Mary Lou McDonald (Dublin Central, Sinn Fein)
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I move:

That Dáil Éireann:

notes that:

— children are legally entitled to an assessment of their health and education needs under the Disability Act 2005, and that the assessment must take place within six months; and

— the law is being broken with respect to the 15,296 children whose Assessment of Need is overdue, and with just 4,162 assessments conducted last year the number of children being failed is rising; and

calls on the Government to:

— comply with its legal obligations to provide assessments within six months;

— take emergency action and make funding available to "Cara's Fund", to clear the backlog and provide these children with the assessments to which they are legally entitled to;

— set a specific target date by which the Government aims to comply with the legal entitlement to an Assessment of Need under the Disability Act 2005;

— deliver a longer term sustainable solution, including an urgent workforce plan to recruit, train and retain enough staff to finally end this breach of children's rights once and for all;

— fund special needs services, including speech and language, physio, and occupational and behavioural therapies; and

— provide appropriate school places for children with special needs.

Tonight, the combined Opposition has come together to call out the Government's failure to comply with the law and ensure children with disabilities get an assessment of need within six months. This is not an arbitrary issue or timeframe. It is very widely understood that the earlier children are assessed and given the supports and therapies they need the better the chance there is for them to thrive and flourish.

The Government will not oppose our motion this evening yet its response to this issue over the course of today has been nothing short of shocking. Instead of setting out how it intends to comply with the law, the Government has now set out a clear intention to change the law. It has attempted to suggest this has been to streamline the delivery of services, to use capacity better and to ensure the children get the services they are entitled to but the sad reality is that if the Government removes or waters down the right to an assessment of need within six months there will be serious and enduring consequences for vulnerable children. Removing the onus on the State to deliver comprehensive assessment of need within a six month statutory timeline will only benefit a State and a Government that is failing in its duties. It will reward State failure.

Last week, the Families of Autistic and Additional Needs Children Together, a group from the north east inner city of Dublin, came to the Dáil to brief TDs on their experience and on their peer-led research. I would recommend that the Minister and the Taoiseach meet these parents and listen very carefully to what they have to say. They told us that parents, carers and family members of children with autism and-or additional needs are being failed by inadequate systems of support and that public services are often insufficient, unavailable and difficult to access forcing many families, especially those on low incomes, into an impossible position. While some families are able to turn to private services, this is not a viable option for many, reinforcing systemic inequality and denying children and their families the right to equitable care and support.

One family summed it this way when they said:

As a parent through our journey with my son, I can accept his diagnosis and what is required of me to care for him and I will gladly do that as his mother but experiences I have had with the HSE and services they fund to provide services has been hell even when they are trying to do what's right they can't deliver. No one understands how bad things are unless you have been through the disability services.

Over the course of recent days other parents locally talked about their experiences. Hayleigh said her son Parker was on the waiting list for an assessment of need for five years and because Parker waited for five years for his assessment he never received the early intervention that is key for children with autism and this has impacted directly on his development. Crystal said her son has been waiting for two years for therapy. He still has not received any. Instead she, like many mothers, is sent to courses and workshops so that she can act as his OT and speech and language therapist. Another mother spoke of her experience of having to take the HSE to court to force it to do an assessment of need and said the aftermath was actually worse with zero services provided. She said that the whole system is broken. The solution for these families is not to remove or undermine their rights to assessment of need but it is to provide the services they so desperately need in a timely fashion. Early intervention matters.

This is a community already under pressure and like in many other parts of the State, the north inner city CDNT is down five staff with capacity stretched beyond limit. This means it is even more difficult for families to access services and no therapy is being offered. The pressure continues when it comes to getting a suitable school place. With such a lack of SNAs in classrooms, I am dealing with it right across my constituency, in St. Catherine's in Cabra, Broombridge Educate Together National School and many others. What we need is a step change from the Government.

In my remaining time I would like to use the words of Cara Darmody who joins us again in the Visitors Gallery. You have some stamina, Cara, and we are delighted you are here with us again along with your father Mark. Here are some words Cara sent to me this week. She sets this out really well and hits the nail on the head. Here is what she had to say:

My name is Cara Darmody. I think it's fair to say that you're well aware of who I am and the reasons why I felt absolutely compelled to start an unprecedented protest at the gates of Leinster House today.

Put simply, the Government through the HSE is systematically breaking the law as there are now over 15,000 children waiting on an Assessment of Needs. But here’s the shocker - the HSE have admitted through their own projections that the figure will reach almost 25,000 by Christmas.

I have met most of the Cabinet at this point, including a very kind meeting with Minister Norma Foley last Friday. On a personal level, I have enjoyed her company on every single occasion and never once have I uttered an offensive comment towards any Government politician. [Then she says the following to the Government] But it is your ideology that is wrong here. You continue to act like this is a normal problem that can be solved in time. It won’t be. Permanent damage is being caused to children every day because of your failure to act with urgency and emergency.

Those are the words of Cara Dermody. I ask the Minister to heed them, please. It is now time to act with urgency and emergency. Comply with the law and ensure that no child is left behind.

Deputies:

Hear, hear.

Claire Kerrane (Roscommon-Galway, Sinn Fein)
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I begin by also paying tribute to Cara Darmody, who is here in the Public Gallery with her dad Mark. At 14 years of age, she has made a really valuable contribution to the debate around assessment of need and to the reality of the difficulties that individuals and families face when it comes to accessing autism and disability supports. She has been a voice for children and for parents, and I want to take this opportunity to say "thank you" to Cara.

Last week, the HSE provided me with the latest waiting list figures for assessments of need. It has now hit a record 15,296 children, and this figure is only going in one direction. In fact, the HSE itself says it anticipates that it will reach almost 25,000 children by the end of this year, only a short number of months away. These children have not had their legal entitlement met, and they should have had their assessment of need within six months. Of course, we all know the impact this has on a child, particularly when it comes to accessing supports at school, and we all hear from parents who are put in an impossible situation where schools are almost hamstrung when it comes to providing the supports and services that child will need. When you are a child, every day counts.

I sat here for most of the almost three hours when we had statements, and I listened to Government TD after Government TD. You would be blown away by some of the statements made with respect to how awful and terrible the situation is. The waiting list has been more or less growing since 2010, and when you look back at the record of the Dáil, issues have been raised consistently since then in terms of alarm and concern for the waiting list as it continued to grow. Fine Gael has been in government for 14 years; Fianna Fáil has either been supporting or in government for ten. This is not an issue that has arisen overnight. It has continued consistently. With regard to every single action taken by Government, and there have not been many, bar Cara's fund, which I would give credit for, none of the actions taken to date have worked. They have not had an impact on the waiting list, and the figures are there and show that. No matter how many times the Government lauds the number of special classes, the private capacity going in, the money and the investment, it is not having the impact we need to see. Parents are very much at the end of their tether.

The bottom line on this issue is we do not have the people to do the job. We do not have the people to do the assessments of need and we do not have the people when it comes to the therapies. I heard from one young person in my constituency in March. She did her degree in Galway and then tried to get a place on the master's course to become a speech and language therapist. She applied to the University of Limerick. There is a HPAT exam, which costs €160 a pop, with an approximate intake of 30 students, but she was unsuccessful twice due to the competitive nature that is there. She went to Scotland and has been home for ten months. She is a fully qualified speech and language therapist and she is waiting on CORU registration. In her own words, she said:

It is now the case that I am home almost ten months willing and ready to work yet I cannot obtain employment as a speech and language therapist due to the length of the recognition process. My application is only in stage one and I am told it will take at least four months.

She understands that a quicker process has been put in place for occupational therapy, but it has not been for speech and language therapy. We are crying out for therapists. Her master's was done in Scotland, not in Mozambique, yet she is sitting at home and cannot take up a job as a therapist that we so desperately need. Then we wonder why people are not coming home, or are not able to come home or take up a position here. They are going abroad instead, and it is people abroad who are getting the benefit of them.

I might highlight two points the Minister made in her earlier remarks. One was in regard to the €10 million in funding that has been delivered by the Government this year, which the Minister says will deliver 2,850 assessments of need, and she is confident this initiative will continue to support and deliver for these children. We are looking at almost 25,000 children by the end of the year. I would say 2,850 assessments of need is a drop in the ocean. We need to look at that level of funding. The €10 million sum is nowhere near enough, looking at 2,850 assessments of need.

