Dáil debates
Tuesday, 22 January 2019
Saincheisteanna Tráthúla - Topical Issue Debate
Disability Diagnoses
6:50 pm
Martin Ferris (Kerry, Sinn Fein)
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As the Minister of State is probably aware, last week the health committee highlighted that there are massive delays throughout the country for children who need a special needs assessment. He is also aware that under the Disability Act 2005, the assessment of need must start within three months of the completed application being received by the HSE and that the assessment, outside of exceptional cases, must be completed within three months of commencement. This gives a total of six months. The committee also heard that in Kerry and Cork, which produce the highest number of applications and the most reports, have the highest level of overdue assessments. According to the figures I have, in Cork and Kerry those waiting for overdue assessments amount to 1,718.
In the second quarter of 2018, the HSE recorded an average waiting time of 2.5 years for an assessment of needs for children referred from Kerry and Cork. By any standard it is shameful and outrageous that parents who already have the worry of a belief they will get a negative assessment are also burdened with this totally unacceptable delay. While we can speak about facts and figures until the cows come home, the essential point is what these delays mean for a child who must wait this length of time for an assessment and what they mean for a child who cannot communicate and is waiting for speech therapy. Milestones that most children can expect to meet as normal are not being met for these unfortunate children. The ramifications of these overdue assessments are to the public purse and to those who are now adults with special needs who were not assessed and did not receive the necessary interventions in time.
Does the Minister of State not think it is now time to put in place the necessary resources to provide adequate services for our most vulnerable children and their families? It is not me saying this. The HSE claims it will need 400 more therapists in the years ahead. As I have said, Cork and Kerry, because of the number of people there who are overdue for assessment, are seen within the HSE as a priority.
What is also very disturbing is that the standard operating procedures mention taking 90 minutes for screening. This is proposed for cases in which many therapists and doctors would state that 40 hours are required for assessment, particularly for children on the autism spectrum. Not alone are there 1,718 children waiting for an assessment, there is the added dimension of a proposal for a 90-minute screening period where up to 40 hours may be necessary. It is not me or anybody else in the House saying this, it is coming from Dr. Cathal Morgan, who states the standard operating procedures are not adequate to meet the requirements necessary to help resolve the problem.
Will the Minister of State enlighten us on what proposals he has to try to deal with this? In most instances regarding special needs resources we are probably pushing an open door with regard to the Minister of State in charge. I wish to hear his reply on what can be done to try to improve the sector and, in particular, deal with the 1,718 children awaiting assessment.
Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Ferris for raising the issue of waiting lists for children with special needs and I commend him on his work in the Kerry area because it is something in which he has been very involved and he has been very supportive of progressing services for all children with disabilities.
The Government and I recognise that the waiting times for services for children with disabilities need to be improved significantly. A Programme for a Partnership Government commits the Government to improving these services and increasing supports for people with disabilities. This commitment is guided by two principles, namely, equality of opportunity and improving the quality of life of people with disabilities. Significant resources have been invested by the health sector in services for children with disabilities over the past number of years, in particular since the Independent Alliance went into government, with a particular focus on early assessment and intervention for children with special needs.
A number of initiatives are under way to improve access to therapy services. The HSE recognises that early intervention services and services for school-aged children need to be improved and organised more effectively, and this process is well under way nationally. The HSE is engaged in a reconfiguration of existing therapy resources for children into geographic-based teams. This will include Kerry. The objective is to provide one clear referral pathway for all children, irrespective of their disability, where they live or the school they attend. The implementation of this project was at a standstill for some time pending the resolution of various industrial relations issues. These have now been resolved. The appointment of children’s disability network managers has long been identified as a critical enabler for the project. A number of these managers were appointed last November and recruitment for the remaining posts is ongoing, with interviews scheduled for the week commencing 28 January. It is envisaged that the children’s disability network managers will be in place in the first quarter of 2019 and their appointment will enable all geographic areas to reconfigure this year, in line with the policy on progressing disability services for children and young people.
