At the outset, I appreciate the work Cara Darmody has been doing and her campaigning work with her father, Mark. She has been campaigning for quite some time. She initially began to do so in terms of advocacy for her family and now does so nationally in respect of disability rights more generally. When I was appointed Taoiseach earlier in the year, I committed that this would be a Government that would make a step change, comprehensively and across all areas of government, in provision for people with special needs or with disabilities, and with a particular focus on young people. The issue of disability is represented at the Cabinet table by a full Minister, and I am in the process of establishing the first ever disability unit within the Department of An Taoiseach to troubleshoot and co-ordinate across all Departments the provision of services for people with disabilities. To go through the various areas, first, the need is increasing all the time. The 2022 census is indicative of that in terms of the increase in the numbers of people identifying with a special need. Fundamentally, in education, there has been an exponential increase in investment. There has been a major increase in resources in terms of special needs assistants, with approximately 23,400 of them now. There are 20,800 special education teachers. The expenditure on SNAs alone is approximately €1 billion per year and that is the way it should be. Enrolment in special classes has doubled in five years, with nearly 19,000 students being supported in 3,335 classes, and more than 2,700 new placements are planned for 2025-26. A new national therapy service in education, beginning in special schools, has been agreed upon by Cabinet and work is under way to get that in place, partially in the next school year, 2025-26, and fully thereafter. In terms of the National Council for Special Education, NCSE, 39 new therapist posts have been approved. That recruitment is well under way and has been quite successful and effective. In regard to income supports, the Minister for Social Protection is working on specific budget provisions for children in particular, and people more generally, with disabilities. On transport, we have specifically asked the Minister for Transport to work on the mobility issues. We are working with the Department of Finance to put the disabled tax scheme back on a proper footing, and on a better footing than was the case beforehand. In respect of the assessment of need, quite fundamentally, we need to change the legislation. The High Court decision necessitates, in my view, a change in legislation to ensure therapists are directed and streamlined to provide services to children more quickly than is currently the case. We currently have a finite number of therapists in the country. The real objective has to be to use those therapists optimally in providing services to children. I say that very clearly because I am looking for solutions here and that is one nettle we have to grasp. It will be challenging, but we still have a Cabinet subcommittee on disability and it has asked the Minister for children and the Department of children to come back with legislative proposals in respect of the assessment of need area. Recruiting and retaining therapists is very important, as is the mutual recognition of qualifications across Europe and with the United Kingdom to enable us to bring in more therapists from overseas in addition to those we will produce through our colleges. Tá gach aon iarracht á dhéanamh ag an Rialtas chun déileáil leis an bhfadhb seo. Tá an-chuid áiseanna ann ach an rud is tábhachtaí ná go bhfuil gá ann an córas a athrú go tapa.
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The Deputy has offered no solution. She has offered rhetoric, and that is all.
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The bottom line is this. We will do everything we simply can to deal with the existing waiting lists and so forth. There has been a significant increase in the numbers of assessments that have actually taken place - a 30% increase on 2023 - but that in itself will not deal with the current situation. We have to have a multifaceted response. We need more therapists in third level colleges.
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We will be providing more private funding to procure assessments. All of that, however, will not, in my view, redirect the work of therapists most appropriately, which is to provide services to children.
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I am making a point. Under the current system, the status quo is simply not tenable. The Deputy must know that deep down, so there has to be change in respect of that.
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In my view, we have to explore every avenue we can to increase the number of therapists and to recruit more therapists. The money is there in many instances-----
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-----and the HSE has not been able to recruit 100% of its CDNT teams.
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There will be.
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One of the reasons this Government quickly established the need for a therapy-in-school service, which we have now commenced and taken the decision to do, was the inadequacy of the response within the health service itself. Many CDNT teams are experiencing challenges in recruiting and retaining therapists, as well as wider general issues. The issue is actually not one of resources; it is one of capacity. Private funding was provided last year and quite a number of private therapists have been procured. The standard operating procedure model that the HSE adopted was struck down by the courts. The rationale behind it was to prioritise establishing the needs of children, rather than providing the diagnosis immediately, in order to ensure a quicker route to intervention services. I have been informed by the HSE that it is estimated that up to 30% of assessments result in children being identified as not having a disability. It is about how to allocate resources more effectively and in a targeted way to the children who require those services as quickly as possible. That is the objective we have to focus on. What will enable us to do that in the short term more effectively than currently is the case? At the moment, the timeframe for an assessment of need could be between 37 and 90 hours. There is finite capacity in terms of therapists out there, whether in the private sector or the public sector. Yes, we have to create more third level places. We have done that and we are going to do more of it. We have to facilitate more recruitment of therapists from overseas. CORU, the regulatory body, needs to be flexible in that regard. Mutual recognition of qualifications is a general problem because we need to supplement our own development of graduates through our third level system with graduates from overseas to get a higher number assessing and, crucially, providing services to children. In education a line of sight is visible in terms of allocating the resources and getting visibility over the provision of services. We are not quite there yet. I have acknowledged that in Dublin we have issues with some school places. I will not be happy until 100% of children are looked after in terms of a school place for September. However, there is and has been an issue with therapists. That is why we have moved to an education model to commence with special schools, to expand beyond that and then to support the community teams as well. In the short term, there are choices we can take to enable therapists to get to children more quickly and to be used more optimally than currently is the case for children. That is the case I am making for why I think we need legislative change along with a range of other measures. It is not to take away rights, but to provide services to children.
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The Deputy mentioned special education. Special class enrolment has doubled in five years. We have gone from about 9,000 to 19,000. What is that saying? It is revealing the exponential growth in the number of children requiring special needs provision and services and resources have expanded accordingly, in terms of the number of classes, SNAs and special teachers and funding for extra classrooms and so on in the special needs area. Any objective person assessing what has been happening in special education, while not saying we are there yet, would have to acknowledge the very significant growth and expansion and rightly so. I am absolutely committed to this and I want to get this sorted but that will mean taking decisions which I anticipate will run into opposition here, as is the nature of politics and that is fair enough.
