Erin McGreehan (Fianna Fail) | Oireachtas source

The Minister of State is very welcome to the House. It is always good to have her here to discuss the progression of the disability services programme and the assessment of needs. I welcome her robust and honest opening statement. Robustness and honesty from a Minister are always welcome. We in Fianna Fáil very much welcome this debate. We have always been advocates for people with disabilities, and we have worked to assist and worked towards a rights-based model. I am glad the Minister of State is at the helm. When she was speaking, it crossed my mind that there is a lack of movement from the Department of Health. Could she give us an update on that? That would be welcome.

It is excellent to have a champion like the Minister of State fighting for the rights of people with disabilities. No one in the Oireachtas knows the challenges associated with meeting the needs of children with disabilities better than her. She is acutely aware of the delays and discrepancies and their impact on children and their families. Her constant availability and openness to meeting families and representatives of disability organisations are always welcome and appreciated.

The PDS is a significant programme of reform, which we hope will change the way we deliver services and supports for children with complex needs. As we all know, children’s disability services have developed in an ad hocmanner. While some children have received an excellent service, others have received none.

The Minister of State highlighted that the provision of services is currently incredibly inequitable and varies depending on a child’s disability and age, in addition to where he or she goes to school and lives. This inequity is deplorable. What was in place was not working. We must now examine critically and constructively the proposed system and make sure it is flexible and will work. We must ensure there are review mechanisms as we move forward with the programme because we cannot expect one strategy to fit all. Arrangements may need to be amended, and flexibility will need to be written into the system to ensure it works for each community health organisation, CHO. As we know needs differ from one CHO to the next. We need a streamlining of attitudes across all boards.

Last year, the Government provided nearly €8 million to address the backlog affecting assessments of need. I am incredibly disappointed to hear there has been such a dramatic increase in the backlog given all the excellent work during a pandemic. How did the HSE allow the assessment-of-needs backlog to build back up after the huge investment? Is the SOP not working? As I said, a constant review of all our actions needs to be taken.

There is a relationship between the intervention and the assessment of need. As rightly highlighted, this needs to be far more cohesive. Historically, there has been a difficulty because we have no standard way of performing assessments. A clinician in one part of Ireland may carry out an assessment in an entirely different way from a clinician in another part. This has led to the possibility of clinicians being very conservative and spending a great deal of time doing assessments. As the Minister of State said, the PDS is an integral part of Sláintecare. Could we have an update on the Sláintecare reforms from her point of view? I am aware that these are a key priority for her and the Government. We must be positive about this. We must be constructive and look to the future to determine how we can move towards the social model and away from the medical model. The children are not sick; they just need therapy and to have their needs met. Therefore, it is progressive that we are moving away from the Department of Health. The children are not sick; they need help and therapy to be their best selves.

I am contacted regularly on the issue of waiting lists. I will not elaborate on it because my time is running out. I have a few more questions I would like to ask. Has the HSE drafted a clinical baseline for each team to ensure it is not oversubscribed? Has the HSE provided to the Minister of State a breakdown of the number of children assigned to each team? What clinical oversight mechanisms does the executive have in place to ensure teams are not burned out?Has the HSE considered any alternative measures, such as the use of technology, to tackle those terrible waiting lists? At a meeting of the Joint Committee on Disability Matters this year, Dr. Cathal Morgan, head of operations, disability services, said:

There is an old phrase: "Culture eats strategy for breakfast." We can pour in all the resources we want, but if there is not a fundamental change in how clinicians work, there are no standardised norms in how we perform interventions and our system is one of assessments only, then we create a waiting list for assessment and then another for intervention. That has to stop. We must move to a scenario where children are on an intervention pathway from the get-go.

How is that culture, that eats strategy for breakfast, changing?