2026-01-21

The situation regarding waiting times for speech and language therapy in CHO 9, particularly for children in my constituency of Dublin Fingal West, has gone from beyond delay and is entering the territory of systemic neglect. Children in CHO 9 are waiting not months but years for basic speech and language assessments and then face further delays before therapy begins. These children are at the most critical stage of their development, yet the State is, in effect, telling families to wait and hope the damage is not permanent. CHO 9 has, going back years, repeatedly reported some of the longest waiting times nationwide for disability services, especially for contact and assessment, mainly due to staff training shortages and high demand. I know the Minister of State realises early intervention is not a slogan; it is an evidence-based practice. When speech and language needs are not addressed early, children fall behind societally and emotionally. I am dealing with families whose children are in school and unable to communicate at the same level as their peers, not because their need was not identified but because the public system is failing to act on time. These delays are actively undermining children's development. They are increasing demand for resources in education, thereby placing additional strain on teachers. I used to work with those teachers and they have vocalised this to me. The delays are also causing enormous distress to parents whose children are missing crucial developmental milestones. The default response to this crisis has been to cite recruitment and retention difficulties, but recruitment and retention cannot be the only answer when children are being left without services year after year. I would like the Minister of State to answer a couple of questions directly. What is being done to address the unacceptable waiting times in CHO 9 beyond repeating the same recruitment talking points that families have been hearing for years? What concrete mechanisms are in place to train and deploy more speech and language therapists? Are training places in colleges being increased? Are supervised graduate roles being funded? Families are not waiting for strategy documents or further policies that may not work; they are waiting for services. While the system fails them, parents are being forced into private therapies just to prevent their children from falling behind. That is not a choice; it is desperation. Families are paying hundreds and, in some cases, thousands of euro because the public system cannot meet the demand. Some families have taken out credit union loans to fund therapies for their children. I would appreciate it if the Minister of State could clarify one point. Are parents who pay for private therapies being taken off the public waiting lists? In other areas of healthcare, when waiting lists spiral out of control, the State intervenes, and the National Treatment Purchase Fund comes to mind. Why are speech and language services for children treated differently? Why can parents not be reimbursed when they are forced to go private due to excessive public waiting times? A similar reimbursement or purchase scheme would immediately relieve pressure on public services and offer families some measure of fairness, while the Minister works on bringing public waiting times under control. The current approach is effectively outsourcing early intervention to parents’ bank accounts, which is not sustainable. Children in my constituency of Dublin Fingal West and across CHO 9 cannot wait for the system to slowly catch up. I ask the Minister of State to stop managing this process and start resolving it, and to provide clear timelines, meaningful interim supports and a credible plan that delivers services now, not coming up to the next general election.

