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Meeting Minutes

SNPN Donegal Notes  

Anne Rabbitte meeting 23/11/2023.

Huge efforts are going on with to recruit therapists although there is full admission that CDNTs are in crisis. Vacancy rates in Donegal CDNTs currently range from 30% in Donegal Southwest to 70% in Donegal East.

The Minister has committed to having full teams in place by 15th February 2024

  • Recruitment – the panel system for therapists in Donegal CDNT has been abolished this will hopefully speed up and support recruitment.

  • Respite discussed - severe lack of respite services - ideas brought forward on what could be done to support families who need respite including opening all respite centres, a children’s only respite centre and alternative models.

  • Need to review the overall headcount number of therapists allocated to Donegal CDNTs its nowhere near enough for volume of referrals coming into teams.

  • CDNTs should be getting 3rd party private therapists/organisations into complete training programmes like Lamh, Hanen with parents.

  • Schools – discussion on supports for schools including:

    • Responsibility of NCSE to support schools with inclusion.

    • If a school is having an issue with approval for a class for additional needs to contact Anne Rabbitte’s team.

    • Commitment to training for teachers on disability awareness & support.

    • A school-based therapy team is being recruited for the 2 x special schools in Donegal. There is also recognition that there are children with high needs in mainstream schools and there are several ideas on how these can be supported.

    • There are situations around the country where Special Ed schools have received funding for private therapy and she is open to this in Donegal

The Special Needs Parents Network emergency measures based on your input in our survey and our report “Stakeholder impact of the CDNT Crisis” were discussed:

  • EM 1 – families are being contacted about equipment needs although reports that this is not fully consistent. HSE have requested that if any parent has urgent equipment provision/maintenance need they should contact CDNT.

  • EM2 – The Minister when asked about redeployment from other areas of the HSE (Primary Care etc) she confirmed she had no plans to do this - her focus is on staffing the CDNTs.

  • EM3 – Reimbursement for private therapy – the Minister stated that her team are looking into a scheme of private therapy reimbursement however did not make any solid timelines or commitments with this

  • EM 4 – Schools (see above)

 

  • Families and children in crisis who live in an area without the therapeutic support the children need was highlighted at the meeting. The HSE stated that they are responsive to any families who contact them urgently requesting support for a child in crisis.

  • It was also highlighted that every child within the CDNT is complex and needs therapeutic support as soon as possible.

So, in summary, the Minister is engaged about the CDNT crisis in Donegal but we wait eagerly to see action on the ground.

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SNPN Donegal Minutes

Regional Health Forum on CDNTs minutes 8/12/23

 

There is a huge amount of work ongoing by the HSE management and the HR teams to minimise and address the CDNT crisis.

Recruitment

  • Recruitment is ongoing with the removal of the panel system in Donegal, Galway & Waterford.

  • Currently there are 50 posts vacant in Donegal CDNTs, with 12 at a post accepted/offer stage. This leaves at best, 38 current open roles.

  • Unfortunately, expressions of interest in CDNT clinician roles is low.

  • Rolling recruitment campaigns will continue.

  • There is currently a HSE recruitment freeze but disability services are outside the scope of this and can continue to hire.

Emergency Measure # 1

  • Families of children with essential equipment (postural, splints, AFOS, wheelchairs) continue to be contacted by the HSE with regards to an OT/Physio appointment for provision/maintenance. Families who have not been contacted and who have urgent equipment related needs should contact their CDNT.

  • Upper limb clinic taking place in Donegal with therapists from Donegal North supporting Inishowen & Donegal East

Emergency Measure # 2 REDEPLOYMENT

  • Non committal on this

  • Overtime is being offered to CDNT & Primary Care clinicians with the purpose of supporting to reduce the backlog.

  • Incentivisation of CDNT clinician roles was discussed

Emergency Measure # 3 PRIVATE THERAPY – REIMBURSEMENT

  • Minister for Disability is working on a scheme for private therapy reimbursement. SNPN are following up with her office for further details.

  • Private clinicians are being contracted on a part time basis to the CDNTs to support actions in Emergency Measure # 1. There is room for expansion with this.

  • Discussed how this could be further expanded i.e. contacting therapists in other counties to identify if they have the capacity to support children waiting for therapy & families waiting for support in Donegal.

Emergency Measure # 4 SCHOOLS

  • A school based team will be hired for the 2 x Special Ed schools in Donegal. It was relayed that there are many other schools around the county who need clinician support.

