Dáil Éireann díospóireacht -
Tuesday, 29 Mar 2022

Vol. 1020 No. 2

Services for Children with Disabilities: Motion (Resumed) [Private Members]

Debate resumed on the following motion:

That Dáil Éireann:

notes:

— the High Court judgment of 11th March, 2022, in C.T.M. (A Minor) v Assessment Officer and Anor, J.A. (A Minor) v the Health Service Executive 2022 IEHC 131, which found that the 2020 Standard Operating Procedure (SOP) adopted by the Health Service Executive (HSE) was causing its Assessment Officers to "err in law", and that the HSE do not intend to appeal this case;

— that the HSE is in breach of the rights of children with disabilities, as set out by the Oireachtas in the Disability Act 2005, when it does not conduct an Assessment of Need (AON) which identifies the nature and extent of a disability and the corresponding level of service need;

— that the HSE has not submitted a report as required under Section 13 of the Disability Act 2005 since 2015, despite being required to do so annually;

— that, when questioned about the deficit in Section 13 reporting, the HSE have blamed "the outdated database we are currently using" which "was developed by a small software development company, which no longer provides maintenance or technical support for the system", and acknowledged that "the database is 20 years old and has not had the necessary upgrades or technical changes in recent years", but stated that they intended to complete the outstanding reports by year end, in response to Parliamentary Question No. 762 of 1st March, 2022; and

— that fears have been raised by activists, families, and members of the Oireachtas that a review of the Disability Act 2005, as advised by the HSE, could lead to a dilution of the rights of children with disabilities;

reaffirms its commitment to upholding the rights of people with disabilities;

agrees with the assessment of the Ombudsman for Children that the review of the current AON operating procedure is now redundant, and the current procedure is untenable;

further notes the passage of the Sinn Féin motion in relation to Assessment of Needs for Children with Disabilities on 8th March, 2022, with the assent of the Government, which called on the Government to:

— establish Children's Disability Network Teams (CDNTs) in full;

— report to the Dáil on how it intends to ensure that all children have a proper AON and real access to the services which they need;

— publish a costed and timebound implementation strategy for the Disability Services Capacity Review and a cross-departmental strategic workforce development plan; and

— transparently publish all waiting lists for these services; and

calls on the Government to:

— ensure that the rights of children with disabilities are not undermined and, that, if the Disability Act 2005 is to be reviewed, the existing rights of people with disabilities are not diluted and that children with disabilities have access to the services they need;

— immediately ensure that the Assessment Officers' System Database which is used to manage and report on AON and access to children's disability services is updated to reflect changes in policy, operational practice and user requirements;

— engage in proactive, joined-up workforce planning to develop a cross-departmental strategic workforce plan for the breadth of health and social care services, streamline the recruitment process, and work to entice health and social care professionals who have recently left the HSE to return to the public service;

— review the critical skills list in the context of demand for health and social care professionals, while remaining cognisant of the State's international obligations;

— urgently implement the Optional Protocol to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) allowing individuals and families means to challenge the Irish Government on any current or future failures to guarantee the rights contained within the UNCRPD;

— provide a job guarantee to health and social care graduates and proactively engage with them during their degree to advise on employment options in the public health service;

— lay a report before the Houses of the Oireachtas within three months outlining in full the number of Whole-Time Equivalent staffing posts that will be provided to children's disability services for 2022, including the details of the package of supports to provide CDNTs with additional resources to address the backlog of AON and AON which were conducted incorrectly, and to provide additional therapeutic supports as indicated by the Minister of State at the Department of Health, Deputy Anne Rabbitte, in her address to the Dáil on 8th March; and

— report back to the Dáil before the summer recess on how it intends to fully address the matters in this motion and the motion of 8th March, 2022, and lay each outstanding Section 13 Report before the Houses of the Oireachtas by the end of the year.

- (Deputy Pauline Tully)

Deputy Michael Lowry

Ireland prides itself on the caring and helpful nature of its people.