The Minister went on to say we cannot rely on the private sector indefinitely, and of course we cannot. We would not be relying on it at all if capacity had been put in to the public sector, but it has not been. That is the Government's failure, and that is why it now needs to look at increased funding to ensure that all of those 15,296 children and rising get the assessments of need they deserve, are entitled to and are legally required to receive within six months. I would say we are not over-reliant in any way, shape or form on the private sector. We need more of it. It is a pity that we do, but that is the position the Government has brought us to. That is the situation we are in.

Cara Darmody's ask is very clear. Fund Cara's fund, make the money available, and ensure that every one of those children gets the assessment of need they deserve to meet their potential, for them, their parents and their families.

David Cullinane (Waterford, Sinn Fein)
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I also welcome Cara and her father Mark to the Public Gallery. I have met both of them a number of times over recent years and am always struck by the dedication Cara has to this issue. She started out campaigning for her siblings but is now campaigning for every child waiting for an assessment of need. She deserves tremendous credit.

As others have said, assessments of need for 15,000 children are overdue. A previous Fianna Fáil Government put in place the Health Act 2005. At the time, it was welcomed by campaigners and families of children with disabilities because for the first time, it enshrined in law a right for children. It did not enshrine in law a right to access services but it did provide for a legal right to an assessment of need, which had to be carried out within a six-month period.

The logic of the 2005 Act was that the assessment would be a comprehensive one, that it would be carried out for each and every child in a timely fashion and that it would look at the health and educational needs of each and every child, which makes perfect sense. The same Act also provided for an aggregate report to be published and furnished to the Minister. For years, those reports were never furnished because the assessments did not happen. The logic of that was that the Minister of the day could see what the aggregate need was with respect to health and education services, be it therapies or access to schools. What has happened since 2005 is that the waiting list have gone up and up. Children were taking court cases almost daily through their families to get assessments of need but they were not worth the paper they were written on because the Government simply did not put the services and resources in place. This meant the backlog got bigger.

In a deeply cynical move, what did the Government do? It did not train more professionals or make sure we had more therapists who could carry out the assessments. It came up with what it calls the new standard operating procedure, a yellow-pack preliminary team assessment, and it would have pawned that off as an assessment of need only for parents and me and Deputy Mary Lou McDonald. I met a large number of them and ultimately they took a court case, and we dealt with legal people ourselves at that time, in 2022. That court case was a challenge to the Government's preliminary team assessments because it was breaking the law. Rather than actually delivering for the children and accepting its failure, whereby it had failed over that long period since 2005 to get to grips with this issue, put the services in, train the professionals that were needed and ensure that children would have access to assessment of need but also to services, the Government decided that no, it would break the law. It would just pawn them off with a couple of hours of an assessment and call it a preliminary team assessment. Then the Minister stood up in the Dáil Chamber every month and said that waiting lists were coming down as if she was trying to claim credit for something that was actually an insult to families.

Of course, the High Court said the Government had broken the law and it was called out.

In an even more deeply cynical move, we heard from the Taoiseach today, and I have heard the same from the Taoiseach over recent months, that the Government now wants to bring in legislation that will remove the need for an assessment of need. This will be dressed up. The Taoiseach said today it is going to mean more access to services and direct access to services, with no need to worry about assessments of need, but that is an absolute insult to families. The whole logic of an assessment of need, as comprehensive as it needs to be, is to look at each individual child's health needs and educational needs. If that does not happen, the child will not get the services. When they are told not to worry and that the services will be there, when the very same families cannot get a special school place, a speech and language therapist or occupational therapist for their child, they simply do not believe the Government. They see it as cynical, as I do, because that is what it is. The entire Opposition needs to fight this Government really hard to ensure that if it has the brass neck to come in here and try to remove one of the few rights that children with disabilities have, that needs to be resisted and called out for what it is.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Hear, hear.

David Cullinane (Waterford, Sinn Fein)
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It is an absolute, utter disgrace and a deeply cynical move by this Government.

I also want to raise a separate and very serious issue. Because of the failure on the Minister's part and that of the Government, parents are desperate and have to go for private assessments, but that is an unregulated environment. Psychologists carrying out assessments in this space are not regulated. CORU was established in 2007 with the commencement of the Health and Social Care Professionals Act 2005 and has had the power to regulate psychologists since then. Twenty years on, this has not happened. The Psychologists Registration Board was established in 2017, nearly eight years ago.

This scandal was highlighted on an "RTÉ Investigates" programme in 2023, which shone a spotlight on what was described as a wild west of an unregulated space. Many parents are being forced to go private in a space which is not regulated. At the time of the "RTÉ Investigates" programme, CORU gave a response to RTÉ stating that by the first quarter of 2025, the new regulations would be in place and the registry would be open. That is not now going to be happen. It is going to be October before it happens, and even then not all psychologists will be included.

The Government has let families down every step of the way. The State has not provided the service, the Government has broken the law, and people and children are waiting longer for assessments of need and access to services. The Government is gaslighting them, telling them the law will be changed because it is in their interest. The only reason for changing the law is in the Government's interests because Ministers do not want to come in here week in, week out and have to answer for the fact that children are waiting for assessments that they should get. Please do not take people and their families for fools. That is what the Government is doing. From our perspective in Sinn Féin, we will fight this all the way because it will be a disgrace if the Government gaslights those children and their families and takes away one of the few rights they have.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Hear, hear.

Norma Foley (Kerry, Fianna Fail)
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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.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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I want to welcome Cara Darmody and her dad, Mark, to the Gallery. It is unfortunate they are here. I would draw their attention to the fact that the Government has circulated its response to this debate already so no matter what is said here on the floor of the Dáil, its script is already written. It has already decided what it is going to say. It has made it very clear it has no intention of listening to what the combined Opposition has to say. It has made its mind up. It has its script written and will deliver it there at the end. In fact, I will bring a copy up to the Gallery and they can have a read of it if they would like to.

I want to pay tribute to Cara and her dad. Cara should not be here this evening. She should be at home. She should not have to protest outside the Dáil for basic services for her brothers but let us be honest - she is here because they have been left with no choice. Like any campaigner who has been around, she will not be fooled by all the Government’s chat about committees and how well it is doing and all the backslapping that it is doing to itself this evening. It does not fool Cara; it does not fool us, not even for a moment. The Government has created this crisis. That is why we are here. It is not Cara’s fault or ours – the blame rests with the Government. The buck stops with the people on the big bucks. Action is what is needed, not more fine words. The Minister of State, Deputy Naughton, told us the Government is moving in the right direction. How dare she say that when the figures obtained by my colleague, an Teachta Kerrane, show that 10,000 more children will join the list by the end of this year? I want to recognise the work done by advocates like FUSS Balbriggan and parents like Jodie Reid who have been forced onto the streets to campaign for services for their kids. In my constituency, kids wait the longest. We have been utterly failed by the Government so when the junior Minister, Deputy Naughton tells us that it cannot be fixed overnight, the Minister will forgive me for reminding her that Fine Gael has been in government for 14 years. That is almost 6,000 overnights. I do not know how many more overnights the Government wants to be afforded. We understand that it is complicated but we also understand that the people who caused the crisis will in no way be the ones who will fix it.

I had every right to be angry when I heard the Government representative from my own constituency read out her script, commentating on the length of time the kids in my area have been left by her Government. Shame on her. She quotes the shameful record of her Government. She quotes the statistics but she fails to recognise the humanity behind it. Take one family with a two-year-old son awaiting an assessment of need for over a year. They are desperate to try to speed up the process so he receives the help he needs. They are privately paying for speech and occupational therapy: €190 a week; €95 a session; €10,000 a year. They have to earn €16,000 a year to pay that. Another family with a boy who is two, and on the waiting list for the CDNT in Balbriggan, has been told by a healthcare professional that the wait for an assessment could be between four and six years. The family has been told it is really important he gets speech and language therapy and occupational therapy now but he cannot get it until he has been assessed. Shame on this Government.

Pearse Doherty (Donegal, Sinn Fein)
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Before the Minister leaves, I want to say to her that the fact she delivered a copy-and-paste speech is an insult to the 15,000 children who she is failing legally in their entitlement. She read out nearly word for word the speech that was delivered earlier. At least she should have had the decency to put it into her own words and pay a bit more respect to this debate tonight. The Taoiseach told us earlier that the Government will continue to break the law. It is simply unacceptable. We live in a State with a surplus of €8.5 billion but we have a 14-year-old girl who is protesting outside the gates of Leinster House for 50 hours because she is standing up for her brothers and for every other child across the State who the Government is breaking the law in relation to. It is a disgrace that this is happening. There is €8.5 billion of a surplus yet we have 15,296 children who are being failed their legal entitlement to have an assessment of need. That is the reality. That is the type of country we live in.

