Bríd Smith (Dublin South Central, People Before Profit Alliance) | Oireachtas source

Sorry about that, Chair. I do want to welcome the motion and the issue Sinn Féin is highlighting. One of the main demands, that we should scrap the standard operating procedures, is one we would like to echo. This is a con job designed to massage the figures and give the impression that something is being done about the scandal that is the assessment of needs and how the State treats its most vulnerable. Since I came into the Dáil in 2016, I and my colleagues here have had countless constituents coming to us in exasperation and despair about trying to get their children the care and supports they need. The first obstacle in a long list is the assessment of needs process. Those who are forewarned can simply go private or, most often, struggle to do so. Those who cannot go private will languish on waiting lists. When we have submitted parliamentary questions on this issue, we have received astonishing replies from the HSE. Dates were set at a year or 18 months into the future for an assessment.

Then there was the whizz some genius decided on, namely, the standard operating procedure, to give the appearance that something is being done when, in fact, it is only an added process and obstacle - in effect, a queue to get into a queue. We know the consequences and trauma caused by this and have done so for many years. We know there have been serious staff shortages for years.

When we asked for the data on the number of children in each CHO and the time they were waiting to access the services identified in the assessment of needs, the HSE said it does not compile that information. This is extraordinary. All the statistics and all the supposed progress is about identifying the needs children have, not meeting those needs or supplying the services. The explanation given in the responses to parliamentary questions for the rationale behind the standard operation procedure needs to be challenged. The claim is that it is for consistency and that assessment officers and clinicians were "erring on the side of requesting a wide range of assessments in as short a timeframe as possible" because they were under pressure from the legislation.

It is worth comparing that bureaucratic answer with the experiences of a friend of mine. Lynda is from Tallaght and has a son called Sé who is nine and has Down's syndrome. In an interview with The Irish Timeslast year, she explained that he has had sporadic supports over the years. She said:

[Sé] was referred for an autism assessment three years ago - it hasn't even been acknowledged. There is maybe one occupational therapy session per year. No speech and language for the first few years and then a block of six hours before he's signed off the system. When I started fighting for services after Sé was born, I was told I have unresolved childhood issues. Instead of working together, it's about blame. We've spent all our savings on private therapies and we're in a precarious position now.

In the same article, Dr. Irwin Gill says of the current process:

It's not a meaningful assessment; it does not help children and merely moves them to another waiting list for a more useful assessment, for which there is no statutory time limit and therefore no legal recourse. The prevailing opinion is that this is a cynical attempt by the HSE to protect itself rather than act in the interests of children.

Clinicians on the ground reiterated this, with one of them saying they "feel disheartened and many feel they cannot stay in the HSE if this is the future". Another clinician said:

It's against all our ethical practices. We cannot assess in 90 minutes as to whether or not a child has a disability, but if we say they don't, they won't get services. So most of us will probably recommend further assessment and say we suspect a disability. I feel despondent.

One of the serious questions that arises is why this crisis has been allowed to grow. Despite all the rhetoric from the Minister for Health and his predecessors, the HSE has overseen catastrophic failures to provide the services needed by our children. The assessment of needs issue shows again the deep crisis in our national health service in general and the attempt to suggest that somehow these issues are complex and inexplicable. In fact, the roots of the problems are the multiple crises in the health system stemming from the fact we have supported and maintained a two-tier health system for years - a crisis-ridden public system and an ever-increasing and largely profitable private system. This is the reason the private system is being grown. There is a vested interest in private healthcare precisely because we have a dysfunctional public healthcare system. There is a dysfunctional public healthcare system in order to promote the private system. They are two sides of the same coin and any attempt to deal with one without the other does not understand this issue and the attempt will flounder. We need a one-tier national public health system that understands that when we force nurses or public health doctors out on strike or drive them out of the service or the country because the conditions are so bad, we are deliberately undermining the provision of public health and facilitating the increased need for private, for-profit healthcare.

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