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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“I visited CDYS in Mitchelstown on two occasions recently and I was hugely impressed by the work it does with young people, not just from north Cork but also from parts of counties Limerick and Tipperary. It also works closely with young people from the asylum-seeking and refugee community living locally. The staff exhaust all grants available to them to maintain an innovative, diverse range of activities. They help young people who are really struggling to fit in or to continue their education to get back on track in life and give them a sense of belonging, purpose and connection. This is really invaluable work, far-reaching in its impact, yet it is operating on a shoestring. Its current staffing is just one full-time project co-ordinator, one part-time community employment worker and one part-time youth worker.”
“I call on the Government to set out without delay a firm timeline for the introduction of a cost-of-disability payment and to make provision for it in the upcoming budget.”
“The introduction of a cost-of-disability payment has been proposed but not acted upon for far too long. Detailed research and costings were carried out by the National Disability Authority as far back as 2006 and updated in the comprehensive Indecon report of 2021. Both reports clearly demonstrated the significant additional costs that come with living with a disability. These findings have been consistently echoed by the Disability Federation of Ireland, which has long advocated for a permanent payment that recognises these unavoidable expenses. A cost-of-disability payment would represent a structural long-term recognition of the daily additional costs of disability, covering such areas as transport, heating, medical needs, equipment and more. This is a matter of basic fairness and equality.”
“I urge the Minister to take the evidence seriously and to introduce a specific cost-of-disability payment in the upcoming budget. People with disabilities cannot be expected to wait any longer.”
“I thank the Minister for his response. A recent report from the Economic and Social Research Institute and the Irish Human Rights and Equality Commission shows that the additional costs faced by disabled people are now estimated to be between 52% and 59% of disposable income. For those with more severe disabilities, that rises to as much as 93%. These costs arise across essential areas, including transport, medicines, specialised equipment, the need for personal assistance and care hours. The report also highlights how traditional poverty measurements underestimate the levels of deprivation experienced by disabled people as they fail to take account of these unavoidable additional costs. This is a stark reflection of how far behind we are in providing meaningful support to disabled citizens.”
“Will the Minister provide some detail on the Government's commitment to introduce a permanent cost of disability payment to help to address the significant additional costs that come with having a disability and impose financial hardship on many of our disabled citizens?”
“Although this amendment was not accepted at the time, I urge the Government to reconsider its merits. Addressing this issue is crucial to ensuring that family carers, who play an essential role in our society, are not left financially vulnerable in their later years. I urge the Minister of State to address these aspects of the pension auto-enrolment system, which are clear ethical shortcomings in what is overall a welcome initiative.”
“According to the 2021 census, approximately 300,000 people in Ireland provide unpaid care. This marks a notable increase over the past six years. These carers often face challenges in maintaining consistent employment due to their caregiving responsibilities, leading to gaps in their pension entitlements. This situation disproportionately affects women, who are more likely to take on caregiving roles, thereby aggravating gender inequalities in pension provision. On Committee Stage of the Automatic Enrolment Retirement Savings System Bill in the Seanad, Senator Higgins tabled an amendment advocating for a report outlining measures to ensure that individuals engaged in care work outside the formal labour market are supported by the new pension system and have equitable access to its entitlements.”
“Given the scale of the fund and its potential impact, we need robust safeguards to ensure public money is not invested in companies that contribute to environmental degradation or engage in activities contrary to our ethical standards. In 2018, Ireland became the first country globally to commit to divesting public funds from fossil fuel companies, marking a significant milestone in our environmental policy. It is imperative that we uphold this commitment and ensure that My Future Fund aligns with our climate and ethical objectives. I urge the Government to revisit discussions from the passage of the pensions Bill concerning the expansion of the pension scheme to include individuals not initially covered. A particularly significant group to consider is family carers.”
