Oireachtas Joint and Select Committees

Tuesday, 15 December 2020

Joint Oireachtas Committee on Children and Youth Affairs

Children's Unmet Needs: Engagement with Minister of State at the Department of Children, Disability, Equality, Integration and Youth

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Apologies have been received from Deputy Phelan. Before we begin, I request that members sit only in the permitted seats and in front of available microphones to ensure they are heard. This is important as not doing so causes serious problems for broadcast, editorial and sound staff. I remind those present to please maintain social distancing at all times during and following the meeting. Before we start, I invite those attending the meeting virtually to unmute their devices to allow the sound to feed into the committee room.

Our meeting today is to discuss consideration of the Ombudsman for Children report, entitled Unmet Needs, with the Minister of State at the Department of Children, Equality, Disability, Integration and Youth, Deputy Anne Rabbitte, who has responsibility for disability. I welcome her to the committee. This is her first time to address the committee. She has been in her role for several months, but I wish to formally congratulate her on being appointed as Minister of State. I also extend a welcome to the officials accompanying the Minister of State, Ms Jenny Andersson, assistant principal officer, and Mr. Noel Byrne, special adviser to the Minister of State.

Before I invite the Minister of State to deliver her opening statement, I wish to advise her of the following in relation to parliamentary privilege. She is protected by absolute privilege in respect of the presentation she makes to the committee. That means that she has an absolute defence against any defamation action for anything she says at the meeting. However, she is expected not to abuse the privilege and it is my duty, as Chair, to ensure it is not abused. Therefore, if her statements are potentially defamatory to any identifiable person or entity, she will be directed to discontinue her remarks and it is imperative that she comply with any such direction.

The purpose of the meeting is to discuss with the Minister of State the issues identified in the report published in October 2020 by Dr. Niall Muldoon, Ombudsman for Children, and entitled Unmet Needs. The report identified serious shortcomings in how assessments of needs of children are now conducted and the unacceptable waiting lists that face children who require an assessment of their needs. Before I invite the Minister of State to commence her opening statement, I wish to remind members that, when putting their questions to the Minister of State, they should adhere to the agenda item scheduled for this meeting, which is to examine the contents of the report by the Ombudsman for Children. I invite the Minister of State to deliver her opening statement, to be followed by a question and answer session with members.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Chairman and members of the committee for this opportunity to address some of the issues raised in the recent and very welcome report of the Ombudsman for Children on unmet needs. The assessment of needs backlog has been a top priority for me since taking up office as Minister of State with special responsibility for disability.

To put it simply, the current waiting times for services for children with disabilities are totally unacceptable and they need to be improved dramatically. I have made that clear to all in my meetings with the HSE on this very issue. I have watched previous meetings of the committee on this subject and many valid points have been made by various people on the many aspects of the assessment process. Most importantly, the impact on children and families left waiting for assessments and interventions has really been brought to the fore. From the sheer volume of representations from families to my office, I am very aware of the delays in the assessment of need process and the incredible stress and upset this has caused children and their families.

I agree with the ombudsman when he says steps must be taken to fix this problem. We are on the exact same page in that regard. In order to fix the problem, we must ensure that a permanent solution can be found; not just a temporary one. We must develop a sustainable and child-centred model of service. This will ensure timely access to assessments and interventions for all children who require them.

The key to providing responsive children’s services lies in the rolling out of progressive disability services for children and providing services based on need rather than diagnosis. A report on assessment of need published in 2011 by the National Disability Authority found that the assessment of need process worked better and in a more streamlined way in areas that had reconfigured into network teams. In those areas, there was also less emphasis on using the assessment process to develop a diagnosis as a means to access services.

The report of the ombudsman is an honest and thorough examination of where the State stands in terms of its provision of appropriate intervention therapies for children by way of the assessment of need process. There is no doubt that we have failed many children and their families in this process. However, I hope that several steps I am taking within my remit will dramatically improve access to services within 12 months of my appointment as Minister of State with responsibility for disability.

On the issue of resources, the report of the ombudsman states that, "a much greater resource commitment is required in the longer term". Even before taking office, it was clear to me that this requirement needed to be pursued. This is why one of the first things I did as Minister of State was to secure an allocation of €7.8 million Sláintecare funding to eliminate the unacceptable backlog of assessments of need that has built up in recent years. I am sure the committee will agree this is very welcome news.

To ensure that real and tangible progress is being made in clearing the backlog, I have been holding monthly meetings with all the community healthcare organisation, CHO, heads of disability services. The most recent meeting took place on 8 December. I can confirm to the committee that of the 6,558 overdue assessments of need as of 30 June 2020, a total of 1,798 have been completed through September, October and November. This means that by the end of November, the backlog had already been reduced to 4,760.

Of course, that is only one part of the solution as there is no point having an assessment of need completed if one cannot then access the therapies. The elimination of the backlog will free up therapists to devote more time to providing much-needed interventions for children. The more time therapists can spend with children, the more they can help them.

Beyond that, I also secured additional funding in budget 2021 to add another 100 therapy posts to children's disability services next year. That is on top of the 100 therapy posts secured last year.

The ombudsman's report also makes a recommendation for an interdepartmental group on children with disabilities to be established. I would like to point out to the committee that such a cross-sectoral group already exists and meets quarterly to discuss significant issues on children with disabilities. The group comprises members from the Departments of Health, Education and Children, Disability, Equality, Integration and Youth, as well as associated agencies. In addition, there is, at any given time, a number of cross-departmental and cross-agency initiatives being pursued.

In conclusion, I remind the committee that the Government as a whole has committed to a range of actions in order to improve services for children with additional needs and it is my absolute intention to deliver on that. I am proud to hold the office of the Minister of State with responsibility for disabilities and I hope that over my time in this position, I will, once and for all, bring an end to the constant breaches of the Disability Act when it comes to assessments of need. If that is achieved, the Ombudsman for Children will not, I hope, have a need to publish such a report on unmet needs ever again.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I thank the Minister of State. I am going to open up the session to questions now. We will start with Deputy Whitmore. Each member has five to six minutes, which will include responses from the Minister of State. We will take each individual contributor, rather than two or three at a time. I call on Deputy Whitmore.

Photo of Jennifer WhitmoreJennifer Whitmore (Wicklow, Social Democrats)
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I thank the Minister of State for being here today and having this discussion. I understand that she is relatively new in the role but it is great to hear her determination to get this right for children. I imagine that in her previous role as a party spokesperson for children and as a Deputy, she has had an awful lot of interactions with parents and children on this issue, as have we all in our offices. I am sure the Minister of State has a thorough understanding of the difficulties that are faced by parents in not only trying to get the assessment but thereafter trying to get the services.

