleen Breen.

An Leas-Cheann Comhairle

They do not have any worries.

Deputy Michael Murphy

I thank the Leas-Cheann Comhairle. I also pay tribute to former councillor Joe Bourke, from Templemore, who passed away this evening. I had Joe Bourke here in Leinster House a number of weeks ago. Unfortunately, Joe had not been well. I had the distinction of serving with Joe on Tipperary County Council and on the Southern Regional Assembly. He was a man of exceptional traits and character and a real positive force within his community. I am thinking of his family and extended family this evening.

On 10 February, managers at the National Ambulance Service were instructed not to bring their staff vehicles home out of hours until a dispute over benefit-in-kind had been resolved. That particular instruction was confirmed by the Health Service Executive in a statement:

The HSE must comply with Revenue Commissioner regulations in relation to what in this case is the potential personal use of publicly owned vehicles. All HSE employees are covered by these rules. The HSE National Ambulance Service has identified that the number of incidents responded to by vehicle users outside of working hours is minimal.

The statement concluded, "As a public body, the HSE cannot support the use of publicly owned emergency vehicles for purposes that the Revenue Commissioner considers potential personal use or benefit."

I do not think there is any doubt these National Ambulance Service managers are heroes at the local level. Put very simply, they save lives. These are fully equipped and marked emergency vehicles. Such vehicles are not a luxury, and in the context of my intervention, they are not a benefit-in-kind. Our National Ambulance Service managers are not just first responders, they play a crucial role in critical incident operation, planning and management. I also acknowledge the many first responders, members of more than 200 community groups who volunteer and make themselves available in the event of a sudden cardiac arrest.

Every effort must be made to find a resolution between senior management of the HSE and the director of the National Ambulance Service. This decision, if implemented, may lead to National Ambulance Service managers no longer being in a position to rapidly respond to calls out of hours when required. Lives could potentially be lost. I am calling on the Minister to personally intervene with the Revenue Commissioners to give urgent clarity that benefit-in-kind does not apply when it comes to emergency vehicles that are fully equipped and fully marked.

Minister of State at the Department of Justice (Deputy Niall Collins)

I also congratulate the Leas-Cheann Comhairle on his election.

I thank Deputy Murphy for raising this important matter. I am responding on behalf of the Minister for Finance, Deputy Donohoe, who has engaged with the Revenue Commissioners on this matter. He has been informed by Revenue that there has been no change in the legislation nor in Revenue’s interpretation of the existing legislation relating to the benefit-in-kind charge which is applicable on employer-provided vehicles or the exemption relating to the pooling of cars or vans.

Sections 121 and 121A of the Taxes Consolidation Act 1997 provide that where a car or a van is made available to an employee by his or her employer for the employee’s private use, then the employee is chargeable to benefit-in-kind. Where such a benefit is provided, the employer is required to include that notional payment as part of the employee’s emoluments and to deduct tax through the PAYE system accordingly. An employer makes a vehicle available to an employee through the provision of the use of a vehicle, and covering any vehicle running costs, such as insurance and petrol, on behalf of the employee.

Section 121(7) provides that a vehicle which is included in a car or van pool for the use of employees of one or more employers is treated as not available for the private use of employees, that is, not giving rise to a benefit-in-kind charge, if, in the tax year, all of the following conditions are met: that the vehicle is available to, and actually used by, more than one of the employees concerned; in the case of each employee, the vehicle is made available to him or her by reason of his or her employment; the vehicle is not ordinarily used by any one employee to the exclusion of the others; in the case of each of the employees concerned, any private use of the vehicle by him or her is merely incidental to his or her business use; and the vehicle is not normally kept overnight at or in the vicinity of any of the employees’ homes.

The Minister for Finance has asked his officials to engage with the HSE to establish whether there has been any change in policy by it in how it implements this measure. The HSE has also been asked to establish the number of people impacted by the issue.

In addition to the exemption provided for in section 121(7), Revenue has indicated that there is a long-standing published Revenue practice that allows a vehicle provided to an officer of the State, including an officer of a statutory body, to be deemed to be included in a vehicle pool, thus not giving rise to a benefit-in-kind charge if: it is scheduled and verifiable that the officer is obliged to be on call outside of his or her normal working hours to respond to situations giving rise to possible contravention of law; the officer is provided with a vehicle for this purpose during the periods concerned and keeps the vehicle overnight at his or her home; and the vehicle would, but for the on-call obligation noted above, be a pool vehicle.

