Norma Foley (Kerry, Fianna Fail)

I am not opposing the motion and I welcome the opportunity to debate this important issue. Like previous speakers and as I did earlier, I acknowledge Cara and her dad, Mark. In respect of Cara in particular, I acknowledge her absolute determination and her compassion to advocate not just for her own family but for all children in a similar position. It has been really worthwhile to have the opportunity to meet with her on a number of occasions. I acknowledge the work she does.

The Government recognises and shares the concerns expressed through the motion that there are unacceptable delays in access to assessments of need. We accept there is a need to increase the availability of and access to appropriate services for children with disabilities. As reflected in the programme for Government, we are committed to delivering real and tangible solutions to enhance services to better support children with disabilities and address the challenge of growing waiting lists for assessments of need. We are also committed to ensuring that children receive an education appropriate to their needs.

I note that the component parts of the motion may have merit. However, the underlying issues and the ultimate solution to address them are multifaceted and more complex than presented here. In order to have meaningful effect, any solution proposed must form part of wider strategic reforms. I understand that, like me, Members of the House have, as I said earlier, been moved by Cara Darmody's ongoing campaign to have deficiencies in the assessment of need system addressed.

As I outlined, I have met Cara, both in my previous role as Minister for Education and in my current role. As Cara is advocating here in respect of the assessment of need, we need to make progress here and give it the priority it demands. However, it is also important to note that children do not require an assessment of need to access health services including primary care, children's disability network teams or mental health services. Children with complex needs may require supports from their local children's disability network team. More than 43,000 children are being supported by these teams with or without an assessment of need. Children whose needs are more moderate are supported through the primary care system.

These systems, however, face their own challenges. People are pursuing assessments of need because they feel they need to, due to issues in the wider system. From speaking to parents, I know 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 the 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 when they are seeking an autism assessment or diagnosis for their child. I am aware that the HSE has been developing an autism assessment and intervention protocol and I look forward to its introduction and incorporation into the existing health and education systems. Once in place, I hope this will help to alleviate the confusion and stress experienced by so many 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. Work has been under way in this area to ensure that children are referred to the most appropriate service, building on existing HSE policies and joint working protocols. It is an area where 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 then may face another long wait to access the services their child needs. This, understandably, causes frustration and stress for families and it is absolutely not acceptable. We need to look at not only the assessment of need process but also the wider system to identify the barriers and delays and remove them. We need to see a process that ensures a child receives an assessment that is appropriate to their needs because every child is different, with their own unique abilities and needs.

HSE data shows that there has been a significant growth in the number of applications for assessments of need. Applications increased from 8,400 in 2023 to more than 10,600 in 2020, a 26% increase. HSE figures for the first quarter of this year indicate there has been a 20% increase in the number of applications, compared with the same period last year. At the end of March, there were almost 15,300 assessment of need applications overdue for completion nationwide, an 8% increase on the number overdue at the end of December. These figures are worrying and absolutely demonstrate the nature and extent of the challenge we face. Behind these numbers are children and families facing their own challenges every day and relying on the State to support and help them.

Although these numbers are growing, initiatives are under way to address the increasing volume. In 2024, more than 4,100 assessments were completed, an increase of 30% over the previous year. This is a considerable achievement, reflecting the effort and investment of the Department and the HSE to address the waiting list. Recent HSE data shows that this upward trend is continuing, with over 1,400 assessments completed in the first three months of this year, a 65% increase compared with the same period last year.

While this is welcome progress, it is abundantly clear that much more needs to be done. It is essential that we maintain this momentum and indeed accelerate it. The fact that demand continues to outpace the capacity of the system to meet it was recognised in May of last year, when the Government introduced the targeted waiting list initiative. This provides funding for the procurement of assessments from approved private providers for those families who have been waiting the longest. Between June and December of last year, this resulted in more than 2,470 assessments commissioned from private providers at a cost of over €8 million.

This Government has allocated €10 million in funding this year to deliver approximately 2,850 assessments of need. The additional funding is already showing results and an increase was reported at the start of this year. I am confident the initiative will continue to support and deliver for children and families who have been waiting longest for assessments, but I am determined that funding will not stand in the way of doing what is necessary and effective to respond to the challenges.

Although there is a limit to the capacity of the system to provide private assessments, if there is any additional capacity in the private system to do more, the Government is giving the commitment that money will not be a barrier. However, I am acutely aware that private assessment in isolation is not sufficient to support the capacity of the healthcare system to deliver assessments of need. We cannot rely on the private sector indefinitely so we must ensure that the public system can meet the clearly growing demand. As part of 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 regions.

Another and 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 that 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 my Department to fill vacancies within the 93 children’s development network teams. Some progress is being made in this regard. 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 in 2025 to meet growing service demands.

I fully recognise there are many challenges here. I want to underline and emphasise again that the Government is absolutely determined to improve the process to ensure that children have the maximum opportunity at the earliest opportunity to receive the therapies they need and deserve. There is cross-departmental co-operation between Ministers. Significant work is being done by the Cabinet subcommittee and additional resources are being put in place where they are required.

I want to refer briefly to the significant State investment in the provision of special education which is now at €2.9 billion. That is a 48% increase since 2020. It has seen the doubling of special classes, an additional 16 new special schools established and we have more than 40,000 professionals working in this area. Much more needs to be done and is being done.

The scale of the challenge we face is clear. We are committed to delivering real and tangible solutions to enhance services to better support children with disabilities in Ireland and address the challenge of growing waiting lists for assessments of need. However, this is an issue the Government is taking extremely seriously and according it the highest priority. As Minister for Children, Disability and Equality, it is one of my highest priorities. I am committed to working across the Government and with the Minister of State, Deputy Naughton, to ensure we have a better outcome for all the children who are in our care.

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