The Minister of State has, unfortunately, inherited a broken system. She says that steps must be taken and the ombudsman has said the same and we all agree with that. However, it would appear from what we have heard and the information we have received over the past number of meetings, the path that she is going down is completely the wrong one. I am not sure if the Minister of State had an opportunity to listen to last week's committee meeting or to review the transcript. A representative from the Psychological Society of Ireland, Mr. Mark Smyth, was before the committee. He also was representing the Association of Occupational Therapists of Ireland and the Irish Association of Speech and Language Therapists. Mr. Gareth Noble, family courts lawyer, and parents from Enough is Enough were also before the committee. Each and every one of them spoke about how the current system is failing children and their families. I will read out some of the discussion with Mr. Mark Smyth about the new procedure that is being implemented to try to address the problems with the assessment of needs process. He said "The implementation of the new [standard operating procedure, SOP] has proceeded despite our professional bodies clearly stating that it is not in the best interests of children" and that it "will, in many cases, prove detrimental to children and their families". He noted the clinicians are also "concerned that compliance with the SOP could lead to them being in breach of codes of conduct and ethics". He also said that in the majority of cases, it will not be possible for a clinician to answer the questions or to feed back to parents "within the maximum timeframe permitted within the SOP of 90 minutes" or to come to a determination as to whether the child has a disability. Those are stark statements for someone representing the Psychological Association of Ireland and the other groups to make.

What is the response or feedback of the Minister of State to those statements made last week about the SOP? It is clear that it was always envisaged that this SOP was going to be difficult. The previous committee directed the HSE to consult with these groups but it did not do so and we are now seeing the result of that, which is a system being established that is not going to meet the needs of parents or children and will cause difficulty for clinicians. I will cut to the chase. Will the Minister of State agree to suspend the roll-out of this new operating procedure until the consultation can happen with the clinicians and parents to ensure that procedures that are being put in place will actually do what they need to for children and not further disadvantage them or stick them onto another waiting list to languish for another three or four years?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank Deputy Whitmore for her questions. I watched the meeting last week. I have watched the committee proceedings for the past number of weeks, to be honest. I compliment the committee on all the speakers it has brought in because it is getting a wide flavour of all the challenges that are there. I was a spokesperson for children and youth affairs and a week never went by in my constituency office in Portumna or Loughrea when I did not have families come before me who were awaiting an assessment of need and it was not weeks or months but years that we were talking about.

When I took office in July, the standard operating procedure or SOP as it is known, had come into operation in January of this year. It had started before I ever arrived in office. In actual fact, the SOP is there now but because of Covid-19, it is probably not up and running to its full potential. As far as I was concerned when I took office, my issue was to address that backlog of 6,500 people. I want to crack the nut on this. I want to get to the stage where we are talking about interventions. We do not want to be in the position of facing the sorts of cases that Mr. Noble talked about last week around the country. We should be delivering on time and getting straight to the intervention piece.

The Deputy asked if I will pause the SOP for further engagement. I have asked what is happening with the SOP and was told that Fórsa was the staff representative organisation with negotiating rights for clinicians involved in the assessment of need process. I was told that the SOP was implemented in January following successful conclusion of the HSE engagement with Fórsa. That is exactly what has been presented to me. I have heard what Mr. Mark Smyth said last week about the clinicians. We absolutely need to listen to all parts of this discussion. I will make a suggestion, if the Chair does not mind. The committee needs to bring before it Professor MacLachlan, the disability clinical lead of the HSE, Dr. Cathal Morgan, head of disability services of the HSE, and Ms Angela O'Neill, national disability specialist and national lead on the assessment of need of the HSE. When the committee has had all of those people before it, has talked to the HSE and received presentations from the various representatives that have come before the committee, I will then further review the roll-out of the SOP.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Are the officials to whom the Minister of State has referred from the HSE?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Yes. They are the leads. They are the people who have been engaging in the process so far. That is my understanding and if we are to look at it in the round and have a fair understanding of why we have decided to use this model, I want it understood that this model is not adding an extra layer but is the right thing to do by families. It is not based on an idea of protecting the State from the requirement to meet the needs of the child or protect the State from litigation but because is the right thing to do. If that is the case, we will continue with it and if it is not, we will have to review it.

Patrick Costello (Dublin South Central, Green Party)
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I welcome the Minister of State and thank her for her statement. As Deputy Whitmore said, the Minister of State has inherited a broken system and has only recently come into her role. It is good to hear her say that she wants to end the constant breaches of the Disability Act.

The backlog of assessment of need is coming down quite dramatically. On the face of it, that is a very good thing. These are assessments that have been caught up under the terms of the new standard operating procedures, SOPs. As we have seen in previous weeks, the standard operating procedures are just not up to scratch. They do not provide a quality assessment and they themselves appear to be in breach of the Disability Act. Will the Minister of State commit to reviewing them? It seems we are playing with smoke and mirrors in reducing the backlog of assessment needs but not actually meeting the needs of the young people who are being assessed.

Constituents have asked me to raise a few things with the Minister of State when they heard she was coming before the committee. One was the availability of therapists. Many front-line staff have moved on to Covid tracing. When will they return to their work? Constituents asked if the Minister of State thinks it is acceptable that these people are being moved from therapeutic services to Covid tracing when there is a backlog in therapeutic services? Are we making the best use of clinicians? A senior psychologist might be doing a parenting course which could equally be delivered by a social worker or social care worker on a multidisciplinary team whereas a social worker or social care worker could not do the same work that the senior psychologist can. Tied to this is parents' frustration at a lack of consistency. Often, when they go to services, it is with a completely new person. We all know that a lack of consistency can be a problem for many reasons which I do not need to go into.

Will we ratify and follow through on the optional protocol for the United Nations Convention on the Rights of Persons with Disabilities?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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On the backlog and the SOP, the reason I sought the funding was that, as of 30 June, there were 6,500 children on a backlog and only a very small proportion related to the SOP at all. They were historical. They were not sick for three or six months but for nine or 12 months. That is primarily what the funding was for. The proportion of those on the SOP was minute. The first would have gone on in June because it only came in on 1 January. There would be children who are only six months on it, but the majority was the backlog.

I agree on the therapeutic services. I totally understand parents' frustration, and there is no doubt of that, that a therapist could be out contact tracing or swabbing. It is unacceptable that it would have continued for so long. There are still people on it, but between the disability teams and the primary care team, 189 therapists are still part of it. They are not on contact tracing now, but they are on swabbing. When I came into office, the number was twice that if not a hell of a lot more. It has reduced considerably. I met with Paul Reid on 5 October on the issue and met with the Minister for Health, Deputy Donnelly, twice on the matter. There has been a recruitment plan to address it and get the clinicians back to the front line of doing what they are supposed to. I have acknowledged the frustration, which all members of the committee and every parent speak of.

The current target to enact the optional protocol is 2022.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I also welcome the Minister of State as a former member of the committee. While we are on very friendly terms and I am conscious of not throwing any brickbats at her, I have some very direct questions. I think she will appreciate that.