I am aware that in many parts of the country, parents experience significant delays in accessing the assessment of need process and additional measures are being taken to address this. I accept the Deputy's argument that Kerry is one of them. These include a standardised process to be used nationally for conducting the assessment. This will help children and young people with a disability to access the services they need as quickly as possible. The requirement for additional resources to provide appropriate and timely services for children and young people with complex needs has been identified by the HSE and the National Disability Authority. The allocation of 100 new development posts as part of budget 2019 will support the efforts to address the waiting times for access to therapy services.
The HSE is also addressing waiting lists with a cross-divisional team working on a detailed analysis of waiting times and resource deployment throughout the country. National service improvement groups and the HSE primary care unit are working with the chief officers in each area to address waiting lists. I take Deputy Ferris's views on board. We need to move on this as quickly as possible.
7:00 pm
Martin Ferris (Kerry, Sinn Fein)
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I thank the Minister of State for his response. I take his word that the Government has recognised that the waiting time for services for children with disabilities needs to be improved significantly. The Minister of State mentioned that A Programme for a Partnership Government committed to improving these services. This Government is now into its fourth year and one would have assumed that this would have been much further on. I hope the commitments from the Minister of State today on this issue will be realised in the short term.
The Minster of State also mentioned the standardised process to be used nationally for conducting the assessments. Is that standardised process the standard operating procedure, SOP, or is it more detailed than that? Children with extreme special needs, be that autism or severe intellectual disabilities, will need a standardised assessment, compared to that of 90 minutes, of up to 40 hours. I hope there will be adequate time for the proper assessment of children in need.
The appointment of 100 extra personnel was also mentioned by the Minister of State. The HSE itself claims that it will need 400 more therapists in the coming years. I hope that will also be dealt with. One thing that has always struck me in my constituency work dealing with children with special needs and their parents on the issue of special needs therapy and assistance is the need for early intervention. Early intervention can be crucial. In many instances it can give a child an opportunity. I refer to speech therapy or whatever other necessary requirements there may be for a specific child. I hope early intervention for children with special needs, which has been mentioned, will also be a priority. The Minister of State said there is going to be a particular focus on it.
Finian McGrath (Dublin Bay North, Independent)
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I thank Deputy Ferris for raising these particular issues. I accept his figures regarding Cork and Kerry. It is about more than the argument about facts and figures. It is about young children and it is time for resources. On the standardised process, there has to be adequate time for assessment. That is a very sensible argument and it is something I am pushing very strongly. We need to get those children in quicker and to give them quality time as well. I accept too that the 100 new therapy posts are not enough. We could do with more. However, it is a start for 2019 but I intend to roll out more as we go along.
It is also important to recognise that this year €1.9 billion is being provided for health and personal social services for a wide and complex range of services and supports for people with disabilities. That is an historic figure and the most ever spent on disability funding. That is the record of the Independence Alliance in Government. I reiterate that there will be €1.9 billion in 2019. One of the key priorities of the HSE is to improve waiting times for therapy services for children, as Deputy Ferris mentioned. Additional funding secured by the HSE for these therapeutic services has been invested in progressing disability services for children and young people's programmes.
Since 2014, the roll-out of the programme has had a targeted investment of €14 million as well as the provision of 275 staff to increase services for all children with disabilities. As I stated, budget 2019 provided for 100 new posts for children's disability services. It is a start and I accept Deputy Ferris's argument that we need to push this up to the figure of 400 that he mentioned. Initiatives such as the reconfiguration of therapy services into local geographical teams and the provision of these new therapy posts are expected to have a significant positive impact on the waiting lists.
All CHO areas also have improvement plans to deal with the assessment of need waiting lists. I am committed and the HSE is committed to work in partnership with other service providers to achieve the maximum benefits for children and adults who require access to therapy services. It is aimed to ensure that the resources available for therapy resources are used in the most effective manner possible. The HSE is acutely aware of the importance of addressing waiting times for children with special needs and I assure the House that every effort is being made to tackle this issue. This is something I personally prioritised as well in the HSE service plan for 2019. We have dealt with respite care and residential places but we need to deal with the assessment of need issue.