“The joint Oireachtas committee on social protection's pre-legislative scrutiny report from 2023 recommended that the forthcoming auto-enrolment retirement savings scheme — dubbed My Future Fund — would prohibit investments in fossil fuels and the arms industry. Additionally, the committee suggested allocating a minimum percentage of funds to Irish renewable energy developments to support the nation's climate action goals. In response, the then Minister, Heather Humphreys, introduced an amendment requiring NAERSA to produce statistical data on the types of investments held by investment management providers. While this amendment aims to enhance transparency, it falls short of the committee's recommendation for explicit investment restrictions. This approach is insufficient.”
“Certain large US institutions have reduced emphasis on climate commitments and some European pension funds are revising their exclusions to include companies with defence business. In addition, proposals under the EU’s corporate sustainability reporting directive could, if adopted, remove a significant proportion of companies — potentially up to 80% — from mandatory sustainability reporting. Taken together, these developments show we cannot rely solely on the discretion of investment and pension managers to ensure that funds are directed responsibly, avoiding companies that pollute, disregard workers’ rights or are involved in the arms industry. Strong regulatory oversight and clear ethical commitments are essential to protect people and our natural world.”
“By directing money away from polluting industries or companies that ignore workers’ rights, pension funds can exert real pressure and help change corporate behaviour. For many years, there was growing recognition of this responsibility, with pension fund managers adopting ESG principles. However, there is now evidence that some funds are rowing back and are placing less emphasis on conscious investment and more on short-term returns. This is a worrying trend. Given their scale, pension funds should be a force for positive change, not contributors to environmental destruction or poor labour standards. Quite likely influenced by Trump’s "greed is good, regulation is bad" hypercapitalist mentality, there is growing evidence that some investment and pension fund managers are scaling back their commitments to ESG principles.”
“One aspect of the auto-enrolment scheme which was never sorted out as the legislation passed through the Oireachtas and which I would like to raise again is where the funds from the scheme - which are the public’s money - will be invested. I know that this issue was raised previously and that as the legislation went through the Houses, colleagues proposed amendments which would have restricted the scheme from, for example, investing in fossil fuels or the arms industry, but these were not accepted by the Minister at the time, Heather Humphreys. Those amendments should be reconsidered. Pension funds are among the largest investors in our financial system. They control vast sums of capital. Where they choose to invest has real consequences.”
“I thank the Minister of State, Deputy Grealish, for being here. The Social Democrats' views on the auto-enrolment system have been well articulated by my colleague Deputy Gannon in previous Dáil debates, particularly in April of last year. We very much welcome the concept but have concerns which I will go into in some detail. Every worker should have access to a retirement income capable of providing them with a decent quality of life as they age. There are many positives to auto-enrolment. Certainly, a greater role for the State in ensuring workers can retire with dignity is inevitable and something we should all embrace.”
“These children have been granted placement in a school on the basis of disadvantage yet are being excluded from accessing transport to that school. It is not rocket science to design a school bus system that is joined-up, meets the needs of all students within reason and has some degree of flexibility and humanity built into it for families who do not have their applications in on time because they are new to the system or find themselves in difficult social circumstances. The Department really needs to get a grip on this issue.”
“I am also advocating for an autistic, visually impaired child who has been offered a special school placement on the other side of Midleton from where they live but who has not been allocated transport to get to that school. I am representing two children in Leamlara who live closer to Carrigtwohill than Midleton. They have been assigned concessionary status for the school bus, which means they have been put to the back of the queue and are not guaranteed places. This happened on the basis they live closer to Carrigtwohill and have chosen St. Colman's in Midleton for their secondary education. However, St. Colman's is their nearest DEIS school, yet that has not being taken into account. This is an absurd state of affairs.”
“No grace is shown to families who are unfamiliar with the system or who missed the deadline for applications and are now left stranded. This will disproportionately impact families in disadvantaged social circumstances. I am thinking in particular of two children I know of in Cloyne who were refused places due to late applications. Their parents have no access to a car. These children will now have to take the unreliable public bus home at 6.15 p.m., which will be particularly punitive during winter. Some other examples of the fallout from the system include a family based in Clonmult who were allocated a route that is too far from their home to be a feasible option. Yet, a school bus on a route that has not been offered to them passes directly by their home.”