I represent the area covered by community healthcare organisation, CHO, 4, which comprises Kerry, north Cork, north Lee and south Lee. Of the €7.8 million that was allocated for the 6,558 people, €1.1 million was allocated to CHO 4. The Minister of State said that as of 30 June, a total of 1,798 assessments of need have been completed over September to November, inclusive. Will she provide me with a breakdown of how this cuts across CHO 4? I ask because it is still not clear to me whether these assessments of need, which the Minister of State says are historical, are under the new SOP and are, therefore, under the 90-minute bracket. If the answer is that they are, then, given evidence that has come before the committee, I have serious concerns about that. The case for CHO 4 can be extrapolated to all the CHOs in the country. I need some words of comfort from the Minister of State for the families and children whom I represent so that they do not come back to me in a matter of months, having received the initial assessment of need, to say there has been no follow-up of services, or saying the assessment of need, as previous witnesses have suggested, is a sub-par method by any international standard of assessing a child with needs. That is the first reassurance I seek.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I am more than happy to provide Deputy Sherlock with an answer this minute. As of 30 June, CHO 4 had 1,098 children on the backlog for assessment of need. The funding was provided and the HSE put in place a plan. The numbers at the end of each month are as follows: in September it was 1,069; on 31 October it was 1,000; and on 30 November it was 743. To reverse it, in CHO 4 during September there were 29 assessments of needs carried out, in October there were 69, and in November there were 257. The definition of "carried out" is completed in its entirety.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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That is not the 90-minute desktop assessment but a full and proper assessment.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I am led to believe that 90% of those assessments are full assessments of need, as were there in 2019.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I thank the Minister of State. As this will be an ongoing issue, I would appreciate if she offered to communicate with the committee's Chairman to give figures for each of the CHOs to assess those numbers on an ongoing basis. This would be very useful. We will put down our own parliamentary questions anyway.

When the ombudsman was before the committee, he suggested without any ambiguity that some sort of a refund scheme could be established for those families who wished to procure private assessments. The Minister of State, in a parliamentary reply to me dated 30 October 2020, referred to a letter from Dr. Cathal Morgan in which it was stated that, in relation to Sláintecare funding, which is the €7.8 million provided on a once-off basis and which is time limited, the CHOs would engage with private providers in their areas to procure private assessments where appropriate.

Will the Minister of State provide us with a breakdown of the cost and the number of private assessments? As I understand it, the €7.8 million is not fully allocated or spent yet. To what extent is that funding being given over to private providers? Once that funding is spent, is there scope for families who wish to seek private assessments to get a refund? That would provide a massive alleviation because the €7.8 million will not cover the full extent of the demand. That is the point I am making.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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That is a very relevant question and I welcome the opportunity to answer it. All members have a breakdown of the €7.8 million per individual CHO. The CHOs were then tasked with addressing it and they set their own timelines and targets. I did not set them. As part and parcel of that, they had to engage with private providers to have the assessments done in a timely fashion because this is time sensitive. They went out and spoke to other section 38 and 39 organisations and some private providers. They also spoke with the HSE, which had given staff the option of working extra hours or overtime if they wanted. The money has already left the Department of Health and it has been given in its entirety. I asked about this matter last week because I wanted to see more progress. That money has been given in its entirety. As the Deputy can see from the figures, and I can get other figures for any Member who wants them, all the organisations that have signed up to this are making progress, right across the board. The money will be there to ensure everybody gets an assessment in a timely fashion and that the backlog is cleared. We are engaging with private providers to do that.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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I asked about a potential refund for families. After this backlog is cleared, or even if this backlog is cleared, there will always be demand and the resources will not always follow. The Minister of State will know from her own experience that families are forced into a situation where they are waiting on the public list for an inordinate time. The pressure comes on them to take out a credit union loan to get a private assessment. All families will do that if needs be. Is there any scope, as per the ombudsman's suggestion, for some sort of recoupment of those costs for individual families at the family level? Could the State intervene to facilitate that family or, if the family made a request for the recoupment of expenses, could an application or some sort of protocol or process be set up to facilitate that?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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What I would like to do with the money that has been delivered is carry out a cost-benefit analysis. Out of that, I would see exactly what was delivered through the HSE, what was delivered through the section 38 and 39 organisations and what was delivered through private providers. We need to drill down to see that the money being provided by the Department is being spent in a time-sensitive fashion because it has not been in the past. There is no denying that whatsoever. If had been, I would not have a backlog. That is the point of this whole exercise.

I am not gong to give an answer to the Deputy's question because I do not know the correct answer. I know exactly where he is coming from and I appreciate it. I understand why families had to resort to doing what they did, at enormous expense to themselves, to get therapies or supports in the schools their children were attending. I understand where the ombudsman is coming from and I understand the line of the Deputy's question but I do not have a clear answer on this at the moment. I want to do a cost-benefit analysis to see whether this is an issue right across the State or in a particular CHO or where exactly the problem needs to be addressed. However, I am not ruling the Deputy's suggestion out.

Photo of Seán SherlockSeán Sherlock (Cork East, Labour)
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That is an honest and fair answer. I accept that.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I thank the Minister of State for her upfront appraisal of the failure of the assessments of needs, as well as the limited access to the wrap-around services that are needed after an AON. She said she listened in to this committee and she would have heard the ombudsman talking about a three-card trick and how he felt that children were being moved from list to list without getting adequate services. One issue that has been mentioned relates to the SOP. We heard last week from the Psychological Society of Ireland that a child may incorrectly be deemed not to have a disability as the disability is not evident or fully reported by parents or carers at the screening assessment. We also heard from the parents' group, Enough is Enough, and those parents are absolutely terrified that they may miss something that will delay their child's developmental needs and the services they need to develop. These parents are under enough pressure without adding any more. As they said last week, parents are not therapists. They are parents and they want the best for their children.

I will probably ask some questions that have been asked. Does the Minister of State think the SOP is adequate? Will it be reviewed or can it be suspended? She can correct me if I am wrong but she said that of the 1,798 assessments completed since June 2020, the vast majority were standard comprehensive assessments of need. If we have gotten that many done since June 2020, why do we need a standard operating procedure? If we are getting through them comprehensively, why are we putting parents under this pressure?

I want to touch on two more areas. This year, there were 691 investigations into complaints by parents to the HSE, under the Disability Act 2005, that their children did not get their assessment in a timely manner, and 634 of these were upheld. That is 92%, which is a damning indictment of the AON system. However, it is a good indication that the complaints system is working. That leads me to the second part of my question. Since late 2018, 115 cases have been taken to court by parents. Those parents had to go to court for an enforcement order for the assessment of need. Defending this system must cost the HSE a significant amount when it knows that 92% of the complaints are being upheld. Why is the HSE making parents who are already under enough pressure go to court to get enforcement orders instead of providing the services they need?

The Minister of State mentioned that the €7.8 million in Sláintecare money that is being AONs is time sensitive. Will that time run out? If the money is not used, can we get a guarantee that it will be ring-fenced and that it does not go back into a black hole of the HSE or some other area? If it is not used in time, will it still be there to be used for assessments of needs going forward?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The Deputy asked many questions and I was very slow at writing them down. I will start at the end. He asked me if the money will go into a black hole if it is not used. It will be used because every one of those 6,500 children is going to get their assessment of need. This money is going to be used. That is why I am holding monthly meetings and that is why I can tell Deputy Sherlock what has happened in his CHO in the past three months. I can tell every member what is going on in his or her CHO because my finger is on the pulse as regards assessments. The money will be spent in a timely fashion and it will be delivered, so we will clear the backlog.

