9th May 2016
Cllr Francis Timmons,
16 Cherrywood Villas,
Dublin 22.
E-mail: ftimmons@cllrs.sdublincoco.ie

Dear Cllr Timmons,

This office has been requested to reply directly to you in the context of your representation to the Minister for Health concerning the number of people waiting for speech and language assessments and Language therapy.
HSE Response

Speech and Language Therapy Services

Each individual that presents to the HSE’s Speech and Language Therapy Service has an initial assessment to determine their individual need for therapy. The therapist in conjunction with the parent(s) or carer will determine the severity of the individual’s difficulties and prioritise for therapy accordingly. The level of intervention is in line with clinical policy, age and severity of the diagnosis. The waiting period for intervention is dependent on the nature and severity of the disorder following assessment.
The HSE aims to ensure that the resources available are used to best effect, in order to provide assessment and ongoing therapy to children and adults in line with their prioritised needs. Along with the significant investment in area of speech and language therapists employed in recent years, a range of new approaches have been developed and used in many Speech and Language Therapy services across the country. These include providing structures, training and support to parents /carers so that they can work to help improve the individual’s speech and language. In addition, therapy is delivered in group settings where appropriate.
The data outlined below represents all speech and language therapy services provided directly by the HSE and the majority of speech and language therapy services provided by voluntary agencies.

The tables below set out the number of children and adults waiting on assessment and intervention for speech and language therapy to end of December 2015. Please note that the HSE does not currently collect data on the age breakdown of numbers awaiting Speech & Language Therapy


The HSE is committed to working in partnership with other service providers to achieve maximum benefits for children and adults with speech and language therapy requirements, and aims to ensure that the speech and language therapy resources available are used in the most effective manner possible.

Number awaiting Assessment

Number Waiting Initial Assessment – 0 to 4 months
Number Waiting Initial Assessment – 4 months & 1 day to 8 months
Number Waiting Initial Assessment – 8 months & 1 day to 12 months
Number Waiting Initial Assessment – 12 months & 1 day to 18 months
Number Waiting Initial Assessment – 18 months & 1 day to 24 months
Number awaiting Initial Therapy
Number Waiting Initial Therapy – 0 to 4 months
Number Waiting Initial Therapy – 4 months & 1 day to 8 months
Number Waiting Initial Therapy – 8 months & 1 day to 12 months
Number Waiting Initial Therapy – 12 months & 1 day to 18 months
Number Waiting Initial Therapy – 18 months & 1 day to 24 months

Service Improvement Initiative

The HSE does not just focus on waiting numbers and access times although the Primary Care and Social Care Divisions are addressing waiting lists in Speech and Language therapy as a joint project, with a cross divisional team working on the detailed analysis of waiting times and resource deployment across the country. Regular reports are now being compiled by each division containing analysis by CHO (and county) of the waiting lists and waiting times by category of referral and whether clients are awaiting assessment or treatment. The work on this is ongoing, with actions planned or already underway as follows:-

Validating the assessment and treatment waiting lists

Standardising the prioritisation system

Increasing the number of Speech and Language Therapy Drop-In Assessment Clinics

Agreeing flexible opening hours in the context of evening and week-end sessions for group sessions and parent education

Setting target and performance indicators to be allocated

Recruiting additional therapists, assistant therapists and support staff on fixed term/specified purpose contracts specifically for this initiative

Providing for maternity leave substitute posts

Reviewing existing practice, examples of innovation and international best evidence to agree a new model of care for speech and language therapy relating to both assessment and treatment

Agreeing performance monitoring and measurement arrangements against the targets set and the additional funding available.
Therapy services for adults and children are generally delivered through Primary Care Teams or community therapy services; through specialist disability providers or Early Intervention and Children’s Teams for 0-18 years, which are continually being developed under Progressing Disability Services for Children and Young People (0-18yrs) Programme. In 2013, additional funding of €20m was provided to strengthen primary care services. This comprised over €18.5m for the recruitment of over 260 primary care team posts and over €1.4m to support community intervention team development. Additional funding of €4 million was also provided for the Primary Care Speech and Language initiative in 2016.

Progressing Disability Services for Children & Young People (0-18 years)

The HSE has commenced the reconfiguration of children’s disability services into geographically-based early-intervention and school-aged teams as part of the Progressing Disability Services for Children and Young People Programme. The objective of the Programme is to provide one clear referral pathway for all children (0-18s), irrespective of their disability, where they live or the school they attend.

Some HSE Areas have already reconfigured into interdisciplinary Children’s Disability Network Teams whilst others are developing their reconfiguration and implementation plan. The Programme is being implemented on a phased basis with final areas to be reconfigured by 2016. Note that all HSE Areas planning reconfiguration continue to have significant Early Intervention Services in place, provided either directly by the HSE, including Beechpark Autism Services or by voluntary service providers funded by the HSE, such as Enable Ireland, Kare, Muriosa Foundation, St. John of God Services, Brothers of Charity Services, St. Michael’s House, Cope Foundation, CRC, Daughters of Charity Services etc.

In 2014, the roll out of the Progressing Disability Services for Children and Young People (0-18s) Programme entailed targeted investment of €4m and the provision of 80 additional therapy staff (including 27.5 Speech and Language Therapists), to increase services for children with all disabilities.

A further €6m allocation was announced in 2015 for the reconfiguration of children’s disability services, which will enable us to drive implementation of the Progressing Disability Services for Children and Young People Programme through 120 new staff appointments to reconfigured multi-disciplinary, geographic-based teams, and through using innovative approaches, involving public, voluntary and private providers, to achieve targeted reduction of waiting lists. These include 35.5 Speech and Language Therapists.
Further funding of €4m was announced in the 2016 National Service Plan to provide 75 additional therapy posts, including 25.5 speech and language therapists, which will see the establishment of the full 129 Children’s Disability Network Teams by the end of the year. This initiative is being implemented in the context of fully supporting the implementation of the Report of the Inter-departmental Group on Supporting Access to Early Childhood Care and Education Programme (ECCE) for Children with a Disability.

The HSE is working in partnership with DCYA to implement the IDG Supporting Access to the Early Childhood Care and Education Programme for children with a disability. This will include reviewing current models of good practice supporting families and preschools and ensuring similar good models are implemented across the country for all children, as appropriate. Special schools will remain in place until the report is fully implemented and evaluated over a number of years. It is envisaged that a small number of children with highly complex needs will continue to need special preschool setting.

These measures will have a positive impact on the provision of clinical services for all children requiring access to health related supports including Speech and Language Therapy.

Yours sincerely,
Marion Meany,
Head of Operations and Service Improvement,
Disability Services, Social Care Division