Mr. Paul Reid:

I thank the committee for the invitation to attend this meeting to discuss consideration of the Ombudsman for Children report, Unmet Needs, and waiting lists for children to access AONs and related matters. The chairperson has listed my colleagues who are in attendance so I will not repeat those details.

The HSE is committed to providing appropriate services and supports for all children in the State. We recognise that difficulties accessing services create additional stress for families. Our programme of reform is intended to ensure children have timely access to services based on their needs. The HSE regrets the negative experience of families, where the current service may fall short of what is needed to meet the needs of children and their families.

The ombudsman’s report, Unmet Needs, makes a number of recommendations with regard to the needs of children and young people with disabilities. The HSE particularly welcomes the recommendation that Part 2 of the Disability Act 2005 should be reviewed. The Disability Act and the EPSEN Act were developed in parallel with one another and it was intended that both Acts would align. Unfortunately, the relevant sections of the EPSEN Act were never commenced. This has contributed to the HSE’s challenges with compliance. The Minister of State at the Department of Education, Deputy Josepha Madigan, recently announced a review of the EPSEN Act. The HSE welcomes and intends making a submission to this review. We believe that a parallel review of the Disability Act is timely and would provide a valuable opportunity to ensure both Acts are aligned and updated so that people with disabilities can access appropriate health and education supports.

Dr. Muldoon also recommended a review of services that continue to rely on diagnosis for access. In the main, these services are provided by the education sector. Health and social care services for children with disabilities are delivered based on the child’s presenting needs and do not require a diagnosis. The practice for children’s disability network teams, CDNTs, to be requested to provide diagnostic assessments to facilitate access to supports in schools is particularly challenging. The resources allocated to these teams are often directed towards providing reports for the education sector rather than providing the necessary health supports. The HSE is fully supportive of the recommendation that access criteria for such services should be reviewed.

Since the commencement of Part 2 of the Disability Act in June 2007, the HSE has endeavoured to meet its legislative requirements as set out in the Act. Under the Act, any person suspected of having a disability born on or after 1 June 2002 is eligible to apply for an AON. The Disability Act 2005 outlines the statutory timelines under which AONs must be completed. In effect, the assessment must be completed within six months of the application date with a further month to assess the report and service statement. In addition, the Disability Act requires us to review each assessment after one year.

The HSE receives almost 6,000 applications for assessment of need each year. We have done substantial work to address the waiting times for these assessments and have made good progress in this regard. In June 2020, the number of overdue assessments of need stood at 6,558. The allocation of €7.8 million through Sláintecare has facilitated a significant reduction in this figure. The most recent quarterly report at the end of December 2021 shows 2,395 overdue assessments. Indicative figures at the end of February show a further reduction to approximately 1,800. In 2021, the HSE completed 8,353 assessments of need under the Act. This was the highest number since Part 2 was commenced in 2007.

The implementation of the HSE’s SOP for assessment of need was intended to ensure that children received timely assessments under the provisions of the Act. In 2021, almost 5,000 preliminary team assessments were undertaken. On the basis of these assessments, 86% of the children were put on an intervention pathway. Some 54% were identified as requiring further assessment but this did not delay their access to health services. The recent High Court judgment requires us to now revise this approach. The HSE accepts this judgement and will not appeal it. We are committed to ensuring that we meet our legislative obligations and we will revise our process, in consultation with families, staff and professional bodies, to ensure that children receive the necessary assessments under the Act.

Some 91 CDNTs are now in place throughout the country. These teams provide child and family centred supports for children with complex disability needs regardless of their diagnosis. It is important to highlight that an AON is not required to access these services. Any parent, health professional or teacher can refer directly to the community disability network teams. We acknowledge that there are waiting lists for these services, however, substantial additional resources have been provided to these teams since 2019. During this period, more than 475 posts have been allocated to children’s disability services.

The posts have been allocated to the various community healthcare organisation, CHOs, based on a number of factors, including the existing ratio of staff to children with disabilities in the area.

We recently undertook a census of the staff on these teams. The data from this census will allow us to identify further gaps and to develop a comprehensive workforce plan for the area. However, it is important to acknowledge that the supply of qualified health and social care professions does not meet the current level of resources available for new posts and we are seeking to address this.

We are aware that many families are reporting difficulties accessing services for their children. We are listening to their feedback and are committed to working with stakeholders to address their concerns. We are developing immediate actions to prioritise services for children and to ensure services prioritise direct support to children.

That concludes my opening statement. Together with my colleagues, I will endeavour to answer any questions committee members may have.