The Minister for Health has asked me to thank the Deputy for raising this matter and for the opportunity to update the Dáil on this important issue. She is acutely aware of the role that primary care services, such as speech and language therapy, have in offering the opportunity for early and cost-effective interventions for children and young people. Nobody will disagree with the Deputy’s point that early intervention is key. There is nothing more worrying or frustrating for parents when their child needs an intervention than that the child is on a waiting list. I accept and acknowledge that. We all have issues about that in our own constituencies. The Minister fully acknowledges that waiting lists for primary care therapies have increased significantly over recent years. The waiting lists are too long, with too many people, especially children, waiting a very long time to access services. We know we need to address this. The HSE has advised that the increased pressure and demand on primary care therapy services are related to an increase in referrals, the increasing complexity of presentations, leading to longer interventions, and challenges related to recruitment and retention of healthcare professionals in the community. These factors have all contributed to an increase in waiting lists for services across the country. I will now respond to the Deputy’s specific questions. In the integrated healthcare area, IHA, for north county Dublin, the HSE has advised that there is an ongoing focus on recruitment to fill the vacancies in this speech and language therapy service. In this area, the HSE has undertaken a number of measures to address the long waiting times for SLT services, working to improve access, ensure appropriate prioritisation and provide ongoing support to families awaiting direct intervention. Such measures include monthly advice clinics that are available to all children and families in the community. These clinics provide an opportunity for families to receive guidance, resources and early support while awaiting an SLT assessment. Additionally, the HSE is running overtime clinics across the area to target children with the longest waiting times. The HSE has also advised that a prioritisation tool is being utilised to identify children with the highest levels of need, that is, to triage the children to enable the most appropriate response. Furthermore, the HSE is delivering a project for those aged under three years in the north Dublin IHA, which specifically targets younger children and facilitates early intervention, with shorter waiting times. Notwithstanding that good work, the Minister acknowledges that a lot more needs to be done to improve timely access to services. To address the long waiting times at a national level, the Department of Health is currently working with the HSE on a focused programmatic approach to primary care therapy waiting list management. I have spoken at length with the CEO of the HSE, Bernard Gloster, and the Minister in relation to this issue. I welcome this dedicated focus on a programmatic approach to primary care therapy waiting list management, given that the waiting lists are extremely long. As part of that work programme, the Minister has asked the HSE to reduce the waiting times for three therapies to less than ten months by the end of this year. The three therapies targeted are speech and language therapy, occupational therapy and physiotherapy. This initiative will remove over 60,000 people, including children, from the waiting lists and will be a huge improvement on the current position, which is that approximately one third of people on primary care waiting lists are waiting over a year for a service.

I appreciate the measures being undertaken. This is not an issue to play politics with. To achieve a timeframe of ten months will be a huge bonus in CHO 9, given where we are now. I have raised this issue previously, although not with the Minister of State. I feel compelled to raise it again, and I have permission from the parents to do so. A child in my constituency of Dublin Fingal West, Willow, who turned nine last November, has been waiting for speech and language therapy for two years, since she was seven, so ten months would be a big improvement. We know that children of Willow’s age are acutely aware of their differences in school, and the delay is severely affecting her confidence both in school and with her peers. Her parents now feel they have no choice but to consider private therapy. That is why I am asking if they will be taken off the waiting list if they choose to go for private therapy. They are trying to do their best for their child and the family. I have been pursuing a resolution of this case for over ten months. I continue to be passed from health to disability services and back to health again, but I have failed to progress the matter. In Willow’s case, we have failed. We have failed children who continually wait for speech and language therapy. We need to address this issue now. I welcome the Minister of State's response and the measures being taken.

I acknowledge the Deputy’s continued advocacy on the provision of the myriad therapies that children, young people and adults need. It is important to recognise that overall activity within the eight core primary care therapies was significant in 2025, with approximately 1.24 million appointments provided across occupational therapy, physiotherapy, dietetics, psychology, speech and language therapy, audiology, ophthalmology and podiatry services to the end of November 2025. However, that is cold comfort to any family or child waiting for these services. I thank the Deputy for sharing that story. It is very difficult for a young girl of seven who is awaiting these services. She must be feeling the challenges when in school and noticing the differences among her classmates. I acknowledge all of that. It is extremely difficult. My understanding of the waiting lists strategy is that if the family decide to go private, I assume they will still be on the HSE waiting list unless they actively remove themselves. I stand open to correction on that. The Minister is committed to building capacity in primary care, as outlined in the programme for Government, by recruiting additional staff numbers and increasing the number of college training places for health and social care professionals, HSCP. She has worked closely with the Minister for higher education, Deputy Lawless. There are approximately 480 additional college training places this year, and the priorities focus on the therapies. It takes a while for them to come through the college system, but every effort is being made to do that. In June 2025, the Government announced a major expansion in HSCP training places, with 461 new places to be delivered up to 2030 across nine priority disciplines. This expansion relates to the creation of 310 additional student places in 2025, with a further 151 to come in subsequent years. I again thank the Deputy for raising the issue.