“Enrolment in our school bus system has become an annual crisis, involving huge stress and uncertainty for many families. It is a stand-out example of the Government's inability or unwillingness to get the basics right for families. What should be a straightforward service has become an epic fiasco of poor, disjointed planning and crude restrictions, with so much unnecessary worry and hassle for those families caught up in it. Across Cork East, the frustration is acute. From Youghal to Cobh to Mitchelstown, I have been inundated with calls and emails from families who are at the end of their tethers trying to access school bus places for their children. The system is both spectacularly haphazard and mercilessly rigid.”
“It is reported that the options for those families are home tuition or a return to preschool. The figures the Minister of State quotes need to reflect the realities on the ground in special education provision. As things stand, a single-digit figure for children without a school placement is a mirage covering over a huge depth of unmet need.”
“If data on additional needs placements is to be meaningful, it must reflect the degree to which children's right to be educated in their community, where they live, is being upheld. In the Minister of State's responses to parliamentary questions on this subject, the terminology that comes up is "pathway to education". It has been brought to my attention by the campaign group Families Unite for Services and Support, FUSS, that it has information on significant numbers of children who have been offered placements in schools for which no buildings yet exist. I have been informed that a school on the northside of Dublin recently notified families who had been offered places that, due to building delays, the predicted opening date for 12 special education places in two classes is being pushed out to 2026.”
“I commend Sinn Féin on its motion. At the Committee on Disability Matters this morning, the Minister of State told us that the number of children without a special education placement for this school term was in single digits. It is fair to say there was some respectful scepticism among committee members about that claim. I raised with the Minister of State the fact that there is a world of difference between a school placement in a child's local community and a school placement that is a very long distance away from that child's home. We know many families are caught up in gruelling school commutes that add hugely to the challenges they face. The Minister of State's officials confirmed that no data is gathered by his Department on the journey times children educated outside of their own areas endure every day.”
“There is no indication, however, of how the Government will commit to the findings of the ombudsman's Wasted Lives report into their circumstances, which is now four years old. In the action plans to follow this new disability strategy, it is vital that the Government moves beyond aspirational language towards clear timeframes, staffing benchmarks and funding commitments. We also need to see an unambiguous commitment to uphold the right of people with disabilities to be educated within their local communities and to plan for creating that capacity.”
“An embargo certainly was employed from November 2023 to July 2024. Since then, the Government's pay and numbers strategy has continued to hamper recruitment. Even prior to these restrictions, there had been chronic underresourcing of primary care for years and the redirection of large numbers of young people from children's disability network teams when the progressing disability model of care was rolled out. Children basically went from one waiting list to the next without the necessary recruitment following them. The disability strategy refers very briefly to the over 1,200 disabled people aged under 65 who are residing in nursing homes due to a lack of specialised residential services, rehabilitation and statutory home care supports.”
“As I confirmed earlier this year through parliamentary questions, the neglect of these services by successive governments over many years has led to children throughout the country routinely waiting many years for supports such as occupational therapy, physiotherapy, psychology and speech and language therapy. Within those figures are instances of children waiting nine and a half years for occupational therapy in the Dublin north area, seven years for physiotherapy in the north Lee area in Cork, six years for speech and language therapy in the Dublin north west area and an incredible 13 and a half years for psychology in the same area. It shocked primary care clinicians when the Taoiseach claimed during Leaders' Questions in July that a recruitment embargo had not been applied to these services.”
“There is also reference in the document to building capacity in primary care but, crucially, there is no commitment to staffing targets for these services in either the disability strategy itself or the roadmap documents it refers to. The strategy does clearly commit to a single point of access approach to services across primary care, disability and child and adolescent mental health services, CAMHS. While this will certainly help prevent children being passed from one waiting list to the next, it will not paper over the cracks of chronic underresourcing of primary care services and the continued recruitment restrictions imposed on them by the pay and numbers strategy.”
