Liam Quaide
Cork East · Social Democrats · Ireland
“The Department is not funding the teams. That is the main issue. There is a stark double standard here. In mainstream CAMHS, multidisciplinary staffing is treated as basic good practice.”
“I already established, earlier this year, that the staffing levels of CAMHS-ID teams across the country are abysmal. These are children and teenagers with very complex needs. They experience major challenges across all aspects of their daily lives, including with communication and learning.”
“I ask about CAMHS-ID services, which are specialist teams for children and adolescents with a moderate to profound intellectual disability and coexisting mental health difficulties. According to the HSE, and by its own admission, no CAMHS-ID team nationally is staffed to the level recommended in its own model of care.”
“This is a particularly vulnerable cohort of young people, and the lack of investment is particularly stark. The Minister of State should not look at me with an expression of incredulity because we have seen this across primary care and in child, adult and older adult mental health services. This is all out in the public domain.”
“Their needs are often more complex than those of young people attending standard CAMHS. I am asking the Minister of State for a clear commitment. When will the Government move beyond small, incremental additions year by year and fully fund CAMHS-ID teams in every region? When will that happen?”
“Worried, anxious, fearful, angry, afraid, powerless, terrified, scared, overwhelmed, abandoned, hopeless. Words like these came up again and again in a survey the Social Democrats conducted in the run-up to this motion.”
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“Both involve significant travel time and disconnection of that boy from his local community. As things stand, both these schools are oversubscribed, so other options the family may have to consider would be as far away as Waterford city or Rochestown in Cork. The additional travel time with bus transfers would involve chronic stress loaded upon so many other challenges for this boy and his parents, and we all know that transitions from primary to secondary school can be difficult in the best of circumstances. This family's experience of assessment and therapies for their son has been sorely lacking. They had to pursue a private autism assessment at significant financial cost.”
“The family have experienced great relief and peace of mind as a result of this special school placement and they are deeply appreciative of the consistent support and attunement of staff to their son's needs. They are also keenly aware, however, that other families are having to travel outside their communities for this basic provision. Overall, the experience of primary education is going well for this family. However, the lead-up to being granted that school place was a time of major trepidation as it was far from guaranteed due to the level of need out there. Looking ahead to secondary school options, the picture is far more uncertain and anxiety-provoking for this family. The two nearest suitable placements would be in Dungarvan or Carrigtohill.”
“I spoke to a parent of an autistic child last night about the key challenges he sees within services. His first response was the lack of forward planning. This man and his wife, who live in Youghal, feel very fortunate that their son, who is nonverbal, has been offered a place in a special class in their local primary school. There are six children in the class supported by two special needs assistants and a teacher. The school is near where they live and the boy's parents and siblings can drop in briefly to soothe him in times of emotional or sensory overwhelm. Some of the children in the school will have integration time in the mainstream school that the autism class is part of, and there is reverse integration in the autism class for pupils of the mainstream school.”
“I welcome the Minister, Deputy McEntee, and the Minister of State, Deputy Michael Moynihan, and congratulate them on their appointments. The area of special educational needs and disability involves so much frustration, worry and stress and unnecessary daily hardship for families, as well as so much discontinuity and inconsistency of care and rehabilitation, that it is difficult to know where to focus. As I said in an earlier contribution today on mental health, it is imperative for the Minister to engage intensively with the key stakeholders here, who are the families at the centre of the crisis and the clinicians and the teaching staff supporting them. These staff members are often under enormous and unsustainable stress in overstretched services.”
“In primary care psychology the problems with recruitment are primarily to do with insufficient efforts to recruit qualified staff on secure contracts and this is further hampered by the pay and numbers strategy. There is an overreliance on assistant psychologists who are not fully qualified and therefore are very limited in what they can provide clients. I wish the Minister of State well in her post. Though we are on different sides of the House I hope to work in partnership with her, the HSE and other agencies for the betterment of services over the coming years.”
“The crises in primary care, psychology and child disability network teams are interrelated and staff on the ground will quickly inform the Minister of State of what needs to be done. For the most part the answers relate to recruitment. Installing another layer of management to implement the retrograde pay and numbers strategy by redeploying existing staff will not solve the out-of-control waiting lists in primary care, psychology and CDNTs. It will lead to a plummeting of morale and drive clinicians out of the health service. There is no HSE service with an excess of psychologists. Some are doing relatively well with their waiting times, but this is something we should be striving to emulate rather than undermining it through a race-to-the-bottom redeployment strategy.”
