Norma Foley (Kerry, Fianna Fail)

Gabhaim buíochas leis an gCeann Comhairle as ucht an t-am agus an deis seo a thabhairt dom. Cara Darmody, a 14-year-old child, will be outside Leinster House for 50 hours starting today, highlighting the deficiencies in the assessment of need system and the impact it has on families. I have met and engaged with Cara and her father Mark on three occasions, including last week. I have been impressed by her intelligence, passion and enormous commitment. She is a strong and vocal advocate for her own family and other families across the State affected by assessment of need delays. Cara is highlighting the impact that delays in access to an assessment of need can have on children who need them and their families. The Minister of State, Deputy Naughton, and I are firmly committed to addressing these delays and ensuring the assessment of need process is effective and efficient.

This Government remains committed to delivering real and tangible solutions to enhance services to better support children with disabilities. This is clearly reflected in the programme for Government, as is our commitment to address the challenge of growing waiting lists for assessment of need. I am under no illusion about the issues facing the assessment of need system. They are complex and a multifaceted approach is required to address them. These issues are not just a priority for my Department but require a cross-governmental and cross-departmental response. It is important to note that children do not require an assessment of need to access health services, including primary care, children’s disability network teams, CDNTs, or mental health services. Children with complex needs may require supports from their local CDNT. More than 43,000 children are currently supported by these teams with or without an assessment of need. Children whose needs are more moderate are supported through their primary care team. I know these systems face their own challenges.

People are pursuing assessments of need because they feel they need to due to issues in the wider system. I know from speaking to parents that this system is not working as it should for their children, many of whom are on long waiting lists for those services. Indeed, some children may be on multiple waiting lists. It is within this broader system that the assessment of need process sits. I understand that a significant source of concern and frustration for parents is a lack of clarity about where they should go, in particular where they are seeking an autism assessment or diagnosis for their child. Data on the disability category identified in completed assessment of need reports show that the "autism spectrum disorder” category increased from 18% of all completed assessment reports in 2013 to 36% of all completed assessment reports in 2023. The HSE has been developing an autism assessment and intervention protocol. I look forward, as a priority, to its introduction and incorporation into the existing health and education systems. Once in place, I believe this will help to alleviate the confusion and stress experienced by a lot of children and their parents.

More generally, I believe that parents would like more clarity about the path to take within the healthcare system when they feel their child may have a disability or additional needs. The HSE is working on a single point of access to disability services to ensure children are directed to the correct service provider and receive the necessary services as soon as possible. It is an area in which we need to see more progress in the coming months. Delays in service provision in other parts of the system mean that parents look at all options, including assessment of need, to get early access to services and supports for their child. However, parents find that having waited to get the assessment, they may then face another long wait to access the services their child needs. This understandably causes frustration and stress for families. It is not acceptable. We need to look not only at the assessment of need process but also at the wider system to identify the barriers and delays and remove them. I would like to see a process that ensures a child receives an assessment that is appropriate to their needs because every child is different, with his or her own unique abilities and needs.

HSE data shows there has been significant growth in the number of applications for assessment of need in recent years. Applications increased from 8,400 in 2023 to more than 10,600 in 2024, a 26% increase. HSE figures for the first quarter of this year indicate that there has been a 20% increase in the number of applications compared to the same period last year. At the end of March, almost 15,300 assessment of need applications were overdue for completion nationwide, an 8% increase on the number overdue at the end of December 2024. These figures are worrying and demonstrate the nature and extent of the challenge we face. Behind these numbers are children and families facing their own challenges every day, relying on the State to help and support them. Although these numbers are growing, initiatives are already under way to address this increasing volume. In 2024, more than 4,100 assessments were completed, an increase of 30% over the previous year. Recent HSE data shows that this upward trend is continuing with more than 1,400 assessments completed in the first three months of this year, a 65% increase compared to this time last year.

While this is welcome progress, it is clear that much more needs to be done. It is essential that we maintain this momentum and accelerate it even further. The fact that demand continues to outpace the capacity of the system was recognised in May last year when the Government introduced the targeted waiting list initiative. This provides funding for the procurement of assessments from approved private providers for families who have been waiting the longest. Between June and December last year, it resulted in more than 2,470 assessments being commissioned from private providers at a cost of €8.23 million. The Government has allocated €10 million this year to deliver approximately 2,850 assessments of need as well as to provide for additional capacity within the public system. I am confident this initiative will continue to support and deliver for children and families who have been waiting longest for assessments. I am also determined that funding will not stand in the way of doing what is necessary and effective to respond to these challenges. Although there is a limit to the capacity of the system to provide private assessments, if there is the capacity to do more, the Government is giving the commitment that we will not let financial resources be a barrier. However, I am acutely aware that this measure in isolation is not sufficient to support the capacity of the healthcare system to deliver assessment of need. We cannot rely on the private sector indefinitely; we must ensure that the public system can meet the clearly growing demand. As part of the efforts to support the efficient delivery of assessment of need within the public system, regional assessment hubs are being rolled out by the HSE, aligned with the six new HSE health regions. This will help in some way to streamline the assessment of need process while preserving the time of clinical staff to provide therapy interventions for children and their families.

