Mr. Odhr?n Allen:

Deputy Collins is asking a question that picks up on what others have asked today. We are coming back to the same issues, AON, PTA, how the services are delivered, children on waiting lists, families being frustrated and so on. I will zoom out a little and talk about the top-down and bottom-up approach I feel is needed. All these issues are symptomatic of a bigger problem. Health and social care professionals, HSCP, are the poor cousins in the health services. As regards top-down approaches for the State, we need to see HSCP leadership in Departments. We do not currently have health and social care expertise in the Departments of Education; Health; or Children, Equality, Disability, Integration and Youth. We need them. We have medical and nursing colleagues in Departments. It is necessary. Why do we not have health and social care professionals? If we do not have top-down leadership and planning for the State, we will run into operational difficulties down the road. That is necessary as one top-down measure. I would also argue that it is clear from all these issues that we need a HSCP cross-departmental strategy. Many of these issues are affecting many of our citizens. Today we are focusing on people with autism but many other people are affected by this lack of leadership and lack of joined-up thinking. We need a HSCP strategy that is cross-departmental.

With respect to bottom-up approaches, I echo what colleagues have said. We need consultation. When services are being delivered in a manner and local policies are in place that are forcing occupational therapists, speech therapists and psychologists to work in a way that is unethical, the system is broken.

That has happened in the roll-out of PDS with the PTA. It was unethical to force therapists to practise in a way that went against their code of ethics and to force them to do an assessment they knew was not the assessment they would otherwise carry out. There is something wrong with the system. Services cannot be designed without consultation with the professionals delivering them and, as members are hearing, that is persisting to this day. We do not know what is happening. The professional bodies have not been consulted. We represent clinicians and therapists on the ground. The unions are consulted but, with all due respect, they are unions and not professional bodies. They do not represent the professions. We need consultation with the professions, therapists on the ground and professional bodies, as well as people with autism and their families. They need to be at the centre of the model of service delivery.

At another forum recently I used the analogy of a supermarket. Many people say they do not like to go into one supermarket or other because it does not stock what they want to buy, treat them well or give them what they need. It would be hard to understand how management in such a supermarket would dismiss what people are saying and say their service is fine and their supermarket is great. Unfortunately, with the health services, people do not have the choice to go elsewhere. Many families cannot afford to go privately. Some are forced to and, luckily for them, can afford to do so. The majority of citizens are dependent on our public health system and do not have the alternative to go a private route. They are denied basic services. We need to design our services with adults and children with autism and their families at the centre. They need to be consulted. If they say, as the majority of families are saying, that PDS is not working, they are right. The service is for them. If they say it is not working, we have to listen.

There needs to be a significant increase in the percentage of the health budget spent on disabilities. It is ridiculously low. I think it is something like 2% or 3%. I know everyone is looking for more budget but our citizens with disability deserve better and the State can do better.

To summarise, top-down, we need leadership of our professions in Departments and a joined-up strategy, because many of these issues cannot be dealt with piecemeal; and we need a bottom-up approach where there is consultation with people and therapists and an increase in the budget. A joined-up framework is needed because many of these issues will persist. I am not optimistic about solving these problems in the next two to three years because we will not find the therapists. We do not have enough occupational therapists, speech therapists and psychologists in Ireland to provide for the current need in our health services, never mind the projected increase. We will not fill that gap, I am sorry. We can try to fill it from abroad but other countries face the same problem. It will continue to be a challenge for us but there are practical things that could be changed today to make a difference to families, children and adults with autism and to therapists on the ground, if only families and therapists were listened to. That is my call.