Failures in the speech and language sector in the HSE
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I want to remind people about a conversation we had yesterday on the show. It was with Gareth Noble from KOD Lines, the law firm, and he specialises in child law. And we spoke about delays that families face when it comes to getting care for their children with additional needs. We talked about the Disability Act explaining

Exactly why, I guess on paper, it is so progressive, but then why in effect that progression isn't always felt by the families who need help. Take a little listen. But I mean, the Disability Act was actually a very progressive piece of legislation because what it said to families and to children is you have a legal right to an assessment of need within that six month timeframe. It also specifically said in the Disability Act that a lack of resources is not a defence. So when we do go to court, of course,

In 99% of cases, the court will make the order in favour of the child because lack of resources is not something that can be opened as a legal defence to those proceedings. However, the reality on the ground is that parents are being told it is in fact a lack of resources that sees their children perhaps not being assessed for three, four years when it should be done within that six month timeframe.

So that's just a little bit of Gareth speaking on the show yesterday. And what we talked about won't be news to anybody who's had to deal with this system. And we've talked about it on this show many, many times. So initially, what do you need? If a child is suspected of having additional needs or you know they have additional needs, they need an assessment of needs and it's meant to happen within six months. It almost never happens within six months. And then after the assessment of needs...

there is a plan put in place and that plan would involve occupational therapists or physical therapists or physiotherapists or speech and language therapists or all of the above. But you never get as much therapy as you need. And again, there is waiting times for all of that, which is why parents end up going down the private route or they go down the legal route and try to enforce the child's rights. So that's what we talked about yesterday. But Brenda Kenny is with me in studio to continue the conversation today.

because Brenda's a retired speech and language therapy manager with the HSE. So, Brenda, thanks a million for coming in to us. No problem. Thank you for having me. So, I mean, how do you feel having worked in the system when you hear, say, Gareth talking about it yesterday or when we hear from parents who find themselves in this situation? Well, it just feels very dispiriting. I mean, the UN Children's Charter Act,

enshrines the right to communicate. Children need to have their voice heard. So speech and language therapists are eminently placed and have expertise in giving voice to the child. And I think the current just very justifiable discussion around grace clearly shows that when you are without a voice, you are exceptionally vulnerable. And I think the HSE's

continuous inability or refusal to adequately staff their clinical teams, be they in primary care or disability. And to the public, it doesn't really matter primary care or disability. They simply want a service for their child. But a continuous failure to adequately staff

workforce plan and to recruit staff compromises children's life outcomes across every domain of their development. So how functional or otherwise dysfunctional maybe is the system from the inside?

Because we're left kind of on the outside looking in at this big opaque thing and trying to work out what the problem is. OK. Well, Tony O'Brien, when he was CEO of the health service, he described it as an amorphous blob. Now, if it's possible for a blob to become even more amorphous or whatever the word is, and even blobbier, it has become that. And...

There is a huge, there's a disproportionate increase in middle management. I was astounded myself when I looked at their staff census. So there are about six or seven layers of management. You've got executive management, senior management, middle management and admin management. And the figures as of January 23 were 24,000.

And this contrasts very heavily with the... We're called allied health and social care professionals, so essentially we're the clinicians. And if you like, you know, with respect, we are the ones who deliver health care. So be it podiatrists, dieticians, speech therapist, clinical psychologists, we are the ones who do the work. It's as simple as that. So it's hard to understand why...

the HSE continues to build those layers and layers and layers of non-clinical duties or non-clinical staff. Another issue is that

Clinicians are accountable for everything they do, you know, and we have deliverables. So our deliverables are reduction in waiting list, better therapy outcomes for children, better life outcomes for children. On the other hand...

the management level, there are no deliverables. There is no accountability. So that is a huge disconnect. Yeah, I think that's something that always confuses us from the outside looking in is how often we hear the same thing when it comes to a paucity of services. It's about resources. We don't have the speech and language therapists. We don't have the occupational health therapists. We don't have the child psychologists or psychiatrists. We don't have the frontline services. And yet,

figures are produced that shows the HSE is getting bigger and bigger and bigger. And we wonder, who are they hiring if they're not hiring the frontline workers? They are hiring people with no front-facing clinical duties. And the narrative that is spun out there is these managerial roles are to support clinicians. It is absolutely not the case. So, for instance...

