Dr. Cathal Morgan:

We are grateful for the invitation to attend the meeting to address matters relating to the AON under the Disability Act 2005. I am joined today by my colleague, Ms Angela O’Neill. She is a national disability specialist and works with me as part of the national operations team. I understand that the committee wishes to gain greater understanding of issues surrounding the SOP, which the HSE regards as a necessary operational support to implementing the Act and which is currently the subject of an important consultation process with Fórsa trade union.

Since the commencement of Part 2 of the Disability Act 2005 in June 2007, the HSE has endeavoured to meet its legislative requirements as set out in the Act. Under the Act, any child born on or after 1 June 2002 is eligible to apply for an assessment of need. Children who qualify for an AON under the Act have a right to an assessment of their health needs arising from their disability; an assessment report; a statement of the services they will receive; and to make a complaint if they are not happy with any part of the process. The Disability Act outlines the statutory timelines under which an assessment of need must be completed. In effect, the assessment must be completed within six months of the application date with a further month to issue the report and service statement.

The numbers of applications for AON under the Act have increased steadily since its implementation in June 2007. In 2008, 2,535 applications for an assessment were received with 1,392 assessments completed. By 2017, the number of applications received had grown to 5,814 with 3,660 assessments completed. When originally implemented, it was envisaged that the assessment of need would apply to children aged less than five years and the Education for Persons with Special Education Needs Act, EPSEN, 2004 would address the needs of older children. The committee may be aware that the EPSEN Act has not been fully implemented and, following a High Court ruling in 2009, eligibility for AON was expanded to include all children born on or after 1 June 2002.

A 2016 review of the practice of implementation of this Part of the Act confirmed anecdotal evidence that the approach to AON is not consistent across the country. There is evidence that practice varies widely across the nine community health organisation areas. While a large number of guidance notes regarding AON processes have been issued since 2007, there has been no nationally standardised or agreed definition of "assessment of need". As a consequence, it is a considered view on the part of the HSE that the Act includes a number of definitions that are open to interpretation operationally, therefore, leading to an inconsistent approach as well as inequity in time afforded to "assessment" versus "support or treatment" interventions with children and their families.

While the Disability Act does not attempt to define an assessment of need, it does state that the assessment officer must prepare a report of the results of the assessment. This report must set out the findings of the assessment together with determinations on:

(a) whether the applicant has a disability;

(b) where the applicant has a disabilityi. a statement of the nature and extent of the disability

ii. a statement of the health needs (if any) occasioned to the person by the disability

iii. a statement of the services considered appropriate to meet the needs of the applicant and the period of time ideally required for the provision of those services and the order of such provision

iv. a statement of the period within which a review of the assessment should be carried out

In practice, because of a perceived legislative requirement to undertake a detailed and comprehensive assessment, assessment officers and clinicians have erred on the side of requesting and administering a wide range of assessments in as short a timeframe as possible. In some cases, children may undergo numerous assessments in a short timeframe where a period of diagnostic intervention might be more appropriate.

In an effort to standardise procedures and to facilitate timely assessments, the HSE identified a requirement to develop a SOP for assessment of need under the Disability Act. This SOP is intended to replace the suite of approximately 50 guidance notes issued since 2007 and will define the assessment. It is intended that an AON will comprise a PTA that will determine a child’s needs and will identify initial interventions that will be required to meet these needs. In developing this SOP, a consultation workshop was held in September 2017. Attendance included representatives from the following disciplines: assessment officers; liaison officers; community health doctors and paediatricians; occupational therapists; physiotherapists; psychologists; and speech and language therapists. Following this workshop, a range of email submissions were received and considered. Parent feedback provided through a parallel review of ASD services was also included in our considerations.

It is intended that the National Policy on Access to Services for Children and Young People with Disability and Developmental Delay 2016 will form the basis of the revised structure for the AON. The implementation of this policy has been identified as a priority in the national HSE operational plan for 2018. The decision-making process outlined in the access policy should be utilised to determine whether the child presents with the level of difficulty and complexity that would require referral to a children's disability service. Children who do not require a disability service would generally be deemed not to meet the criteria for eligibility for an AON.

It is important to note the implementation of the revised AON procedure and the national access policy are linked to the wider reconfiguration of children's disability services. This reconfiguration project is advanced and represents a change from an historical model whereby children access services based on criteria such as age and diagnosis. The new model is designed to facilitate equitable, timely access to services based on need.

The SOP is intended to ensure a standardised approach across the State in respect of the operational application of the Disability Act. Additionally, it offers an important opportunity to balance or ensure equity in terms of assessment and support interventions for vulnerable children and young people with disability. Regarding the current status of the SOP, it is important to reiterate that the HSE is engaged with a consultation process through Fórsa and hopes to successfully conclude this engagement in the coming weeks, prior to roll-out. This concludes my opening statement and together with my colleague, I will endeavour to answer members' questions.