As a people, we embrace those in need and open our hearts and arms to those who require assistance. Unfortunately, more than 50% of the families of children with disabilities surveyed by Inclusion Ireland reported they were not receiving any medical therapies. A separate survey undertaken by Down Syndrome Ireland, DSI, confirms this finding, with almost half of its respondents reporting they have received no therapy of any kind in the past year.

Let us put ourselves in the place of the parents of these children. They love their children. They want the very best for them, for them to learn and achieve everything they possibly can and to have access to everything they require. The parents certainly do not want to have to fight or beg for essential services for their children or to scramble for their children's entitlements. It is a battle that is lost before the struggle begins. This is the stark reality for families of disabled children.

Down Syndrome Ireland recently released details of a survey carried out with 400 of its members on the services they received over the past year. Of those surveyed, 65% had received no speech and language therapy, 70% had received no physiotherapy, 87% had received no occupational therapy and 95% had received no psychology services. Overall, 44% of those surveyed had received no therapy service of any kind. It is an appalling vista. When the results of this survey were put to the HSE, the response was "there are 91 Children's Disability Network Teams, CDNTs, across the country and that these teams ensure children with complex needs can access child and family centred supports based on their need rather than their diagnosis". When questioned at the Oireachtas joint committee, it emerged that the HSE is functioning at 75% of its capacity. Therefore, the truth remains that the organisation has an understaffed service where overworked professionals cannot meet demands.

When we hear these figures and statistics, they alarm us. They are frustrating and annoying. To really grasp what these figures mean, however, we must look beyond the numbers. We must fully comprehend how the lack of services has an impact on those left without them. These children and young people are not numbers. They are young girls and boys and sons and daughters. They are people who need support, but that help is being denied to them. To deny them the necessary supports is to deny them the chance to live their best lives. It prevents these young people and their families from reaching their maximum potential. It confines them to a life controlled by disability rather than providing them with the means to live in which disabled family members can contribute the very best of themselves.

Not providing essential therapies is a form of neglect. By being denied speech and language therapy, children are not only being deprived of the help they require with communicating but also being denied help with eating, drinking and swallowing. These skills fall within the remit of a speech and language therapist. Occupational therapy allows children to develop their fine motor skills, to improve hand-to-eye co-ordination and to perform the tasks associated with everyday life. Physiotherapy helps to improve movement and function in the body and address issues caused by problems with muscles, bones or the nervous system.

Every therapy recommended for children with disabilities is vital for those children. The therapies help them to gain coping skills, to learn self-regulation, social skills and social thinking, to understand their own strengths and weaknesses, to connect with their emotions and to improve their self-esteem. To deny them this help is to deny them their basic fundamental rights as individuals. It prevents them from achieving their full potential. The HSE has stated that it is seeking to address the shortage of staff required to provide services to all children with disabilities and that it is working to identify gaps and to develop a comprehensive workforce plan for the sector.

I call these responses platitudes. The Minister needs to ask the HSE to provide evidence of exactly what it is doing to provide services for vulnerable children and young people. How much time will it take to identify and address the gaps? What is the timescale involved? When can we expect to see an efficient and effective service in place? Children in Tipperary and in every town and village in the country do not have the time to wait for the HSE to seek and to identify. They need these services urgently. As children, this is their window of opportunity to access the help they need. Further excuses and delays must not be tolerated. Parents and their children demand and deserve a proper professional service.

Deputy Verona Murphy

I thank Sinn Féin for its work in putting together and tabling this motion. I recently submitted four parliamentary questions relating to disability services in Wexford. I asked the Minister to state the number of occupational therapists employed as part of the CDNT in Wexford. The response stated that three occupational therapists were currently in posts across the County Wexford CDNT, that a total of nine occupational therapists had been approved for Wexford and that the HSE was experiencing significant staff recruitment challenges, which were having an impact on service delivery. The HSE and the Department of Health have identified the need for nine occupational therapists and yet we have just three employed in the county. That is 33% of what is required for the children of Wexford.