All clinical therapy managers have absolutely no admin support. Their staff have no admin support. So you can imagine the waste of clinical time in performing admin duties. How frustrating is it? It is unbelievable. I mean, I went into this profession as a speech language therapist because of my...

you know, commitment to giving voice to people who don't have a voice. And we have to also remember that the purpose of a health service is to reduce the health inequalities brought about by economic disadvantage. And yet every decision the HSE makes goes against that. So they fail across so many levels.

We talked about slouchy care, right care, right time, right place. So everything that's happening currently goes against those principles. And there is no, from my perspective in working with the HSE and having been there and attended years and years of management meetings where my...

ears would be bleeding listening to meaningless nonsense where patient care was never the focus of the meeting. Never, ever, ever the focus of the meeting. So you really wonder what these people who are, I find it laughing to call them, you know, senior management, executive management, are

What is their motivation? Where is the vision for the delivery of a health care service? And this is getting into the realm of supposition, but why do you think

this has happened. You know, I doubt when you kind of, on an individual level, the senior kind of management roles in the HSE are not populated by bad people. They're not out there. They don't get up in the morning and say, I'm going to try and make the health service more dysfunctional. You know what I mean? One would like to think so. One would like to think so. One would like to be utterly cynical. Yeah, let's park our cynicism for a moment and say that, you know, they're

On some level, they're motivated by the same thing as everybody else, which is kind of, you know, incremental improvement. And yet for them, incremental improvement means I must expand middle management. That would seem to be it. Can you make sense of that for me?

I can make sense from their perspective. If you have a job, you want to advance in that job. And if they continue to add to the layers of middle management and executive management and corporate people, they have to go somewhere. There has to be a career trajectory for them.

Unlike in the therapy professions, you know, we have a very small, you know, the heights to which we can aspire are fairly flattened, you know, so that creates, you know, a disparity. So there's just a culture of management for the sake of management. It feels like that. Yeah. It really does feel like that. And I suppose...

A lot of people have been there for a very long time. It seems they would interview each other. They would build relationships with each other. So, you know, there are some very questionable HR things that happen in terms of promotion. And it was pretty obvious during COVID where...

It was the clinicians who were all redeployed for very significant amounts of time to the assessment centres and testers and all of that. Whereas no managers were. And yet they, following COVID, they were promoted again. And the clinicians were not allowed to put themselves forward for these promotion roles. So it's...

You know, there is very much a culture of it's almost like clinicians are seen as the enemy. We're the source of the problems in the HSE. Because when you think of it, it looks like the waiting lists are caused by the clinicians. That isn't the reality. Clinicians have no voice at senior management tables. So then the voice of the patient is absent as well. So, yeah.

If you don't understand the patient journey or never actually speak with the patient or a service user, as they prefer, you called them, you don't really have any understanding. You know, so if you decide to make some changes in the health service, if senior management decide to do that,

If it takes five years for this thing to bed down, it really doesn't matter because you never have to listen to a parent of a possibly autistic child, you know, talk about taking her own life because there are no services and she sees no future for her child. And when you describe yourself being in these meetings where your ears would be bleeding with the meaningless management speak, how often do they talk about the patient in those meetings?

What did you call them? The service users they prefer? I don't know what the preferred nomenclature is at this point. Never. I mean, there will be talk of new templates. I mean, they're great for templates and data. But the data, even the data that clinicians capture, it's meaningless. They call it

key performance indicators, it's nothing to do with your performance. All it is, is waiting list data. They need a manager to go through it all. Absolutely. And there are plenty of them, believe me. And there's also an acceptance that

So, for instance, your statistics that are presented or your KPIs, it's only when the waiting lists go beyond 12 months that any alarm bells are raised. So there's an acceptance that a year or more in the life of a child, it's OK to wait. It doesn't matter. And, you know, we know that early intervention is key and that it works. Given how long...

we have been talking about this and how little movement there has been on waiting lists. So the Disability Act is two decades old now, 20 years, 24 years. We never hit that, almost never hit that six month target for an assessment of needs. How much or how little confidence have you that the system will improve in the foreseeable future? I have absolutely none, Ciarán. No, I mean, it's shocking. I often think

Back, I did work in the UK and the English people had such pride in their National Health Service. And I don't think in Ireland we've ever had pride in the HSE in its various iterations. And that's, it's quite shocking to work in an environment and in an institution that you don't have confidence in or you don't feel the capacity for positive change is there. Yeah.

Brenda, listen, thanks a million for coming in to us. Really appreciate it. And fascinated to get the insight from inside the machine. Brenda, Kenny is a retired speech and language therapy manager with the HSE.