Why has this come about? It has not happened overnight. We have told the Government the solutions over and over again, but it will not listen. It will not resource the system. As Cara rightly pointed out, it is about ideology. I am so impressed by the amazing campaign Cara Darmody has fought - every single person on the Opposition benches can talk about it - but a 14-year-old child should not be fighting a campaign like this. Every person in this State should have the right to have an assessment carried out in relation to the needs they have and then the services should flow after. That we are in this situation is a shame on the Government, as is the fact that the Government’s response is not to fix the problem but to take away the right that was fought for and won 20 years ago in the Disability Act. I refer to the right of someone with a disability - the only right they have - that within six months the State will carry out an assessment of what their needs are. The Government has failed over and over, and because it has no solution to fix the system it is taking away that right. Shame on the Government. We will fight it tooth and nail on this. We do not need to take away rights but to deliver on those rights. Assessments of need must be delivered within six months. The Government can do that by funding the Cara fund, by proper workforce management and by treating this as the emergency it is. Then it needs to make sure all the services and treatments follow, including school places, speech and language and all of the rest.

Do I have any confidence that this Government will deliver? Absolutely not. Shame on this Government that in a country that is rich with resources, a 14-year-old girl has to sleep outside Leinster House to draw attention to its failures.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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I pay tribute to Cara, her family and the thousands of families throughout the country who are in the same position. We all meet them in our constituencies. There are 15,296 people waiting for assessments of need. This wait-time can vary depending on their location and creates inequity across the system. Some children are better served than others based purely on geography. We saw this recently in Sligo-Leitrim where there is very high staff turnover, no clinical lead and waiting lists are rising daily. Many parents soon realise they are only starting the first battle in what seems a long and arduous war to try to obtain some sort of service for their children. The assessment of need is the first major hurdle in what they will soon come to discover is wait-list after wait-list. Many are forced into the private sector to get assessed at huge and ever-rising costs of anything from €1,200 to €2,200. Some of these assessments may not even be accepted by the Department because psychology services in Ireland are not fully regulated. This delay in assessments of need has a long and ever-lasting effect on many young people. Adequate services are not put in place soon enough, which has knock-on effects for future development.

The INTO recently voiced concerns regarding the growing involvement of teachers and school principals in assessment of children's needs due to the recent changes under the revised education report mechanism. Teachers are not clinically trained to diagnose complex disabilities leading to concerns about misidentification and incomplete assessments. Even when people get an assessment, and their fight has been hard for that, they wonder what is next. Where is their next battle? If they get through the assessment of need, they can and may be accepted by the children's disability network team. If they get that, they may be on another waiting list for a vital service. Occupational therapists, speech and language services, and psychology, educational and psychiatry services, all have delays and more delays. If the young person does not meet the criteria, he or she will be put onto another waiting list. That young person will be referred to the post-diagnostic team and, before he or she can be accepted, parents have to participate in a five-week course. This is mandatory for parents. They also have to request a one-to-one session with a post-diagnostic team psychologist and then, if it is accepted, the child is on a waiting list, which is currently set at 18 months.

The post-diagnostic team is for those with mild to moderate difficulties. If a child requires services for CAMHS, for moderate to severe difficulties, this is a separate application that must be filled in by parents in conjunction with doctors. Waiting times are anything from six to 12 months. In the meantime, parents are left to their own devices and told - we come across many of them regularly in our clinics - to bring their child to the emergency department if the child's mental health deteriorates. The impact on families is immense. The cumulative effect of delays, inconsistent practices and unclear responsibilities for services causes stress and frustration for parents who constantly have to fight and advocate for their child's right to support. There is a high turnover of staff who find that they are working in a stressed and understaffed environment to try to maintain services.

The Minister and the Government's response to the rights of children is to remove those rights by amending legislation. It is simply unacceptable.

Mark Wall (Kildare South, Labour)
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I acknowledge the young lady who has brought the entire Opposition together on this very important motion. I met Cara Darmody for the first time in November 2022, when I was a member of the first all-party autism Oireachtas committee. At just 11 years of age, Cara came in to give her testimony. She was the youngest ever person to give testimony at an Oireachtas committee. On the day, just a small number of us were in that committee room, including two members of a local support group from my hometown of Athy. Cara's testimony was powerful and emotional. She spoke about her two brothers, John and Neil, and the challenges they faced on a daily basis. Almost three years later, Cara and her dad, Mark, who I acknowledge in the Public Gallery, are back on the protest again. I joined them earlier today, as I have done numerous times previously. I want everyone to know that Cara's resolve is unbroken from the 11-year-old I first listened to in 2022.

Cara continues to have my support and the support of the entire Labour Party. I will talk about the national emergency she wants declared. Cara has a simple ask for the Government: stop breaking the assessment of needs law and declare that emergency, but it is an ask that the Government has ignored. Many Government leaders and Ministers have met Cara over the past few years and can attest to her determination in advocating for her brothers. However, meetings are not enough. Maybe the Government thought that Cara would disappear but that is another mistake by the Government. Cara is not going anywhere. Families like hers are not going anywhere. Cara's next step is advocating for her brothers and others like them, as she begins her 50-hour protest at Leinster House today.

In my area of County Kildare, we have the second highest number of children who are overdue an assessment of need at nearly 1,700 children. Tens of thousands of children are languishing on waiting lists for essential therapies. More than 20,000 children are waiting on psychology and OT. Nearly 19,000 children are waiting on speech and language therapy while nearly 10,000 are waiting on physio. We know that early intervention is key, yet the average waiting time for the CDNT in my area is more than three years. The CDNT in Kildare is dealing with a massive caseload. We need to seriously consider having two CDNTs to cover this particular area.

It is always important to give the day-to-day experiences of many of the people I deal with. I am dealing with one family at present whose child continues to beat their head off the floor day in, day out. The response from the HSE is group therapy - that the family should talk about their child's needs with their neighbours and strangers. As the mother said to me today, does anyone realise how demeaning that is to her and her family? It is the same for another child who got an assessment in 2012. That child is still waiting for a follow-up assessment. That child is now an adult and will be 21 years of age in February. That is just two cases out of the many cases I deal with on a daily basis, as do many of my colleagues on the Opposition benches. I am sure the Minister of State and her colleagues are dealing with cases also, but we are not getting the reaction these families deserve. We are not getting the reaction that Cara, her father, Mark, her brothers and everybody else deserves.

It is time that the Government moved on this. It is time the Government realised that Cara Darmody is not going anywhere. She will continue her protest.

George Lawlor (Wexford, Labour)
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The appalling waiting lists for children in Ireland awaiting an assessment of need that we have heard listed out today are nothing short of a national disgrace. It is an indictment of the values of society that we allow vulnerable children to languish in limbo, with their futures hanging in the balance, while bureaucratic inefficiencies and systematic failures continue to plague our health and education systems. This situation is not just a logistical nightmare; it is a moral failing that demands our immediate attention and action.

Every day countless families, such as Cara Darmody's, and I pay tribute to her, find themselves caught in this agonising waiting game, often for years as we all know, as they seek the assessments necessary to secure vital services and supports for their children. These are not just numbers on a list; these are real children, each with unique needs and potential, who deserve better than to be treated as an afterthought. The impact of these waiting lists is profound, not only on the children but also their families, who are left to navigate a maze of uncertainty and frustration. The emotional toll is staggering as parents are forced to watch their children struggle without access to the help they so desperately need.

Of course, the assessments of need waiting times are just the beginning of what can only be described as a list to get on a list. Once the assessment is carried out for those lucky enough to be in the 7% who manage to get an assessment in a relatively timely manner, they then face the prospect of yet another extensive and prolonged wait to access the therapies they have assessed as being in need of. One manager working in the services told me that by the time children access the need they were initially assessed for, that need may well have completely changed, which in turn leads to further and more complex problems for those children and their families.

I appreciate that the reasons behind the lengthy waiting times are multifaceted, ranging from insufficient funding to a shortage of qualified professionals, yet these explanations do little to alleviate the suffering experienced by families. We must demand accountability from this Government and health authorities. How can we justify a system that prioritises red tape over the well-being of our youngest and most vulnerable children? The lack of urgency in addressing this crisis is absolutely infuriating. We are failing an entire generation of children who are being denied timely access to assessments that could and will significantly improve their quality of life and educational outcomes.

