Mr. Pat Healy:

I thank the Chairman and members for the invitation to attend today. I am joined by my colleague Ms Anne Melly, specialist in disability services. The committee requested information on the provision of therapy services for children with special needs in educational settings and I will outline the national programme under way to standardise and develop the way in which services for children with disability, including those with autism, are delivered. I will then deal specifically with issues in the Dublin north and north city area in which St. Joseph’s school is located.

The Health Service Executive has recognised the overall need to standardise the way in which services for children with disabilities, including those with autism, are delivered. We are currently engaged in a reconfiguration of our existing therapy resources to multidisciplinary geographical based teams for children as part of the national programme on Progressing Disability Services for Children and Young People between zero and 18 years. The objective of this exercise is to achieve a national unified approach to delivering disability health services so there is a clear path to services for all children, regardless of where they live, what school the go to or the nature of their disability. There is a national structure to underpin this change management programme with national, regional and local implementation groups in place. All elements of the implementation structure include multi-stakeholder involvement, including representatives from the Department of Education and Skills and its relevant service strands, including the National Educational Psychology Service and the National Council for Special Education.

The vision for service delivery is that every child and its family will have access to required services; there will be equity and consistency across the country; effective teams will work in partnership with parents; resources will be used to the optimum; and health and education will work jointly to achieve best outcomes for children. The intention is to roll out an integrated care model that will allow children, whatever the nature of their disability, to be seen as locally to their home and school as possible, at primary care level when their needs can be met there and by a network specialist interdisciplinary team if their needs are more complex. The primary and network teams will be supported as appropriate by specialist support services with a high level of expertise in particular fields.

An additional €4 million has been specifically allocated in 2014 to drive implementation of the programme, and this equates to approximately 80 therapy posts. As the programme is rolled out, it will ensure that the resources available are used to best effect in order to provide health supports and ongoing therapy to all children between zero and 18 in line with their prioritised needs. In particular and over time, it will mean that all children, regardless of where they live will have equitable access to services based on their needs.

Within the Health Service Executive, local services are delivered through integrated service areas, ISAs. Each of these is at different stages of development across the country and the 2014 plan will see developments across a number of categories. The local implementation groups in the mid west, Meath, west Cork, Cavan and Monaghan are already well developed and will consolidate implementation of the model, building on progress to date. The local implementation groups in Kerry, Mayo, Galway, north and south Lee in Cork, Wexford, Kildare and west Wicklow and the midlands are ready to move to the next phase and will begin to fully reconfigure their services in line with the model. The local implementation groups in Dublin will also see significant progress; Dublin north and Dublin north city on the north side and Dublin south, south east, south west and south central on the south side will finalise the consultation phase with all stakeholders, complete implementation plans and commence reconfiguration towards the new model of service. The local implementation groups in Donegal, Sligo, Leitrim, Roscommon, Louth, Carlow, Kilkenny, Waterford, south Tipperary, north Cork and Wicklow will progress to the consultation phase and will establish a health and education forum, reviewing and amending governance and management structures, service policies and procedures and prepare for reconfiguration in 2015.

Turning to the reconfiguration in the Dublin north area, Dublin north and Dublin north city, services to children with disabilities in this area are provided by a variety of service providers, including St. Michael’s House, Daughters of Charity, Central Remedial Clinic, St. Paul's hospital and special school, which is linked to the Mater hospital, St. Joseph’s School for the Blind, Child and Adolescent Mental Health Services, HSE early intervention services and Beechpark services for children with autism.
While many models of good practice have been developed and implemented to meet the needs of children with disabilities in Dublin north and Dublin north city, access to services and the timeliness of the response to identified needs has been largely determined by whether a child resides in an area where there is a service provider with a level of resources which enables a speedy and appropriate response. Access to ASD services for children with normal IQ or mild intellectual disability has been determined by whether the child attends a class supported by Beechpark services.
With regard to autism-specific services and complex needs, Beechpark services and St. Paul's hospital and special school are autism-specific services, but the remaining service providers are also involved in meeting the needs of children with autism when the presenting need is less complex or where the primary disability is intellectual or physical or sensory. Beechpark services are primarily targeted at providing appropriate multidisciplinary supports to children in Dublin north and Dublin north city who attend special ASD-specific classes that have been developed in special and mainstream schools.
With the multiplicity of service providers involved and the diversity of children’s needs, ranging from mild intellectual disability to much more complex needs involving multiple disabilities, issues have been identified regarding the need to have very clear identified care pathways for all children requiring health and personal social services. Evidence would suggest that there is greater clarity with regard to access where needs are clear and diagnosis is straightforward. However, the pathway for children presenting with complex needs has not been as clear, and gaps have been identified. In this context, some children diagnosed with ASD have had difficulty accessing a service and transitioning from one service to another.
In response to the many challenges emerging regarding the reconfiguration of multidisciplinary services in these areas, a dedicated senior manager has been assigned by the HSE to manage the reconfiguration programme. An implementation group comprising all stakeholders - including all service providers, representatives from the education sector and parents - is in place and work is actively progressing to attend to the realignment and reconfiguration of the service delivery system in line with the agreed policy direction. This work involves considerable system changes and it has been recognised that during the period of implementation additional resources will be required to address waiting lists and service pressures. In this context an additional five posts were approved in 2013 to enhance the service response for children with ASD, and these posts are currently being recruited. More important, a further 21 posts have been sanctioned in 2014. This additional resource will enable the commencement of an enhanced service response for those children presenting with complex needs, including ASD, in this area.
The HSE and the Department of Health jointly commissioned the NDA to carry out research into the practice of assessment of need. The findings of the report produced on the national programme for children aged 0 to 18 years highlighted that where the Health Service Executive has configured disability services for children into geographically integrated teams, the statutory assessment of need process worked better and in a more streamlined way. There was also less emphasis on using the assessment process to develop diagnoses in order to meet the specific entry requirements of individual services. Accelerating the reconfiguration into geographically integrated teams would be very important, therefore, in improving the efficiency and effectiveness of the statutory assessment of need process.
I am happy to answer any questions from members of the committee.