Martin Browne (Tipperary, Sinn Fein)
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It will come as no great surprise that I rise to discuss the assessment of needs and disability services for children with special needs. I do this on behalf of many families across County Tipperary who are at their wits’ end in trying to get timely access for their children. The seriousness of this situation is conveyed on a daily basis in Tipperary, with parents getting in touch with me, with parents going on local radio and with parents discussing the situation that their children are faced with on social media.

Take, for example, the case of a family of a young girl who has fallen foul of the system by having an initial diagnosis of autism. I have been told she will not get a full diagnosis for at least 24 months. They cannot afford to go private like many others are forced to do. They thought getting the domiciliary care allowance might give them room to do this, but after applying they were told they are not entitled to it because there was no diagnostic report available. Outlining the dysfunctional nature of the system, the Department of Social Protection said in a letter of refusal that it is not that it does not consider the child to need additional care, it is that there is no objective information to indicate the extent of the care needed. However, this is the tip of the iceberg.

One such parent, Linda, was on Tipp FM this week. She has a six-year-old son who has been waiting for an assessment for 37 months. This is another family failed by the system that the Minister of State has a role in overseeing. He has been left with no SNA in school and will not qualify for one until he is assessed. What about four-year-old Ollie, who has been on a waiting list for speech and language and occupational therapy and has needed assessment for nearly two years now?

He is a year away from starting school. Early intervention is key, but he is not getting it.

Under the Disability Act 2005, an assessment of need must be commenced within three months of receipt of an application and completed within a further three months. The recent High Court ruling essentially found that the HSE failed to comply with the provisions of the Act. The executive tried to subvert its obligations under the Act by replacing the assessment of needs process with a standing operating procedure, SOP. The SOP essentially amounted to a screening exercise. In cases which indicate that a child requires a comprehensive assessment, they are referred to an additional waiting list for further assessment. As the Ombudsman for Children stated, this effectively created a second waiting list.

Not only did the HSE steer away from its obligations in this regard, my colleague, Deputy Cullinane, has since found out that the last time that it submitted a report on the needs of children with disabilities, as it is required to do under section 13 of the Act, was in 2014. These reports are essential to provide a picture of what resources are needed. When confronted with this, the HSE questioned the Act until the fact that it operated under an outdated database was highlighted. Again, this was discovered by my colleague.

Behind every reason these children are being failed by the State likes yet another reason. I would appreciate it if the Minister of State could answer some of the questions I am posing and not reel off a load of corporate speak, as the ombudsman put it, that does not reflect the needs of the children concerned. The Minister of State knows that I am from County Tipperary. In that context, can she tell me what measures are being put in place to ensure not just the recruitment of staff but also the retention of existing staff? What specifics has she got? In terms of recruitment, what process is under way in the community healthcare organisation, CHO, 3 and CHO 5 areas? How many staff are needed and how many are being taken on? Is it true that people are applying for speech and language therapist and occupational therapist positions but are being turned away? Can she tell me the causes of differing levels of access available across the CHOs? Is the outsourcing in some areas and not in others causing this? If she needs me to repeat my questions, I will be more than happy to do so. I wish to stress that there are parents who want answers and there are children whose future is being put at risk because of a crisis that the HSE has tried to hide.

Finally, can the Minister of State tell me why the HSE was allowed to get away with the SOP farce? Why was the database to inform the Department about the extent of needs allowed to get outdated and why were reports allowed to go unwritten?

Catherine Connolly (Galway West, Independent)
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There are a lot of questions.

Anne Rabbitte (Galway East, Fianna Fail)
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Yes, there are a lot of questions. I will read the blacks later on in order that I can obtain answers to them all. The questions that the Deputy has asked are no different from those asked by parents in Tipperary, Clonmel, Galway, Dublin, Limerick or wherever. These are the questions that every parent wants to get answers for.

I thank the Deputy for raising these important issues for discussion in the House. I am involved in ongoing discussions with the HSE on this matter in light of the urgency involved. I am going to focus on the SOP. I hope that is okay with the Deputy. It relates to one of his main questions.