During my first month in this House, I raised the question of training and of how the HSE advertised its staffing requirements across every area and communicated that need to the third level institutions. The Ceann Comhairle intervened at the time with the Minister and demanded an answer. The Minister's response was that the issue would be rectified and fixed, yet we still see only three colleges accrediting courses for occupational therapists, OTs. The starting salary for an OT is €37,000. That will sound like a lot of money to the parents seeking intervention, but it is only 9% of the salary received by the CEO of the HSE, Paul Reid. Perhaps there could be a re-examination of the pay scales to reduce some of the obscene salaries paid to top executives. Allocating funds to better starting salaries for front-line areas might help with recruitment. It would certainly be a more beneficial and effective use of funds.

In another parliamentary question, I asked the Minister to outline the number of children awaiting an appointment with the occupational therapist in the CDNT in County Wexford and the time they had been waiting. Unfortunately, the HSE did not provide an answer to either of those questions. I can tell it the answer, though. One of my constituents, Amy, has a little son who has been waiting since he was two years old. He is six years old now and has had no appointment yet. That would mean the waiting time is four years. This is not early intervention. It is pure and utter neglect.

I asked another question about the number of children awaiting an assessment with the CDNT in County Wexford and the time each child had been waiting. My last question was about the number of children aged under 18 waiting to be seen by the CDNT and the autism services in County Wexford and the length of time each child had been waiting and had been on a waiting list. The response I received was that the number of children waiting in County Wexford before the reconfiguration of the services was 445 and that this number was likely to increase. The response was unclear as to whether this figure was an answer to my first question, my second question or both queries.

This is pretty infuriating. Almost all the dealings I have with HSE services involve some major issue. Sometimes it is a staffing problem and sometimes a funding problem or a problem of capacity or physical resources. All these issues combined demonstrate clearly to me that the HSE is in crisis and is being poorly led. The organisation's CEO, Paul Reid, earns more than the Minister and the Taoiseach put together, and what do we have to show for it? I do not see any evidence of improving outcomes for patients and I do not see value for money for the taxpayers. What I do see are waiting lists getting longer and longer. I am pretty sure Paul Reid does not have to wait four years for anything.

People in these situations, who have been on waiting lists for years, have been caring for children whose needs it is incredibly difficult to meet without support from experts and specialists, which those parents and their children currently cannot access. People are at their wits' end trying to cope with no help in sight. I receive heartbreaking phone calls daily from parents like Amy who plead with me to help and to see if anything can be done for their children. These are the very people who deserve to go to the wellness conferences, but they are not earning enough money to do so. Their tax payments contribute to the very large salaries of those in charge, but these parents are barely keeping their heads above water and trying to do right by their children. All they want is timely help and early intervention, but they are not getting that. Why can we not get it right for once? Why are we ignoring court rules that state it is wrong?

Are we just going to ignore it and give somebody else a pay rise that might deflect from the seriousness of this matter? This is utter and total negligence by the hierarchy of the HSE and, more so, by the Government for allowing the executive to get away with it without accountability.

Deputy Carol Nolan

The waiting times for children who have disabilities and need access to the likes of speech and language therapy and occupational therapy are totally unacceptable. It is also horrendous that parents must fight tooth and nail for these basic and essential services. We have a very serious problem in the State.

In my constituency of Laois-Offaly, those therapies are virtually non-existent. I am aware of the case of a seven-year-old child who has never received a session of speech therapy. It is absolutely shocking, and the child in question has profound disabilities. I am asking for something to be done fast and for urgency to be applied to this unacceptable crisis, particularly in Laois-Offaly. I ask for the recruitment of speech and language therapists and occupational therapists to be given top priority because this has gone on for years. I remember being here as a newly elected Deputy in 2016 raising these same matters.

My offices across Laois and Offaly are inundated with calls from desperate, upset and frustrated parents who seem to encounter barrier after barrier when it comes to accessing speech and occupational therapy or even the assessment of need. There is a terrible number of barriers that must be overcome and these parents and children need assistance. They will not be able to reach their educational potential if they are not given that vital, basic and necessary support when they are young children in the system, either through early intervention or the school-age teams. This must happen urgently.