The Deputy's first question is well-put. He asked why we need a standard operating procedure if the backlog is being cleared. I said at the beginning that this is a nut we need to crack.

I want to get to the intervention element. By spending as much time as we have been in simply addressing backlogs, we would not deliver on intervention. For the information of some members who may not be aware of this, when one get an assessment of needs and, say, it relates to speech and language therapy, one has to go a speech and language therapist to get an assessment. One then gets a first round of therapy and that could continue for six weeks and if one needs further follow-up one is directed to a list of speech and language therapists further up the line. I am trying to get to the intervention piece. That was the reason I sought funding to clear the backlog so that everybody concerned could get to the space where we are discussing intervention.

Regarding 92% of the cases being upheld, they were being upheld because they were not being dealt within a timely fashion. We all know this. The Act clearly stipulates one has a right to an assessment within six months. If one does not get it, the law will uphold that right. That is enshrined in law since 2005.

It is important to realise that 100 therapist posts were sought under the confidence and supply agreement in last year's budget. Some of those therapists who came on stream never hit the network disability teams because they went straight into contact tracing and swabbing. They are only starting to come back to this work now. I have also sought another 100 therapist posts in this budget. If I am fortunate enough, and with the support of the Minister, Deputy Donnelly, I would like us to block book the funding for those posts whereby we would recruit the therapists in one block. I would like that to happen in quarter 1 rather than over quarters 1, 2 and 3 and in that way, we could populate our network disability teams and the intervention could continue at an accelerated rate.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I have a follow-up question. While the Minister of State answered me she did not answer the question I asked. I appreciate the focus on moving from assessment to intervention as that is exactly what is needed. The Minister of State said 1,978 comprehensive assessments of need have been carried out since June of this year. Why do we then need to go from the comprehensive assessment of needs process to the standard operating procedure exercise? They are two different things. One is comprehensive, as the Minister of State said, and the other is a 90-minute desktop assessment, which parents are being put under undue pressure to fill out.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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There are two answers to that question and I do not want to evasive. First, the reason we have to deliver on the comprehensive assessment of needs is that the backlog was there before 2020. That is what has to happen. To my understanding, the reason the standard operating procedure was brought forward was to streamline the entire procedure. People are of the opinion that the standard operating procedure, SOP, is a desktop exercise. That is not what I am led to believe. It is a face-to-face exercise. I acknowledge the role of the Chairman and the members of the committee in bringing in various speakers. The committee needs to have a conversation in the entire round by bringing in HSE lead personnel in this area to get their vision of the roll-out of the SOP and whether it is another layer, is it a face-to face appointment, whether it has the same value and if it gets us to the intervention element quicker. The final question I would ask, which must be asked, is why are so many of the clinicians not in favour of it. While we need to have those conversations, the important element that needs to be addressed is whether it gets people to an intervention at a direct point of access quicker.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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I thank the Minister of State.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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We hope to have the HSE officials in before the committee at our first meeting in January. We will be following up on that. I will move on to Senator Ruane.

Photo of Lynn RuaneLynn Ruane (Independent)
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I thank the Minister of State for being here this afternoon. I have a few questions and I might ask them together, if the Minister of State can take note of them and reply to them together. To follow on from Deputy Ward's point on pre-assessment, the Minister of State said it is her understanding that was brought forward for it to be streamlined. What exactly does "for it to be streamlined" mean? That is a word that is used and everyone says the process is streamlined but what does that even mean? To be honest, the comprehensive assessment is what children need and "streamlined" is a made-up word that is used for people to think something is happening but it is not happening. I would like the Minister of State to explain what she means by “streamlined”.

I have a question related to the pre-assessment, that is, the 90-minute exercise. We spoke on foot of Deputy Costello's question on the ratification of the optional protocol. It feels like that 90-minute pre-assessment exercise is a breach of the Disability Act, which leaves us further away from meeting the requirement to have the optional protocol in place in time. We want to remove obstacles for people to be able to take cases but there is a sense we have created the 90-minute assessment to stave off court proceedings rather than have a system that is streamlined.

The report also explains where the Disability Act 2005 covers assessment for health needs. The Education for Persons with Special Educational Needs, EPSEN, Act covers assessment for special needs assessment. The report outlines how essentially, both Acts go hand in hand. However, due to the fact that different sections of the EPSEN Act were deferred because of financial constraints in 2008, the provision of a education service to a child is often neglected or not pursued. For example, where the assessment of needs identify the need for an education service for a child, the assessment officer would refer the matter either to the principal of the child’s school to practically meet the educational needs of the student concerned or for a special educational needs assessment. However, the second option does not exist since the relevant sections of the EPSEN Act have not yet commenced. This means that despite the fact that the need for additional education services are stated in this statement of assessment, the child could potentially never receive the appropriate supports because the relevant actions of the Act have not commenced. The question I have for the Minister of State in that respect is whether the Department has looked at implementing these relevant sections of the EPSEN Act to ensure children are receiving an adequate assessment of needs process, as outlined in both Acts.

Through the assessment of needs, the only gateway to access services is through a disability finding. This means if an assessment officer finds that a child does not have a disability, a liaison officer cannot provide a service statement, regardless of the child’s other identified needs. This makes the 2005 Act a diagnosis-led rather than needs-led model. The question I have for the Minister of State in that respect is whether the Department has looked at different ways of reconfiguring the current regime to adopt to a more needs-led model.

Finally, what is the cost of providing the SOP system? Would that money have been better spent in going with the funding she allocated to address the backlog? Have we redirected funding? What is the cost of the funding to do the pre-assessment? Would it have been better spent in helping the Minister of State to continue to address the current backlog with a more comprehensive model?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I have noted everything Senator Ruane raised. She has asked some mind-blowing questions that I have asked myself.

Photo of Lynn RuaneLynn Ruane (Independent)
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I can forward on all the questions in writing.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for that but I want to address what she asked. Regarding the pre-assessment and the word "streamline" that is used, I asked about that and the answer I got was that we would have the same procedure happening right across every community healthcare organisation, CHO, in the country. To reverse back to 31 December 2019, it was not the case that all CHOs in the country operated at the same level with respect to how they did an assessment. The idea of the SOP was to streamline it. I have to be clear with the Senator. Certain CHOs are getting through their backlog is a very timely fashion but that is not the case for other CHOs. I ask them what is the story, that they told me last month this would happen but it did not happen and they reply that consultation is taking place or conversations are happening where teams have to meet to come to a final decision about assessment.

That is part and parcel of where the SOP ended up and what has added to the backlog. I am not ascribing blame to anybody in making that statement; I am stating a fact. The idea was to have streamlined assessments. The idea was that every CHO would have the same.

