Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I thank the committee for this further opportunity to update it on some of the issues raised in the Ombudsman for Children's report, Unmet Needs. Since becoming Minister of State with responsibility for disability, addressing and tackling the assessment of needs backlog has been and remains a top priority for me. Less than two weeks ago, I spoke at the beginning of a Private Members' motion on autism services of my vision for the provision of disability services for people of all ages in the coming years. A number of Deputies who were present in the convention centre that day are present again today. They heard me say that my vision had been ambitious from my first day as Minister of State, and I make no apologies for that.

Children are referred for assessments of need where it is considered that they may have a disability. This assessment identifies a child's health needs and the accompanying service statement outlines what supporting services will be provided to meet those needs. The length of time to complete an assessment of need varies depending on the child's complexity of need. However, the most up-to-date data show that the national average time it took to complete an assessment of need in the last quarter of 2020 was under 20 months. We are all in agreement that this is far too long for any child who is in need of crucial therapeutic intervention.

Therefore, in an effort to standardise procedures and facilitate the timely completion of assessments as well as early access to interventions, the HSE has developed a standard operating procedure, SOP, for assessments. The SOP was implemented for all applications for assessment of need from January 2020. The assessment of need process now comprises a preliminary team assessment that determines a child’s needs and the initial intervention required to meet those needs. Contrary to previous statements, professionals are not limited to a 90-minute assessment. Clinicians undertaking assessments of need will use their clinical judgment to determine the format of the assessment based on the presenting needs of the child. However, the practice of targeting resources exclusively towards assessments taking 100 hours or more over a long period without providing interventions cannot and will not continue.

Despite Covid restrictions, figures for quarter 1 of 2021 indicate that, of the completed preliminary team assessments, 86% of children were referred for intervention based on the outcome of those assessments while 48% were referred for further assessment. Nonetheless, I am aware that the SOP has been widely discussed in various forums in recent months, with different stakeholders raising concerns around the new format for assessment. That is why I welcome the appointment of Mr. Robbie Ryan to chair the review of the SOP, which is currently under way. This provides an excellent opportunity to assess how the new format of assessment is working on the ground for children, families and clinicians. I look forward to the outcome of the review and any recommendations that may be made.

On assuming ministerial responsibility for disability, one of the issues I sought to remedy was the situation whereby, through a combination of factors, the number of overdue assessments of need for children across the country had risen to approximately 6,500 by June of last year. By working with the Minister for Health, Deputy Stephen Donnelly, I secured funding of €7.8 million to address this issue. I am pleased to inform the committee that we have reduced the waiting list to approximately 1,510 cases at the end of April 2021. This is a reduction of just over 77%. In addition, three of the nine HSE community healthcare organisations, CHOs, have cleared their backlogs and progress continues to be made. I thank the HSE, its staff and clinicians around the country for these impressive results. It is important to note as well that this progress continues to be made despite the challenges posed by the current pandemic. Even more importantly, the clearing of this backlog will allow services to focus on intervention to support the child, which is the key piece.

Ensuring these therapies can be delivered in the timeliest way is where progressing the disability services for children and young people programme, or PDS as we know it, comes into play. This will completely change how we deliver services and supports for children from birth to 18 years of age. Under PDS, children’s services will be reconfigured into 91 children’s disability networks, CDNs, by the end of June this year. These teams will deliver equitable, child and family-centred services for children and young people with complex needs. This new model of service delivery will reduce the reliance on assessment of need and will support timely access to services. The teams will provide specialist support services for all children with significant disability, regardless of their diagnoses, where they live or where they go to school. It will also mean the end of the unacceptable situation where children can age out of early intervention services and will help to tackle the current waiting lists, which we all know are at an unacceptable level.

Last month, I asked the HSE to pause the relocation of existing special school-based services to allow for additional engagements. This stemmed from concerns raised with me by parents and Oireachtas Members over the potential for a reduction in existing services within specific school-based settings. I wish to clarify for the committee that there will be no removal of posts from special schools and the HSE is working locally with the schools to ensure clarity is provided. It is very important to note that this does not mean the roll-out of PDS stops, just the removal of these specific posts. It is worth noting as well that these clinicians will still form part of the local children’s disability network team, CDNT, as it is not best practice from a clinical perspective for clinicians to work in a silo. They will remain linked to the CDNT.

Since being appointed Minister of State, I have made it a priority to meet with families of children with special needs to hear their concerns. Some people experience frustration as they try to navigate access to services and often come up against long waiting lists for interventions. I am very aware of the importance of the requirement for the Government to consult and listen to disabled people about their experiences. "Nothing about us, without us" is not just a catchy media slogan. We must ensure that people with disabilities are part of the decision making. As Naoise Dolan wrote in the Sunday Independent at the weekend, this is not about pity, but equality. The Government must continue to achieve equality in the fullest sense. We must stop othering disabled people and ensure that across government we are achieving the commitments set out in the programme for Government, the national disability inclusion strategy, the comprehensive employment strategy and so forth. We cannot let these become box-ticking exercises. There has undoubtedly been great work done in recent years, but we still have a great deal more to do. As I see it, unlike in the case of other Ministers, there is an underlying role of advocacy built into my brief. This means ensuring other Departments are fulfilling their roles, and I will not apologise for being ruthless in achieving equality.

When it comes to children, we all are aware of the importance of early intervention and of the enormous positive impact that timely access to intervention can have on a person’s ability to reach his or her full potential. Improving disability services for all children is a priority for this Government. We also must be realistic. One simply cannot eliminate waiting times for assessments and therapies overnight by waving a magic wand. If only it were that simple. Instead, I have approached the issues which need to be addressed by speaking to all the relevant stakeholders about what can be fixed in the short term, such as the assessment of need backlog, and issues that need longer-term solutions, such as sustainable and quicker access to therapies. It is my opinion that we are on the right track.

Thank you, Chairman, for allowing me to speak for a little longer. I appreciate your flexibility.