Wednesday, 29 June 1994
Dáil Éireann Debate
Ms O'Donnell: Speech therapy, part of the health care service, does not receive much political attention, particularly in this House. It is only when one has direct experience of a communication disorder, whether as the parent of a child with such a disorder or the relative of a victim of a stroke, that one requires the vast level of expertise in this area. The reality is that if one can pay for these services there is no problem in receiving them. This issue relates to equality of access to vital treatment in the medical health services.
In the Eastern Health Board area, the greater Dublin area, approximately 2,170 people are awaiting speech therapy. The average waiting time over all of the community care area is nine months but many of these people have been waiting for over a year, and some two years.
 Speech and language therapy encompasses the assessment, diagnosis, management and prevention of disorders of communication. Speech therapists, the majority of them female, work with a range of clients, from babies with swallowing or feeding difficulties to elderly stroke patients who have lost the power of speech. They are also very much involved in the counselling of relatives and parents of children with difficulties, working in play schools, hospitals and in the community. It is very much an interdisciplinary profession.
These are highly trained people who have been undervalued in the service. Intervention in speech disorders requires early expert intervention and can transform the quality of life of patients when appropriately administered. There are various speech therapy client groups — people with developmental speech disorders, language delay or impairment. For example, there can be people with learning difficulties related to communication, with a mental handicap, with sensory impairment or children and adults with autism. On the matter of autism I want to raise the question of the James Connolly Memorial Hospital in Blanchardstown which has been operating for the past two years without any speech therapy services. The Minister should investigate that matter.
On the matter of waiting lists, the schedule attached to the parliamentary reply given me yesterday showed that in Dublin South, area 3, my constituency, there were 149 people awaiting speech therapy services for 12 months and that in Dublin South Central area 4,521 people have been awaiting speech therapy services for 12 months. This is unacceptable.
Speech and language therapists work with people with fluency disorders, with stammers and with cleft palates. The work is undertaken from infancy, involves a huge amount of counselling and is interdisciplinary. Developmental work with children forms a large  caseload of community care speech and language therapists, and delays of up to two years in some areas causes irreparable damage in children. This can compound parents' anxiety. As such treatment is related to the development of children it cannot be delayed because treatment postponed is treatment denied.
I should like to refer to staffing levels dealt with by the Minister in his reply. The present number of speech and language therapists in Ireland is 214 while the recommended number, based on British research relating to the Irish population, is 808. It will clearly be seen that we have a serious shortage of speech therapists and that those we have are underpaid. We also have a brain drain in that, because of the low pay and status of these women in the service, many are going overseas. This means that therapists, trained at great expenses to our taxpayers, are leaving the public service because they will be paid more in other jobs here and abroad. Comparable professions in the health services earn up to 48 per cent more than speech and language therapists.
I want the Minister to examine the waiting lists and equality of access to this valuable service, so vital where needed. The second is the gender issue, the fact that most of the women who work in this service feel under-valued, like nurses. On the day when An Bord Altranais has presented the Minister with a report suggesting a total re-evaluation and reassessment of the role of the nursing profession, the Minister should examine the status and salary levels of speech and language therapists.
Mr. Howlin: As the Deputy and the House will be aware, health boards and hospitals have discretion to prioritise service demands and the related staffing  composition within their overall established staffing complement and financial allocation in relation to the provision of a given service. Therefore, it is a matter for each health board to decide on the priority it affords the various services in the light of available resources. Accordingly, the provision of the speech therapy service in the Eastern Health Board region is a matter for that board.
As I stated yesterday in a reply to a written parliamentary question tabled by Deputy O'Donnell, there are 2,170 persons awaiting speech therapy services in the Eastern Health Board region at present and the average waiting time is nine months. While in some community care areas, people have been waiting over a year for speech therapy services nevertheless it should be noted that in other areas waiting times are of three to four months.
This variation in the waiting times is due to the staffing levels in particular community care areas as well as the priority afforded to different categories of clients, for example, priority has been given to children with speech and language disorders.
I understand that interviews to recruit additional speech therapists have been held by the Eastern Health Board and, when the additional staff become available, the waiting period for speech therapy services will be considerably reduced. Since 1991 the Eastern Health Board has increased the number of speech therapists posts from 26 to 51 in 1994.
With reference to speech therapy services generally, I would like to remind the Deputy that I expressed my concern in this House on a number of occasions at the level of speech therapy services in certain areas of the country and that I regard the expansion of such services as a priority.
On foot of an interim report by the Review Group on Services for People with a Physical or Sensory Disability, an  additional £1.5 million was made available for service developments, including the provision of speech therapy services. This additional funding is being maintained in the annual budget, and a further £1.5 million has been made available this year. Last year, £200,000 of this additional funding was devoted to this service. I expect that a proportion of this year's allocation will be devoted again to improving and expanding community-based therapy services, including speech therapy.
One of the difficulties in relation to the provision of speech therapy services is the lack of sufficient numbers of trained speech therapists graduating each year. My Department has taken steps to remedy the situation by arranging for six extra training places to be provided at the School of Clinical Speech and Language Studies, Trinity College, Dublin commencing in the 1992-93 academic year. The total student body will increase in phases from 80 students in 1992 to 104 students in 1995-96. The increased level of graduate output resulting from this important development should make a significant improvement in the provision of speech therapy services.
I might add that the review group on physical and sensory disabilities has been examining a range of services for people with physical disabilities, including speech therapy. I am expecting that the group will submit its final report to me within the next few months. The report's recommendations will receive urgent consideration by my Department.
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