Mr. Bernard O'Regan:

There are a couple of things. First of all, the joint protocol itself was reviewed in 2020 and that kind of reflected what had been learned from 2017. We are reviewing it again at the moment. The Deputy made the point that it was reported by the ombudsman that there is not consistency across all areas. Part of the reason for the review is to make sure we amend the protocol in order to promote the kind of work that is needed. Undoubtedly, there are circumstances where some of the children we are talking about end up in situations where they need the intervention of the State, whether that is in residential services or with significant home support packages. The nature of the need for some of those children sometimes means that the solution at that stage is not easy to find and sometimes that contributes to the delays. What we are trying to do is develop it on two fronts. One is that there is earlier intervention so that we are not allowing children and families to get into the position where they are reliant on hospital services, in particular, which are not appropriate. It is also trying to avoid a reliance on residential services until that is absolutely necessary and ensuring that we are stronger in terms of other supports including things like shared care respite and so on, which Ms Murphy also mentioned.

In terms of autism, we have been working with colleagues to develop a joint approach with child and adolescent mental health services, CAMHS, and mental health colleagues to assessment of need around autism and by extension the gateways that are there. We are working with chief officers and others jointly with primary care at the moment to develop some pathways that are better designed to support children and families to be able to access the service they need regardless of the care group. It is actually about what the need is for the child and family and that they are able to access that. That takes a bit of work. There are some examples happening in some of the community healthcare organisations, CHOs, and there is a forum in which we meet regularly with the CHOs, Mr. Walsh and the chief operations officer so that some of the learnings from those are being shared and that we build a consistent approach to it based on the learning. There are, therefore, measures happening to try to share learning but also to improve the pathways that are there. Dr. Burke or Mr. Kelly might wish to comment.