CDNT staffing gaps continue despite reforms

Niamh Cahill reports on continuing difficulties accessing supports, services, and therapies from children’s disability network teams

In 2010, the HSE established the Progressing Disability Services for Children and Young People Programme. The programme was based on the recommendations of the 2009 Report of the Reference Group on Multi-disciplinary Services for Children aged 5 to 18 Years.

The aim of the programme was to oversee the restructuring of children’s disability services to deliver equitable family-centred services for children and young people with complex disabilities.

Under the programme, children’s disability network teams (CDNTs) were to be developed.

While roll-out was officially completed in 2018, staffing the teams has proven difficult.

Over the past several years, public representatives, GPs, parents, and families have highlighted the continued problems accessing support from teams.

While improvements have been made and staffing levels within teams have increased in recent times, it is evident that significant challenges remain.

In the Dáil in February, Sinn Féin Deputy Louis O’Hara outlined how service inadequacies are directly impacting vulnerable children in Galway in urgent need of care.

“I am inundated with families contacting me who are having a real difficulty accessing the supports, services, and therapies that their children need from CDNTs. The HSE data from last month [January 2026] showed a number of vacancies across the CDNT network in Galway,” Deputy O’Hara stated.

“At that time, just one CDNT out of 15 in the broader west and north-west region was fully staffed. The result of that is that children are facing extreme waits to access the services they need. It is causing untold stress to families as well.”

Minister Emer Higgins

He described the situation of a family in Co Galway, who had written to the Minister of State with special responsibility for Disability, Emer Higgins, about this issue.

“Despite repeated requests, they cannot get individual speech and language therapy for their son who is non-verbal and autistic,” he said.

“It is heartbreaking for them as parents to see their child not getting the supports that they need and they are not the only ones.”

Deputy O’Hara was speaking following a parliamentary question (PQ) by Fine Gael Deputy John Clendennen.

“My concern relates to families, who have seen a child diagnosed and put on a list,” Deputy Clendennen stated in the PQ.

Deputy John Clendennen

“They are waiting for a CDNT and they are not getting that support. The longer that goes on, the larger this problem is becoming. I appreciate that additional resources are being applied and delays are being addressed, but I would like to see a level of accountability and efficiency in how these services are being improved and expanded with the additional resources that are being applied.”

Access

The problem of access is being experienced across the country, according to GPs.

Earlier this year, Medical Independent (MI) columnist GP Dr Lucia Gannon wrote in this newspaper on the subject.

Dr Gannon outlined that CDNTs had been “hampered by a lack of staff and excessive bureaucracy” since their roll-out.

“Yet instead of acknowledging this as a reason not to accept children, the teams create barriers for families and GPs who try to access the service.”

The situation was “frustrating and time-consuming for GPs, but it is much worse for the children and their families”, wrote Dr Gannon.

Currently, around 45,000 children are receiving care through CDNTs nationally.

According to HSE data provided to MI following a Freedom of Information (FoI) request, the number of children referred to teams nationally has remained relatively static in recent years.

In 2025, some 10,383 children were referred for care. This compared to 10,281 children in 2024 and 10,661 in 2023.

A 2025 CDNT workforce report, compiled at the end of last year, stated the number of children awaiting care was 9,360 (as of November 2025).

Despite the staffing challenges, this was a reduction compared to April 2025 when 12,900 children were waiting.

Each CDNT should include nurses, occupational therapists, psychologists, physiotherapists, speech and language therapists, social workers, and dietitians, among other healthcare professionals.

Supports are available to children with complex needs, such as those with intellectual, physical, or sensory disabilities.

CDNTs are structured to be “family-centred and based on the needs of the child”, the HSE stated in its FoI response.

“This includes universal, targeted, and specialised supports and interventions, as appropriate to the individual child and family,” the Executive said.

“It is based on the objectives of empowering and supporting parents and others who are with the child on a daily basis to facilitate the child’s developmental needs.”

According to the HSE, there are 93 teams aligned to 96 community healthcare networks providing services and supports for children and teenagers up to 18 years of age.

However, only two of the 93 CDNTs nationally had a full staff complement in October 2025, according to the data supplied to MI.

The workforce report states there is a staff vacancy rate of 18 per cent.

Vacancy rates

The HSE is the lead agency for CDNTs nationally, managing 43 of the 93 teams. Enable Ireland operates a further 20 teams, while the Brothers of Charity manages six. The remaining teams are overseen by nine other agencies.

The Roadmap for Service Improvement for Disability Services for Children and Young People 2023–2026 sought to strengthen staff retention, development, and recruitment. The strategy was developed at a time when the CDNT staff vacancy rate had reached 36 per cent.

However, a breakdown of vacancy rates across CDNTs nationally in the 2025 workforce report highlights continuing significant variation between teams.

The Clonmel CDNT, managed by the HSE, has the highest vacancy rate at 58 per cent.

The Gorey CDNT and the Waterford North City CDNT, also operated by the HSE, each have vacancy rates of 52 per cent. The Swords team, run by the Central Remedial Clinic, has a vacancy rate of 47 per cent.

