Mark Wall (Labour)
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I will start by painting a picture of two of the many cases I want to speak about. The first case if that of the family of a young man from Newbridge. The family speaks of a loving son whose preschool teachers first raised concerns about him. The boy was granted the access and inclusion model, AIM, programme. He was due to have an assessment by teachers at the end of junior infants' class to see if there were any additional needs. When the pandemic hit, the school was closed and this assessment was delayed until senior infants' class. When it was carried out, his teacher pinpointed a number of things that needed to be investigated. The family submitted the initial assessment of need application in November 2021. The family then spent the next 14 months ringing and emailing. Some dates very given but those dates came and went. Then his mother stated it came to light about the High Court ruling at the end of March 2022 that required the Department to change the process of the assessment of needs, AON. More calls were made and only yesterday the family were told by someone in the assessment of needs office that there was no timeframe and their son remains on the waitlist. However, they were told every child that had previously been assessed, prior to the High Court ruling, is entitled to a re-assessment first, resulting in longer delays. That person in the AON office also informed the Newbridge family that extra assessments require qualified staff that it does not have but it is doing a recruitment drive. The reply from the exhausted mother to me was that it had been the first transparent response she had received.

The second family I want to talk about are from Athy. Their son had an assessment of needs in 2012. He received a letter from the appeals office in November 2021 after years of calls and no answers. The letter stated that his review had commenced and he would be offered a preliminary team assessment, PTA, given the length of time involved since the last one and the change in his presentation. Roll on to September 2022 and a reply I received on behalf of the family stating that this young man was highlighted as requiring a review of his assessment of needs in August 2020. A plan was in place in late 2021 to review his case using the PTA, but due to the High Court ruling referenced earlier, this method had been invalidated. The team now has no alternative for this young man and his case will be highlighted as one of a number of past assessment of needs where requests for reviews have been made

Both families tell stories of their young loved ones finding life so difficult, drifting through each day, looking to their parents for help. Both sets of parents say they are at their wits' end, not knowing how to help them and not getting answers despite numerous calls and emails. This is just a small example of the many representations I get in Kildare. I am dealing with them day in and day out. I am also a member of the Joint Committee on Autism, which the Minister of State has appeared before. Recently we had some senior officials from the HSE in and they were at pains to point out that an assessment of needs was not required to access services. Time and again, they told us that was the case. Unfortunately, time and again, and since that discussion, parents tell me the exact opposite. They tell me they cannot access services without an assessment of needs. They tell me those offering the services, if they can get through to them that is, demand an assessment of needs before they will engage.I hope the Minister of State is bringing some positive news to these families today. The families want certainty. They want routine. Their children are years without this. We need clarity on the assessment of need and whether it is needed for access. How is the recruitment going that was mentioned in previous replies I have received? Most important, when will these families, particularly their loved ones, see the services they need, which, as I have said, they have been without for years?

Anne Rabbitte (Galway East, Fianna Fail)
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I thank the Senator for raising this topic and for giving me the opportunity to engage with him on it. To put it in context, we are talking specifically of community healthcare organisation, CHO, 7, which covers the Senator's Kildare-Athy region, the surrounds of Maynooth and reaches as far as areas of Dublin.

It is important for me to be honest and transparent with the Senator. I thank him for raising the issues of the two families. The Senator is after getting a script but I need to correct something on it. It states "CHO 7 currently reports 1,320". Thankfully, Noel in my office kept digging until we got the actual figure so that I could give the Senator real openness and transparency on it. The figure is 2,665. That is the number of families in CHO 7 awaiting an assessment of need. That is Groundhog Day. That is as bad as it can get. To be honest, the HSE has not kept pace with the growth in population as shown in the census returns. Funding has not kept pace with disability sector and the growing population. It is important to say that.

