What’S Wrong with Ireland’s Speech and Language Therapy Service?

Ireland is far from unique in terms of the challenges it is facing with respect to the provision of interventions and supports for children and adolescents experiencing a delayed or Developmental Language Disorder (DLD) requiring speech and language therapy.

Developmental Language Disorder is a condition in which a child’s language performance significantly differs from the performance of the majority of his/her peers without any underlying biomedical explanation.

In fact, research from CATALISE, a Multinational and Multidisciplinary Delphi Consensus Study Identifying Language Impairments in Children has found varying levels of success in member states across Europe when it comes to responding in a timely manner to the therapeutic needs of the approximately 5.8 million children and adolescents that have a DLD in the EU.

The specific magnitude of the challenges that Ireland is currently experiencing can be seen in the growth in demand for speech and language assessments over the course of the last decade and the parallel, if partial, deterioration in the level of services available, due in the main to an inability to recruit a sufficient number of therapists.

These are features that are replicated in many EU member states and in Ireland’s nearest neighbour, the UK. Analysis of the available data from England shows that as of July 2024, approximately 76,000 children were waiting for speech and language therapy. Challenges in remedying this situation are being compounded by a 17% vacancy rate in private and National Health Service (NHS) speech and language therapy posts (16% of the vacancies are specifically in NHS posts).

A review of the progression of the problem in Ireland shows that in 2014 the number of children awaiting a speech and language assessment for more than 12 months was approximately 3,000.

As of March 2021, the cohort who were waiting more than 12 months had ballooned to over 14,000 children.

Zooming out, the situation in 2021 across all waiting time periods was even more alarming with nearly 45,000 children on a waiting list for speech and language assessments and therapy.

Additional data obtained from reporting in Ireland’s media has identified that of the 45,000 children wating in 2021, more than 16,000 were awaiting initial assessments. 9,574 were waiting for initial therapy, with nearly half of these waiting over a year. Additionally, it was reported that 18,552 were awaiting further therapy, with more than 6,000 waiting for over a year.

In May 2022, national waiting lists in Ireland recorded 32,151 children waiting for SLT services, with approximately 11% waiting over a year.

Jumping forward to 2024 it can be observed that despite significant recruitment challenges the situation has generally improved with Ireland’s Health Service Executive confirming that just under 20,000 people were waiting for an initial assessment for speech and language therapy.

Unfortunately, this is not the entire picture as parents and children still must endure long waiting times to access actual therapeutic appointments and service provision following their initial assessment process.

This is partially explained by the wider challenges present in Ireland’s Assessment of Need (AON’s) regime in which speech and language therapy provision is embedded. In Ireland the Health Service Executive (HSE) operates under a legally mandated time frame for AON’s as set out in the Disability Act 2005. Currently over 10,000 children are waiting for an Assessment of Need (AON) and 110,000 are awaiting essential therapies.

A significant number of parliamentarians in Ireland routinely highlight how this increasingly involves parents and caregivers taking the Irish state to court to have their children’s rights vindicated under the Disability Act. Debates on this matter within the Irish Dáil have pointed to the fact that 25 families a month on average are compelled to go to court to force the State to provide an AON.

Further challenges confronting parents and caregivers when trying to access speech and language therapy through Ireland’s public health service relate to the fact that referrals are often sought from a General Practitioner or directly by parents through the local Children’s Disability Network Teams (CDNT’s).

There is however a recognised crisis in both of these networks in Ireland. The Irish College of General Practitioners (ICGP) have said that while the ICGP is now training 70% more GPs per year than it did six years ago, it has an ageing workforce and an expanding population with a quarter of its GP’s over 60 years of age and operating in practices that are at full capacity. This essentially cuts off timely access to one of the main referral routes to speech and language therapy for many parents.

In terms of the CDNT’s. These were established in response to the unintended difficulties created by AON legislation and as part of Ireland’s Progressing Disability Services strategy in 2020 that required the pooling together of all resources, including staff, facilities and equipment, from the different voluntary agencies and the HSE providing specialist children’s disability services.

However, although the objective was laudable; to enable a child to access CDNT services based on his/her needs, i.e. that a diagnosis would not be required, the expansion of the service to include all children with complex need arising from their disability has overwhelmed the CDNT model and led to further delays and lengthy waiting time lists.

Essentially all children with a disability with varying degrees of complexity from mild to severe are trying to access the same limited availability of service provision.

In the broader international context Ireland is also experiencing many challenges created by the regulatory environment both domestically and within the EU.  Much of this is related to the need to comply with Directive 2005/36/EC on the Recognition of Professional Qualifications which provides a number of mechanisms for the recognition of professional qualifications across the EU.

This Directive applies to all EEA nationals who wish to practise any regulated profession in an EEA Member State other than that in which they obtained their professional qualifications.

This includes Irish citizens with professional qualifications obtained in any of the other EEA Member States, including the United Kingdom, who seek to return to Ireland to practise their profession.

Specifically for speech and language therapists, this means that while qualifications from one EU member state should be recognised in another, the process remains highly complex and difficult to navigate.

This is usually attributable to the amount of time involved in assessing qualifications against the standards of the host member state (e.g., Ireland) to ensure comparability of professional activities. So, while regulations to ensure safeguards are in place are welcome, one of the effects has been a delay in allowing trained therapists to take up employment in states where the need is particularly high.

Statements issued by the Irish Health Minister in response to parliamentary questions on this issue has further elaborated how the Directive works in practice.

These statements have noted how the General System of the Directive, which applies in the case of speech and language therapy qualifications, provides for an assessment on a case-by-case basis of the qualifications of an applicant against those required to practise in the host member state if the professional activities covered are comparable. If the professional activities are not comparable then the qualifications cannot be recognised.

However, if the professional activities are comparable but deficits in the qualification are identified, subsequent post-qualification professional experience of the applicant must be considered for successful registration in Ireland.

If deficits in qualifications remain, the Directive provides for the competent authority to offer an applicant a compensation measure i.e. the choice between a period of adaptation (a placement) and an aptitude test.

The Speech and Language Therapists Registration Board is designated as the competent authority under Directive 2005/36/EC in Ireland for professional speech and language therapy qualifications.

It is clear then that while there are strong provisions for the right of children and adolescents to access professionally competent therapists, the registration process remains somewhat cumbersome, thereby allowing further lengthy waiting times to emerge.

It is also clear that as Ireland’s population becomes significantly more diverse there will be a growing need for multi-lingual speech and language therapists. One major survey across multiple European countries, including Ireland, has found that while there is an awareness of the need for specialised approaches for multilingual children, there is also a consistent complaint around the lack of resources and training for this very specific kind.

Overall, a picture of the state of speech of language therapy provision in Ireland is mixed. There has certainly been a concerted attempt by Governments to ensure sufficient exchequer funding is directed toward meeting the need for disability services which includes speech and language therapies. Building on previous years, the outgoing Government allocated an unprecedented level of funding of almost €2.8bn for Disability services for 2024. This followed substantial increases in recent budgets to address the shortfalls identified in the Government’s Disability Capacity Review.

The fact remains however that Ireland, like a number of other EU member states is experiencing ongoing and severe challenges relating to recruitment and retention of qualified staff irrespective of the enormous funding that is available. It has also yet to find an appropriate model of service provision whose configuration is capable of meeting the various levels of need children with Developmental Language Disorder experience ranging from the mild to complex.

The political will is there. The problem lies with identifying the way to appropriately respond to a service beset by high demand and unacceptably high waiting lists.