These waiting lists reflect broader societal issues, such as the stigma surrounding mental health issues and disability. By allowing the children to wait in silence, we are sending a message that their needs are not a priority and that their struggles are not worthy of our immediate attention. This attitude must change. We need to foster a culture that recognises the importance of early intervention and support and values every child's right to a fair shot at success. For too long, parents, advocacy groups and families have had to plead in unison and demand change. It is absolutely incumbent on us as public representatives to hold our Government to account and insist that it prioritise the resources and infrastructure needed to address this crisis. The time for excuses is over; the time for action is now. We need a comprehensive plan that includes increased funding, the recruitment of additional professionals and streamlined processes that eliminate unnecessary delays.

The waiting list for children in Ireland awaiting an assessment of need is a glaring example of systematic failure that must be addressed. Our children deserve better. They deserve timely assessments and the support they need to thrive. Let us not be complacent in the face of injustice. The future of our society depends on how we treat our most vulnerable members. We cannot afford to fail them any longer.

Eoghan Kenny (Cork North-Central, Labour)
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I commend Cara Darmody and her father, Mark. I was delighted to meet them this morning with my party leader, Deputy Ivana Bacik, at the gates of Leinster House. I commend Cara on the wonderful work she is doing.

I want to read an email I received from a parent:

I am just touching base to see if anything can be done to try and progress an Autism Assessment. I have 3 year old twins who both need Assessment ... (we have only just been accepted by CDNT Mallow), and CDNT have told me that they have since gone back and requested ... [an outsourcing of] the assessment just under a month ago now. They currently attend Mainstream Creche/Pre School 3 days a week but the room leader has mentioned to me that she feels they would really benefit from an Early Intervention Class .... But to get an Early Intervention Class for them they both need a formal diagnosis and obviously having twins I am going to find it extremely difficult to get a space for them both .... I [have now considered but] can't afford to go private for assessment for them ...

She states she has enquired about taking out a credit union loan but currently just cannot afford the cost. She adds:

Is there anything I can do to progress their AON Assessment so that I can get a formal diagnosis and hopefully secure an Early Intervention Class for them. Also to note I have been in contact with one School who said they can't ... put them on a waiting list for a space until we have an official formal diagnosis.

This cross-party motion refers to what is a shocking indictment of the failure of the State. We have failed and continue to fail children across the country. There are 15,296 children waiting for an assessment of need, many of whom are in my county, Cork. For far too long, families across the country have had to beg for services and supports. Nobody in this Chamber wants this type of Ireland.

We are told that finance will not be a barrier, but what about personnel? We consistently hear about the lack of services within our system. The HSE itself will tell you that. Earlier, my colleague Deputy Alan Kelly, said he thinks this was a cry for help from the HSE. I do not believe he is wrong.

I want to focus specifically on children in school and the lack of assessments of needs. Having been lucky enough to teach in two fantastic schools, I note that the level of need in a modern classroom is far different from that of 20 years ago. Supports must be put in place. The role of special needs assistants in our schools is pivotal and of course they benefit the children they assist. Schools across the country have to beg for SNAs. I have had constant communication with school principals across Cork North-Central and they have informed me that trying to increase the number of SNAs or keep SNAs is like knocking on a brick wall. It is so difficult and such is the level of need that school management, particularly at mainstream level, find themselves acting as SNAs. Early intervention is essential, particularly regarding school places. All Members of this House are consistently asked for help in securing school places for children.

Fianna Fáil and Fine Gael have been in government for the best part of ten years and the situation is actually getting worse. Planning early intervention, allowing assessments of need to take place, providing the necessary supports and having school places ready for children sound like basic rights but we do not provide these services.

The Labour Party has consistently brought solutions to the Government. They are genuine and very possible but just need Government approval.

Liam Quaide (Cork East, Social Democrats)
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I pay tribute to Cara Darmody and her dad, Mark. I acknowledge the leadership Cara has shown in bringing us all here this evening with this collective motion.

Clinical services and educational supports for children with additional needs and disabilities are in a dire state, directly resulting from years of poor planning and under-resourcing. All of this did not come about by chance. These are the results of poor political decision-making over many years. They can be resolved by more progressive political decision-making.

The chronic neglect of disability services in special education by successive Governments has left families at the mercy of a disjointed patchwork of a support system for their children. The Disability Act 2005 provided children with a legal right to an assessment of need within six months of being applied for. In reality, more than 90% of assessments of need are completed outside the legally agreed timeline.

A response to a parliamentary question of mine in March showed that the HSE spent €7.9 million between April 2021 and February 2025 defending legal cases against families trying to access an assessment of need. This legal cost equates to 180 years' worth of salary for a newly qualified occupational therapist. For much of that almost-four-year period, the HSE was implementing a recruitment embargo or similar recruitment restrictions, thereby stymieing its own capacity to carry out assessments of need, not to mention much essential clinical work after an assessment is completed. This is a tragic farce among so many other political failings that are having an enormous impact on the lives of children with disabilities.

After completing an assessment of need, families often face a further abyss of prolonged waiting to access therapies and are forced to seek these privately, if they can afford to. What we therefore need is wholesale investment across services. The purpose of an assessment of need is, after all, to access intervention. Children with mild to moderate developmental issues or disabilities may be referred to primary care services, while children with more complex difficulties come under the remit of children's disability network teams. We see the consequences of the failure to plan most dramatically in the south-west regional health area, Cork-Kerry, where the waiting list for primary care psychology services exceeded 6,000 earlier this year. That was after my colleague Holly Cairns highlighted last year that there were 5,000 children on the list. However, we did not see the recruitment drive that was necessary to address this in the meantime.

In January, one Cork East constituent was given an estimated waiting time of five years and nine months for primary care psychology for her son, who had recently received a diagnosis of autism following an assessment of need. The family has since been told – in recent weeks – that following a file review in primary care, their son should now actually be seen by the CDNT. This will involve being diverted onto another set of waiting lists for therapies, which may not materialise for years or may never materialise. Therefore, the initial service statement of the HSE from January has been overturned by other HSE professionals and the boy has not been seen by any of the services yet. This is an example of what is called “defensive practice” among clinicians, whereby services that are overstretched bat referrals back in an attempt to sustain a manageable waiting list. For families impacted by these decisions, it is an extremely frustrating experience to be passed from one service to the next. In that context, it is easy to see how families lose faith in the HSE and feel private clinicians are their only option. How many families can afford to even consider a private clinician?

The HSE cites "recruitment difficulties" as the main source of the crisis in primary care, and in Cork–Kerry it has even created a new layer of management to address this. It fails to mention in its briefings and parliamentary question responses that the main difficulty has been its own failure to pursue recruitment for necessary posts over many years and over-reliance on unqualified assistant psychologists. All of this results from Government policy, including the pay and numbers strategy.

Behind all these waiting lists are families languishing through what feels for them like one purgatory after another, waiting and waiting for an assessment before then being on further waiting lists for support, with no end in sight. The main ongoing roadblock to staffing primary care services is the Government's pay and numbers strategy, which in some cases is proving to be almost as restrictive as the official recruitment embargo that preceded it. It has been roundly criticised by all the main unions as putting a stranglehold on service development. The HSE is increasingly referring assessments of need to private clinicians at an average cost of €3,300 per assessment. What we really need to see is proper workforce planning and a comprehensive recruitment drive to meet the level of need at all stages of service provision. This will provide continuity of care for service users, more integrated services and better morale among existing staff.

The crises in disability services and additional needs education provision are resolvable through reform that is driven by meaningful and sustained engagement with the families and the front-line staff at the epicentre of the crisis. Above all else, we need to see much greater investment by the Government in these essential services for our disabled citizens. We should not have to rely on the remarkable courage and determination of Cara Darmody to see that commitment made.

Rory Hearne (Dublin North-West, Social Democrats)
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Cara, you are an inspiration to parents and children up and down this country. You are a citizen in the true meaning of the word. You have taken selfless action to right what is wrong, you have spoken truth to power and, while you see empty Government seats, that does not diminish in the slightest what you have done, your powerful action or the massive impact you are having. We in the Social Democrats and across the Opposition will continue to support you in what is happening. Mark, I am sure you are a very proud father. As a parent, I feel deeply that our State is utterly failing its children, particularly its most vulnerable children. It is failing to deliver their rights and to deliver services to them. The Ministers of State present know that it is the first duty of a republic to look after and protect its most vulnerable. Our Proclamation refers to "cherishing all the children of the nation equally" yet here we are utterly failing our most vulnerable children. It should be our starting point, our priority as a country.