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Sorry, I have already organised that. There has been engagement and we will meet.
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I have met Cara before and Deputies-----
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From day one, the Government has identified the entire area of disability and special needs as a key priority, along with housing and, as I said earlier, child poverty. That will be reflected in the forthcoming budget and has already been reflected in Government initiatives. Decisions have been taken at recent meetings of the Cabinet subcommittee in respect of this. Going back, when the party the Deputy was in at the time was in government, the CDNT progressing disability initiative was taken. I am not blaming anybody, but I do not think that worked. I said at the time it would not work and have said so consistently. Quite frankly, that is why a new national therapy-in-school service is being established. The CDNTs have had huge difficulty in recruiting a sufficiency of therapists. There is a 21% vacancy rate in CDNTs throughout the country. That model has not worked for a variety of reasons. I am not blaming High Court decisions but the HSE's standard operating procedure model was proving to be effective and impactful for many children because it was getting therapy services to children more quickly. The legislation needs to be changed without removing any rights. To be fair, when the courts rule, it is then up to legislators to deal with that ruling by amending the Act and so on-----
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-----given the finite number of therapists we have. We can pass all the motions we like but we have to deal in a very pragmatic, solution-based approach right now. We have to deal with this in a multifaceted way but, right now, we need to make sure that the therapists we have are focused on providing services to children as quickly as we possibly can, consistent with the needs of those children. We have made a lot of progress in education. We want to make more progress on mobility and transport. We have made progress on increasing various payments but we want to do a lot more regarding income-related supports for children and families where there is disability. Right across the board, we want to make good-quality improvements for people with disabilities. We are determined to do that and to build on progress that has been made in most areas, bar the health area. I acknowledge that the issue of providing therapists to children has not worked at all. I am absolutely determined that this Government will do everything in its power to deal with this issue. At present, as an interim measure, we are providing finance and funding for procuring private capacity but, again, it is very often within the overall framework of finite capacity. There are so only so many therapists in the country at any one time.
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Early intervention is the key. I could not agree more. We need to expand early childcare services for children with additional needs, particularly early childhood education provision for those children. We are doing that and will continue to expand services there. The HSE is not in a position to fulfil the law right now. The Deputy knows that and I know that. We have to respond to enable us to get therapy services to children as effectively and optimally as we can. Our agenda is to use the resources we have for children who need services. I refer to existing resources and how we add to those resources through recruitment, retention and increasing the number of therapy places in our third level colleges for those who wish to work in therapy assistance, including more and greater provision in that regard. However, as a society we have to work smarter to utilise existing therapist resources for the benefit of children.
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I thank the Deputy very much for raising the issue of the crucial importance of primary care provision. When I was Minister for Health and Children in 2001, we made primary care the cornerstone of the then health strategy, Quality and Fairness. It took some time. In the modern area, we have progressed fairly significantly in terms of the provision of primary care centres. There are now about 179 of them across the country, 50 of which have been opened since 2020. Overall, the Government is delivering record levels of investment in health services. A record €25 billion has been made available for 2025, and that represents an increase in health funding since 2019 of over 70%. In parallel with primary care, it supports very important initiatives like enhanced community care, and it also supports oral health and palliative, cardiovascular and cancer care. Sometimes people say health absorbs an awful lot of expenditure and ask if we are pouring all the money into a black hole. We are not, actually. Outcomes are improving all the time, and that needs to be acknowledged as well. Life expectancy is now above 82. We are in a small group of seven EU member states where that is the case. Our mortality rate fell by 11% over the years 2014-22. The mortality rate for all circulatory system diseases fell by 20% in that period, with heart disease and stroke falling by 28% and 37%, respectively. A lot of that was due to the work on primary care in terms of cardiac initiatives in particular. The mortality rate for all cancers in that period dropped by 15%, with cancer of the trachea, bronchus and lung and breast cancer dropping by 21% and 22%, respectively. The mortality rate for all respiratory system diseases has fallen by 15%, with chronic lower respiratory diseases and pneumonia falling by 9% and 41%, respectively. We are making progress in terms of investment in health and, critically, health outcomes. There are other aspects of that - healthy lifestyles, nutrition and so on - but primary care is central to it. As regards chronic disease and chronic disease management, for example, primary care is where it is at. Some 95% of GPs are now signed up to the chronic disease management programme, with over 645,000 patient reviews by GPs in 2024 alone. Some 92% of patients with chronic disease are now fully managed routinely in primary care and not attending hospital for the management of their conditions. From what the Deputy has said, I would say progress is happening in his constituency. I think he said that in Portlaoise the design stage is complete for the primary care centre and he has said it is an excellent site. I anticipate progress in that regard. I will check with the Minister-----
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-----and the HSE in respect of the capital requirements for that. I hear the Deputy loud and clear. This is an important centre of population that requires a primary care centre.
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I said 179.
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I said there are 179 primary care centres now in place. Of those, 50 have opened since 2020. I take the Deputy's point that we still need more GPs. The outgoing Minister for Health, Stephen Donnelly, had approved, with the outgoing Minister for higher education, now Tánaiste, additional places in all third level colleges in respect of medicine and also, in terms of nursing and so on, in Northern Ireland. In terms of the specifics, we also have programmes to attract people into rural Ireland and to provide greater cover in rural Ireland in terms of rural GP programmes. We fully accept the challenges that are out there and I will inquire about Rathdowney and other locations in County Laois and, critically, the status of the Portlaoise project. We are committed to primary care and we will continue to expand primary care.
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