Mark Wall (Labour)
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I welcome the Minister of State to the House. I also want to acknowledge that last night I received a phone call from the office of the Minister of State, Deputy Rabbitte, to say she would unfortunately be delayed as had a prior commitment today.

There is a trend this morning in some of the Commencement matters that have been raised, because this is the third time I have brought up the issue of assessments of need, AONs. It continues to be an almost daily issue for my office and indeed for people who ring me when they are rightly in despair. I had a debate with the Minister of State, Deputy Rabbitte, in this House just a number of months ago. I described the waiting lists and figures for the area in which I live. I said there were approximately 2,000 families, but she corrected me on that day and said that the figure was 2,665 families, rather than the figure I gave, and the figure in the official report she was about to read out, which stated that there were 1,320 families waiting on an assessment of need. She described that day as “Groundhog Day”. She also went on to say that this is as bad as it gets. She said that the HSE has not kept pace with the growth in population in the census return. That is what she stated on that day.

Today, I want to concentrate on one family I have dealt with for the past number of years. They are John and Yvonne Creaney and their son, Pádraig. Their son had an assessment of need in 2012 when he was seven years of age. Pádraig has struggled over the years and, given his struggles, his family has sought the best for him by following up to try to get an updated assessment for their son. The family received a letter from the appeals office in November 2021, after years of them calling without being answered. It stated that his review had commenced and that he would be offered a preliminary team assessment, PTA, given the length of time involved since the last one and, most importantly, given the changes in Pádraig’s presentation.

Unfortunately, in September 2020, a reply I received on behalf of the family stated that this young man was highlighted as requiring a review in August 2020. A plan was in place in late 2021 to review his case, using the PTA. As the Minister of State will know, this method had been invalidated. The team stated that it had no alternative for this young man and his case will be highlighted as one of a number of past AONs. I followed up with the Minister of State, Deputy Rabbitte, in November 2022 and I received the same reply I just outlined. It stated that there was no alternative pathway or formal allocation to review an AON case.

The Minister of State, Deputy Richmond, will know that last year, in a debate the Dáil on autism and pathways for assessments of need, the Minister of State, Deputy Rabbitte, in an unusual intervention, said she was going to change all of this. She said we would have changes to AONs, with the setting up of six units for assessments. It gave hope to families, like the Creaney family in Athy. After a number of months, and after I sent a number of letters to the Minister of State and the HSE, I received an updated response on 14 February this year. To say that the response was disappointing would be an understatement. It was a copy and paste of the letter from August 2022, stating once again that the assessment of need office currently had no alternative pathway and no formal allocation of resources in place to carry out a clinical reassessment for AON cases. That is the same reply I received two years prior regarding that particular family.

That is just an example of one family, but I get calls like that from so many families week in week out. They are looking for an assessment and a re-assessment of need. That child was seven in 2012. It is now 2024 and he has not had his re-assessment of need. The family is crying out for it and there are more families in the line. There does not seem to be any improvement in relation to assessment of need. When I receive a letter that states that there is no formal pathway, there is no alternative and I have to share that with a family who are in despair, it beggars belief. I hope that the Minister of State has brought some good news for the Creaney family in Athy and all the other families who have contacted me and other public representatives in the CHO 7 area.

Neale Richmond (Dublin Rathdown, Fine Gael)
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The Minister of State, Deputy Rabbitte, asked me to pass on her personal thanks to the Senator for his understanding of the situation this morning. She appreciates him taking the time to talk last night. Regarding the specific needs of the Creaney family in Athy, she has taken the correspondence the Senator provided her office on board. While the relevant points in the correspondence of September 2022 were entirely valid at the time, the position has developed greatly in the interim.

The Minister of State, Deputy Rabbitte, acknowledges the challenges that are being faced by children and young people with disabilities and their families in the assessment of need process, but she remains firm in ensuring that they receive the opportunity to access health services in a timely manner. However, under the Disability Act 2005, children do not require an assessment of need to access services. Presently, there are many children in receipt of therapy services who have not gone through the AON process.

