Mr. Adam Harris:

I thank the Deputy. There are a few pieces there. The Autism Empowerment Act in Malta started its life in the Parliament there as the autism disorders Bill. When it was published, there was very extensive engagement with autistic adults which led to the shape of the Bill being changed significantly. The fundamentals of that Act are that it requires a strategy, which I think is for a three-year term. It requires the Minister of the day to report on it and it establishes a council that steers the implementation. That council must have a majority of autistic representatives on it. That is fundamentally what the Maltese legislation does, and it really is seen as best practice in the autism community globally.

In terms of the assessment of need and how we get more psychologists and other therapists to stay here, the Deputy has hit the nail on the head with many of the suggestions she has made. I am sure that if there was someone from a professional body here, they would have more to say than I would. However, what I would say as a starting point is that training more is critical. We know we are not training enough, so that is an obvious starting point. It will obviously take a number of years for us to benefit from training more. However, if we are going to train more, we need to look at the sort of infrastructure we can put in place to make sure that the people who benefit from those additional places can then contribute to the Irish healthcare system.

Career progression is a problem for many therapists. People can get entry level jobs but there are perhaps fewer opportunities to progress at the same pace as one would in other environments. More senior roles are an issue. Culture must be a huge challenge. We know the scale of the challenge for children's disability network teams, CDNTs, for example, from the perspective of families. I can only imagine how challenging it must be to work in that environment when you do not have a full team, when you are trying to support people and when you are very under-resourced and all the stress and strain that goes with that. It ultimately comes down to a matter of getting more people to stay and work within the system. Then, people would see it as a more desirable or more pleasant place to work. That is important.

We also need to look at private practice. This is a bit like Sláintecare, where consultants are tying themselves into the public system. There are many people working within the public system who are also doing private practice. Sometimes the lines can blur there as well. There has to be a clearer line - you are either in the public system or the private system. That is something we hear from families.

In terms of the education element of the assessment of need, which came in based on a recent judgment from the courts, we have massive concerns about the approach that sees a principal or someone in the school completing that element of the report. That is for a number of reasons. First, for us filling out a form based on existing paperwork already in the school cannot be seen as any kind of assessment. I am concerned that if a family inevitably challenges that element of the assessment, as they would be perfectly entitled to do, that would be struck down and we would end up seeing the Department of Education or the NCSE making the same mistake the Department of Health made, whereby if we try to cut corners around assessment of need we will end up with large numbers of people who will end up having to have their assessment redone. That, in turn, will only extend waiting lists.

Even if none of that was an issue, we are fundamentally concerned about the fact that principals have a role in allocating the resources in the school, in line with guidelines, to students in the school. Therefore, if you are asking the person to allocate the resources and to assess what a person's educational needs are, that is clearly a conflict for us. We think that places both principals and families in an unenviable position.

The private psychology piece is really worrying. The AsIAm position is that it is not enough to just protect subsets of psychologists. I know what is being looked at now are educational psychologists, clinical psychologists and counselling psychologists, starting with those terms. However, we will still have people then presenting themselves as a consulting psychologist or child psychologist to try to get around those rules. We have seen that happen in other jurisdictions. There needs to be very robust regulation.

What we also think is a problem in Ireland, and perhaps this is something for the committee's recommendations, is that in the UK there are very clear national guidelines as to what constitutes an autism assessment. Therefore, if people are going privately, they know where they stand and what the report needs to say. In Ireland, we have a very confusing system whereby people are not told what needs to be in the report and then, when they get the report, they are told it is not good enough. We would like to see national guidelines because they would both protect families and improve practice across the board. The community piece around supporting community groups is very important. That is one of the things we would like to see. We welcome any opportunity for parent groups to be given a stronger voice and be consulted. Critically, what we would also like to see happen for parent groups is funding to be made available or some sort of national pot of money to which groups could apply to support their activities. I see what these groups are doing on the back of table quizzes and race nights, so I can only imagine the difference they could make in a very tangible way on the ground if they received even a small amount of support from the State.