Dr. Cathal Morgan:

I should respond immediately to Deputy O'Reilly's point that the standard operating procedure, in and of itself, will not resolve these problems. That is absolutely the case. If I thought it would , that would be great but it is not the case.

There are four key points in order to contextualise. It is the case that, as a result of population growth, we will see a lot more children coming, necessarily, forward for services. The factors that affect disability have changed quite dramatically. Senator Conway-Walsh mentioned autism. It is a very substantial factor that needs to be considered in the context of the delays we have in making assessments and offering diagnoses and interventions. One will see that pattern very clearly when one looks at it by CHO area. Very high numbers of people are waiting primarily because certain assessments and interventions need to take place. That is one factor. The second factor that is critically important to emphasise is the issue of access. What I mean by access is it is absolutely the case there are not sufficient therapy grades in the system. There is no doubt about it. A recent National Disability Authority report indicates that we will need at least another 400 therapy grades in the next three years or so in order to be able to respond adequately to presenting need. It is important to make that point at the outset. We could add in all these therapy grades, which we need, but if we do not deal with structural and practice issues, we could still end up with inequity in the system. From a structural point of view, what we have been trying to implement in each of the nine CHO areas, as a partnership between the HSE services and our colleagues in section 38 and section 39 organisations, which are the very familiar disability organisations that most people know about, are what are called progressing disability services.

Many of our therapy resources are delivered through the section 38 and section 39 organisations. What we are trying to do structurally is to have in place a network team that is made up of people from the various disciplines that are required to deal with very complex disability cases. The team would be overseen by a manager. Currently, services in each CHO area tend to operate in silos. We are trying to move away from that, which the sector has accepted, and to have much more of a network team approach whereby a lead clinician or manager would pool the resources to ensure that there is good assessment, good follow-up and intervention happening. In other words, that the resources would be used much more efficiently. This is because, at present, there is huge inequity in the system.

In addition, we have been trying to implement a national access policy. Some children, because of their complex set of circumstances, will require the involvement of a number of different disciples simultaneously. Some people may need to access only one intervention. For example, a person may need to see a speech and language therapist or a psychologist. The national access policy is a guide to steering people toward the right service, for example, advising a person that it is best for him or her to go to his or her primary care service. When there is a complexity of need, the person should be with a network team and then he or she would become part of the caseload of that multidisciplinary team.

The fourth element is that we believe there is a need to examine the way in which professionals work within the system, in other words, practice concerns. That leads me to the point we have been making regarding the standard operating procedure. We are not trying to dumb down or limit clinicians in terms of their autonomous working, rather we are trying to put a framework in place within which we can meet our statutory needs but also strike a balance between diagnostics and assessment versus intervention. I will ask Ms O'Neill to go into this in some depth to address Deputy Donnelly's question when he asked that we talk him through what the new standard operating procedure involves and the steps to be taken. Nowhere in the standard operating procedure are we saying that a full assessment should not be done. There is an opportunity to do a preliminary team assessment at an early stage. When children and families come forward, they are likely to engage mostly with an assessment officer who is not necessarily a clinician. An assessment officer has to rely on a multitude of disciplines to advise him or her on the best approach to take in an assessment of need under the Act versus full assessments that need to be taken on board in regard to doing intervention work. We are trying to see if we can get a balance between assessment and intervention. That is what we are trying to do with this standing operating procedure. I will ask Ms Angela O'Neill to describe the current system and what we are trying to move towards.