Hildegarde Naughton (Galway West, Fine Gael)

The challenges and problems associated with the assessment of need process and the provision of services for disabled children, adults and their families have been illustrated in stark detail in this Chamber today. It is not acceptable that vulnerable people clearly in need of State support are left wanting. It is not acceptable that families are stressed and frustrated, and despair that the State appears to have ignored their pleas for help. It is not acceptable that any person feels they must stage a public protest to draw attention to this issue.

As Minister of State with responsibility for disability, I believe there are three fundamental issues which Government must address to deliver the step change in disability services as promised in the programme for Government. The first is tackling the long and growing waiting lists for assessments of needs. Our primary focus must be on the assessment of need process, identifying the delays and blockages which are causing the growing waiting list. We then need to find the most effective solution to these blockages. This may require legislative change, while being clear that no one will lose his or her statutory right to an assessment of need. It will likely involve operational changes, increased staffing resources, better IT systems or outsourcing to the private sector where appropriate. It will also involve ensuring nobody is asked to undergo an assessment of needs to access State services unnecessarily. This work is already under way with officials from the Department of Children, Disability and Equality working intensively with the HSE to deliver existing actions, including those set out in the roadmap for service improvement, and to develop new ones.

The second fundamental issue which must be addressed is providing speech and language therapy, occupational therapy, physiotherapist, psychology and other supports to everyone who needs them. That involves providing more places at third level, more work placements and upskilling. It means continuing with the recruitment drives which have helped deliver an additional 272 staff in our CDNT network last year alone. It also involves measures being put in place to retain existing staff in the system and attracting new entrants. This is of particular importance for the children’s disability network teams which provide specialised community-based services for children with complex needs and that do not yet have the full staff complement they need to deliver their services.

The third fundamental reform that I, my colleague, the Minister, Deputy Foley, and Government is committed to introducing is providing clarity to families and individuals on how to navigate our overly-bureaucratic health system in order to secure the services they need. That involves making sure there is no wrong door, that a child is directed to the appropriate service regardless of how they enter the system, whether through the primary care system, CDNTs, CAMHS or any other avenue.

This is an emotive topic, one that affects many children and families right across the country, causing anxiety and stress for parents who are seeking the supports their children need. The State needs to communicate better. It needs to map out a pathway through services and deliver those services in a timely manner. The challenges associated with the assessment of need process and the wider system are significant and they require a proportionate response from Government. Since taking office, both the Taoiseach and the Tánaiste have consistently highlighted that disability services, in particular disability services for children, are a key priority for this Government. The priority is reflected in the fact that both the Minister, Deputy Foley, and I sit at the Cabinet table where disability matters are in sharp focus. A Cabinet committee with a specific focus on disability has also been created to ensure there is a whole-of-government response to issues affecting children with disabilities, whether through fixing the broken assessment of needs process, providing appropriate education supports and, crucially, access to therapy services. A dedicated unit in the Department of the Taoiseach is also being created to drive change and hold Departments and State agencies to account.

Specifically around the assessment of needs process, the Minister, Deputy Foley, has been very clear about the stark nature of this challenge. There are almost 15,300 assessment of need applications overdue for completion. In 2021, the figure stood at 3,500. Over 10,600 new applications were received last year with some 4,100 completed assessments in 2024. Those numbers do not work for anyone and it is clear that demand is greatly outstripping the capacity of the system to meet it. The introduction of the targeted waiting list by Government last May is without doubt helping, with over 3,600 assessments commissioned from private providers between June 2024 and the end of March this year. I am also encouraged by the 30% increase in assessments completed last year compared to 2023 and the 65% increase in completed assessments in the first three months of this year compared to the same period last year. These figures show we are moving in the right direction but we need to do much more, much faster. However, it is not enough to clear the current backlog and think that the job is done. We need to ensure another backlog does not grow to take its place. This will not be a quick fix. The problem is complex. Parents rightfully want access to services and supports for their children. In many cases, when they seek that support from primary care, CAMHS or children's disability network teams, they are told that they have been added to a long waiting list. This leads many people to apply for an assessment of need, a statutory right set out in the Disability Act. They may believe that this will give them early or accelerated access to services only to find that, even if they are provided with an assessment report, it leads only to another waiting list. Some parents feel they have no option but to turn to the legal system to ensure their statutory rights enshrined in the Act are met.

The Minister, Deputy Foley, called this situation "untenable" and I agree. We can and should do better.

We must ensure that any changes introduced are effective and can be sustained over time. This will mean that whenever an application for an assessment of need is submitted, it is dealt with promptly and within the statutory timeframes. While this work is under way, we need to look at the wider system to identify the blockages that are resulting in long waiting lists for children who need to access HSE services and supports, whether these are in primary care, CAMHS or the children's disability network teams. We are all aware of the many demands on our healthcare system, but we must ensure that our disability services are appropriately and adequately resourced and staffed to meet the needs of people with disabilities in Ireland.

In this regard, I look forward to the development of a dedicated disability workforce strategy this year, to meet growing service demands and address recruitment and retention challenges across the specialist disability services. However, it is important to emphasise that increased capacity and enhanced service delivery in the disability sector will not be possible unless we, as a Government, ensure there are proper resources in place to service this ambition. A total of €3.2 billion has been allocated for HSE disability services this year. That is an 11.5% increase in funding on last year and an overall increase of €1.2 billion since 2020. This is a significant increase in funding, but I appreciate that significant pressures are facing the sector.

Collaborative working across Departments will be vital over the coming period. For example, we will work closely with the Department of Health on the resourcing of disability services, with the Department of Further and Higher Education, Research, Innovation and Science on expanding the pipeline of future therapists, and with the Department of Education and Youth on the development of the national therapy service in education.

There is no doubt that addressing the problems with the assessment of need process is a challenging piece of work. It requires a well thought-out, comprehensive plan to ensure all aspects of the system are examined and, where necessary, improved or fixed. It is a priority for the Government. We owe it to the children of Ireland and their families who are relying on the State to put in place a sustainable assessment of need system that works.

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