“Let us not go back in time with this proposal and misdirect lots of money in the process. I also appeal to the Minister of State to engage intensively with front-line staff in mental health services that are in serious difficulty. Consulting senior management is obviously necessary in the Minister of State’s role, but senior managers are one group amid several key stakeholders. They often have their own pressures and are usually operating at a significant remove from the day-to-day running of services. Engaging with front-line staff in a confidential format would be invaluable to understanding where we are going wrong with service provision in some areas. I make the same suggestion to the Minister of State, Deputy Moynihan.”
“This proposal, therefore, does not remotely reflect the kind of community integration espoused by A Vision for Change, Sharing the Vision or the HSE’s policy for people with severe and enduring mental illness and complex needs. It is also at odds with the UN Convention on the Rights of People with Disabilities, which enshrines the right of people with disabilities to live in their community. St. Stephen’s is a fine location for an elective hospital but it is not a suitable place for people to live over a period of years and in some cases for the rest of their lives. Centralising these residential placements in St. Stephen’s will necessarily disconnect people from their communities because a service of that size will take people in from a broad catchment area.”
“Stephen’s is a service station a 1.7 km walk from the hospital’s entrance. The first kilometre of that route has no footpath and Cork City Council has no plans to develop one. The nearest grocery shop is in Riverstown, which is 3 km walk from the hospital and again there is no footpath for the first kilometre. There are no community amenities within walking distance of St. Stephen’s and no plans to develop any. These residents typically do not drive, some have mobility issues and the distances cited above may be considerably longer depending on the exact location of the proposed residences within the large hospital campus.”
“The HSE has responded to concerns I have raised about this proposal by emphasising the buildings, which will be five bungalows, will not be institutional in design. However, a home is about much more than a building; it is about the broader community in which a person is embedded. When residents of the Owenacurra Centre in Midleton were being uprooted in 2021 they were not concerned about the size of their bedrooms but devastated at the loss of community connections formed over years or in some cases decades. This relationship with their community was a core part of their identity, as it is for all of us. The land around St. Stephen’s is zoned for agricultural use and the land directly across from it for light industry, namely, an online warehouse. The nearest shop of any description to St.”
“Stephen’s hospital in Glanmire to reintegrate back into their communities. It was painstaking, complex and ultimately transformative work. That north Cork team and its three 24 hour-staffed community residences in Kanturk, Mallow and Fermoy remain an exemplar for the direction we need to take towards community integration for people with the highest level of mental health need. Unfortunately, the HSE’s current proposal to invest €64 million to develop a 50-bed residential mental health service on the grounds of St. Stephen’s is entirely at odds with that progressive trend and national mental health policy. It will lock vast amounts of public money into a centralised, isolated service when it should be spent on community-integrated settings in towns such as Cobh and Clonakilty where none currently exist.”
“The hub is a joint venture between the HSE’s social inclusion team and Coolmine itself and provides community-based support for people with addiction. We heard from a woman attending the service whose life has been transformed by the support and connection she experiences there. A focus for me over this Dáil term will be services for people with severe and enduring mental health difficulties, who are among the most vulnerable attending our services. They have often suffered greatly throughout their lives and may require ongoing intensive multidisciplinary support and sometimes residential placement in order to attain stability and a decent quality of life. When I joined the north Cork mental health services as a psychologist in 2013 the rehabilitation and recovery team in that location was helping many long stay patients of St.”
“I congratulate the Minister of State on her reappointment as Minister of State with responsibility for mental health. We hear so many stories about what is going wrong with our mental health services and as public representatives advocating for our constituents it is difficult not to fall into a position of perpetual complaint and outrage at times because there is so much unmet need out there and sometimes decisions are made that are not in the interests of people attending our services. It is important to acknowledge there are also very fine examples of services from which we can draw inspiration and learning. I visited one of these last Friday in Midleton. It was the launch of the Coolmine east Cork hub.”
“At present, Cork County Council is not being granted sufficient funding by central government for these measures. As a result, many people are living with dangerous road conditions outside their homes. they are fearful for their children's safety and are obliged to endure constant noise pollution. I urge the Minister of State to provide much-increased funding for road safety measures, particularly speed ramps, to make our residential areas safer, quieter and more peaceful places to live.”
“Despite this need, when it comes to advocating for these communities, it is generally a long struggle, sometimes over several years, to get a particular project onto the road safety programme. Those in many communities are left perplexed that they are enduring chronic safety hazards and noise pollution outside their front doors, with no end in sight. I am thinking of one striking example of a group of residents on the Killeagh Road in the village of Mogeely. They have been so frustrated and concerned about road safety that some families were willing to consider diverting moneys from a playground upgrade fund for the village in order to prioritise traffic-calming measures. These are parents with young children. They should not have to be considering these kinds of trade-offs.”