In my constituency of Dublin North-West, I have been working with parents who have been trying to get assessments of need. They have been waiting months and years to get assessments and then further months and years for services. To give the House the figures, in CHO 9, which is an area that includes my constituency, 2,411 children are waiting for an initial contact. They have been waiting 12 months for an initial contact with a CDNT. These are areas such as Ballymun and Finglas, some of the most disadvantaged areas in our country, where children need intervention and parents cannot afford to pay for services privately. How is it acceptable? It is entrenching deep inequalities. These children have done nothing other than to be born in the wrong area and not be able to have access to services, supports and assessments of need. Many families are going private and breaking themselves to try to cover that cost.

What has happened in this regard is absolutely not acceptable. Different reasons have been given as to why these delays are happening. One of the reasons the Tánaiste gave was that the length of assessments of need was causing significant delays. He said some assessments can take up to 90 hours. I have followed this up with the HSE and it has been unable to provide data which shows that assessments of need are taking 90 hours. Why are the Tánaiste and the Government plucking figures from the air to try to justify reducing services and the number of assessments of need? It is not acceptable.

Cara and Mark, we will continue, as all the Opposition will, to push on this until children get the services they have a right to and need.

Sinéad Gibney (Dublin Rathdown, Social Democrats)
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Hi, Cara. We have not had a chance to meet yet, but thank you for everything you are doing. I hope to pop out to you tomorrow morning to say hello.

I have met so many people in the disability community and in my work in the rights and equality space who, like Cara, have had to become advocates and experts in rights and equality simply to realise their own rights because the State is failing them so badly and because they are not able to access the appropriate services, the seirbhísí cuí, that they should simply have available to them by virtue of the legal status provided for in our Constitution. Time and again, the onus is just put back on citizens to take up the slack where the State is letting them down. One point I do not want to be lost in this debate - there has been an awful lot of discussion about this today - is the fact that when these rights are denied, in so many instances we then see the State fight with all its legal might against those families who are simply trying to realise their rights. That alone is something this Government must look at. I do not know that there is a litigation policy. I have been advised that there is not necessarily a policy that sets in place how the State determines whether or not it will bring such legal might against vulnerable families who are simply trying to realise their rights. Where there is not one there should be one, and it should recognise the power dynamic of the State having a lot more legal power to bring to those battles and what it is doing by fighting tooth and nail against people who are simply trying to realise those rights.

Many of those people are people in my constituency, people who have been in contact with me and my team, who tell us about how they have simply had to put their lives on hold and how they have had to reshape their whole families around the fact that their children cannot access assessments of need or the appropriate services. As we have heard from many speakers today, this is of course simply the first hurdle because assessment of need is only the thing that allows us to get into the queues for the many services that are required for people to participate fully in society. I was really disheartened earlier to hear the Taoiseach's response during Leaders' Questions because it seemed to be simply about numbers. The argument is that the numbers are so overwhelming that the Government and the State cannot respond to this. It just seems to lack such vision and ambition as to what inclusive education should be. This is not special education we are looking for; we are looking for an education system that recognises and meets the needs of everybody within it.

In 1966 Donogh O'Malley announced free education, and a year later it was brought in. He was a Fianna Fáil Minister, it was an unannounced speech and that was transformation that happened like that. This Government is lacking that vision, that ambition and the commitment that is required to transform our education system into one that is inclusive.

Séamus Healy (Tipperary South, Independent)
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I compliment the remarkable courage of Cara Darmody, a 14-year-old disability rights campaigner from my constituency. I welcome her and her dad here this evening. Cara started her campaign in support of her two brothers, who have autism diagnoses, but now she is supporting and campaigning on behalf of all children in the State with disabilities. She has been very successful to date. She extracted €10 million from the current Tánaiste during the general election campaign. This issue, of course, was huge in the election campaign, and we had all sorts of promises and commitments. Housing and disability services were the biggest issues during the campaign and they are supposed to be the Government's highest priorities. "More needs to be done." That is what we have heard time and time again. Sorry, but it does not wash any more. This has been the standard response from successive Ministers for years. I have been raising this issue in this House for over ten years. There was a parliamentary question on 2 February 2017, and on 22 February 2018 I raised the issue during Leaders' Questions with the current Tánaiste, who was Minister for Health at the time. It is always the same answer: "We must do more." He said on that day:

I thank Deputy Healy for raising this very important issue on the assessment of needs for children with disabilities. He is entirely correct; this is an area in which the State needs to do an awful lot more.

Fine Gael and Fianna Fáil have been in government in one form or another for the last 14 years but, far from improving the situation, the provision of assessments of need has disimproved hugely.

Some 15,296 children are on the waiting lists, up 8% from the end of last year. In the first quarter of the year, only 7% were assessed within the time limit. The HSE stated there will be 25,000 children on the list at the end of this year and the average waiting time will be more than two years. These figures are shocking. Children are being failed every hour of every day. The State is breaking the law every hour of every day. The question has to be asked, is there one law for citizens and another for Government Ministers? If a citizen broke the law, they would be prosecuted. I wonder when a Government Minister will be prosecuted. I was shocked at the arrogance of the Taoiseach during Leaders' Questions today. His attitude was "shoot the messenger" and blame the psychologists - we are breaking the law but we will change the law. I warn the Taoiseach there is widespread frustration and anger among the public about this issue. Any attempt to change the six-month legal timeframe will be met with huge pushback that will endanger his Government. I urge the Taoiseach to take emergency action now on this issue before it is too late.

Ruth Coppinger (Dublin West, Solidarity)
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I too pay tribute to Cara and her father and all the campaigners and the people who have already slept outside the Dáil this year, Families Unite for Services and Support, FUSS, Equality in Education, ASD15 and the myriad local groups that have been banging on about this issue for a long time. One thing I have learned about neurodivergent, autistic and disabled people is that they hate social pretence and falsity. There is a lot of pretence going here on all night. First, Government TDs pretending they are not in the Government. Second, that they are not part of the problem and it is the fault of the HSE, not Government policy, which obviously determines everything. The other pretence is that a sanctioned school class for autism is an actual class. That is the pretence we have been hearing about all year. There is another pretence as well - this Government denies there is a chronic crisis and shortage in teacher recruitment and retention and the same for professional therapists. If the Government keeps denying that, this problem will persist. I have spoken to many principals and saw it myself when I went back into teaching. Australia is recruiting teachers hand over fist from Ireland because it provides 20 grand extra in pay. The UK is attracting people to do teacher training there while this Government has done not one thing. It has not brought in a special education allowance, which principals in special schools have been asking for. It has not brought in a city allowance, which is vital if you want to get people to teach and be able to afford to pay rent in Dublin. This problem will persist until the Government does something about it. There is a massive shortage of therapists. Only 7% of assessments of need are done on time. The Government is breaking the law for the other 93%. In Dublin 15, the Blakestown CDNT has a seven and a half year waiting list, while the list in the other CDNT is a bit shorter. This is ruining the development and the lives of many children. I am sick, sore and tired of hearing a Minister say it is not acceptable. You are the Minister. You should resign if it is not acceptable. The other Minister, who is not here now, said the whole system was not fit for purpose. What a disgrace that they are willing to stay in their positions. They have been in government for years.

The other issue is that we carry on regardless and take no action on the huge problem of the shortages in CDNTs. Approximately 530 posts are unfilled because people are leaving the public sector due to the stress and strain. Then, because it is told to do so by the Government, the HSE has to pay those same therapists, when they go to the private sector, to carry out assessments of need that should be done in the public sector, each costing €3,300. Those people could work in the public sector like they always used to if it was an attractive place to work, they could live on the pay, and there was promotion and recognition and enough staff to do their work. Until that happens, this crisis will continue. The Government is willing to spend €100 million on military jets but is not willing to put in the money needed for this issue. It is not complex; it is very simple. Please do not try to pretend it is really complicated. It is about investing money to recruit teachers, therapists, SNAs, physiotherapists, occupational therapists and psychologists and to provide proper buildings to put classes into. For assessments of need, the Government could recruit in the short term for a big project to clear those lists and people would turn up and do the work.