All of this represents an appalling indictment of the State's capacity to understand what its legal obligations were and are with respect to the assessment of needs process. The High Court judgment referred to in the motion has staggering implications and we can consider how the process adopted by the Health Service Executive caused its assessment officers to err in law. The HSE does not intend to appeal the High Court case and is in breach of its obligations to vindicate the rights of children with disabilities.

Deputy Mattie McGrath

I am also glad to be able to support this motion this evening. It is the third time, I think, a motion like this has been before the Dáil recently, as Sinn Féin Deputies indicated when presenting the motion. They indicated that this motion has been moved because of the many High Court challenges.

What is going on in the country that the HSE, including Mr. Paul Reid and others in the top management under the Minister's watch, can do as they like without being accountable to anybody? The Minister can fly out to Dubai or Abu Dhabi or wherever he was; it could be Timbuktu and I hope he might stay there. It is all these people are fit for. They are not accountable to anybody and they do not respect the people. They do not respect children, na daoine óga. Before Covid-19 I knew of people waiting two years for a service and now they are waiting four or five years.

Have the people responsible for this no shame? We are meant to cherish people equally - mol an óige and tiocfaidh sí. Our children are being denied their rights and people are being forced to go to the courts, where the State has seen loss after loss. It does not cost the Department or the HSE anything but it costs the taxpayer to fight each of those cases. Nobody seems to be accountable.

I heard the Taoiseach comment when he was in America that if there is to be an inquiry into the appalling way Covid-19 was handled, he does not expect Mr. Reid or Dr. Holohan to be brought before it. Why would these people not hide and scurry and blackguard people when they have got away with the likes of this for decades? There is no accountability and they are on shocking money.

Young people need speech and language therapy and assessments. I meet dozens of people every week who say they are looking for jobs as speech and language therapists but cannot get them. What is going on? It is a con job and the people know it. The Government has no shame and its members will try to run and hide. They have no place to hide.

Deputy Danny Healy-Rae

I am glad to get the opportunity to speak to this matter again because it is so important. The Government, the Department of Health and the HSE are really letting down children with disabilities. It is a tough cross to bear for these parents and the children when they do not come into this world 100% and are lacking what they need. An assessment of needs takes forever and they do not get the speech and language therapy they need so much. There is also occupational therapy, physiotherapy and all the other therapies.

I know parents of children who are going mad because they cannot get orthodontic treatment. The children's little gums go too strong and their teeth go wrong so they need treatment. They must wait four years. Please, Minister. There are also cases of scoliosis and spina bifida, and we see little children crying on television telling their stories about their spines going crooked. Please, Minister. The Taoiseach has said the Government was allocating €5.2 million to this but then the Government statement indicates the sum as €4 million per year. Who is right or wrong? Who is the Government trying to kid? Children with Down's syndrome dearly need the July provision but there is a lack of such services every year when it comes to July. Those children need routine and continuity in schooling. If they miss July, they can lose an entire year.

There is no accountability in the Government, the Department of Health, the HSE or the services that are supposed to be provided. The entire process is going wrong.

Deputy Michael Collins

We have a serious problem with children and adults with disabilities. Only a couple of months ago I was fighting in here to save the Kilbrittain early intervention unit in west Cork. It was fully intended to close that unit and, luckily enough, parents sat down within hours of hearing the story and I had it back before the Dáil within a couple of days. Okay, the decision was reversed, but unfortunately for the intervention unit, it faces the same problem of closure this time next year. I had to fundraise for it a number of years ago. It is an excellent unit run by the school in Kilbrittain.

There is also a lack of SNAs in west Cork. I attended a fundraiser last week and I thought it shameful that we had to attend such a fundraiser for a special needs assistant in Ballydehob. Is that what the system in our country has come to? We cannot get the services for the young people and they must go out fundraising.

It is the same issue with the recent closure of the Castletownbere CoAction centre. Pay parity is the issue and CoAction has told me it cannot get staff. That ends up with services for people being closed. We have an entire system mired in difficulty that has been left unattended. Unfortunately, people suffer as a result.