“When I was canvassing for the local and general elections last year, the need for measures to combat speeding in residential areas was one of the most pressing issues for constituents. In the local elections, it was probably one of the top three issues. Speed measures are essential for safety and quality of life. They provide a backdrop of calm in residential areas and give peace of mind to parents in particular in order that they do not have to be in a constant state of vigilance and threat when their children are playing outside. Speed ramps are often the only effective means of slowing down traffic, but they are like hen's teeth when it comes to getting them in my constituency.”
“Is the Government going to heed the grave warnings from all our main unions on the pay and numbers strategy and abandon it? Will it undertake a comprehensive recruitment drive for primary care services in Cork instead of plucking psychologists from other services where they are needed and potentially undermining those services? How does the Government expect to sustain services when it is keeping the stranglehold on basic recruitment in place?”
“It was not until October and then November that front-line psychology recruitment for primary care in Cork was attempted by the HSE, still nowhere near meeting the level of need within those services, and unfortunately some of these posts were temporary contracts and have not been filled. Recent briefings from the HSE and from our regional health officer, Dr. Andy Phillips, suggest they intend to address crisis waiting lists by redeploying psychologists from services that are in a relatively healthy state; in other words, robbing Peter to pay Paul to adhere to the regressive and nonsensical pay and numbers strategy. A constituent of mine was recently told in a service statement from primary care services in Cork that her child would be offered a service in October 2030, five years and nine months from the issuing of that statement.”
“Also, the roll-out of the progressing disability services programme meant large volumes of so-called non-complex referrals were redirected at the time to primary care services but there was no commensurate increase in staffing levels in Cork primary care at the time. Cork's primary care services had a fraction of the required staff long before either the official embargo or the pay and numbers strategy were introduced. Instead of undertaking an extensive recruitment drive to address these shocking waiting lists, the HSE's first priority in July was the creation of a new layer of psychology management through a director of psychology role over all other psychology mangers in Cork and Kerry. This new managerial post could have funded two full-time permanent contract psychologists, each of whom would have had a substantial caseload.”
“It has been roundly criticised by all the main unions and led to recent industrial action. The pay and numbers strategy is a very crude instrument to address HSE budget overruns that will not only cause harm to patients, but will also greatly reduce staff morale and will likely impact on the retention of staff. In June of last year, the Social Democrats party leader, Deputy Holly Cairns, revealed in the Dáil there were more than 5,000 young people waiting for an appointment with primary care psychology services in the south west regional health area, which is made up of Cork and Kerry. Of these, 105 young people in Cork were waiting four to five years for an appointment. The primary care psychology services in Cork had been severely under-resourced for many years.”
“I thank the Minister of State for being here. I raise the issue of a long-standing and worsening crisis in my discipline of psychology, and in particular within primary care mental health services for young people, with reference to the programme for Government. There are vague references in the programme for Government to workforce planning and increasing capacity for child and adolescent mental health services but there is no mention of the main roadblock that has been placed in front of the resourcing of these services, namely, the pay and numbers strategy. The official HSE recruitment embargo was lifted in July 2024. However, the Department of Health then introduced the pay and numbers strategy, which is proving to be, in some cases, just as restrictive to the recruitment of essential staff as the embargo itself.”
“The Tánaiste announced in August he would seek fresh legal advice on the Bill from the Attorney General following the International Court of Justice ruling on the illegality of the Israeli settlements. This advice took many weeks to materialise but at the end of October, he announced he was lifting the money message obstruction applied to the Bill. Soon after the election, however, as Taoiseach, he struck a very different tone, characterising the Bill as deeply flawed and suggesting that new legislation would need to be drawn up. It is very clear that the tactic is to go back to the very beginning of the process, drag it out for years, hope that the genocide in Gaza stops and that Palestine becomes much less of an electoral issue. It is utterly cynical and dishonest. We know from a range of law experts that this Bill is legally sound.”
“I thank Sinn Féin for tabling the motion. The time for enacting the occupied territories Bill was six years ago, when it was introduced to the Dáil by Deputy Niall Collins, fully supported at the time by his Fianna Fáil colleagues - a very stark contrast with the scene of desertion on the Fianna Fáil benches this evening. The vote in 2019 was a resounding success with 78 in favour to 45 against. It was democracy in action. We often hear from Fianna Fáil and Fine Gael about threats to our democracy from the far right or from Vladimir Putin, which are entirely legitimate concerns, yet they have in this instance facilitated a blatant interference in our democratic process by US and Israeli diplomats. Prior to the recent general election, the Government engaged in a bad-faith exercise, leading the public on with this Bill.”