The Senator made a valid point, asking if it came in just to save the State a fortune not to end up in court cases. It is part and parcel of it and I will not deny that. It is important to qualify it by saying that the HSE sought legal advice on it. When the HSE is before the committee, it is important and integral to ask if it was about the legal bill or about delivering a standard of intervention at the same level across the country. Was it part of putting a tool in place that every clinician could work to?

The Senator mentioned the EPSEN Act. I have asked that question and tomorrow I will meet with the Minister of State at the Department of Education, Deputy Madigan, about the issue the Senator raised, and I will provide the Senator or Chair with a follow-up to that meeting if they so wish.

Photo of Lynn RuaneLynn Ruane (Independent)
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Will the Minister of State address the ways of reconfiguring the current regime so that it is less diagnosis-led and operates more on a needs model?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The HSE would say that the SOP is about that. It is important that the question is asked again when it comes before the committee. It says that one can have an assessment done in a timely fashion and a child that presents with speech and language needs will get intervention straight away, but a child with more complex needs will go on for further assessment, which is like the comprehensive assessment of need that we have at the moment.

Photo of Lynn RuaneLynn Ruane (Independent)
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The difference between the needs model and the diagnosis model is not necessarily a matter of moving away from diagnosis. It is unfortunate that in the absence of a diagnosis, even if the needs are identified, the liaison officer cannot actually provide a service statement so that some of those needs can be addressed. If there are needs but no diagnosis, the service statement should still accompany that child to address what needs the child may have in the education sector and so on.

Erin McGreehan (Fianna Fail)
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An incredible amount of work seems to lie in front of the Minister of State. Does she have an update for CHO 8, which is my area? If there has been a reduction in numbers, when does she see that backlog clearing? When the backlog is cleared, there will still be many unmet needs, which she is well-versed in. There seems to be a gap between investment and therapies. As the Minister of State mentioned, many staff are not doing what they are supposed to be doing and looking after the children. "Unmet need" is a simple term to describe children who are not thriving and achieving as they should be. There are also unmet needs for many families. Many parents come to me who are struggling, almost grieving the loss of what could be, and concerned about how they will cope with the next 15 to 20 years of getting their child through education or whatever the case may be.

I welcome the Minister of State's openness to reviewing the SOP. We heard from the Ombudsman for Children and Mr. Gareth Noble about their concerns. The Minister of State mentioned clinical concerns too. I welcome that and have listened intently to discussions on it.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The Senator is correct that there is a significant gap between assessment and therapy. I am trying to get to a point where we do not have a backlog for assessments of need and timely intervention and therapy become the priority. The Senator and I have both seen the letters to say that a person is on a two-year waiting list for speech and language therapy. That is unacceptable. We have to stop that and we have to get to the root of delivering therapy. The Senator talked about people in contact tracing and swabbing. At the moment, there is nobody from the network disability teams involved in contact tracing and there are nine from primary care. Last September and October, when I started to have these conversations, there were 866 involved in swabbing. That 866 is down to 189. It is still 189 too many and I will not justify it, but at the same time, I want to demonstrate where we have come from and what we are trying to get back into the teams, for the simple reason that that leads directly to the unmet need of the children and families, the frustration of families and how they must feel, that nobody is thinking of their child or their child's education. That is why I have met with Mr. Paul Reid and spoken with the Minister, Deputy Donnelly. In fairness to the HSE, the Department of Health and the Minister, they are acknowledging it and getting a turnaround.

My next step in that is to ensure, in the roll-out of the vaccines, that our front-line clinicians do not become a casualty of delivering the vaccination. After we got disability acknowledged as an essential service in September, clinicians have returned to posts and the reconfiguration of the children's network disability teams is taking place. We are down to the last seven team leads in the 91 different positions around the country. That is right across the country. We should build on those teams and ensure that those staff do not become part of the vaccination programme. They need to stay to address the unmet need and support the families that the Senator speaks about. We do not want to see those families left for another year without timely intervention.

Regarding CHO 8, as of 30 June, it had 764 children awaiting an assessment of need. As of the end of September, it had 698; at the end of October, it had 630; and as of 30 November, it was back down to 475. Some 66 were completed in September, 68 in October, and 155 in November. The target for completion there is February. I have spoken to the lead for AONs.

Erin McGreehan (Fianna Fail)
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Many parents have come to me and their therapy sessions have gone online and are virtual. For a very young child who is one of those lucky ones to have received an assessment and moved on to therapy, virtual sessions are difficult for a two, three or four year old.

It is very difficult for a two, three or four year old to deal with the virtual environment. It is just another screen with a woman on the other end. It is no good to them.

As a matter of priority, I would appreciate efforts being made with younger children and those who are newly assessed. The older children who have a relationship built up with the therapist are linking in and benefitting far better from the virtual environment.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for raising the matter and she is correct. Where the therapist has built up a relationship with a young person, it is very easy to continue in the virtual environment, although it does not work for everybody. We are trying our best to get back to face-to-face therapy and we must do that. We must learn to live alongside Covid-19. I will take on board the Senator's comments and I am sure the HSE has listened to them as well.

Mary Seery Kearney (Fine Gael)
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As always, I thank the Minister of State for her engagement and briefing. I thank her office for being so engaged and accessible. I really appreciate that.

My home constituency is Dublin South-Central, taking in a little of Dublin 6 and Dublin 6W. In that there seems to be exceptionally long waiting lists and it has been considered quite the black hole. One of my emails to the witnesses argued there is a postcode lottery and this area is particularly badly hit with very long waiting lists. I welcome comments on where we are at in that regard. I received a briefing from the Minister of State, Deputy Frank Feighan, indicating who was deployed where or redeployed into services but figures were missing for the community healthcare organisation, CHO, 7.

Within the area there are a number of families with children with Down's syndrome. There is a commonality of experience. One of the families has been advised that a new ophthalmology service is beginning in April 2021 and I would appreciate an update on that. The family has been placed on a waiting list so what length of time are we looking at for an assessment?

One of the difficulties of being on such a long waiting list is that a child may be in second class is ready to go to a school with an autism spectrum disorder, ASD, unit but if that child has not been assessed, he or she does not qualify to get into the unit despite obviously requiring such support. The lack of assessment is having a detrimental effect on educational needs of children. In such a case, a paediatrician may have written to the HSE to say that an assessment is urgently required but has not occurred. Parents in such cases are getting quotes of €1,850 to get a private assessment but do not know if such an assessment would be accepted.

Children with Down's syndrome are much more likely to suffer from arthritis, at one in 50 children as compared with one in 1,000 for the rest of the population. Such children need an MRI done under a general anaesthetic. If a child has pain now, the earliest appointment for the diagnostic is apparently January 2022. That type of delay is quite common and a recent article in The Irish Timesindicated a delay in waiting times of between four and seven years, which sounds astounding.

I appreciate that there are many questions but I would not mind an update on where things stand with section 39 organisations. I have plagued the witnesses about that before. I thank the Minister of State, as always.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The Senator mentioned CHO 7 and as of the end of June 2020, the figures for the assessment of needs backlog was 1,056. On 30 September 2020, that was 1,050 and at the end of October it was 1,005. In November the number was 846. I can flip this to what has been completed. In September the number of cases dealt with in CHO 7 was six while the number completed in October was 45. The number completed in November was 159.