Care workers and those who help at home, as well as others looking after people with disabilities, such as the Irish Wheelchair Association, thought they would get some respect with the €1,000 payment from the Government but many of them will not get it. Perhaps some of the home help personnel will get it.

I must raise the matter of an adult who fell last week in Bandon. I apologise to the family for not raising it before now but the entire system is failing and cracking at the seams. The lady in question fell at 2 p.m. on Monday, 21 March, and waited 14 hours for an ambulance. She had a fractured hip and broken shoulder and imagine she had to wait 14 hours for an ambulance. There is something wrong in the HSE and the system. It is creaking at the top. That lady had to wait 14 hours at her house before an ambulance attended to her at 4 a.m. That was after falling at 2 p.m. the previous day.

Deputy Richard O'Donoghue

I know the Minister made a visit to University Hospital Limerick. Did the Minister know there is no particular room in that hospital for a person with a child with disabilities displaying challenging behaviour? I also know the Minister said it was a surprise visit. I was in the hospital twice after a road traffic accident I had four weeks ago. I saw what the Minister said he did not see at the hospital because I was there for 24 hours. There were trolleys on corridors everywhere, with nurses and doctors trying to do their jobs. They had to move patients left and right, and exactly what the Minister said was not evident there is happening.

Deputy Stephen Donnelly

To be clear, I never said that.

Deputy Richard O'Donoghue

I will let the Minister speak in a moment. I was there for 24 hours.

On the night that I was there the staff could not do enough for me but I witnessed a health hazard and fire hazards of trolleys on both sides of corridors putting patients and staff at risk.

I also know of a person who took their child with scoliosis to a hospital here in Dublin. They had been preparing for this operation for six months and they had the child on the bed waiting to go to surgery, only to be told the operation was cancelled because they did not have a bed for the child after the surgery was finished. These are the most vulnerable people in our society. I need the Minister's help. I need accountability within our hospital system. The Minister should come and meet me in Limerick on a surprise visit. I will bring him around the hospitals and he will be able to see at first hand what is happening.

Deputy Joan Collins

I thank Sinn Féin and particularly Deputy Tully for tabling this motion on services for children with disabilities. At the end of last year I submitted a question to the HSE and got a very detailed six-page reply on CDNTs, the SOP, preliminary team assessment, resources and so on. According to that reply, all our problems were solved. It stated that the SOP for the assessment of need process sought to ensure that children with disabilities and their families access appropriate assessment and intervention as quickly as possible and that the approach to assessment of need is consistent across all areas. It broke down what the primary team assessment is as a guideline and talked about setting up the CDNTs. Clinicians were being brought back from their reassigned Covid-19 roles, overtime was being given, and all this was being done to deal with the SOP. The reply went on to give details of the composition of the teams and stated that they would all be set up and running by the end of 2021.

We have always known the reality for parents because we are dealing with them every day of the week. It is totally different. We know from the Joint Committee on Health last week that not one of the CDNTs is fully staffed and there is an average vacancy rate of about 25% across the teams. Professor Malcolm MacLachlan, clinical lead for people with disabilities, said some of the CDNTs are staffed to only around 50%. The CDNT on Armagh Road in my area of Dublin 12 needs 11.7 whole-time equivalents. When that question went in at the beginning of March there were 8.8 staff. They had just recruited two and the two left within a matter of two weeks. That was for occupational therapy and physiotherapy. In Brú Chaoimhín, which is also in my constituency, there are nine vacancies.

Families are extremely frustrated and children are open to developing secondary disabilities as they spend longer on waiting lists. The new Our Lady of Hope special school has no on-site therapist and this is scandalous as it leaves teachers, SNAs and children in very difficult situations. CHO 7 is at 60% of the capacity it should be at. This did not happen today or yesterday. It happened when the Minister was putting questions in as an Opposition Deputy in the last Dáil. It was the same thing.