Catherine Connolly (Galway West, Independent)
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Every single member of the Opposition has put their name to this motion. I welcome Cara and her father. It is an indictment of this Government and previous Governments that Cara Darmody, a young teenager, has had to come back two years after she addressed an Oireachtas joint committee in November 2022. At that time, she said, "I am here to tell you what it is like to live in a family that has severely autistic children in it." She goes on to say that they have been treated disgracefully and she is angry. She is just one of many campaigners on the ground. I say this on a day when the Taoiseach was an absolute disgrace and embarrassment, knowing he is not complying with his legal obligations under an Act passed 20 years ago and, rather than deal with that failure, he said he will change the law. He said he did not blame the High Court for its judgment - that was very nice of him - because it had to comply with the law but he is now going to change the law because he does not have to comply with it. That Act was passed in 2005 after much hardship and hard work and myriad case law. When the legislation came in, the guide stated the Act sets out to make significant improvements in the everyday lives of people with disabilities in relation to buildings, employment and assessments of need. It was not radical enough to say there is an obligation to provide services but there was an obligation to carry out an assessment of need and to lay out a service plan for the services required. Two years later, we signed up to the UN protocol. It took us another 11 years to ratify it. I have looked at all of the reports in my time in the Dáil, including the capacity review that told us there was significant unmet need, the cost of disability report that was never brought in and an action plan we failed to comply with. After all of that, a young girl has to sit outside in protest to alert us to what is going on. She does not need to alert the Opposition, however. For as long as we have been here, there has been motion after motion from Sinn Féin, the Social Democrats - every one of us. We have implored and begged and said the Government has a legal obligation. We know today the Taoiseach does not put any value on a legal obligation; he is just going to change the law.

Private therapy was also discussed. Why are there so many private therapists? What has happened to our recruitment system that nobody wants to go into the public service? What happened to our ability to coax people back into the public service? I worked as a psychologist years ago. I considered it a privilege to give two years back to the old western health board. Has it been tried when we educate people on the public purse that they would give back and we would provide housing? We have any amount of documents. We do not need another change in legislation except to hold accountable the person who has breached the law. That is what we need legislation for, if there is no penalty - I have not had a chance to check it. We know every year from the census the number of vacancies. With 817 vacancies on the 91 teams, how can any service be provided? I have two letters here.

Parents are writing to us in desperation. One parent has spent €25,000 on private therapy, but still to no avail. Another parent has begged and implored the disability team just outside Galway, in my constituency, but no services are available, in the 21st century in a Republic.

Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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I welcome Cara and her dad, Mark, to the Public Gallery, as many of my colleagues on these benches have. When Cara walked in to Leinster House today, I noticed that she passed a painting of Countess Markievicz and busts of Mary Robinson and Mary McAleese, women who have left indelible marks on this State. Cara’s name is up there with those great women who have left an indelible mark on this State. I honestly mean that. I wish that was not the case, however. A 14-year-old child should be at home meeting her friends, watching television, playing video games and going out and living her childhood rather than having to sit or stand outside this House to get what she needs as a child and for her brothers. It is an absolute disgrace that we are here in this House and we have 15,000 children - our sons, daughters, nieces, nephews, godchildren and grandchildren - waiting because of this Nixon-esque Government. When the law does not suit the Government, it changes it. That is what Richard Nixon said. He said that when the President does it, it is not illegal. That is whom the Government is learning from. This Government wants to break the law yet again. I am sorry for getting emotional.

Laws are being broken. More than 4,000 assessments were carried out last year. That is not progress; it is failure. These are not statistics but, rather, children - children with speech delays and children who cannot walk. These are children who are locked out of the supports to meet their needs and allow them to have a full life, a life of dignity. This State is breaking its own law and, in doing so, it is breaking the trust of every family waiting in hope and despair. Many of those families have been in my office, on the phone to me or breaking the hearts of my staff. I spoke on the phone to one mother from Tipperary who told me that she is financing the special needs education unit in the school. She is paying for the training of the teacher because that teacher, who was put in place by this Government, has no training whatsoever when it comes to special needs. She is paying for the language therapy for that school in order that her child can be helped.

We in Independent Ireland are calling on the Government to act urgently, honestly and effectively. We ask the Government: first, to fund the Cara fund immediately to clear the backlog now rather than in six months or by the next budget; second, to set without delay a national emergency of real public targets to comply and complete within the six-month timeframe the legislation requires; third, to deliver a workforce plan to recruit and retain specialists we are so badly lacking, be they speech therapists, psychologists, physiotherapists or behavioural teams; and finally, to fund the therapies and school places of these children who do not thrive.

This is about more than legislation. It is about justice, decency and whether we are a Republic that stands by those who need us most or a Republic which turns away and uses the excuse of red tape. We cannot call ourselves a country of prosperity if thousands of those children are left behind. We cannot call ourselves a nation of fairness while knowingly delaying our children’s future. I ask this House and the Government to please invest in the future and not to leave our children behind. It is the only legacy we have in this House and the legacy going forward. It is with shame I stand here while we have to have this debate in the House.

Mattie McGrath (Tipperary South, Independent)
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I agree with most of what people have said tonight. It is a shocking situation. I welcome Cara and her dad. I think of her mam at home as well as her two brothers. It is such an indictment. I know Cara lives in a lovely house in Ardfinnan. Looking out her back window, she can see the Liam Lynch monument, a man who gave his life for our freedom and democracy in this country. What has it come to now? We have the HSE, an organisation set up 25 years ago just to put buffers between the Government and the public who are entitled to services. It is allowed to break the law consistently without any repercussions whatsoever. What have we come to in this State when we can spend three hours making statements on this issue and then debate this motion, but nothing will change? It is getting worse, in fact. The HSE prefers to recruit lines of senior managers and senior executives. I met them at the opening of the Slievenamon wing in Clonmel some weeks ago. I was introduced to several people who I had never seen before. While they have big jobs and titles, they will not look after the basic needs of the people. It is an appalling vista.

Bhí mé thuas san Áiléar Poiblí earlier, and chonaic mé Cara ag foghlaim na Gaeilge. She was doing her homework here tonight. She should be at home with her brothers and with her friends, as has been said, rather than being in this situation where she has to sleep outside the Dáil in this appalling weather. It is unbelievable. She has met four or five taoisigh during her campaign. It was all promises and no empathy. There may have been empathy, but there was no action. We will not have any action after this, either. I am convinced we will not because the HSE is not accountable to anyone. It flouts the Disability Act 2005 and every other Act as well. We bring in these Acts and proclaim how great they are, but they are only for some people. It is an appalling vista that this has to go on.

We all deal with families who are traumatised, impoverished and deflated. The HSE has already spent €8 million fighting parents. Just think about. Some €8 million has been spent fighting parents to deny them the rights to which they are entitled under the Constitution. It is a shocking and depressing situation. I salute Cara, her family and her supporters. This situation is just not good enough or acceptable in this day and age. We will have this debate and rub our hands and it will all go on in its merry way. None of the CAMHS teams and the whole lot of them are properly funded or supported and no one gives a toss.

Danny Healy-Rae (Kerry, Independent)
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I am glad to get the opportunity to talk on this most important matter. First, I welcome Cara and her dad here again today. It is very sad that they have to come here again after being here so many times before. This is still a desperate situation where young families and young parents, when they find that their child is someway not performing to their liking and want to get them assessed, have to wait so long for an assessment, and then to get the therapies they need thereafter. It is so hard, especially in Kerry. We have desperate difficulty in getting these families looked after. Your health is your wealth. We all adore and appreciate the young. For me, that is my grandchildren now. We hope they are and will be fine. That is what we want for them. Every parent wants the best for their child.

While it is one thing to say children must be assessed within six months, therapy and what will be needed after the assessment is another thing. I appeal to this Government to ensure therapists, psychologists or whatever they need are put in place. Funding has to be provided to urgently recruit more therapists to assess these children and young adults presenting with special needs and disabilities.

This has to be a top priority for the Minister for Health and she should stamp her foot on it rather than letting the HSE do what it likes.

Waiting times for assessment of need applicants have to be reduced. How can a child or a young person receive the necessary treatment without a diagnosis? Early intervention is critical and paramount. Assessment, like I said, is only the first step and many parents find that having waited to get the assessment they then face another long wait to access the services their child needs. Many parents have no choice but to go down the route of private assessments and they should be reimbursed when they do this. This is putting a huge burden on families. What about the families who cannot afford a private assessment? What happens to their children and young adults? Applications for financial support for domiciliary care for children and disability allowance when they reach 16 years are complicated and take far too long to process.

St. Francis Special School in Beaufort has requested the establishment of adult day and respite services on the grounds of the St. Mary of the Angels centre for adults with intellectual disabilities. This is critical. St. Mary of the Angels, run by St. John of God, is practically being closed down by stealth. As soon as the people who are there die off their bed is closed down and no one else is put into it. My brother Michael knows it and has been pushing the case for this for so long, but we need to ensure St. Mary of the Angels is revamped. It is in the centre of our county and it is central to everyone. We hear of so many cases where it is suggested people go up to County Meath or far away to some place in Tipperary or at the far end of County Cork. That is not fair on people with intellectual disabilities and their parents who are trying to do their best for them.

