Mr. Odhrán Allen:

We knew this question would be asked and it is not an easy question to answer. We hope that part of what will come out of today is a focus on a solution. From the perspective of the Association of Occupational Therapists of Ireland, this standard operating procedure, SOP, has highlighted three problems in the system. In seeking a solution we must take account of the problems. The SOP has highlighted the under-resourcing of services leading to long waiting lists, which is a reality in the disability services. The SOP will only exacerbate that. There is an inequity of service delivery nationally because only two of the nine community health organisations, CHOs, have been reconfigured under progressing disability services. That is part of the solution that is needed in the system also.

There are issues with the Disability Act and the assessment of needs process, which are matters for the Oireachtas to address. It is clear from the two professional groups represented here and it is certainly a serious concern for our members, that the professional autonomy of occupational therapists is compromised by this SOP. Persons carrying out an assessment of a child to determine whether he or she has a disability need to be able to stand over the report they produce or to which they contribute. They need to be satisfied they have gathered all the correct information and have carried all the necessary assessments to be able to stand over what are very important matters. Certainly the 90-minute cap on assessment is hugely problematic.

Page 79 of the SOP deals with guidance for assessors and under the section on assessment process, it states that a preliminary team assessment will be the first step in every child or young person's interaction with the disability service and that in cases where an assessment has been made for an assessment of need, AON, under the Disability Act 2005, this preliminary assessment will fulfil the team's obligation under AON. What this is saying, not in the body of the SOP but in the guidance notes for assessors, is that the HSE's intention is that this preliminary team assessment will become the model for the first point of contact with all disability services for children.

This is problematic because we understood this was an attempt to address the problem with the AON - the requirement in the Act for it to be completed within three months. However, this states that the preliminary team assessment will become the first point of contact for all children. We do not understand why that would be the case. Surely the first point of contact for somebody who is not seeking an assessment of need should be to be seen by a team for a full team assessment. That needs to be looked at.

The following item in the guidance notes on page 79 needs to be fixed. It states that no family should leave the clinic without some strategies to support the child or young person. We understand why the HSE would want that to happen. No professional would like to be seeing a family in this context and not be able to follow through. However, the reality is that this is a preliminary team assessment under the AON. It is not a full comprehensive professional assessment. We should not conflate the two. A professional cannot be asked to carry out a preliminary team assessment to establish what is required under the Act and then be expected to carry out a level of intervention, which he or she cannot do without first having carried out a full professional autonomous assessment. That is part of the solution. That is my initial response. Ms O'Malley may wish to add to that.