One parent went through the assessment of need procedure. She put a complaint in because her son was still waiting. They have absolutely no supports for their son. They were advised as to what the parent can do but she has absolutely no support. The reply that came back was very simple: that the staff were not there and her son was going to have to wait until they got staff in the next period. It is very demoralising for the parent. The reply stated that recruitment continues to be a major issue, and while all the teams are doing everything possible, which I know they are, the parent's complaint was being closed on the recommendation that the CDNT would continue to engage with her in relation to her child and that clinically appropriate interventions and therapies would be provided when the appropriate clinicians are on board and her child is reached on the waiting list. These families were given a great buzz about the fact that things were changing, they were going to get their assessment of need, and they were going to get their access to therapy. It has just been smacked in their faces again. That is the terrible outcome of this.

The court case is just damning. I will read a few of the judge's points in my last minute. The judge made a ruling in two test actions brought on behalf of minors who in judicial review proceedings brought against the HSE sought to quash reports compiled after they underwent SOPs. They wanted their assessments quashed on the grounds that they did not comply with the requirements of the 2005 Act. It was further argued that the SOP findings did not amount to a proper diagnosis or assessment of their needs, which amounted to a breach of their rights. In her decision, the judge said that in order to comply with the time requirements of the 2005 Act, the HSE developed the SOP which was implemented from January 2020. The SOP, she said, provides for preliminary or triage-type assessment instead of the full assessments which had previously been carried out. She said the SOP came about because in a significant number of cases the statutory time period fixed for completing the assessment of need was not respected and this in turn led to delays in completing assessments and associated litigation. It is a damning judgment of the HSE. I would really like to know exactly how it affects the 10,000 children who underwent that SOP.

Deputy Marian Harkin

I thank Sinn Féin and Deputy Tully for giving us the opportunity to discuss and hold the Government to account on the deteriorating situation in regard to services for children with disabilities. It is most concerning that just over two weeks ago the High Court decided that the HSE is in breach of the rights of children with disabilities as set out in the Disability Act 2005. That is 17 years ago. The assessment of need that is conducted is simply not adequate to identify the extent and nature of the disability or, crucially, the corresponding level of service that is needed to assist those children in living their lives, in supporting their families and in helping to ensure the children have the best possible chance to live their lives and to maximise their quality of life just like every other citizen of the State.

I am shocked by what has happened. I have sat in this Chamber and heard time and time again that real progress was being made in the assessments of need of children with disabilities. When I heard of this supposed progress I was happy to hear it but in the back of my mind I was hoping they had the services in place to deal with all of these successful assessments. Little did I think that the first step, the assessment of need, was not being adequately dealt with. I was concerned about the second step, the meeting of those needs and the services to address them. Are we moving children from one list to another? Can the Minister clarify the difference between screening and assessment? I listened carefully to what was being said here in the Dáil. Can the Minister tell me why I thought this assessment was taking place and was virtually completed? I am not talking about pre-assessment and screening; I thought it was done and dusted. I do not know what is happening. I listened to the response earlier and we were told that the Minister would tell us what is happening. I am very anxious to hear that but, to be honest, I am really disappointed because I believed what I heard and thought we were making progress.

In my own constituency in the last 12 to 15 months I have been calling for the CHO 1 area of Sligo, Leitrim, Donegal, Cavan and Monaghan to be included as part of the school inclusion model, which delivers a range of in-school supports and therapies including speech and language therapy, occupational therapy and so on. The idea is that special needs assistants, SNAs, would be fully trained and allocated as needed and that additional professional supports would be available to schools. Three years ago the Government approved the setting up of the first pilot programme. I understand Covid intervened. This pilot programme was in CHO 7 and the Minister's constituency is part of that. We were told that the programme would be extended. Time and time again I have asked for this to be extended to CHO 1 and we are still awaiting a response. The reason I have done this is on foot of information I have to hand, for example in regard to the recruitment of speech and language therapists.