“While Article 24 of the UN Convention on the Rights of Persons with Disabilities is clear on a disabled person's right to "an inclusive education system at all levels" in the communities in which they live, the Government's strategy only commits to "Develop a Roadmap for Inclusive Education ... to take account of ... Ireland’s commitments under the" UNCRPD. This is vague non-committal language that will offer no comfort to families facing lengthy gruelling commutes to their child's school. Another crisis skirted by this strategy is that of waiting lists in primary care services. The strategy aims to "Deliver actions to ensure more timely access to primary care therapy".”
“As much as we should welcome the human rights-focused language of this strategy and its emphasis on consultation with disabled people, the document will be largely meaningless if its implementation is not funded in upcoming budgets. We have had visionary Government documents on disability reform in the past that have essentially come to nothing because they were not followed by political will to invest in services and to vindicate the rights of our disabled citizens. It is extremely worrying that the strategy contains no clear commitment to upholding the rights of children with additional needs to be educated within their local communities.”
“I thank the Minister for being here. The Government's newly launched national human rights strategy for disabled people is strong on aspirational language but we have yet to see any details on implementation such as funding commitments, staffing benchmarks or timeframes to back it up. For a sector that is so deep in crisis across all areas, including educational placements, access to therapies in residential services, employment and transport, a disability strategy with meaningful targets has never been more urgently needed. In fairness, there are action plans for this strategy to follow. The first is to be published within three months of this document's publication. It is imperative that these contain clear timelines, benchmarks and funding commitments.”
“We have children waiting up to seven years for physiotherapy in Cork, up to six years for speech and language therapy in Dublin, up to nine and a half years for occupational therapy in Dublin, up to nine and a half years for psychology in Galway and, incredibly, up to 13 and a half years for psychology in Dublin. Astonishingly, during Leaders' Questions this week, the Taoiseach denied that there had been any recruitment embargo in primary care services. Does the Tánaiste accept that he was misled by the HSE about the crisis in primary care this time last year? Does he agree that the Taoiseach distorted the reality of recruitment restrictions on primary care this week in the Dáil? Will he now commit to an urgent recruitment drive to address these out-of-control waiting lists?”
“I also pay tribute to the outstanding staff in the Oireachtas, with a special mention for the excellent broadcast workers here, 13 of whom will be laid off over the summer due to the precarious and unfair nature of their contracts. Almost one year ago to the day, my party leader, Deputy Holly Cairns, raised the issue of more than 5,000 young people waiting for primary care psychology services in the Cork-Kerry region. Of this group, 109 had been waiting for between four and five years. The Tánaiste responded to Deputy Cairns by saying that there seemed to be a particular challenge in the region that he did not believe was replicated nationally. A year later, it is clear from figures I have extracted with great difficulty from the HSE that the primary care crisis is not only national, but it is also across disciplines.”
“If this was a ground-level clinician who was breaching the HSE’s communications policy by criticising the HSE publicly, the sanctions would be swift and decisive.”
“It relented from its plan to close the service, not as a result of self-reflection or being persuaded by the very obvious arguments around patient rights, human rights and the United Nations Convention on the Rights of Persons with Disabilities, but because management caved in under a sustained barrage of negative publicity. If we are true to that value of accountability, as set out in the corporate plan, where is the accountability for managers who operate in this way towards people with such a high level of vulnerability? Where is the accountability for the managers in the Emily case, who allegedly obstructed the extension of a safeguarding review into other possible cases of abuse within the same facility?”
“Added to that, they would have most likely suffered the indignity of sharing dormitories in these long-stay wards and residing in settings that had received some of the worst Mental Health Commission inspection ratings of any mental health service nationally. Meanwhile, Mental Health Commission compliance ratings at the service being closed in Midleton, which is known as the Owenacurra Centre, both at the time of this proposed closure and since, were exceptionally good. The HSE banked on people observing this closure to not even read those Mental Health Commission reports, or not even read the building reports, which also did not stand up to scrutiny.”