In addition to the engagement with the HSE, the Deputy should note that the Minister for Finance has asked his officials to examine this matter in conjunction with the Revenue Commissioners.

Deputy Michael Murphy

I welcome the engagement launched by the Minister for Finance with the HSE and the fact that he has asked his departmental officials to examine the matter in conjunction with Revenue. In the event of an update following that engagement, will the Minister update the House?

Deputy Niall Collins

I will convey to the Minister for Finance the Deputy's request to be kept up to date.

As I indicated in my opening remarks, there has been no change in the legislation, or Revenue's interpretation of same, relating to the benefit-in-kind charge that is applicable on employer-provided vehicles or the exemption relating to the pooling of cars or vans. However, the nature of this Topical Issue and the number of parliamentary questions that have been received on the issue suggest that there has been a change in how such matters are being treated by the HSE. Consequently, Department of Finance officials intend to engage with the HSE to establish whether any changes have arisen on its side as regards the provision of employer-provided vehicles and-or the application of the benefit-in-kind charge in the context of pooled vehicles taken home at night by the aforementioned National Ambulance Service staff.

Special Educational Needs

Deputy Liam Quaide

I congratulate the Leas-Cheann Comhairle on his appointment.

The lack of suitable school places for children with additional needs is critical for many families in my constituency of Cork East. There are 16 autism classes in five primary schools in or around the Youghal area. These are feeder schools for Youghal's only secondary school, Pobalscoil na Tríonóide, which has only three autism classes. This equates to 96 students in primary schools who will be seeking to avail of one of 18 secondary school places. Parents can be left in a deeply unsettling state of uncertainty in the lead up to a decision on their school placement applications for their children.

I spoke earlier about the draw that took place recently in St. John's Special School in Dungarvan, overseen by a Garda superintendent, after which 20 children from Cork, south Tipperary and Waterford were left without a school place. This means families have to transport their children long distances daily for their basic schooling. In my constituency, it means families having to face travelling into Cork city or potentially Waterford city to access education for their children. The stress of long school commutes, some of which are spent in traffic congestion, can take an immense and cumulative psychological toll on these children and their families. Attending school so far from home also disconnects children from their communities at a particularly sensitive stage of their development. This is entirely at odds with their interests and their rights and is heaping another form of chronic stress upon the many other challenges these families contend with.

A group of parents has come together to advocate for an additional autism class in Youghal. I ask for the Government's support to establish this special educational needs class in Youghal, which would be aimed at students known as "special educational needs betweeners", who are autistic children with mild learning disabilities. These students have educational needs that are too complex for mainstream classes but would not necessarily qualify for a special school placement. They are at risk of falling between the cracks of the mainstream and special school systems. The proposed class would help to address some of the educational gaps these students face while allowing them to attend school in their existing school community. The class would allow students to follow a differentiated curriculum and access additional supports, such as individualised education plans customised to meet each student's needs. The class would be integrated into the wider school community, ensuring social inclusion and helping to reduce the stigma that can often be associated with disabilities.

I mention the efforts of my TD and councillor colleagues in east Cork, who are also committed to this campaign. I am glad to hear that Deputy O'Connor, who is working closely with families and other stakeholders, has invited the Minister of State to meet the stakeholders of this campaign in Youghal. I believe a date has been scheduled for this visit.

Minister of State at the Department of Education (Deputy Michael Moynihan)

I congratulate the Leas-Cheann Comhairle on his elevation to the position and wish him the very best of luck. It has been a long time since we shared an office in the engineering block many years ago. We have both served long apprenticeships in this building.

I thank Deputy Quaide for raising the issue. I stress that enabling students with special educational needs to receive an appropriate education is a priority for me and the Government. It is the Government’s priority to ensure that all children have an appropriate school placement and that the necessary supports are provided to our schools to allow children with special educational needs to flourish and prosper. The spend on special education is at an all-time high, with more than a quarter of the education budget allocated to special education, providing additional teaching and care supports for children with special educational needs.