It is time this Government stood up to the HSE because it is practically doing what it likes. It has done so. I am not blaming the workers, the nurses or the people on the ground but the top officials, the directors, the people we do not see at all who are pushing the pens and the people who are making the laws. It is time our Minister for Health and Ministers of State at the Department of Health stood up to the HSE. There is so much money going in there and I am very dubious about how it is being spent, because it is certainly not reflected on the ground when people become sick. We have the situation where, but for SouthDoc, there is no doctor to be found anywhere in Kerry after 5 p.m. on a Friday evening.

There is more downtime and people have to wait until morning and try to stay alive, if they can, until morning. There are so many things that need to be addressed. I am appealing to the Government not to fudge on this issue. These are people with disabilities. Ask that little girl up there who is fighting for all our people who need help. We need to do something about this now, make a real attempt to put the funding into it and make sure the HSE delivers on the funding.

Barry Heneghan (Dublin Bay North, Independent)
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Bhí an Teachta Healy-Rae ag caint faoi rud éigint atá thar a bheith fíor. An rud ná nach bhfuil gá ag an Aire ná ag an HSE. Nuair atáim ag cur ceisteanna parlaiminte isteach chuig an HSE nó NTA, tá sé soiléir go bhfuil rud éigint mícheart leis an system atá againn. Níl aon duine responsible. It is ridiculous. I do not understand how we have given the power to these senior civil servants and I wonder who is actually running this country. That is something that really needs to be changed because people in these positions-----

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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The Government you support.

Denise Mitchell (Dublin Bay North, Sinn Fein)
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You are.

Barry Heneghan (Dublin Bay North, Independent)
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Listen, I did not disturb you when you spoke so please be quiet. I will get a lot more done than any of you will. I want to highlight the unacceptable surge in waiting lists for autism assessments and broader failings in the assessment of need systems. The regional group negotiated pay parity for section 38 and section 39 workers and I am delighted to see it has been done, but let us be honest about what is happening here, namely, that families are exhausted, children are waiting too long and it is not just for assessment but access to real, life-changing supports. The system is letting them down at multiple stages and the consequences are serious. Developmental windows are being missed, family well-being is deteriorating and trust in the system is evaporating.

Two weeks ago I was in the AV room at the invitation of Deputy McDonald. It was to do with my neighbouring constituency in the north inner city and it was great. I heard life experience from mothers and fathers who fought for this and I really was moved by it, and I saw and heard this on the doorsteps during the election campaign. The HSE has reported a 65% increase in completed assessments in the first quarter of this year and that should be acknowledged, but the cold comfort is 15,000 children are still waiting to receive speech therapy, occupational therapy or behavioural supports. Families are being sent from queue to queue and we call it a system. The Minister, Deputy Foley, has committed to reform and that is welcome, but families need not another working group or consultation but immediate action.

Cara, I met you first as a councillor when you invited me to the monster rally outside Leinster House and I thank you for that. I really want to say thanks from the bottom of my heart and from everyone here. You are doing Trojan work. You are doing our job - the job we should be doing. You are asking for the establishment of a task force and I really hope this Government listens to you, because here is the truth. Despite a 65% increase in assessments this year, there were still over 15,000 overdue in March. While the promised reform and the €10 million that, as I have already said, has been allocated is great, it is not solving the core problem. Families do not want paperwork but consistent professional therapy for their children, especially those who have waited years for diagnosis. We need a system that meets children where they are and not one that makes families chase diagnostician after diagnostician just to be seen. We must stop using assessment as a gatekeeper to care and start delivering care based on need.

I believe this Government is serious about its commitments. I am committed to the programme for Government because a government’s role at its core is simply to protect and support those who need it most. I acknowledge the work of my predecessor, Finian McGrath, who did an incredible job as Minister of State with responsibility for disabilities. His leadership and passion sparked my interest in politics at a young age. He showed me that politics, especially Independent politics, is about putting people first and standing up for those who need it most. Gabhaim buíochas leis an Aire Stáit as ucht éisteacht liom.

Hildegarde Naughton (Galway West, Fine Gael)
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I acknowledge the contributions of everyone here and assure them this issue of assessment of need is a top priority for me as a Minister of State with responsibility for disability who sits at the Cabinet table and indeed it is a priority for the whole of Government, as is the national disability strategy. As Deputies know there is a disability unit set up within the Department of the Taoiseach. We have also had a number of Cabinet committee meetings on disability and assessment of need is a top priority. I assure Deputies I have heard and listened to all their comments. It is an absolute priority for me to ensure we have action on this. I will certainly be open to working with everyone across the House to ensure children have access to the services they require. In my last Ministry of State, where I had responsibility for special education, I travelled the length and breadth of the country and heard the lived experience of parents and teachers and of the children who do not have access to speech and language therapy and occupational therapy. We have put in place a pilot relating to special schools of putting therapists in schools. We are rolling that out to all special schools and beyond. That is work that is ongoing with Government.

I want to make reference to a number of issues raised throughout the evening. Early intervention is absolutely critical if we are to get this right. We are dealing with the issue of waiting lists for assessments of need but we have to go right back to the start and those early milestones of a child’s life to ensure that where they are not meeting them they get access to those therapies at that level. That is what is happening as part of our national disability strategy. This is our all-of-government blueprint that we will be publishing in the coming weeks. It will be the blueprint over the next few years to ensure there is an action plan associated with that strategy as well.

Returning to the Private Members’ motion on assessments of need, there is a huge amount of work happening on recruitment and retention at domestic and international levels. CORU is working on recognising qualifications of people who are working abroad and want to come home. These issues were raised in this debate. Again, I assure Deputies we are working hard across government on that. There is the no wrong door approach.

This comes back to parents who want access to these services for their children, whether they go into the primary care setting, CDNTs or CAMHS, being signposted in the right direction and getting access to the services they need.

The issue of the length of time for the assessments of need was raised. The average length of an assessment of need is approximately 30 hours and it can be up to 90 hours. We want to ensure that children or adults who are going through an assessment of need have access to the therapies they need at the earliest stage possible along that process. I know that parents are frustrated and angry. I meet them regularly in this brief, as I did in my previous brief. I am determined that we get this right but it is complex, as many Deputies have acknowledged. It is not just a question of reducing the waiting list. It is not just about recruitment and retention. It is also about looking at where an assessment of need is required. It is often not required by some of our Departments. In housing, for example, it is asked for but it is actually not required. One is entitled to get services and housing supports such as domiciliary care allowance. One does not need to provide an assessment of need. It is a smaller part of the jigsaw but these are all the areas we need to be looking at to get this right.

I acknowledge Cara. I have met her previously. I know how she has been advocating not only for her own family but for families across the country. She should not be here today; I concur with colleagues that nobody should have to protest outside the gates of Leinster House or a Department to get access to services that he or she needs.

On the challenges associated with that assessment of need process, we need to consider a system-wide approach. It requires a proportionate response from the Government, one that is real, tangible and clear and provides positive outcomes for parents where they actually know the pathway in getting access to services for their children. We need to spell that out.

The motion highlights some of the aspects of a complex issue, including the need to increase the availability of and access to appropriate services for children with disabilities and the need to ensure that children receive an education appropriate to their needs. The Minister, Helen McEntee, is doing a lot of work in this area. We are increasing the number of special classes and therapies in school and we will continue to do that, and to resource it as well.

There are unacceptable delays in accessing assessments of need. The data has been set out many times this evening in respect of the 15,300 assessment of need applications that are overdue for completion. More than 10,600 new applications were received last year, with 4,100 assessments completed last year, so demand is clearly outstripping capacity within the system. That is something we need to address. The introduction of the targeted waiting list by the Government last May is helping, but we need to do much more. Over 3,600 assessments were commissioned from private providers between June of last year to the end of March. We will continue to provide and fund those private assessments as part of the solution. I am encouraged by the 30% increase in assessments completed last year compared to 2023. There was a 65% increase in completed assessments in the first three months of this year. We are moving in the right direction but we have much more to do.

