‘I won’t depend on the HSE for anything. You can’t depend on them for anything’

"I have three boys with autism," says Louise Lawlor. "My first son Aidan is nine now, he was diagnosed in 2018. I had concerns about him in 2016, I would have raised them in 2015. And then, apparently, his paperwork was lost so I paid for a private diagnosis.

“Eventually, when the HSE did look at Aidan they gave him the same diagnosis. At that point, Aidan already had a year and half under his belt at an autism pre-school. So he was well on the road.

“I won’t depend on the HSE for anything. You can’t depend on them for anything. This is long before the pandemic. All the HSE has given nine-year-old Aidan to date is four occupational therapy sessions. They haven’t given him any speech and language therapy.”

'Charlie is five and his paperwork was given into the HSE, but I haven't heard anything about Charlie as of yet and his paperwork was given in in 2020'

The Dublin woman is experiencing similar issues with her second son. “Charlie is five and his paperwork was given into the HSE, but I haven’t heard anything about Charlie as of yet and his paperwork was given in in 2020.”

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Some speech and language therapists say parents have become worried about their children’s language development recently due to the pandemic. These fears stem from the lack of socialisation, as many are “curious about the long term effects it may have”. However, these worries also stem from the threat that delays to accessing services pose, as early intervention is essential.

The Irish Association of Speech and Language Therapists (IASLT) recognises that communication is a basic human right. The representative group has expressed concern about the potential longer-term negative impacts on clients with communication difficulties who are facing very lengthy waiting lists for assessment and treatment. “The societal and financial benefits of early intervention and treatment, as well as the positive developmental outcomes for children with additional needs, have been well documented.”

Even prior to the pandemic, the IASLT had expressed serious concerns about lengthy waiting lists in accessing services. It highlighted the detrimental consequences of such delays, as “early intervention and treatment are both so critical to client outcomes”.

Lawlor claims a lack of transparency about these waiting lists is also a problem. “They’ll tell you the list is however many months long, let’s say 20 months, but they don’t tell you that that’s an assessment list. Once you move to the top of that list, someone will see it and say, ‘Do you need speech and language therapy? Okay, we’ll put you on the list to see an actual therapist.’ It’s a lot of waiting lists.”

Significant risk

The lack of accessibility to speech and language therapy services pose significant risk to children’s educational needs. “Once you book private, you get your diagnoses and you know what you’re looking at,” says Lawlor. “Then you have the ability to sign the child up with an autism pre-school. You can’t get a child into a school without that paperwork.”

'These children are at significant risk of long-term difficulties with understanding others... reading, challenging behaviour and mental health issues'

According to the IASLT, up to two children in every classroom have significant difficulties with speech and language, and this figure is significantly higher for children from disadvantaged backgrounds. “These children are at significant risk of long-term difficulties with understanding others, accessing the curriculum, reading, challenging behaviour problems and mental health issues.”

A Nphet and Joint Department of Health and HSE update in December 2020, indicated that the pandemic had a disproportionate effect on access to speech and language therapy (SLT) services and showed that the total number of SLT patients seen was 44 per cent below the target for that year.

This report also found that the numbers waiting for an SLT assessment were up 37.8 per cent on the previous year, and there was an increase of 36.6 per cent in those awaiting treatment. The Nphet update also stated that the number of individuals waiting over a year is rising for both SLT assessment and treatment.

Members report a disproportionate impact on children and adults with additional needs, especially in delays for endoscopic investigations and long delays in paediatric disability and mental health services, whose waiting lists appear to be the longest.

The current situation results in a two-tier and inequitable system, as those with the means to pay are obliged to access private therapy

The current situation results in a two-tier and inequitable system, as those with the means to pay are obliged to access private therapy and those who cannot do so are faced with the prospect of deteriorating health outcomes and developmental delays for their children. The current situation also produces an unsustainable system as, according to senior speech and language therapist Emma O’Leary: “There are even waiting lists now for private therapy, which wasn’t always a thing.”

The HSE told The Irish Times that it was “committed to delivering efficient, high-quality therapy services to all eligible service users. Community-based care is currently undergoing substantial reform in line with Sláintecare.

“This will involve a significant restructuring in how services are currently delivered and will ensure care is provided in an equitable, efficient and integrated way through newly established Community Healthcare Networks.

“As we develop these networks and teams, we will naturally build the capacity of the primary-care sector, recruiting around 2,000 additional frontline staff across a range of disciplines including speech and language therapists, nurses, occupational therapists, physiotherapists and other healthcare professionals,” the HSE said.

Vocabulary development: what to expect

– By 12 months: Using 1-6 words.
– By 18 months: Using 10-50 words.
– By 24 months: Using 50-250 words and starting to combine words.
– By 36 months: Using 250-1,500 words and combining simple sentences.
– Bilingual and multilingual children are not exempt. Just like children who speak one language, a percentage of bilingual children will present with language difficulties and may need intervention to support them in developing their language skills.
– It is important for parents to keep an eye on milestones. They are not designed to cause alarm, but are a useful tool to give parents insight when their child might need a bit of extra support.
– If you are concerned and feel your child is not developing their language as expected, consult with a speech and language therapist who can provide you with advice and support and arrange an assessment if appropriate.
– Panel by senior speech and language therapist Emma O'Leary.