Mary Seery Kearney (Fine Gael)
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Well done. That is great.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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This will prompt questions we can talk again about. The questions must be asked about the involvement of the HSE and the section 38 and section 39 organisations that would be supported. What was the involvement of private operators coming on board? I responded earlier to Deputy Sherlock and spoke about 29 cases being dealt with in the same period. There are questions to be asked.

The Senator spoke about issues affecting people with autism. I come from rural Galway and when a child goes into junior infants, he or she does not leave the school until sixth class is finished. It is a different sort of mechanism in Dublin, which I learned by meeting representatives of Involve Autism, and it is possible the Senator met those people as well.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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They have articulated frustration on assessment needs and paying for assessments. Deputy Sherlock asked about that earlier. The children must move from junior to senior school and they are not in the same school settings. Some of the families, as the classrooms are not in a local community school, may have to travel for an hour or an hour and a half across the city to access services. It is one of the main reasons I am meeting the Minister of State, Deputy Madigan, tomorrow. It is to get an understanding of our roll-out plan for classrooms not just in Dublin and the areas identified by the Senator but right across the country.

The Senator spoke about children with Down's syndrome being affected with arthritis. She mentioned a ratio of one child in 50 being affected as opposed to one in every 1,000 children who do not have Down's syndrome. The last time I inquired about this I was told there is a recruitment problem. It is a major difficulty but it is not new. It is something that needs to be prioritised. There are six posts that deal with rheumatoid arthritis but only two are filled.

The Senator spoke about section 39 organisations. It is wonderful to see that great work has been done through the Labour Relations Commission as of last Thursday evening, with the HSE and unions coming to an understanding. It is very welcome news. The next 250 bodies for the section 39 organisations are now moving forward with pay restoration.

Mary Seery Kearney (Fine Gael)
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I thank the Minister of State for her sign language earlier in the Seanad. It was an excellent job. Well done.

Mary Fitzpatrick (Fianna Fail)
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I thank the Minister of State for giving her time and engaging with the committee. The report from the ombudsman was a real indictment of the State's failure of children with special needs, their families, carers and supporters.

I really welcome the Minister of State's appointment. As a spokesperson for the Opposition she demonstrated passion and energy and she has brought that to her office. I am greatly encouraged.

I will not go over everything that has been discussed because it has been well articulated. The Minister of State knows these challenges. I can make a couple of suggestions for the committee.

I absolutely agree with the Minister of State that the HSE has to come into the committee, which is scheduled, and that we, as a committee, engage very energetically. We need to challenge it on behalf of all the children and families and we will do that. The Minister of State could help the committee if it could be provided with a monthly report to give members a breakdown of how the assessment of needs is progressing. That would be useful for this committee to have. The Minister of State clearly has the information and the data are available. The committee should be looking at that once a month so that the issue is on our minds not just at a committee meeting such as this.

I am very mindful that it is distressing for parents. They demonstrate love, energy and care for their children but it is very distressing for them to have to battle for an assessment of needs to start with, and then the therapies and supports. Does the Minister of State have a report, similar to the one available on the assessment of needs, on waiting lists for therapies and supports? Again, perhaps this could be provided to the committee monthly. It is important that this committee would track that and engage with the HSE on it. It would also create for the committee the transparency on how children and families are being responded to in every area. It may give us an opportunity to assess whether there is a uniformity to the quality and timeliness of the response, and to the appropriateness of the supports provided to the children and their families.

With regard to the ongoing support and care, I am very aware that when parents and their children have overcome the initial challenge of getting their assessment of needs, the young child - hopefully but not always - will get the required supports, therapies and interventions. As that child becomes an older child, a teenager and then a young adult - this is my experience from dealing with families - every time there is a developmental change there can be a kind of disconnect in the ongoing and projected assessment of needs, and especially into adulthood. In the Minister of State's short time in office has she had a chance to examine that, or is it something she could take on and examine into the future?

I would also appreciate the Minister of State using her office to raise the issue of the appropriateness of the housing needs assessment that takes place with local authorities in the State for families who have a family member with special needs. The local authorities generally do not take intellectual needs into account. Very often a key requirement to cope with intellectual challenges can be having an appropriate built environment within which to live. I would appreciate it if the Minister of State could also look at that. I thank her for her time.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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This gives me an opportunity to welcome what Senator Fitzpatrick said, and I will tell her why. The committee members know me and my work on the children and youth affairs committee over the past four years, and members know exactly the sort of person I am. I am very open and transparency is very much part and parcel of the person I am. I would welcome the opportunity of laying before the committee every month the figures on the assessments of needs.

I would welcome also the opportunity to provide to the committee the figures monthly of everybody who is waiting for a clinician's appointment in the State and I commit to that. I gave the example earlier of the speech and language therapy figures, including those who are on their original assessment, those who are waiting in their first period of time on the waiting list, and those who are going on further. I will save members the bother of putting down parliamentary questions every single month. It takes time out of the Department and it takes time out of the HSE. I am doing it myself and I will share my information with the Chairman and the committee monthly.

I welcome the fact the committee has made this issue a priority in its first term and I want it to be kept front and centre. Every one of us knows that intervention has to be key to what we are doing. If we all work together, my office and I, along with the committee, the Department of Health and the HSE, and if we are all accountable to ensuring that children get a timely intervention, and if we work hard, then that is how we will get it done. I have no fear in sharing the information. It is not going to be locked in a vault. I am happy to publish it.

Mary Fitzpatrick (Fianna Fail)
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I thank the Minister of State. I really appreciate that. The Minister of State did not respond to my issue about the housing needs assessment. It is not the Minister of State's remit but-----

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I am talking to the Minister, Deputy Darragh O'Brien, about universal design in this regard. It also came up at the Joint Committee on Disability Matters, which it is building in as part and parcel of its piece also. Universal design is very important. The Senator referred to local authorities. I do not wish to bring up again the standard operating procedure, SOP, in the context of assessment, but different local authorities view disabilities on different levels. A particular local authority in the State, for example, did not view autism as a disability, so when families applied to the local authority it did not see autism or having a child with autistic needs on the housing list as a priority, or even take autism or intellectual disabilities into consideration from a space point of view. There is much work to be done there but I am totally open to it. I am aware that the Minister, Deputy O'Brien, is also very open to that.

On the issue of older children who age out from school-years services, we talk about the primary care system that is there. My Department is very much entwined with the role of primary care when it comes to assessment of needs and the delivery of services.