  • Clarification that children in Special Ed schools who in the future will have access to a school based team will still remain on their local CDNT caseload and receive support in the home from their local CDNT clinicians.

Also discussed:

  • HSE noted that 13% of clinic appointments were no shows in October – acknowledgment this is likely due to unforeseen circumstances such as sickness. Suggestions were made regarding text message reminders.

  • Childrens Disability Grant – a number of organisations in Donegal have applied for this, unfortunately payment has been delayed. Importance of prioritisation of Donegal applicants for payment was relayed.

  • Lack of available Respite remains a huge issue for families in Donegal and needs immediate focus to support families.

Outcomes from this meeting,

  • We believe that families and children around the county need urgent support now – recruitment is taking too long for our kids.

  • We hope that the HSE will contact and outsource private therapy to provide support for families and children whilst recruitment for open roles is ongoing.

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SNPN Donegal Minutes

Regional Health Forum on CDNTs brief minutes 01/03/24. 

  • SNPN Donegal asked for a number of items to be put on the agenda for the Regional Health Forum meeting including

    • Equipment wait times

    • Details of universal, targeted & intensive interventions per CDNT area and the number of children involved in each.

    • Outsourcing to support service provision.

 

  • Disability Services Update

    • An update on disability services was provided including details of the types of universal, targeted and intensive interventions that are available in the CDNTs.  Disappointingly, the HSE did not have details of the number of interventions in each area nor the number of children involved in each.

    • Disability Childrens Grant – it was relayed that applicants should hear back on whether their applications have been successful or not by the end of next week.

    • Outsourcing was discussed, HSE confirmed that a number of options are being considered however there was no concrete information on what, where and when. Was pointed out that clinicians in the county have contacted the HSE and were told that there are no roles available – HSE committed to following up with interested applicants.

    • Equipment – typical wait times for AAC are 3 weeks for funding & 4 – 6 weeks for supply of equipment. This can be longer for more complex systems. In general OT equipment e.g. standers should take between 4-6 weeks but there are stock issues with some suppliers

    • Accommodation remains a significant challenge in Donegal East & the HSE are reviewing suitable locations for the CDNT team.

 

  • Recruitment Update

    • Significant number of open vacancies remain in Donegal CDNTs. There has been progress in certain areas and for certain disciplines. Physiotherapy remains a challenge although there is a new physiotherapist appointed in Inishowen & a new physiotherapist & staff grade OT in Donegal East.

    • They are recruiting a new CDNT manager for Donegal East.

    • There is a bursary programme for physiotherapy & OT students which should result in graduates returning to work in CHO1 once their studies in the UK have completed, some due to come on board Summer 24.

 

  • Parent Rep & SNPN feedback

    • Respite remains to be a huge issue for families in Donegal, with many of the respite centres having little to no capacity. This needs to become a political priority in Donegal. Parent representatives noted that one family has been waiting up to 6 years for respite which is completely unacceptable. There is opportunity to make better use of the respite centres and HSE have committed to following up with Estates on this.

    • Donegal East remains a huge concern with 65% vacancy rate, significantly higher than other CDNT areas. It was asked whether it would better meet the needs of families and children in that area if they were absorbed into caseload of other 3 x CDNT areas in Donegal – HSE were initially not in favour of this idea but have committed to come back to us on it.

    • Opportunities exist  for better support for families particularly in Donegal East from a social care perspective. Donegal South West issue a regular newsletter to families – this practice could be replicated elsewhere.

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HSE Regional Health Forum re: CDNTs Meeting Minutes 15/6/24

In attendance: HSE Management, HSE HR & Comms representatives, Pearse Doherty, Gerry McMonagle, Albert Doherty, representative from Charlie McConalogues office, parent reps & SNPN

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HSE Presentation

Recruitment

  • Staff % headcount levels

    • Donegal East & Inishowen 62%

    • Donegal North 51% (mainly due to vacancies in Special Education schools)

    • Donegal South West 73%

 

  • Claire O’Connor has been appointed the CDNT Manager in Donegal East

  • New policy with regards to offering student placements for those studying relevant 3rd level qualifications.

