Tuesday, 22 May 2001
Dáil Eireann Debate
Dr. Upton: The current crisis in the occupational therapy services provided by the Eastern Regional Health Authority has reached alarming proportions. Last weekend, the health board on Old County Road advertised eight occupational therapist posts. This recruitment drive is intended to fill five existing vacancies and to replace a further three people who have indicated their intention to resign in the near future.
Waiting times for patients in my constituency to be seen by an occupational therapist have now reached an unacceptable point and the quality of life for some people on the waiting list has  deteriorated significantly. One of my constituents, who is aged 84 years, had to wait more than six months for the provision of a wheelchair because an occupational therapist had to advise on the case. This level of waiting time is surely not necessary for the provision of what must be a standard support.
The South-Western Area Health Board intends to recruit an occupational therapist specifically dedicated to the needs of the elderly. I welcome this development and I hope it will help to improve the quality of life for those who have been waiting, in some cases for almost a year, for provision of occupational therapy services.
The need for occupational therapy facilities is now so acute that Dublin Corporation, while assessing the needs of the elderly, has engaged its own private occupational therapists. The health board service can no longer cope with the demand within a reasonable time frame. The people who are intended to be facilitated by the corporation are being deprived, in effect, of a quality of life.
However, the shortage does not only affect the elderly. Another of my constituents is a young girl, a student, who suffers from serious back problems. She has been told it will be a further year before she is considered for provision of the special bed she needs to make her life a little more comfortable. There are many more cases like those I have outlined but the message just becomes highly repetitive.
Occupational therapy, by its nature, is a service that is needed now, not in 12 months or two years. The number of students who are accepted each year to study occupational therapy is relatively small in comparison with the need for therapists. The Minister should review the intake of students into occupational therapy courses in the State and make provision, as a matter of urgency, for additional places on the courses. That eight vacancies exist for occupational therapists in one relatively small geographical area is an indicator of the gap between supply and demand.
The inadequate staffing is not just about supply and demand. Just as in the medical profession, many occupational therapists are opting out of the public service because of the pressure and demands. Promotional opportunities are limited and the stress and time demands are becoming more acute. The quality and level of occupational therapy being provided is seriously compromised through insufficient staffing. More importantly, the quality of life of a large number of elderly people could be significantly enhanced if an adequate occupational therapy service could be provided. I ask the Minister, as a matter of urgency, to review the provision of occupational therapy services so that both their level and quality can be upgraded.
Minister of State at the Department of Health and Children (Dr. Moffatt): The provision of occupational therapy services to eligible persons is the statutory responsibility of the relevant health board and, in this case, the Eastern Regional Health Authority.
I have been advised by the regional chief executive of the authority that two issues affect provision of occupational therapy services, increasing demand and recruitment difficulties. In relation to the former, I am advised that the decision by people to remain in their own homes and avail of occupational therapy, together with the complexity of cases and problems arising out of requests to receive treatment at home, has placed increased demands on the service. Furthermore, the regional chief executive has informed me that the difficulty in recruiting occupational therapists has also contributed to delays. The authority states that the three area health boards are making every effort to address this problem through active recruitment campaigns.
The study on the current and future supply and demand conditions for certain professional therapists which my Department commissioned Dr. Peter Bacon and Associates to conduct is expected to be published shortly. Among the issues to be addressed by this study is the number of additional training places required for physiotherapists, occupational therapists and speech and language therapists. Through the Higher Education Authority the possibility of increasing the number of training colleges as well as training places will also be addressed. In the meantime, following contacts between the Minister for Health and Children and the Minister for Education and Science, the number of occupational therapist training places was increased by five places in 2000 and a further additional five places per annum will be provided over the next three years.
The expert group on various health professions reported in April 2000 and recommended that talks begin between the parties on the establishment of a new grade of clinical specialist in the therapy grades. Following discussions between IMPACT, the Health Service Employers Agency and officials of my Department, employers were advised last week of the creation of this new grade. The establishment of this grade allows for the recognition and reward of those with a high degree of clinical expertise. By providing an avenue of career progression for those who do not wish to move into management it will also serve as a retention mechanism. Employers have been notified of their allocation of posts, along with details of qualifying criteria and post responsibilities, to enable them to draw up individual job descriptions for the post. The operation of these new posts will be the subject of an evaluation process after 12 months.
Through the implementation of the expert  group, the criteria for the upgrading of therapists from basic grade to senior have been improved. On this basis, a survey of all employers was undertaken to identify posts which would meet these new criteria and in December of last year sanction was given for the upgrading of these posts. Approximately half of all basic grade therapy posts were upgraded through this process.
I take this opportunity to point out that additional revenue funding provided to services for older people has been increased significantly in recent years, from £3 million in 1997 to an additional £7 million in 1998, an additional £12 million in 1999 and an additional £28.5 million in 2000. In 2001, an additional £33 million will be provided. When nursing home subventions are included, the investment for 2001 will total more than £47 million. A proportion of the development funding available this year has been targeted at the provision of additional community supports, that is, nursing and paramedical posts. It is intended to improve these community supports in the coming years, leading to an enhancement of service provision.
This Government has also significantly increased funding for physical and sensory disability services and, since coming into office, has provided additional funding of just over £107 million for services to people with physical and sensory disabilities. This additional funding includes a total of approximately £55 million additional ongoing revenue – £5 million provided in 1998, £9 million in 1999, £17.823 million in 2000 and just under £23 million this year – for the maintenance and development of services, including paramedical services, for people with physical and sensory disabilities. Priorities for the allocation of funding available for the development of services in the sector are decided by the health boards, in consultation with their regional co-ordinating committees for physical and sensory disability services.
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