Alan Dillon (Mayo, Fine Gael)
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I thank the Minister of State for her time today and for her extremely effective work to date. In her statement, she outlined the €7.8 million to clear the backlog. This is very important in the assessment of needs. The Minister of State's monthly meetings with the community health organisations, CHO, heads have been an important part of doing that. What has the feedback been from the CHO heads? Being from the west of Ireland, like the Minister of State, we see many issues and barriers in trying to get information from the different service providers within the HSE. They outline the challenges they have in meeting the needs of children with disability services. They are conscious of the impact it has on children and families. I would like to get an understanding of what the dialogue is within those meetings.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The dialogue has been absolutely fantastic, to be fair. There is a massive team working within the HSE and it is led by Dr. Cathal Morgan and Mr. Bernard O' Regan, with whom I meet or chat to at least once a week. Since taking office, I have seen that that train had started when I arrived and the commitment was there before I arrived. These people were committed to the roll out and the reconfiguration of the children's network disability teams. When I talk about the 91 network disability teams, this was already in progress. Unfortunately, Covid landed, but the commitment and enthusiasm for delivery was there. This has been borne out in how they have addressed putting a focus on the assessment of needs. I cannot thank them enough for how they co-operate and work with me and the Department.

Alan Dillon (Mayo, Fine Gael)
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The Minister of State spoke of the children's disability network teams and the 91 different units.

Where are we in terms of the recruitment and retention of staff within those network teams? Much of our difficulty is access to therapies. The Minister of State mentioned that previously. I refer to the lack of occupational therapists and speech and language therapies, the significant delays and parents losing faith in the system. Where are we in terms of trying to recruit in areas, such as community healthcare organisation, CHO, 2 and is there a plan in place for 2021?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I thank Deputy Dillon. It is important to acknowledge the work that CHO 2 does. The Deputy and I live in CHO 2. That is Galway, Mayo and Roscommon, and under the lead of Mr. John Fitzmaurice and Ms Breda Crehan-Roche, they have done phenomenal work. The number there in June of 2020 was 100 and as of November, the number has been brought back to 55. That is a commitment and a demonstration of the HSE's staff but also the section 38 and section 39 organisations that they have worked closely with.

I already said that if the HSE disability team can get the block funding to recruit in block the third post that is required, it would mean that we would have everybody in place at the beginning of the year in quarter 1 as opposed to looking at recruitment going on for those 100 therapist posts that would lead us to having it finished by the time we would arrive at the next budget. I would like to see the recruitment start now and fill them out.

Of the 91 network disability teams, of which there are nine in CHO 2 to be delivered between the three counties, from what I can gather right across the country, we are down to the last seven team lead posts being filled. A lot of positive work has been done.

However, we have an issue in relation to unmet needs. While I might be meeting the Minister of State, Deputy Madigan, tomorrow, I am also meeting the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, with a focus on the CAO offers perhaps providing additional availability to help address some of my unmet need in the disability sector. I refer to occupational therapists, OTs, physiotherapists, and speech and language therapists. Tusla will be recruiting for social care. I need to recruit for social care. The Minister of State, Deputy Madigan, will also be recruiting as part of her school inclusion model for therapists in the schools. We need to accelerate and make more posts available so that we do not have a retention crisis or a recruitment crisis. The funding is there. We now need to match the funding with the people. That is a challenge.

Alan Dillon (Mayo, Fine Gael)
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I thank the Minister of State for her response. I agree with everything the Minister of State said in terms of additional college places because it is an area where we fall down in getting people into full-time positions.

I have one final question. In regards to availability of funding for speech devices, a number of parents have come to me about speech-generating devices used by children who are non-verbal. They find it difficult, especially in Mayo, with the limited funding that is available. Multiple families have access to funding through their speech and language therapists. The Minister of State might provide a note on when funding can be granted. These devices cost up to €6,000. It is causing some difficulty between some families. I might send the Minister of State a note on that after the meeting.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I would welcome that for the simple reason that we have embraced technology throughout Covid and we would not want to leave anyone behind. That was the motto at the start of Covid and it should still be the motto. That was one of the reasons when I provided the additional €20 million after the budget that some of the providers, if they were making a request for funding, must also address technology to bring everybody with us. I will provide the Deputy with a note on it.

Alan Dillon (Mayo, Fine Gael)
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I thank the Minister of State.

Cathal Crowe (Clare, Fianna Fail)
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I thank the Minister of State for everything she has been doing. I like the approach Deputy Rabbitte takes in the Department. The Minister of State has been backed by Government with an increase in budget which always helps but it is not only about money. It is about how measures are rolled out. The Minister of State is certainly taking a hands-on approach with the Department and I appreciate that.

There are a few points I would like to raise. As the Minister of State will be aware, up until February of this year, before I was elected to this House, I was a teacher. There are some overlapping functions, both for Deputy Rabbitte's Department and, indeed, her colleague, the junior Minister, Deputy Madigan. There is an acute shortage of autism spectrum disorder, ASD, units in County Clare. At present, the incidence of autism among children in Ireland, which depends on the level of diagnosis and assessment, is between 1.6% and 2%, but our availability of ASD units is grossly short of that. In a town such as Ennis with a population of 30,000, or Shannon with a population of 10,000, there is only a handful of places. When a unit opens, it only caters for six children. There is a huge shortage.

Increasingly, special educational needs organisers, SENOs, have been going around to schools, speaking with and writing to principals saying that they want them, in September 2021, to open ASD units in their schools. That is brilliant, but there is no accommodation. They are saying to principals that they should find some place in their schools. Some of these schools have not a place for a mop bucket or their physical education, PE, equipment. Suddenly, they are expected to clear out cupboards and find a place for an ASD unit. It will require joined-up thinking, both within the Department of Deputy Rabbitte, as someone who is a champion for disability, and that of the Minister of State, Deputy Madigan. Ultimately, the Department of Education has to also step up and say that this school is willing to provide an ASD unit and it will need additional accommodation.

The next issue I wish to raise is that of SENOs. They wield an awful lot of power when they come into schools. With the Education Act 1998 and the Disability Act 2005, there are many legislative pieces that empower youngsters living with disability and there are many parents who go out and battle for them. I have seen it on many occasions. One sees parents come into one's classroom knowing that they have to fight a battle and they realise pretty quickly that the teacher is onside because we are fighting that battle too. The reality is volumes of paperwork go before a SENO. There is every type of psychological report. There could be occupational therapy reports. With a stroke of a pen, they can strike out many of these recommendations. I made this point in this very room a few weeks ago. In the case of many of the recommendations they are striking out as being invalid or not reaching a threshold, they are not qualified to make that interpretation. I am not an educational psychologist. I am, by profession, a teacher. I am not qualified to go in, dissect a report, and say that makes sense and that does not. There is something wrong in that and Deputy Rabbitte's Department and, indeed, the Minister of State, Deputy Madigan, should look at that. They do the same with assistive technology recommendations. They will approve some laptops and some devices and they will strike out others. That is fundamentally wrong.

In March and April, there was a need for speech and language therapists and others to be reassigned to tracing and testing roles. The same occurred with orthodontists and others within the broad spectrum of health services. There was a need for them to be redeployed. They simply had not the caseload coming into their offices. That has changed now. Testing and tracing has changed. There is still a small few, certainly in the mid-west, I know of who are still testing and tracing and we need them back offering the service that they are most qualified to do.