“The letter reassured the shocked residents that the HSE would “work with each resident individually and with their loved ones to make sure you have a new placement that suits your needs.” Little did those residents know at the time, as revealed the following year through an FOI request, that the HSE had been planing to move as many of those residents as possible from their single-room, town-centre, long-term residence where they had built up a wealth of connections in the community over years and in some cases over decades. As many as possible were being moved into long-stay wards in St. Stephen’s Hospital, Glanmire, an institutional setting removed from anything resembling community living, surrounded by fields, without even a footpath to the nearest service station, which is 1.7 km away.”
“The residents, some of whom did not have family support, received a letter from the HSE in June 2021 telling them that, in the context of refurbishment works at the facility, it had become clear that the building could not be made fit for purpose “to meet the high standards of the Mental Health Commission”. The letter went on to say that the building could not be “brought to the standard needed and that you deserve”, addressing the residents directly.”
“A paragraph on trust in the HSE’s corporate plan states: “We will be open and transparent in how we provide services. We will show honesty, integrity, consistency and accountability in decisions and actions.” I was involved in a campaign to oppose the closure of a residential mental health service in Midleton over a number of years. It was an epic struggle, involving the deployment of several Oireachtas committees, multiple freedom of information requests and a litany of parliamentary questions, to expose the serious infringement this abrupt closure imposed on the rights of the residents and people in east Cork who will require residential support in future.”
“The idea of a single point of access for child services, which is being trialled at present by the HSE, has merit in that it will reduce the practice of children being moved from one waiting list to the next but it will not even paper over the cracks of years of under-resourcing. The reason children are being moved from one waiting list to the next in the first place is that the services are so restricted that they are attempting to manage their waiting lists by becoming rigid in their inclusion criteria. There is no getting away from the need for proper workforce planning and investment in primary care services. We need a clear benchmark for a clinician to population ratio and an urgent, comprehensive recruitment plan to follow that.”
“The main reason is that a shorter therapeutic assessment in primary care services - for those children who are eligible for primary care - followed by timely intervention is not remotely available to them. It is a complete fantasy. I ask the Minister to please engage with the clinicians on the ground and the families affected. She will see what various types of recruitment restrictions, as well as the redirection of large numbers of children from children’s disability network teams, CDNTs, without following up with the necessary recruitment, have done to primary care services for young people. This is a disaster with regard to service provision that has been growing in plain sight for years now.”
“You cannot address the crisis if you do not even recognise the reality of its existence. The Government's only consistent response to questions on the primary care service crisis has been to refer to a need to change disability legislation, strongly hinting at a dilution of the right to an assessment of need. The Minister has made the case that clinicians are overly embroiled in completing assessments of need and not available for interventions as a result. There is a small grain of truth in that but the Government narrative ignores the broad context and the fact that under-resourcing of services is pushing more and more families into the assessment of need process because that is the only right they have in law.”
“He said this to Deputy Cian O'Callaghan with clear impatience, bordering on disdain, for the questions being put to him around the need for a comprehensive recruitment drive in primary care services for young people, as if he was dealing with an unserious, politically motivated and entirely unreasonable line of attack. Both of these responses, from the Minister two weeks ago and the Taoiseach yesterday, reflected either complete detachment from the reality of primary care services for young people or a wilful denial of that reality. If I was a clinician working in one of these services in Cork, Dublin or Galway, where recruitment has been so restricted for years, or if I was a parent whose child was on one of those epic waiting lists, I would have been left feeling utterly distraught hearing those responses.”
“He raised the fact that the longest wait times nationally are up to seven years for physiotherapy in Cork North Lee; up to six years for speech and language therapy in Dublin North-West; up to nine and a half years for occupational therapy in Dublin North; and a staggering 13 and a half years for psychology in Dublin North-West. I have mentioned Dublin and Cork quite a bit but it is a national crisis. We have also had, for instance, a wait of nine and a half years for psychology in Galway. The Taoiseach's response was: There has been no recruitment embargo. We do need to get a bit real here. [...] so do not say we are cutting back or are not allocating. The Deputy cannot say that with credibility.”