In contrast, some teams report relatively low vacancy levels. The Finglas CDNT, operated by the HSE, has a vacancy rate of just 3 per cent. Nationally, only two teams have their full staff complement in place – the Kilkenny CDNT and the Galway City West CDNT – both managed by Enable Ireland.

“Despite continuous recruitment efforts, CDNTs are facing challenges in sourcing suitably qualified and experienced candidates for several grades,” according to the 2025 workforce report.

“These roles undergo consistent recruitment efforts through multiple channels. CDNTs may also choose to reconfigure a chronically unfilled post into another grade or discipline.”

The report found that 457.4 whole-time equivalent (WTE)-funded posts remained unfilled at the time.

It also provides a profession-by-profession breakdown of vacancies nationally.

Dietitians had a vacancy rate of 33 per cent, down from 63 per cent in 2023.

Psychologists had a vacancy rate of 26 per cent, social care professionals 23 per cent, and speech and language therapists 20 per cent. Most professions within CDNTs recorded vacancy rates of around 20 per cent.

A more detailed staffing breakdown shows there were no intellectual disability staff nurses working within teams nationally.

Agency staff are used to supplement recruitment efforts, according to the report.

“Where possible, and in order to maximise recruitment, funded posts may be filled through flexible contracting arrangements. This approach assists with ongoing recruitment and retention by providing the flexibility required to meet the needs of both the current workforce and potential recruits. Agency staff are used to fill short-term vacant posts while recruitment is ongoing and also can be used to fill longer-term vacant posts where recruitment has been unsuccessful.”

Staff leave is another contributing factor. According to the report, 189.7 WTEs of 2,042.3 WTE staff were on leave, with maternity and parental leave accounting for the majority.

Of the 457.4 unfilled WTE posts, 321.1 were classified as replacement posts, while the remaining 136.3 WTE were development posts.

Retention

The report outlines that a strategy is in place to retain existing staff. To support this, a “CDNT research project” is due to take place this year.

“This research aims to understand the characteristics and motivations of healthcare workers who support children with lifelong disabilities,” according to the report.

“It will identify the key factors influencing retention, providing a foundation for developing effective retention and attraction strategies, as well as informed job design. This research will offer rich information to support us in developing and retaining our CDNT staff.”

A new CDNT sponsorship programme for newly qualified speech and language therapists, occupational therapists, physiotherapists, and social workers was launched in April 2025. The initiative resulted in 45 graduates taking up positions with teams across the country.

There has also been an increase in clinical placements within CDNTs. Between 2022 and 2025, the number of placements rose from 243 to 376. According to the report, trainee health and social care professionals are more likely to take up a postgraduate role in a service where they completed a clinical placement.

The aim, the report stated, is to create a “future pipeline of staff for CDNTs”.

Pathway

According to the FoI response, referrals deemed inappropriate for CDNTs are either returned to the referrer with an explanation or redirected to a more appropriate service under the HSE primary care/disability/child and adolescent mental health services joint protocol. These cases are not recorded as referrals received by CDNTs.

“If the referral takes a number of weeks to gather additional information, follow up with other services, etc, before the ‘right’ service is agreed, and clinicians’ time has been used to do so, then it is counted as a new referral received, and then discharged (transferred to another service),” the Executive stated.

The process was developed and worked through with CDNT managers.

A nationally standardised initial CDNT pathway – from waiting list to completion of initial contact intervention – will be applicable to all new referrals received from 1 June 2026. It will include a letter of acknowledgement within two weeks and an appointment for initial contact intervention within 10 weeks.

According to a HSE update report on the roadmap (Quarter three, 2025), 63 per cent of actions had been achieved and the remaining 27 per cent were “well advanced”.

“We are now planning the transition from the roadmap by year end to a new service improvement programme for children and young people’s services [in] 2026,” according to the update.

“This programme will be broader, incorporating residential and respite services, single point of access to children’s services, roll-out of Enable Ireland’s parent peer-to-peer support pilot, a nurse-led early intervention service for waitlisted children, and more.”

Commitment

The level of non-pay annual funding allocated to the service has increased from €5.4 million in 2022 to €8.2 million in 2025.

The HSE National Service Plan 2026 commits to a further reduction in waiting lists by 25 per cent in 2026 and that no child will wait longer than 12 months.

The HSE hopes the recruitment of 202 additional staff will help it achieve the targets.

In response to a PQ from Fine Gael

Deputy Peter Roche

in February, the HSE said recruitment will be conducted through “bespoke campaigns”.

A case co-ordinator role will be established in each network and a national lead for clinical pathways for children with physical support needs will be appointed, stated the PQ response.

Also responding to the PQs, Minister Higgins emphasised the efforts underway to improve services.

“We are embarking on a recruitment campaign to make sure we are bolstering our teams,” she stated.

“Part of that will be international and national recruitment, but it will also be making sure, for example, that we are expanding training places, which happened in June of last year.

“There will be up to 461 additional student places by the end of 2028 and the majority of those have commenced. New roles and training pathways are being developed to expand the skills mix and the pipeline of people we can hire. We have student bursaries and trainee programmes.”