Dáil debates

Tuesday, 30 May 2023

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Disabilities Assessments

8:55 pm

Photo of Michael LowryMichael Lowry (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

35. To ask the Minister for Children, Equality, Disability, Integration and Youth if he will verify the current and precise total number of children on waiting lists for assessment of need in CHO 5, south Tipperary and CHO 3, north Tipperary; the number of children waiting on historical waiting lists, the number of new applications, and the number of children or families still awaiting assessment following a preliminary team assessment review; and if he will make a statement on the matter. [26325/23]

Photo of Seán CanneySeán Canney (Galway East, Independent)
Link to this: Individually | In context | Oireachtas source

I am asking this question on behalf of Deputy Lowry. I ask the Minister to outline the total number of children on waiting lists for assessment of need in CHO 5, south Tipperary, and CHO 3, north Tipperary. This should include the number of children waiting on historical waiting lists, the number of new applications and the number of children or families still awaiting assessment following a preliminary investigation. I want an overview of the criteria being used for these waiting lists. Are they just figures?

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Children with complex special needs access therapy services through the children’s disability network teams, CDNTs. These services can be accessed through the assessment of needs, AON, process but children do not require an assessment of need under the Disability Act to access health services. The Government and the HSE both acknowledge the challenges in meeting the demand for these disability services and are acutely aware of how these challenges impact on children and their families.

The HSE has advised that there are currently 124 outstanding applications for assessment of needs in the Tipperary area, CHO 3 and CHO 5, at the end of quarter 1 of 2023. A total of 42 new applications for assessment of needs were also received in this time.

The High Court judgment delivered in March directed that the preliminary team assessment, PTA, approach did not fulfil the requirements of the assessment of need under the Disability Act. The judgment stated that a diagnosis is required to determine the nature and extent of a person’s disability. In that regard, new interim clinical guidance to replace the PTA has been clinically approved. This guidance has been designed to take cognisance of the March 2022 judgment that requires a diagnostic assessment. In the last month, the new clinical guidance has been submitted to the Department for consideration by me and the Minister, Deputy O'Gorman.

The HSE has been allocated €11 million in budget 2023 to facilitate additional assessments through a suite of measures, including the establishment of dedicated AON assessment teams; private procurement and overtime initiatives for existing staff; and the recruitment of administrative resources to free up therapists to assist with AONs. The HSE is continuing to review the files of all children who received a preliminary team assessment. If the Deputy wishes, I can go through it in more depth for the past two years.

9:05 pm

Photo of Seán CanneySeán Canney (Galway East, Independent)
Link to this: Individually | In context | Oireachtas source

The question that has been raised here, and it is a national issue really, is about the fact we do the preliminary assessment and then the patient or child comes off the waiting list. What is the waiting list used for? I read an interesting thing in the FUSS report from a member of staff regarding when they are asked to produce numbers. They said there was an "Apparent lack of awareness or insight into how bad things actually are on the ground, e.g constantly seeking figures and KPIs - for what? What is happening with the waitlist figures we send? What is happening with the risks we are highlighting?" The kernel of the question is about the numbers we have on the waiting lists. Do those numbers exclude the people who have had a preliminary assessment? If so, that preliminary assessment is of no use because they do not actually get to an assessment they require. Lots of parents feel this is a box-ticking exercise. They bring in somebody, introduce them and let them out so that person is off the list now.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I totally understand what the Deputy is saying. When the court judgment came in March 2022, PTAs were stood down completely. They stopped. That was a decision that we made at that stage within the Department of Health. We did not challenge it. We reverted back to the original assessment of need process. The PTAs no longer exist. They had been in operation from January 2020 to when they were stood down in March 2022. The children who are in that particular bundle now have to go through the proper assessment of need process, which is what the clinical governance is for. At the moment, some of them are going through the old assessment of need, which is not timebound. That is the process at the moment. Children are not waiting. They are going through that process at the moment but let me reassure everybody that the PTA has been stood down and is null and void.

Photo of Seán CanneySeán Canney (Galway East, Independent)
Link to this: Individually | In context | Oireachtas source

The question that arises all the time is what good these waiting lists are and what action is being taken to sort them out. For instance, I know of a case of a therapist who is going on maternity leave. The children she was seeing have been told they have to go back on the waiting list because she will not be replaced until she returns from maternity leave. She is probably going to take ten months. The kernel of the problem here is that we have waiting lists, and we can manipulate figures or whatever, but the people on the ground and the parents are not getting the service. They are not getting the early intervention quickly enough. We can have beautiful names and acronyms and everything but at the end of the day, the children are not being seen quick enough. The early interventions are not happening. While we have all these things going on and things being stood down and other things being looked at and other reports being done, children are waiting up to a year and a half or two years for an assessment, whether speech and language or other assessments. That is the problem. How do we address that? If somebody goes on maternity leave, it is well flagged that they are doing so. Efforts should be made to back-fill that position until the person returns.

Photo of Anne RabbitteAnne Rabbitte (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I completely agree. In actual fact, I said the first day I became a Minister of State that we do not need 100% of a workforce but 140%, in order to ensure people can go on maternity leave. I agree with the Deputy on that. The HSE is back-filling. Funding was provided to ensure managers of the CDNTs could be back-filled. It is also very important for the HSE to implement its own policy, which is called the national access policy. That would mean that when a person goes in the front door and has their initial meeting, they should know if they need to be in the primary care waiting room, the disability waiting room or the CAMHS one. This idea of pushing people from one waiting list to the next is not acceptable by any manner or means. We need the three units to talk to each other. I am grateful that Bernard O'Regan has started that process, supported by Yvonne O'Neill, to ensure we have a true line of sight on figures.