Another, more significant factor is addressing workforce issues. I am conscious of the challenges and strains facing the health and social care sector when it comes to the recruitment and retention of staff, not to mention the impact this has on the delivery of therapeutic services to children with disabilities and on the delivery of assessments of need. It is a key focus for the Department to fill vacancies within the 93 CDNTs. Clear progress has been made in this regard in recent times with the workforce increasing by 17% from 2023 to 2024. This represents significant growth of an additional 272 whole-time equivalent staff working across CDNTs. We will build on this progress with funding of €2.84 million provided by the Department this year for 75 additional posts. The Department and the HSE are also looking at staffing levels for the assessment of need process. This requires both assessment officers, who are responsible for the production of assessment reports, and liaison officers, who produce service statements on foot of assessment reports. We must ensure that the assessment of need system is adequately staffed to meet demand, with the necessary administrative supports in place to ensure that the assessment and liaison officers can focus on the core aspects of their roles - the production of assessment reports and service statements for children.

We also need to look at the bigger picture of how disability services are staffed. In this regard, a dedicated disability workforce strategy is being developed to meet growing service demands and address recruitment and retention challenges across specialist disability services. This will include identification of barriers to increasing the disability workforce both within the HSE and funded agencies as well as factors that influence staff to remain in practice in the area of disabilities. The HSE continues to drive intensive domestic and international recruitment efforts and to undertake a portfolio of workforce initiatives to support sustained growth of CDNTs and the wider disability service. I am not naive about the scale of the challenge or the impact on children and parents should we fail to meet that challenge. I also know there is so much more to be done. I have tasked officials within the Department to delve deeper in identifying issues within the assessment of need system that are causing delays and larger system-wide factors such that parents feel their only option is to seek an assessment of need for their child.

Intensive analysis is under way at present by officials in my Department, working with HSE senior management and experienced clinicians, with the intention of bringing forward such changes as might be required as quickly as possible. I emphasise that this process is to support effectiveness and efficiency within the assessment of need process. It will not affect the statutory right of any individual to access an assessment of need.

The Department is also looking at whether there is misinformation or misunderstanding about what an assessment of need is for, particularly where there may be a belief that the assessment will bolster or enhance applications for other Government services and supports. This will require some Departments to review their schemes and programmes to ensure they are not inadvertently encouraging people to seek an assessment of need where one is not warranted. It should not be the case that a person feels they need an assessment of need to access a service or support to which they may already be entitled. For example, people may think they need an assessment of need to get their domiciliary care allowance. I have spoken to the Minister for Social Protection, Deputy Dara Calleary, in this regard. There will now be no requirement for an assessment of need report when a person is applying for the domiciliary care allowance for their child. This is a positive development.

Any work addressing the assessment of need challenges must also note the continued work of the education system to develop an inclusive education system for all children to reach their fullest potential. The commencement of a national therapy service in education is a commitment under the programme for Government. It is intended that the national therapy service will commence work on a phased basis initially in special schools and subsequently extend to special classes and mainstream classes at a later stage in the 2025-26 school year. This service will be delivered by the National Council for Special Education, NCSE. Officials in the Department of Education and Youth have begun engagement with my Department and other relevant Departments and agencies on the design, timelines, alignment, integrated working and costings involved to deliver this ambitious programme of work.

The national therapy service will provide occupational therapy and speech and language therapy supports directly to children in schools. This will be in addition to, and aligned with, existing services. While the national therapy service will not have a direct role in the assessment of need process, it is expected that a more effective and direct system of therapeutic support delivery can only help alleviate the pressures felt in the assessment of need system. A co-ordinated approach is required to deliver this range of activities, with Ministers and their Departments working closely and collaboratively to deliver the results that children and their families need. I assure the House that this issue has the highest priority for the Taoiseach, the Tánaiste and the other Members of the Cabinet committee on disability, who are closely following all activity in this area.

At departmental level, a cross-departmental steering group has been established. I expect this group to identify and address any blockages or barriers across the system that may be affecting the delivery of assessments of need. The Department is working closely with HSE colleagues and clinicians to ensure that any changes introduced will have a positive and noticeable impact for children and families who are applying for an assessment of need. Ensuring that necessary changes are introduced and implemented correctly and promptly requires the delivery of a range of actions. The Department will manage this process, monitor delivery and report regularly on progress to me, the Minister of State, Deputy Naughton, and the Cabinet committee on disability.

Returning to the critical issue of information and communication, what I hear from parents most frequently is their sense of frustration and confusion. They do not know where they should go for support or who to ask. This is an area ripe for immediate improvement. We need to be better at explaining to parents what is available, whether an application for an assessment of need is actually required and who is the best person a parent can talk to for advice about the service their child needs. We need to look at how best to make this information available and ensure it is up to date and accurate as well as helpful and useful. This is the very least we can do. It is what families need and deserve.

As I said earlier, I will not understate or sugarcoat the scale or nature of the challenge we face in addressing the growing backlog of assessments of need. However, this is an issue the Government is taking extremely seriously and according to it the highest priority. As Minister for Children, Disability and Equality, it is one of my highest priorities because I find the current situation both unacceptable and, indeed, untenable. There are a range of activities currently under way or being developed that will help to address this complex and multifaceted problem. It will not be a quick fix, however. While we cannot click our fingers and make it go away, we will work every single day to do better. We need a system that works and can be sustained over time. In order to do this, my Government colleagues and I will work intensively, persistently and collaboratively to put in place an effective and efficient assessment of need system to deliver the service that children and their families deserve.

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