As for what I will do as Minister of State to address that, because 2,665 families are waiting for an assessment of need which will open many chapters, be it in education, domiciliary supports or whatever, in working with the HSE I am looking at putting in place a number of regional teams. At a local level, I have to complement Ms Deborah Jacob, and I complement my leads in that area, namely, Stewarts Care and the Central Remedial Clinic. They work very hard with Ms Jacob in ensuring what can be delivered under the Progressing Disability Services for Children and Young People, PDS, programme and the assessment of needs can be done.

However, there is a legacy piece to do with the preliminary team assessment, PTAs. It also requires us to address the High Court ruling. I have received the report on it from the HSE. I have sent it to the legal department in the HSE for its independent advice on it before we make a final decision because what was in the past did not work. The PTA, which was there when we came into office, did not work and we need to be not unsure about the next step.

When I have the final report back within a number of days, my suggestion is to put in place six regional teams to match the regional health areas, RHAs. I was fortunate in the recent budget to secure €11.5 million to address this backlog in assessment of needs. Those six regional teams will cover the various areas, so we will have a complementary team in each RHA that will specifically address assessments of needs and we will get through them. When those assessments are done, the children who need whatever supports are required will, depending on the need, either find themselves back with a primary care team or back with the children's disability network teams, CDNTs. They will have the results they can present to the Department of Education to get their educational supports.

There are three different levels to this. While it might sound complex, the flow of this will be quite seamless and it will be dependent on the staff. As opposed to putting the pressure on each single team, because we have neither the staff on the team nor the clinical governance piece to assess the risk of it, by doing six teams, each CHO manager lead, that is, the head of community health, needs to support the disability manager and work with primary care. We also need education on those RHA teams. It is the whole of the child, the child at the centre and what the child needs. That is the ambition, and sooner rather than later.

Mark Wall (Labour)
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I thank the Minister of State. Once again, she gave an honest answer. That is the message I have got from the families I deal with. It is like what that woman said to me yesterday, that it was the first transparent answer she got after almost three years of asking. The Minister of State has given that today, albeit with the disturbing figure of 2,665 children that she has also given us. The Minister of State mentioned that is a crossroads we have to come back from urgently.

I appreciate the Minister of State will put in place the six regional teams but we also need to address that statement by the HSE that an assessment of need is not needed, because it is. That is huge. The HSE representatives were at pains to point out at the committee that it is not needed, but the first question every clinician visited by families I have dealt with ask is where is the child's report or assessment of need. They will not talk to the families unless they produce those. The Minister of State said her short-term goal is to address that and put those six regional teams in place, but we need to address something else. There is communication lacking somewhere when the HSE comes to the Committee on Autism and states an assessment of need is not required when the facts on the ground are completely different.

I thank the Minister of State for her honesty.

Anne Rabbitte (Galway East, Fianna Fail)
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I will focus on that point because the Senator is correct. There are two different trains of thought on this. To be fair to the HSE, if a child is in need, for example, for occupational therapy, physiotherapy or speech and language therapy, the health needs will be met within the teams. If a child is P1 or P2, that priority listing of behavioural needs, he or she will be seen to because of that need and should not need a diagnosis to access it. However, a diagnosis is needed for education and for social welfare. Three different Departments have two different understandings of what is the need. At all times, we are saying we are a health model and, therefore, we meet the needs of the individual. I totally understand that. Unfortunately, the Department of Social Protection and the Department of Education say two different things. If a person does not have that piece of paper, his or her child cannot access a special class, a special unit, domiciliary allowance or carer's allowance. That is a piece that needs to be sorted out. However, the HSE is correct in what it is saying to the Senator, but it is unjust not to acknowledge that, without a diagnosis, a person cannot access the other services. I am trying to break down that barrier of understanding.

Lynn Boylan (Sinn Fein)
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In terms of trying to get answers from Ministers, it would be great if all Commencement matters were addressed in such an honest way.

Mark Wall (Labour)
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Absolutely.

Lynn Boylan (Sinn Fein)
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I thank the Minister of State for coming in and speaking in such a manner.