Since 2020, almost 1,700 new special classes have been provided, bringing the total to more than 3,300. Over the same period, 11 new special schools have been opened. Four of these new special schools opened last year and five more will be established for the 2025-26 school year. Of these 16 new special schools, four are located in County Cork. In 2023, a new special school was established in east Cork in Carrigtwohill. This special school will grow and expand over time. I am absolutely sure of that. By the end of this year, there will be 17 special schools in the country educating more than 1,000 students. More than 400 new special classes were sanctioned for the present school year, with classes provided in every county. Of these, 66 were sanctioned in County Cork. This brings the total number of special classes in County Cork to 563, comprising 395 at primary level and 168 at post-primary level, providing places for approximately 3,400 students. An additional 22 classes have already been sanctioned for the 2025-26 school year and more will be sanctioned in the coming weeks. The vast majority of these classes are autism classes and have a teacher-student ratio of 1:6.

Some 120 SENOs now operate nationwide, 18 of them operating solely in County Cork. The NCSE has completed more than 1,000 school planning visits nationwide in recent months. These meetings will be key to determining which schools will open new special classes in the 2025-26 school year.

The Deputy referred in particular to Youghal and the issues there. He is correct that Deputy O'Connor raised the matter with me a number of times. We have had a number of discussions on it. I look forward to visiting the schools and engaging because it is a priority for me to ensure that places are available in a timely fashion at both primary level and post-primary level. There is a great deal of work going on and there is an awful lot of need out there. I have met the SENOs, the NCSE and the Department of Education officials on numerous occasion in recent weeks to impress on them the importance of making sure people find out where their children are going to school in a timely fashion, particularly in terms of the transition from primary to post-primary school, where there is a particular difficulty nationally. However, we are working to ensure that the advice and information is given to parents in a timely fashion to avoid as much stress as possible, as there is no doubt that families are under enormous stress over these issues.

Deputy Liam Quaide

I thank the Minister of State. This week I spoke to a family that is campaigning for the proposed secondary school autism class in Youghal. Their current experience of primary education in Youghal is going very well for their son. However, the lead-up to being granted that school placement was a time of major trepidation as it was far from guaranteed due to the level of need out there. Looking ahead to secondary school options, the picture is far more uncertain and anxiety-provoking for this family and many other families in the area. The two nearest suitable placements would be either in Dungarvan or Carrigtwohill. Both involve significant travel time and disconnection of that boy from his local community. As things stand both of those schools are very much oversubscribed so other options the family may have to consider would be as far away as Waterford city or Rochestown in Cork. The additional travel time would be a huge additional imposition of stress for this family. This stress would be avoidable for these families if the Government was to vindicate the right of their children to be educated locally. We all know that transitions from primary school to secondary school can be difficult in the best of circumstances. This proposed new special education class would bring peace of mind to many families in and around Youghal who are currently in a very distressing limbo with regard to their children's prospective secondary school placements. I ask again for the Government's support with this through a concrete funding commitment.

Deputy Michael Moynihan

There is funding available in the current year for additional classes. In his earlier contribution Deputy Quaide mentioned Waterford and Dungarvan, and it would be remiss of me not to refer to that. We have had a number of meetings in relation to the issues there as well. Most recently we met with the Minister of State, Deputy Butler, and with officials to try and make sure there is a focus on that and so that we understand the challenges there. I understand the challenges first hand in relation to these issues.

The Government is committed to ensure there are places available. Our duty is to make sure those places are available in a timely fashion. I will be working with the NCSE, and with the Department of Education officials to make sure they are available in a timely fashion. There are more SENOs this year than ever. They are in place and on the ground since 1 September. As I said at the outset, they are working through 1,000 school visits. We have to bring that together over the next number of weeks because we have to give certainty to parents. Parents are stressed and are extremely concerned, not just about the transition but also about where they are going to have places.

