Michael McGrath (Cork South Central, Fianna Fail)
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I am pleased to raise this critically important and urgent issue. If a society is measured by how well it looks after the most vulnerable, and if there is to be a degree of compassion in our country so that we can deliver a fair society, we must bring about dramatic improvements in this area. The waiting times for an assessment for autism in Cork are a disgrace and a scandal. The HSE has given me the latest waiting times and the figure for St. Joseph's Foundation is 18 months, for the Cope Foundation it is 25 months and for the Brothers of Charity it is 28 months. It is not the fault of the service providers in question as they can only do what they can with the resources they are given.

I recently raised an individual case of a young girl who is just short of three years of age. She joined the list in January 2018 and she has been told she is likely to get her assessment after 28 months, in May 2020. The lack of a public diagnosis can have very serious implications. Where is the early intervention for children who are facing these waiting lists? Some schools in Cork have a policy whereby they do not accept a child on the waiting list to attend the special school, or a unit in the school, in the absence of a public diagnosis. Some parents pay for a private assessment to be done and can thereby access domiciliary care, home tuition and the incapacitated child tax credit. Not everyone can afford a private assessment, but even if they can, many children cannot access appropriate education without a public assessment and diagnosis.

This is a priority and the way these children and their families are being treated is a scandal. I hope there will be a radical intervention to make a tangible difference.

Margaret Murphy O'Mahony (Cork South West, Fianna Fail)
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What steps is the Minister of State taking to address the disgraceful situation whereby the waiting time for an autism spectrum disorder assessment for children in Cork city and county, many of whom are in my constituency of Cork South-West, can take up to 28 months? The Minister is aware that children with disabilities are legally entitled to an assessment of need under the Disability Act 2005. Moreover, assessments should commence within three months of an application being received and completed within a further three months. I am aware of the roll-out of the new standard operating procedure and note the concerns about this raised by various stakeholders at the Committee on Health last week.

More than 1,150 children in Cork are waiting on stage 2 of the assessment of needs process. These children are waiting for clinical assessments to be completed and roughly 900 have been referred for an autism spectrum disorder assessment. Many of these will wait up to 28 months for an ASD assessment. Why has Cork got such a large waiting list? Why has Cork been left waiting so long? Behind these figures are human beings, parents and siblings, people who are waiting for an official diagnosis to be able to plan a future for their family.

Finian McGrath (Dublin Bay North, Independent)
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I thank the Deputies for raising this important issue today. There have been significant year-on-year increases in the number of children applying for assessment, including for autism spectrum disorder and for disability services generally, which has led to delays in timeframes. The clinical picture of autism is complex and variable because of differences in the severity of autism itself.

In the 12 months prior to October 2017, Cork-Kerry community healthcare had received a total of 1,110 referrals for assessment under the Disability Act. In January 2017, approximately 808 applicants were waiting to move from stage 1, the assessment officer stage, to stage 2, the clinical assessment. I understand that a number of initiatives had been put in place in Cork-Kerry community healthcare, including recruitment of additional administration staff and additional assessment officers to screen applications. By October 2017, the waiting list had reduced to 137. The backlog has now been cleared and all assessment of need applications are commenced within a month. There are, however, a very high volume of applications coming through for assessment of need in Cork, with upwards of 100 applications being received per month.

At the end of April 2018, there were 1,150 children awaiting stage 2 clinical assessment as part of the assessment of need process in Cork. Approximately 800 of these cases have been referred for an autism spectrum disorder, ASD, assessment. The Cork-Kerry community healthcare organisation recognises the long waiting times for clinical assessments within the current assessment of need process, and a pilot project has commenced with the South Lee ASD team to look at reducing the time taken to undertake an ASD assessment.

In an effort to standardise assessment of need procedures and to facilitate timely assessments, the HSE identified a requirement to develop a standard operating procedure, SOP. This SOP is intended to replace the suite of approximately 50 guidance notes that have been issued since 2007 and will define the assessment. It will ensure a standardised approach across the State in respect of the operational application of the Disability Act 2005 and provide an important opportunity to balance and ensure equity in terms of assessment and support interventions for vulnerable children and young people with a disability. The HSE recognises that early intervention services and services for school-aged children with disabilities are paramount and need to be improved and organised more effectively. This process is well under way nationwide.

Michael McGrath (Cork South Central, Fianna Fail)
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I hope the Minister really gets this issue. The intervention to deal with this will have to be radical because it is a sick joke that children have to wait 28 months for an assessment for autism while they go from aged two to aged almost five. It cannot be tolerated.

There is much talk about the confidence and supply agreement and the Taoiseach says he wants to extend the agreement and enter negotiations. One part of the agreement calls for improved services and increased supports for people with disabilities, particularly for early assessment and intervention for children with special needs. Given that this has not happened, before the Taoiseach comes knocking, looking for more time and an extension of the agreement, he needs to deliver. This is one issue on which we will not accept failure. It must be delivered.

Margaret Murphy O'Mahony (Cork South West, Fianna Fail)
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I am glad the Minister of State accepted that the waiting lists are increasing but acceptance is not good enough. At this stage we need strong and fast action. Early intervention is of the utmost importance. It must be remembered that even after a diagnosis these children will face long waiting lists for therapies. The assessment of need must be worked on. Combined, the waiting lists for assessment and therapies make early intervention almost impossible. A diagnosis is required for many schools throughout Cork and to achieve this, the Minister of State must take action and hire more staff.

Finian McGrath (Dublin Bay North, Independent)
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I assure Deputies Michael McGrath and Murphy O'Mahony that I get the point and accept they have a particular issue. We have a national issue but I also understand there is a particular issue with services in Cork. I acknowledge that we have to take action on disability services. However, the disability service is already engaged in a major reconfiguration of existing therapy resources for children with disabilities into multidisciplinary geographical based teams as part of its national programme on progressing disability services for children and young people aged up to 18 years. It is also anticipated that the combined efforts being undertaken by Cork-Kerry community healthcare and the HSE nationally relating to the assessment of needs process and progress on disabilities will have a significant positive impact on the waiting lists as we progress through 2018.

The Deputies asked me what I have been doing. I have been in regular contact with officials in the HSE on this issue. Last Monday afternoon, I sat down with the HSE and Department of Health. That was among my six priority issues. I have discussed this previously with both Deputies.

I appreciate the Deputies' support on this issue when it comes to the broader political issue in terms of the confidence and supply agreement. I am putting people with disabilities and similar issues at the top of the agenda and I welcome the Deputies support, which is needed. I will continue to be in regular contact with HSE officials on this issue to ensure this remains the case. People with disabilities cannot be left behind and I will accept my responsibility in that regard. I appreciate any support on this issue because a debate is taking place on whether we should have tax cuts or investment in services. From my point of view, I favour the latter and, in the context of this debate, services for children with disabilities.