Wednesday, 22 November 2023
Nithe i dtosach suíonna - Commencement Matters
I thank the Minister of State, Deputy Rabbitte, for coming to the Chamber. My question this morning relates to the establishment of the assessment hub in CHO 9 on the north side of Dublin.
As the Minister of State is all too aware, when it comes to children with additional needs in this country, the word that appears in almost every single conversation is “wait”. There are waiting lists to be assessed, then there are waiting lists to access services and then they must wait for the education system and the health system to be joined up so that kids will not be left with a shocking wait for basic things like assistive technology.
Two years ago, on the north side of Dublin in CHO 9, some 2,824 children had been waiting for 12 months or longer for an initial contact from a disability service in the HSE. While there are efforts on the ground, that does not take away from the fact that a torturous wait remains for families and particularly children to be assessed, to get a diagnosis and to get treatment or a service.
My question today relates to the assessment of needs. At the end of the second quarter of this year, some 1,906 children had been waiting for at least six months or more for an assessment of need on the north side of Dublin in CHO 9. The vast majority of those 1,900 children were waiting way longer than those six months. The response from the Government has been to establish these assessment hubs, which is very welcome, as well as to rely on the private sector to deliver the assessments. Today, I ask for the details of how many staff will be in these assessment hubs and how precisely they will operate.
To my mind, staff are at the heart of the discussion on the waiting times. As we all know, there is a chronic shortage of therapists, psychologists and clinicians to provide services. The recurring theme on the ground at the moment, particularly within the HSE, is that many of these therapists and clinicians are voting with their feet. They cannot go on with the reality of the enormous waiting lists and they are moving into the private sector. This is because they cannot cope with the impact that this is having on the children who are at the centre of all this.
While subcontracting to the private sector is unfortunately a necessary action, one of the questions I have relates to the extent to which this is the long-term response to managing the very dramatic increase in requests for assessment of needs that has taken place over the last number of years. There is a real capacity issue within the private sector already. Anybody who is trying to access a private assessment at the moment knows that it is impossible to get on a waiting list, particularly here in Dublin. Those who get an assessment are scheduled well into the end of 2024 or indeed into 2025. Of course, at the heart of all this are the children and families who are waiting. They are dealing with the lost weeks, months and indeed years in which they have had no access to a service.
I am very conscious when speaking of the assessment of need for a service that it is not a legal requirement that one can access the CDNTs and primary care. That is important to say. Yet, we all know the reality on the ground. The shortage of services means that unless a child has an assessment of need and a diagnosis, they will not have a passport to open up the door to the services and therapies they desperately need to access. It is therefore crucially important that we get the assessment of need piece right to ensure children are properly diagnosed accordingly. I look forward to the Minister of State’s response.
I thank the Senator for the opportunity to discuss this in the House. As Minister of State with responsibility for disability, and as I have said in this House a number of times, I am committed to delivering real and tangible solutions to enhance the capacity of our children’s disability services, and to provide better supports to children and young people with additional needs, as well as to their families. One of the solutions put forward was to develop an AON assessment hub. As the Senator is aware, during a Labour motion last May I committed to having six planned regional assessment teams in place by 1 August to tackle AON waiting lists. If not, I said I would consider covering costs incurred by parents - no pressure. Following discussions with the HSE at both national and local CHO levels, I confirm to the House today that the hubs were in place at the start of August undertaking AON caseloads. These hubs and their effectiveness will be examined in the context of feedback received from clinical staff, the implementation of the progressing disability services, PDS, roadmap and the development of the regional health authorities in early 2024. In terms of CHO 9, the HSE advises that overall 2,829 children were awaiting an AON as of June 2023. It is important to note that a more recent figure is not available due to ongoing industrial action. An AON administrative hub has been established in the Swords area of CHO 9 to maximise efficiency and deliver a CHO-wide approach to AONs. The current configuration of the CHO consists of an AON hub manager, four whole-time equivalent assessment officers of which one post is vacant, three whole-time liaison officers and four whole-time equivalent administrative support staff. All are in place bar the one. The following specialists are allocated to the CHO 9 hub. There is one whole-time equivalent clinical psychologist, one 0.8 whole-time equivalent clinical OT and a specialist speech and language therapist. That is currently vacant due to maternity leave.
In terms of work being done around all of the assessment hubs, each CHO has developed an approach to establish a hub based on the unique circumstances that apply in the CHO. It also reflects the capacity they have within their existing resources. I assure the Senator that while the challenges across children’s disability services are considerable, we will continue to work with colleagues in the HSE and in my own Department to pursue all reasonable avenues to reduce the AON backlogs. It is important to acknowledge that, when I made that statement in the Dáil, hubs were not in place. It is important to acknowledge that the HSE has worked at speed, both Bernard Gloster and Bernard O'Regan, to put these in place. There are names, locations and staff attached to them.
The next part is that at the moment the configuration is being made up from within the teams themselves. That is not private. Those are publicly funded and staffed teams. I have not seen the tender documents that have come in to add additional capacity. I have started from within our own resources, and what we can do with them. I spoke about private services in the Dáil last May, and I still talk about the tender document that went out and has come back in, and which is being assessed to add additional capacity. I committed to 60 hubs. In fact I have delivered on eight. The ninth one, in CHO 2, has its own configuration of how it has always worked, and it has the lowest AON numbers in the country. What it is doing is working, so why change? They are content, so I am not going to force that by any means. We will take the learnings from either side.
I will say one final thing. In health you do not need a diagnosis to access services, but in education and social protection you do. There is our problem and that is our challenge.
I thank the Minister of State for her comprehensive response, and for her last comment. She hit the nail on the head with regard to the challenges many of us, as public representatives, daily come across. I talked about the lack of joined-up thinking between education and our health system. I am grateful for the detail provided by the Minister of State. One of my outstanding questions concerns the extent to which this represents new staff, or the reallocation of existing staff within CHO 9. We talk about overall shortages, and I welcome the establishment of the assessment hub and the efforts she is putting in to ensure we cut back on the disgraceful backlog in the assessment of need. I know there is a recruitment drive by the HSE, but we need to understand how successful that is. We are not necessarily seeing that on the ground at the moment. I know it will take time, but it is important to understand whether this is an additional service within CHO 9, or a reallocation of existing personnel into the assessment hub.
On reallocation of staff, I can tell the Senator that the part of the HSE teams which will always be reposted are the liaison officers. The reason is that the HSE holds the right to ensure the assessments are carried out within a legal framework. They will always be part of the HSE staff, so they will always be redeployed.
The current configuration is new and transferred across so we will be backfilling into the teams. However, experience is really important in our hubs. Why is experience important? The first reason is that it took us so long to sort out the paperwork. We do not need to start from there again, and it is all a paper-based exercise. It is ensuring that they go back to the right team when they are assessed so they will not have lost time, but be on the same length and further up to get their intervention. To me those teams are made up of experienced people within the CDNTs. It is also made up of primary care. Part of it will include some people from mental health for the simple reason that, before children are sent back to the CDNT, the next layer on the CHO assessment hub will assess if they are better fitted to mental health or CAMHS. They might perhaps fit better into primary care. The child will access the door that will open and deliver his or her services. For me, these teams represent a positive step. For the first time I can say we have delivered something on time, but it will be a combination of experience.
I say well done to the Minister of State, and thank her for all of her work in this area. I welcome Minister of State, Deputy Jennifer Carroll McNeill. I congratulate her on her recent lobbying and hard work on our behalf to try to secure a new EU agency for white collar crime. We are proud of her out there in Brussels. I call Minister, apologies, Senator Conway.