It is totally and absolutely wrong that children are travelling long distances to school. These are children with additional needs and they are expected to travel for over an hour in some instances. That practice cannot continue. We must make sure that we have school places in the communities at primary and secondary levels. We must ensure that all children, especially those with additional needs, are accommodated within their communities insofar as possible. I cannot stress enough that this has to be communicated to parents, families and children in a timely fashion because heretofore it was not. We had some instances where the children did not know where they were going when they finished primary school. They did not know in the last week in June where they would be in the first week of September. That practice is no longer acceptable. We will work might and main to ensure we iron out those difficulties.

Primary Care Services

Deputy Conor Sheehan

I add my congratulations to the concerto of congratulations. I thank the Minister of State, Deputy Butler, for coming to the House this evening. I am sorry to subject the Minister of State to this at this ungodly hour but let it never be said that she does not work hard.

I rise tonight to raise the issue of the lack of a consistent and permanent full-time speech and language therapist, SLT, at King's Island primary care centre in my constituency in Limerick. I do this on the basis that there are 1,257 children in CHO 3, specifically in Limerick, who are waiting two years for speech and language therapy. King's Island is a wonderful community that I am extremely proud to represent, previously as a councillor and now as TD for Limerick City. Like all proud working-class communities it has huge deprivation and many issues. King's Island is considered to be extremely disadvantaged - it is widely acknowledged as one of the most disadvantaged communities in Ireland - and has a deprivation index score of minus 31.9, but the King's Island primary care centre does not have a paediatric speech and language therapist and has not had one for a number of years. This lack of essential support is having a devastating impact on the most vulnerable children and families in our community, many of whom are already facing significant social and educational challenges. The situation is now so dire that the local school principal, Eoghan O'Byrne, has been forced go on local radio and literally plead for this post to be filled. This is simply unacceptable for any child but especially for children from poorer backgrounds who cannot access private therapies. This early intervention is critical and yet children who attend his primary school, St. Mary's National School, are being left behind. This wonderful school in many ways is a victim of its own success with a population that has grown by 70% in three years. With a growing population, however, comes an even greater need for this vital service. The longer this continues, the more children will fall through the cracks and the more issues they will have as they get older.

I will give the Minister of State and the House some context. Some of the figures that pertain to the junior infant pupils are quite stark. If one uses the Renfrew action picture test the class average is 34%, the whole class scored below the 75th percentile, and 85% of the class scored below the 50th percentile. I urge the Minister of State to ask the HSE to prioritise the deployment of a speech and language therapist to this community as a matter of urgency. These children and their families deserve equitable access to the supports that are essential for their development and future success. The absence of a consistent SLT service in King's Island for over three years has had significant and far-reaching implications on the children in this area.

Speech and language therapy is a critical component of early childhood development and for supporting communication skills that are essential for learning social interaction and emotional regulation. The lack of consistent SLT services means that teachers are left without the necessary professional supports to implement effective classroom strategies for these students. The emotional well-being of children in this community is another area of concern. Language difficulties can contribute to frustration and anxiety especially when children cannot express their needs or feelings effectively. We urgently need a full-time speech and language therapist in King's Island primary care centre. This post has been vacant for over three years. The HSE pay and numbers strategy is having a direct negative impact on the provision of primary care services in the mid-west. While approval may have been given to fill this post, will the Minister of State guarantee that the post will be filled before the end of March? In the interim, will the Minister of State please instruct the HSE to ensure that an agency paediatric speech and language therapist will be allocated to King's Island on a full-time basis?

Deputy Mary Butler

I congratulate Deputies Sheehan and Quaide on their recent election to the Dáil and I thank them for their interest in all health matters.

The Minister for Health has asked me to thank Deputy Sheehan for raising this important matter and for the opportunity to update the Dáil on it. Primary care therapy services, such as speech and language therapy, play a central role in providing care and treatment to children and adults in the community. There have been persistent challenges in recruiting certain grades of health and social care professionals to meet the demands for primary care therapy services and other community-based services, in part due to the lack of availability of suitably qualified candidates. In July 2024 we saw the lifting of the HSE recruitment pause. Each of the six health regions and each national service has been provided with a specified number of whole-time equivalents and can replace, recruit and prioritise staff within that approved number. This has given the health regions further control to focus resources where there is the greatest need and it informs decision-making at local level on the filling of available posts.

