Mr. David Walsh:

I am grateful for the invitation to meet the committee to discuss a range of issues concerning disability services. I am joined by my colleague Mr. Bernard O'Regan, Mr. Donan Kelly, Dr. Amanda Burke and Ms Martina Queally.

The role of the HSE is to provide a multidisciplinary team-based approach, which includes the provision of health and personal supports required by children, including children with disabilities, incorporating acute hospital, child and adolescent mental health services, CAMHS, primary care and other community services.

The national policy on access to services for children and young people with disability and developmental delay is designed to ensure that children are directed to the appropriate service, based on the complexity of their presenting need. This may include primary care for non-complex issues, children's disability network teams for more complex issues, and CAMHS for other presenting issues. For a subset of children, all three services may need to work in partnership to achieve the best outcomes for that child. The final report into CAMHS was published by the Mental Health Commission on 26 July this year and all the findings have been accepted by the HSE. Together with the Maskey report, and the findings from HSE commissioned audits on prescribing practices, adherence to CAMHS operating guidelines and service user experiences, these findings are directly contributing to the HSE's programme of work to improve services.

The Ombudsman for Children published his report, Nowhere to Turn: Children with disabilities left with no support, in September of this year. The HSE acknowledges the findings in this report and in response is undertaking a series of actions to identify, as early as possible, children whose discharge from hospital may be delayed and quickly identify and overcome issues that may impact on their discharge. These actions include a national audit of all children delayed in hospital to assess how current discharge processes are working and remedial actions. A draft assessment guidance and framework for the case management of children with complex needs in hospital beyond medical need has been developed and is currently being considered for approval.

The roadmap for service improvement for children's disability network teams has recently been published and is currently being actioned. A national review of alternative care is under way and will be completed by year end. A review of the HSE and Tusla joint protocol is also under way.

The HIQA overview report on monitoring and regulation of disability services in 2022 has been published. While the report reflects continued improvements in the quality and safety of disability residential and respite services, it also points to the need for each registered provider to increase its focus on its governance and management of services. Key learning from this report includes the need for continued attention by registered providers on governance and management, including the importance of each provider to establish the appropriate relationship between the board and executive team.

Congregated settings continue to show higher levels of non-compliance, emphasising the importance of progressing the decongregation policy and the continued work required to ensure a human rights based approach to service delivery

Legislative changes to allow for emergency accommodation will impact positively on the provision of residential services to children. The HSE will continue to engage with internal and external stakeholders, including the Departments of Health and Children, Equality, Disability, Integration and Youth, Tusla and others to promote the provision of high quality services for children with disabilities.