The final question I wish to ask the Minister of State is about the waiting lists in CHO 3, County Clare, and the neighbouring counties of Limerick and Tipperary. I am hoping the Minister of State can give some good news about waiting lists for children who have been awaiting assessments or appointments in that locality.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Before the Minister of State responds, some of the issues, such as that around SENOs, would relate to the Department of Education. I am not saying that the Minister of State cannot answer. In fairness to the Minister of State, it does not fall into the discussion of assessment of needs.

Cathal Crowe (Clare, Fianna Fail)
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I hope I referenced that in my contribution.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Yes. I would just make that point.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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I will reference it because it would not be me not to reference it, as the Deputy will know.

Let me address the CHO 3 question. As of 30 June, the backlog of assessment of needs was 589. In September, it was reduced to 559. In October, it was 503, and in November, 449. I will turn those figures on their head.

One can see that CHO 3 had completed 30 in September, 56 in October and 54 in November.

Last night, I participated in a Zoom call with pals from Loughrea in County Galway. They said they are experiencing the same ASD issues that Deputy Crowe mentioned. There is an acute shortage of ASD units. Many schools do not have enough space for a mop bucket never mind trying to convert a classroom, which is a very serious issue. This seems to be happening across the country because any of these units can only cater for six people.

Last night, I also heard the following and it is something that I have heard on a regular basis in addition to being well articulated by the Deputy. Parents must continually do battle for services, the teachers assist them in their battle but the reports are shredded when they have been completed, which is a situation that needs addressing. Parents and teachers have articulated to me their belief that barriers have been put in the way of progress to assist their children in educational and development spheres. The Minister of State, Deputy Madigan, and I will work well together to ensure that we address this important issue because the current situation cannot continue at the level that I have heard is happening right across the country.

Cathal Crowe (Clare, Fianna Fail)
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I want to discuss special educational needs organisers, SENOs. I do not want to tar everyone with the same brush but the organisation wields way too much power. It is in the realm of education, in which it plays a major function, but it also delves into the realms of occupational therapy and educational psychology. The organisation is empowered to interpret large volumes of assessment paperwork but it can strike out elements with devastating effects thus denying a child access to key enablers such as educational supports, occupational therapy supports or assistive technology. The parents are absolutely infuriated at times and there needs to be standardisation across the board. The issue comes down to a very moral and possibly legal argument that I cannot go into a person's realm and challenge him or her about a report if I am not equally, if not more, qualified yet the organisation does so. An educational psychologist will have spent between four and six years studying for a degree and his or her Master's qualification yet his or her report can be torn asunder by someone who is not equally qualified. I am not being snobbish when I say that and there is a legal point to be made. I could not disregard an assessment by a plumber, mechanic, doctor or an accountant because I am not qualified in any of those disciplines yet a SENO can dissect everything in a report that has been submitted by a school and an educated psychologist or occupational therapist thus denying a child key supports that would enable him or her to live a more structured life in education. I know that these functions overlap with another Department. The Minister of State is a good ambassador and champion for those who have disabilities and I hope that this is an issue she will take on during this term in government.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The Deputy is right that there is a crossover between the Department of Education and my Department but the child that he speaks of is the child with a disability and the parent that he speaks of is the parent of a child with a disability so the children with disabilities are my children. As the Minister of State at the Department of Children, Equality, Disability, Integration and Youth, I am responsible for providing supports for these children. Yes, I will champion their needs. I will work with all parents and all elected representatives on these issues and I hope that we reach the stage that the Deputy has articulated. With his level of experience working in the profession of education he speaks with authority but I agree with what he said about the reports. It is not the first time that I have heard that reports have been rubbished and shredded. I will raise the matter with the Minister of State, Deputy Madigan, tomorrow.

Cathal Crowe (Clare, Fianna Fail)
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I thank the Minister of State. I know that all these committees produce reports after deliberating. I would like the following noted in the minutes of this committee: We, as a committee, have heard concerns expressed that the SENO organisation nationally lacks standardisation and on a whim can have a devastating impact on supports that children desperately need; that there is good and bad but we, as a committee, are concerned at how things have been rolled out heretofore.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I have only a few questions as nearly every question has been asked at this stage. I appreciate that the Minister of State has said she will give us a monthly breakdown. I would also appreciate us having a follow-up on the meeting that she will have tomorrow. Can she supply the CHO 5 figures from her document?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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Yes.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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Since the Minister of State has introduced monthly meetings it seems that the number of assessments being carried out for October and November have been a lot higher. Is that partly due to the monthly meetings? Will increases continue? I ask because it would be excellent to have accountability going forward.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
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The backlog for CHO 5 is as follows: As of 30 June 2020 there were 643; at the end of September the number was still 643; as at the end of October the number was 619; and at the end of November it was 501. Again, to turn the figures on their head, the number of assessments of need completed in CHO 5 for September was nil, for October it was 24 and for November it was 118.

The monthly meetings have proved very fruitful and I will continue to hold them but in two phases. I mean I plan to hold a monthly meeting that will address the assessment of needs. When we get on top of the backlog I plan to remain there. The backlog will still be on my agenda every single month but I will flip its priority and make it the intervention piece. I will start my intervention according to exactly what we have on our list as of 31 December. I know what we have as of 30 June so we will start there and every month I will be able to read the data line by line, just like I read out earlier. When we do not achieve on a line I will try to find out why, what barriers exist, how I can assist, what lessons can be learned and what learnings can be taken from one CHO to another. For the last number of meetings that I have had with the HSE I have found the sharing of information on that particular platform has been really helpful to everyone involved.

I am a new Minister of State who wishes to work hard but I also represent the views of the people who elected me. Not one of us, as elected representatives, would want to see a child on a list for a day longer than he or she should be or any day. I have found the sharing of information very helpful and believe in transparency. Yes, I will give the numbers to the committee every single month.

Photo of Kathleen FunchionKathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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I thank the Minister of State and welcome her commitment. As she will know, having watched or listened to these meetings over the past few weeks the stories told here have been heartbreaking. It was not just in this committee room that we heard such stories because we have all experience in dealing with people in these situations and we all want to find a solution. Therefore, we, as a committee, welcome the opportunity to engage further with the Minister of State. We are on board with doing anything we can to further such provision for these children and their families. I welcome the monthly meetings and the fact that they will continue. I thank the Minister of State and her officials, Ms Jenny Anderson and Mr. Noel Byrne, for appearing via video link. We look forward to an ongoing engagement with the Minister of State. Is it agreed that we publish the Minister of State's opening statement? Agreed.

As this is our last meeting before Christmas, I wish everybody a happy Christmas and thank everybody, the members and the secretariat for all of the work that they have done. This year it has been a lot more difficult than normal to organise meetings due to the arrangements that must be observed to prevent the spread of Covid, including only having two hours for a meeting. Thankfully, the arrangements have worked well so far. I wish everybody, the Minister of State and her staff a very happy Christmas.

The joint committee adjourned at 5.40 p.m. sine die.