Parents want early access to services and supports for their children. In many cases, they seek support from primary care, CDNTs, CAMHS and are then told that they are going onto another waiting list. To repeat, that is not acceptable. It leads to many people applying for assessments of need, which is their statutory right as set out in the Disability Act. They may believe this will give them early or accelerated access to services but they often find themselves on a further waiting list after getting their assessments of need. There is also the issue of legal bills when parents feel they have to resort to the legal system to ensure they get their assessments of need. This is not where we want to be. What I want as Minister of State is to ensure that children are getting that early intervention and access to therapies at a much earlier stage, it is signposted and it works within the health service in particular.

This will require us to address the issue from a number of angles. Our primary focus has to be on the assessment of need process and identifying the delays and blockages causing these long waiting lists. Then, we need to find the most effective solution to these blockages. It may require legislative changes while preserving the statutory right to an assessment of need. It will also require operational changes, increased staffing resources, better IT systems, or outsourcing to the private sector where appropriate. That work is already under way with officials from the Department of children and the HSE. That is set out in the roadmap for service improvement. We also have to ensure that any changes introduced are effective and can be sustained over time. There is no point in alleviating the current waiting list only to have another backlog appear. We need to look at the system and ensure we can reform it sustainably.

We are all aware of the many demands within the healthcare system. We also have to ensure that our disability services are appropriately and adequately resourced and staffed to meet the needs of people with disabilities. I look forward to the development of that dedicated disability workforce strategy this year, which will meet the growing service demands and address recruitment and retention challenges across specialist disability services. It is also important to emphasise that increased capacity and enhanced service delivery in the disability sector will not be possible unless we as a Government ensure that we are resourcing it properly and ambitiously. We are spending €3.2 billion on our HSE disability services this year, an 11.5% increase on last year or €1.2 billion since 2020. This is significant funding. I appreciate that there are significant pressures. People have referred to the incidence levels of those saying that they have a disability. People are ageing, we are all living longer and disability will be part of what we in the House have to deal with.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Many people have said that it is particularly sad that Cara Darmody has to carry out a 50-hour sit-out outside Leinster House. Many of us have met her over several years. This is not the first time she has been up here or the first time she has been out protesting alongside her father Mark, on behalf of her brothers John and Neil, who have been abjectly failed by the State, and on behalf of all the other Johns and Neils who have not got the services they require in any way. The only thing there is going to be agreement on across the Chamber is that there has been a failure to deliver and none of this is good enough. The Government has to take responsibility for its failures. We have all dealt with these cases in our constituencies. I am dealing with a number now. Everybody has seen it before. We talk about a single point of access and we know that even those who are lucky enough to get therapies or an assessment still have to make the journey and deal with elected representatives. That is the sign of a system that does not work. I would love to think that we were getting the sorts of answer we would like on behalf of our constituents who are obviously not getting them. There are 902 people on the waiting list in Louth for AON, with 245 waiting over 12 months. That does not sound like much of a success. There are 15,296 children who have been failed. We cannot talk about success when, by the end of the year, we could be talking about 24,796 children not having received an assessment of need within six months. Government is talking about removing one of the few rights that people have. They are going to exercise this right because they are failing to get the service from the State that they absolutely deserve and that is required.

When my son, Turlough, was moving from primary care back to the CDNT, my wife said she did not need this as we did not need to put him on a list where he would not get any service. That is not to take away from the great work that is done by many people but if you look at the children's disability network team in north Louth, 53% of occupational therapist posts are vacant, as are 52% of speech and language therapist and 48% of psychologist posts. If you exclude administrative staff, there is a 36% vacancy rate across the board. I could go on but unfortunately, we all keep going on about the same thing. There has been a failure to deliver, we need to see real delivery and this is just not good enough.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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This is a bizarre debate full of contradictions and contortions. Essentially, we are discussing a motion endorsed by the combined Opposition that, in its most simple terms, asks the Government to stop breaking the law. The Government states it will not oppose the motion but no, it will not actually stop breaking the law. Anyone who has interacted with disability services in Ireland will understand the contradictions. When it comes to disability in Ireland, it is Ireland at its best and at its worst. A Disability Act that guarantees children with disabilities the right to an assessment of need within six months is Ireland at its best. In the case of Governments that ignore that law, however, which are forced through the courts, found guilty, still ignore the law and, rather than upholding the right, come up with the ingenious solution to simply get rid of the right altogether, that is Ireland at its worst.

I have dealt with hundreds of families in Cavan and Monaghan where parents are fighting every day for their children with disabilities. I have seen the absolute love they have for their special children and the unquenchable love they get in return. I have seen communities rally around them and their demands for respite centres and a special school. I have seen workers in the sector going beyond the call of duty for those children. That is Ireland at its best. I have also seen, however, the heartache of those families who are literally begging anyone who will listen for the services that their children need. I have seen the teenagers who have not advanced to their full potential for no other reason than they were let down by the Government and were denied the services they needed when they needed them. I have stared at the formulaic, bureaucratic, frankly insulting responses from Monaghan and Cavan CDNTs that blandly state that an OT, speech and language, physiotherapy, psychological treatment or assessment of need that those children require is subject to a waiting list. They say sorry for the long wait but we expect an appointment some time in the next few years. It is Ireland at its worst.

It is Ireland's disability services under Fianna Fáil and Fine Gael, propped up by the lackey Independents who are all too happy to blame the HSE rather than the Government they support.

Deputies:

Hear, hear.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Tonight, we are once again treated to all the contradictions and contortions. The message is very clear: for all the rhetoric, the message from the Government is that the families of children with disabilities will have to keep fighting every day. The message back is equally clear: fight they absolutely will and we will stand with them every single step of the way. Disability rights were hard won. They will not be given up regardless of whatever spin is put on them. The message to the Government is clear; stop breaking the law.

Deputies:

Hear, hear.

Conor McGuinness (Waterford, Sinn Fein)
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In Waterford, 147 children are waiting for an assessment of need and some have been waiting for nearly two years. That is illegal. That is the Government breaking its own laws. As the Government knows, under the Disability Act children are entitled to an assessment within six months. That is not optional. That is the law. Yet, the Government breaks that law every single day. Across the State, more than 15,000 children are now overdue their assessment. That number could rise to almost 25,000 by the end of next year. Across the State, more than 15,000 children are being denied their rights under the Disability Act and families are being abandoned. They feel abandoned because they are. They are forced to pay privately or in many cases, go without. It is not just failure. It is a systemic denial of care and it has to stop. Not opposing this motion is not enough. The Government needs to take action and it needs to make it stop.

Budget 2025 allocated some extra funding, namely, €4.5 million on top of €5 million in core funding but we have seen no real change. Just 7% of assessments are completed within the legal timeframe. That is not progress; it is collapse. What is worse is that this is not just about assessments. It is part of a litany of Government failures when it comes to children. Children are left in pain for years waiting on scoliosis surgery. There were unsafe and unnecessary operations on vulnerable children and there is still no accountability. There is a crisis in special school and autism class spaces that is left unresolved year after year. CAMHS is in chaos. Child homelessness is rising again. School absenteeism is on the rise. In Waterford, there is not a single educational welfare officer in post. Three out of three positions are still vacant. It is not a pattern. It cannot be an accident. It is a systemic failure to plan, fund or deliver for children.

Tá na mílte páiste ar fud na tíre ag fanacht ar mheasúnú riachtanais. Céard atá de dhíth orthu don saol, don oideachas agus don chúram? Tá gníomh ag teastáil anois.

Máire Devine (Dublin South Central, Sinn Fein)
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I welcome Mark and his family here. The family named her well as her name is Cara, a friend, and she has become a true friend to not just her brothers but to many in this country hoping for change and the delivery of care that the Government has failed to do. It has failed the children in my constituency and across this nation. It is a clear breach of the Disability Act and more than 15,000 children have overdue assessments. The Government has had 20 years to correct this but all we get are phrases like "we look to", "we endeavour", "we should" and "we plan" ad nauseam. Over 20 years, I am sure it might be a bit tired of saying the same things again but not tired enough to deliver change.

My constituents regularly contact me with frustration and anxiety over severely delayed assessments of need for their children. The HSE and the disability services are under so much pressure that it is impossible to complete assessments within the legally-mandated six month period. It takes more than 12 months before an assessment even gets to the desk of a clinical psychologist in the children's disability network. There is not enough trained staff on these teams to do the assessment and most assessments of need are outsourced privately at a cost to taxpayers. Tightening the deadlines further will just mean more pressure on staff, more outsourcing, further clogging of courts and no services. This is what is so gravely wrong with assessments of need. There is a law but no resources to implement it and perhaps not the determination.

Disability services need a complete overhaul. We must address the disconnect between CAMHS and disability in all. I want the Government to take Cara's fund seriously.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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Well said.