“These generalities did not in any way relate to the waiting lists I raised. There was no acknowledgment that there was a crisis in primary care services for young people. There was a suggestion made of an alternate reality in which these services were actually better staffed than ever, which is clearly not the case. This week, at Leaders' Questions, my colleague Deputy Cian O'Callaghan highlighted the scale and depth of the crisis across health regions and across disciplines revealed by further parliamentary questions I submitted in recent weeks.”
“I highlighted that people are being moved from one waiting list to another with no intervention in sight, and that there has been a stranglehold on recruitment in primary care services for young people resulting from the pay and numbers strategy, the official recruitment embargo before that and years of passive neglect even prior to that. I referenced from a reply to a parliamentary question a wait time in the Dublin and north east health region involving a child initially referred to disability services nine years ago, who is now facing yet another wait of unknown duration for primary care psychology. I set that out at the time and the Minister's response was to quote figures referring to generalities in primary care staffing in the context of the pay and numbers strategy.”
“There is a close relationship between this Bill and the HSE's corporate plan. In the HSE's corporate plan for 2025 to 2027, there is a stated commitment to, "Reduce waiting times for primary care therapies by standardising the management of referrals, waiting lists and discharges." There is no mention of a recruitment drive for services that have been hollowed out by years of recruitment restrictions imposed by successive Governments and senior HSE management, so much so that waiting list figures for them are so stratospheric that they have to be read more than once to be believed. I raised the crisis in primary care waiting lists for young people with the Minister in the Dáil two weeks ago, with particular reference to psychology services.”
“Continued underinvestment in our dental schools has contributed to the insufficient number of dental graduates coming into the system each year and to a growing disparity between need and number of dentists required to meet that need. I appeal to the Government to address this specific issue that is contributing to our crisis in dental care services and to provide the necessary funding for a new dental school and hospital building in Cork.”
“He has highlighted the need to update and even replace much of the dental equipment being used currently within the school. As in so many areas, this Government is not getting the basics right with dental service provision. There had been plans to expand and relocate the Cork University Dental School and Hospital but these now appear to have been dropped, seemingly due to a lack of funding from Government. The school, which is located on the Cork University Hospital campus was granted planning permission back in 2019 for a five-storey building in Curraheen. The new building was designed and the project went to tender. The Tánaiste visited the site and turned the sod but the development appears to have effectively been shelved.”
“If we are to address these ongoing issues around the number of dentists within the system, we must address the funding and capacity issues relating to the education and training system. The two dental schools in this country are run by Trinity College Dublin and University College Cork. Neither has received significant funding in recent years to either update or expand their facilities or increase the number of trainees they have in order to keep up with patient demand. The dean of the school in Cork has described its current building as "frail" and said that its continued use is "untenable without significant investment". He pointed out that it has a leaky roof and other issues that come with buildings of a certain age.”
“I am sure many of the same numbers from the Irish Dental Association will be mentioned time and again during the debate, but I would just like to point out some salient trends. Half of all eligible children are being denied access to their dental screening appointments due to shortages of dentists within the HSE. This means that 104,000 children are missing out on their scheduled check-ups. The number of HSE dentists has declined by nearly one quarter over the past 20 years. We have seen a 31% reduction in the number of children being seen by HSE dentists in the past five years alone. It is not just children who are being affected by shortages in the number of dentists. One in six of all patients is left waiting more than three months for a routine appointment.”
“I thank Deputy Stanley for bringing forward the motion. It presents us with another opportunity to discuss the crisis in dental care. The Social Democrats tabled a similar motion in May of last year. Unfortunately, the challenges facing dental care in Ireland remain and urgent action on the part of the Government is still required. One significant issue relates to the number of dentists within the HSE and the numbers currently being trained to deal with unmet patient need. Patients are being left to sit on waiting lists up to two years for procedures involving general anaesthetic and six years for orthodontics, while the Government is failing to provide adequate funding to increase the number of dentists being trained.”
“Allowing the practice to continue is essentially legislating for the continued under-resourcing of CAMHS inpatient units by Government. As a compromise, we need at the very least a maximum period of 72 hours for such admissions. That would allow for emergency situations at weekends and so on.”