Specifically, to address the Deputy’s question, primary care speech and language therapy services are provided for the community of King’s Island and the surrounding areas in Limerick from King’s Island primary care centre. I note the Deputy's comments around the area being disadvantaged and the challenges in the local national school. The HSE has advised that the staff grade paediatric speech and language therapist post in King’s Island primary care centre has been vacant since January 2024 due to the resignation of the post holder. Since this post became vacant last year, all new referrals have been and will continue to be triaged by senior speech and language therapists within the north Limerick city network. However, I do have some good news that I am happy to report.

Approval has been given for the permanent backfilling of the vacant speech and language therapist post in King’s Island Primary Care Centre. The HSE has advised that this post has been recently accepted from the national staff grade speech and language therapist panel.

The HSE has further advised that it will be a number of weeks before the speech and language therapist is in post. However, as an interim measure, it has been agreed that a new graduate grade paediatric speech and language therapist employed through an agency will provide a level of cover at King's Island Primary Care Centre until the post is filled permanently.

The Minister fully acknowledges the frustration of those who are impacted by the vacancies in primary care therapy services and agrees that much more needs to be done to address the gaps in staffing and the waiting lists for these services, including speech and language therapy. In that context, it is welcome news that progress has been made to fill this specific post in King’s Island Primary Care Centre. We are all very much aware that early intervention is crucial and I am glad to see that there is a pathway here with both a long-term solution and a short-term solution.

Deputy Conor Sheehan

I thank the Minister of State for her reply and I welcome it. The community needs complete certainty as to when exactly this post will be filled because there has been a lack of faith here because the post has been vacant, as I have outlined, for more than three years. It is very clear that the HSE's pay and numbers strategy is not working. Officials in the HSE have told me that they were severely impacted by the moratorium before it was lifted and now, because of the pay and numbers strategy, they are simply unable to fill the vacant posts they have, whether that is due to maternity leave, resignations, etc. We know that with the pay and numbers strategy, that posts are essentially disappearing as if into thin air and that clinical staff are being poached by the private sector. I know of a local speech and language therapist who went to Australia on a career break and could not resume her post when she returned due to the pay and numbers strategy.

Last year, the HSE facilitated a group of parents in this school. One parent from Thomondgate, just across the river from King's Island, spoke in glowing terms about the relationship she and her kids had with the speech and language therapist in Ballynanty Health Centre a kilometre away. All of her children had been seen by the same speech and language therapist for over a decade and have now been discharged. A parent who lives in King's Island, across the river, as I outlined, said that her children had yet to see the speech and language therapist, not to mind develop a meaningful relationship with one. We need to see a change here with regard to the pay and numbers strategy to ensure that this type of situation does not occur again.

Deputy Mary Butler

I thank the Deputy. We have had the change from the nine community healthcare organisations, CHOs, to six individual health regions. Each of the six health regions and each national service has been provided with a specified number of whole-time equivalent staff members that they can hire. They can replace, recruit and prioritise staff within the approved numbers they have. By the end of this year, there will be 133,000 whole-time equivalent staff members working across the HSE. That is an increase of over 20,000 staff in the past four years. The health regions have further control to focus resources where there is the greatest need and this informs decisions made at local level on the filling of available posts. They have informed us, which is very good news, that they have given approval for getting the permanent backfilling of the vacant speech and language therapist post. When a post becomes available and the post of the person moving into that post is not backfilled, nothing happens. It is really good news that that post is being backfilled and, in the short term, an interim measure has been agreed that a new graduate grade paediatric speech and language therapist employed through an agency will provide a level of cover at King's Island Primary Care Centre until the post is filled permanently.

It is really important that I reiterate that recruitment and retention of these very specialised, dedicated staff has become very difficult. Retention is also an issue. It is a full-time post and it is very welcome that the other post is being backfilled. The HSE is confident that the new person will be in place in a number of weeks. That is very positive and we will keep a close eye on this matter for Deputy Sheehan because it is very important that those children have those vital interventions.

Cuireadh an Dáil ar athló ar 10.55 p.m. go dtí 9.12 a.m., Dé Céadaoin, an 26 Feabhra 2025.

The Dáil adjourned at 10.55 p.m. until 9.12 a.m. on Wednesday, 26 February 2025.