Following the High Court ruling on 11 March 2022, to the HSE was required to re-assess children to meet legal requirements. While alternative guidance was developed, the HSE reverted to the pre-2020 process and there may have been a lack of consistency across the country in the application of this interim method. It appears that the correspondence that the Senator sent to the Minister of State referred to the individual who was awaiting an AON within this timeframe.

In July 2023, the head of disability operations at the HSE approved a new and revised standard operating procedure, SOP, which included interim guidance for assessors to provide a clear and consistent approach to managing AONs and the process of referrals. In relation to CHO 7, currently a combined 5,133 AON applications between stage one and stage two are outstanding. The Minister of State, Deputy Rabbitte, and the HSE are entirely focused on driving down the waiting lists for AONs and this is featured strongly in the roadmap for service improvement from 2023 to 2026. Working groups implementing actions to address AON and workforce recruitment and retention the HSE and its lead agencies are continuing to explore a range of options to address AON waiting lists, including the allocation of a total of €16 million to procure private assessments for children and young people. The HSE also launched the first nationwide children's disability network team, CDNT, recruitment campaign in January 2024, which was titled “Be part of our team, be part of their lives”. So far, approximately 495 applications have been received. The HSE has also informed the Department that the interview stage of the selection process is under way and it is hoped that appointments will commence from the middle of this month onwards.

Regional assessment hubs to undertake AONs are currently in place across the country by the HSE. The Minister of State, Deputy Rabbitte, will continue to engage the HSE to advance the appropriate measures to ensure that every family seeking assessment receives one in a timely manner. It is important to acknowledge the services that are currently being delivered by the HSE and its lead agencies were approximately 46,000 children with complex needs are receiving services and supports provided by CDNTs across the State.

In conclusion, the Minister of State, Deputy Rabbitte, will underline that she will continue to engage directly with the Senator not just regarding the family in Athy he mentioned but other families across CHO 7 and particularly as they affect Kildare South.

Mark Wall (Labour)
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I first want to thank the Minister of State for his reply and for going through it in such detail. He underlined in his reply and that they do not require an assessment of need. I have been here before with every family I deal with. The first question they are asked is to give that piece of paper with that assessment the need, so something needs to change there.We need to tell the clinicians and everybody else that they do not require an assessment of need. This is probably the third or fourth time I have said this in the House. It needs to change urgently. That is what the family I have just referred to and the many other families I deal with have been told, namely, if they get an assessment of need, then they will get the pathways. The pathways are not opening up, and that is not just for the Creaney family in Athy but for all of the other families I deal with. There is no pathway.

This child was seven when he got his first assessment of need and he is now a 21-year-old adult. He has had no reassessment and, as I said, there has been a complete change in his personality and his needs. That is what I am fighting for today. I appreciate there has been movement in regard to setting up the assessment of need centres in the various areas but to have 5,133 in CHO 7 is simply not good enough. These are the people who are ringing me and other public representatives daily throughout CHO 7. It needs to change urgently. I hope the Minister of State can bring that message back to the Minister of State, Deputy Rabbitte.

Neale Richmond (Dublin Rathdown, Fine Gael)
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I want to underline that the Government shares the Senator’s absolute concern. Of course, I will bring back the message that is being heard loud and clear by the Minister of State, Deputy Rabbitte, and the entirety of her team. The Minister of State will continue to be heavily involved in advancing the roadmap for service improvements in order to, among other things, improve the assessment of need process and the recruitment of health and social care professionals to our disability services. In this regard, there is a dedicated focus on assessment of need in working groups that had been established within the roadmap governance structures. Work will be centred on ensuring that all care sectors - primary care, disability and CAMHS - work together to address issues that exist for children with disabilities in accessing support.

The Minister of State wishes to reaffirm her commitment and that of the HSE to ensure that each family and their child who wish to receive an assessment have the opportunity to do so in a timely manner. Driving down those numbers in CHO 7 and beyond is an absolute priority.