I met the HSE last Tuesday, 15 March, following the ruling to discuss the High Court ruling with the HSE. Let me be quite clear with the Deputy and the House. I am opposed to the HSE appealing this ruling, and I made that clear at my meeting last week. It is clear that the SOP is not fulfilling the legal obligations of the HSE and that any such appeal would waste State funds. In fairness to the HSE, its intention not to appeal was stated yesterday at the meeting of the Joint Committee on Children, Equality, Disability, Integration and Youth. I have always been acutely aware that there were differing views on the SOP, which is why I was keen to see the results of the review of the standard operation procedure for assessment of need for children, which was launched by me in March 2021. The review group is chaired by Mr. Robbie Ryan and comprises five nominees from Fórsa and five from the HSE. It was the intention of the chairperson to issue interim reports after three months and six months and a final report after 12 months. Unfortunately, these reports have not come before me, but I actually see the review now as being redundant because the court has made its ruling.

What is clear is that the old assessment of needs process was not working. That is was why we had a backlog of 6,500 children when I was appointed in June 2020. We now see that the SOP cannot be used so the HSE and, indeed, this House needs to ensure that we have a system that supports children and their families. All Deputies will agree that the assessment of needs process must have at its core the development of any child with a disability to reach his or her full potential.

I am conscious that the Deputy does not want me to engage in any corporate speak so let me try get into dealing with some of his questions. One of the questions relates to retention and recruitment. Two weeks ago, on the floor of the House, I announced during the debate on a Sinn Féin Private Members' Bill that we are recruiting assistant psychologists within the network disability teams, which would be the first time ever that we have done this. It happens in primary care and mental health, but it was not happening in the area of disability. The second thing I announced on that particular evening was that we would have more senior grade positions. Why should we have more senior grade positions? It is in order that we can have better clinical oversight and encourage more people to come in at a staff level. So more people would be seen to but we would also have more senior experience. That is one of the things we are lacking within the area of disability. As more senior clinical posts are being advertised in the areas of primary care, the care of older persons and mental health, we are losing out.

There is another aspect - this was also raised at yesterday's meeting of the committee - regarding the panel system. I do not believe the panel system is fit for purpose or that it is working. In fact, the panel system is eroding the number of staff available in the area of disability.

The Deputy sought a breakdown in respect of every CHO. It is quite clear from listening to Mr. Bernard O'Regan yesterday that not one of the 91 teams has its full complement of staff. I acknowledge that, and I am currently working on recruitment. Let us be fair, it is not that we have not put funding into it. A serious amount of funding has gone into recruitment. In excess of 365 people have been recruited. I acknowledge that this is still not enough, but that does not mean to say that we will not continue working in order to ensure that we get a solution. I do believe that these teams will work.

Martin Browne (Tipperary, Sinn Fein)
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There is no doubt, both in here and outside, that we have been lambasted with statements that early intervention is required. I know from parents, teachers and so on that this is not happening. I am glad to hear that the Minister of State is not happy with the SOP. What is being done about the matter? The Ombudsman had a go at the HSE and the High Court has ruled against it. Why the database was allowed to be so outdated in the first place is another thing that needs to be answered by the Minister of State or the Department, because the dysfunction of the system spreads further than the HSE's smoke-and-mirrors act, which is what the High Court called it. Yesterday, Mr. Paul Reid said that 91 children's disability network teams are now in place across the country. He pointed out that substantial additional resources have been provided to these teams since 2019.

For one family who contacted me, Mr. Reid's optimistic comments do not wash. Their child had been referred to occupational therapy through an early intervention pathway in September 2020. Then the teams were reconfigured and he was told that he was being transferred to the children's disability network team. However, this seems to have cost him time because when informing the family of this change, the children's disability network team also said that they could not provide them with a timeframe as to when their child will be seen. In terms of early intervention, this case has taken two or three years, which is ridiculous and something needs to be done. I appreciate that the Minister of State has fierce concern about the matter and done a lot of work on it but an awful lot more work needs to be done. I hope, as she has said about the SOP, that even if that can be changed so that families can get more early intervention because the situation breaks their hearts and breaks the heart of the Minister of State. I have no doubt that she and the other Deputies present have listened to the stories of families who are struggling to get that kind of intervention.

Anne Rabbitte (Galway East, Fianna Fail)
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First and foremost, I acknowledge that the 91 disability teams do not have all of the staff that they require to do the job. Second, I acknowledge that there are children who have been waiting far too long on waiting lists and not getting intervention. Third, in the context of the €350 million that was allocated, and in the context of access to care waiting lists, I am ensuring that we get a fair portion of that money in order that we can provide public private therapy intervention so that every child can get a result. I see children on waiting lists as equally as acute to the individual who needs a hip operation. That is where we have to change the mindset and culture within various departments.