  • ATU bursary project ongoing as are other efforts to minimise lead time of CORU registration

  • CDNT activity in Co. Donegal – 1789 contacts/interventions in county with 90% uptake in appointments

  • HSE Roadmap for Service Improvement 2023 – 2026 is ongoing with a number of working groups (all are established with the exception of  number 5 below) more information on the scope of these working groups can be found here https://www.hse.ie/eng/services/publications/disability/roadmap-for-service-improvement-2023-2026.pdf

 

  1. Integrated Services between Disabilities, Primary Care, CAMHS and Tusla

  2. CDNT Service Access and Improvement including AON

  3. Workforce

  4. Communication and Engagement with Children and Families, and with Staff

  5. Engagement with Education and Support for Special Schools

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Childrens Disability Service Grant Fund

  • This process was managed independently of CHO1 management and staff i.e. there was no visibility/input on applications.

  • 500 applications for the grant nationwide

  • Announcement was made on 5th June regarding successful applicants in Co Donegal unsuccessful applicants were contacted thereafter.

  • Funding for larger projects will be on a 3 year cycle.

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Respite Services

  • Work is proposed on Ballymacool respite centre to increase capacity including the reconfiguration of living space and extension of services from 5 days to 7 days

  • Riverwalk respite centre residents have been provided with suitable alternative accommodation and recruitment is ongoing. Plans to increase service from 3.5 to 7 days

  • Drumboe respite centre 2 out of the 3 residents have been provided with suitable alternative accommodation efforts are ongoing to find suitable accommodation for the third resident.

  • Core funding – has been (verbally) approved for alternative respite providers in the county including Bluestack & iCARE.

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Estates

  • Donegal East CDNT will possibly be relocating to Lifford hospital with renovations planned to accommodate. Long term plan is that it would be located in the planned new primary care centre in Lifford.

 

Parent Rep Input

  • Parent rep in Donegal North met with the Minister of Disabilities Anne Rabbitte on the 5th of June to discuss respite services in Co. Donegal.

  • A commitment was made at that meeting that funding would be allocated to improve capacity at Ballymacool, Riverwalk & Drumboe respite centres including 7 day services for all respite centres along with getting Riverwalk respite centre back open by September.

  • Organisations like Bluestack and iCARE provide an invaluable service to children and should be funded accordingly. Timeframes around the reopening of Drumboe was asked HSE could not provide timeframe. It was requested that an update on respite be provided for the next meeting

  • Parent reps in Donegal East had a query with regards to the criteria for inviting parents to courses run by the CDNT. HSE responded due to nature and focus of some initiatives/workshops the selection criteria for these initiatives and similar initiatives will remain confidential

  • Parent rep in Inishowen relayed disappointment that the Children’s Disability grant fund was not allocated to organisations who provide alternative respite to children in Co Donegal

 

SNPN Input

  • SNPN are concerned about timely and appropriate clinical supports for children who urgently need it across the county. There are many scenarios where children and families who urgently need intervention and support cannot avail of it under the current system. This may be due to the services not being available/roles vacant in their particular CDNT area. The delay in accessing timely and appropriate supports is having an enormous impact on the health & wellbeing of the child, their ability to attend school, and the health and wellbeing of the family. Can the HSE provide a clear procedure for accessing supports to families most in need of services by the next meeting.

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  • Feeding Eating Drinking Swallowing (FEDs) support in CDNT. SNPN requested that the HSE provide information on the FEDs support in Co. Donegal. A recent FOI submitted detailed how no FEDs clinics have been in operation since 2019 in the county. HSE responded that under Progressing Disability Services the responsibility for FEDs lies with the paediatric medical team with SLT support. It was stated that a multidisciplinary FEDS clinic is not best practice. SNPN relayed their concerns with regards to this – there is only 1 trained SLT on dysphagia in the county the impact the lack of FEDs support is having a negative impact on children across the county. Can the HSE review this and include on the agenda for the next meeting

 

  • Respiratory physiotherapy in the community – SNPN requested that the HSE provide information on the possibility of increased respiratory physiotherapy in the community.HSE responded that traditionally respiratory physiotherapy is not provided in the community although that is changing for adults with chronic respiratory conditions. They believe that there is a very small number of children who need respiratory physiotherapy so there is no critical mass for services in that area. Respiratory physiotherapy outside of acute care also comes with risks. SNPN: the provision of respiratory physiotherapy would support a proactive approach to the management of respiratory illnesses and complications for children with disabilities which could have a significantly positive impact for them in avoiding long hospital stays. Can the HSE review this and include on the agenda for the next meeting

 

  • Alternative respite providers – SNPN discussed how it was very welcome that core funding has been verbally approved for organisations like iCARE & Bluestack however the communications with regards to the allocation of funding in Co. Donegal could be improved as many organisations were hearing 2nd hand about funding applications.

 

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