There are 32 whole-time equivalent positions allocated but only 19.4 filled. It is not as bad, but it is a similar story in the case of social workers, physiotherapists and occupational therapists. Many positions remain unfilled. If the region were included in the next phase of the pilot programme, it would make a real difference. I do not need to tell the Minister that the numbers of children who are awaiting services under CAMHS increases year on year.

Yesterday, I received one of the saddest letters I have had in a long time. It was about the total inadequacy of youth mental health services in Sligo and Leitrim, including the lack of beds, the lack of communication between professional teams and the neglect of young people in urgent need of such services. It is dreadful that Deputies or any public representatives have to say to a parent who rings them trying to get a child into CAMHS that the only advice they can give is to bring the child to an emergency department and not to leave until he or she is taken into the service. From the bottom of my heart, I hate doing it because emergency departments are full of people who need immediate help. However, there is nothing else I can say to those parents.

Minister for Health (Deputy Stephen Donnelly)

I thank Deputy Tully and Sinn Féin for tabling this motion and colleagues on all sides of the House for their contributions. The Minister of State, Deputy Rabbitte, wanted to be here this evening and she apologises for her absence. As she said in the House three weeks ago to the day, the matters being discussed at that time, and which are raised again in the Private Members' motion, are hugely important and require a ruthless and ambitious focus on our health services and on the implementation of the progressing disability services programme for children.

There is considerable work to do. When I was on the other side of the House, I made very similar contributions to those I have heard today. One of the many reasons I asked to be Minister for Health in the incoming Government was to be able to provide funding, focus and resources for children who need help. It is simply not acceptable in our Republic that children should have to wait for an assessment of need. It is simply not acceptable that, having been assessed as needing help, they should have to wait any length of time to receive it. We all have friends and family, we all know children who need a service and we all know how important those services are and that children need to access them as quickly as possible.

While some areas of the country are doing well, particularly in some therapeutic areas, the reality is that far too many simply are not. We will have to redouble our efforts in this regard. We have invested the money in assessment and the hiring of therapists. I assure the House that the Minister of State, Deputy Rabbitte, has worked tirelessly on this issue. She has driven around the country since she was appointed, CHO by CHO, meeting one therapeutic team after another and asking what money and staff they need and what the barriers to hiring those staff are. I, too, have had many of the same conversations. We all know that, unfortunately, there still is a long way to go. The money has been invested and the policy for a national network, namely, the progressing disability services model, although not perfect, is a good approach. There is a very good relationship between the Minister of State, the Oireachtas committee and those of us in this House who are really passionate about this area.

Before addressing some of the technical issues raised, the court ruling and the content of the motion, I repeat that there is a lot more that needs to be done. We all are aware that in every one of our constituencies, there are mums and dads who are desperate to get therapies for their children, whether occupational therapy, psychology, speech and language therapy or whatever it may be across the range of therapies. We are not going to stop until we have made sure the teams are in place at entry, senior and management level to ensure that when a child gets an assessment, it is the right and appropriate assessment, and that when a need is identified, he or she gets help. I know that nobody on either side of the House will stop until we achieve that.

I acknowledge the content of the judgment that was issued by the High Court on the SOP. It is important to state that in terms of the rationale under which the SOP was introduced, the overarching principle was to establish the needs of children rather than providing a diagnosis. It was about establishing needs and ensuring a quicker route to intervention services. It never was intended to prevent or reduce children's access to their legal entitlements. The SOP was developed following a lot of engagement with expert stakeholders, there was an extensive industrial relations process involved and legal advice was taken on it. The procedure was agreed at the start of 2020 and I allocated money towards the second half of that year to the Minister of State to ensure as many children as possible were assessed. There was a very large backlog of children waiting for assessment and we needed to make sure as many as possible of them were seen.

The question rightly has been raised as to what was done to put the therapies in place. We invested a very considerable amount of money in increasing the workforce. However, as has been pointed out by colleagues this evening, by the Minister of State and by the HSE, it is currently challenging to hire, not just in children's disability services but in acute services, adult services and primary care services right around the country. There are a lot of good things happening, the money is there and the posts have been sanctioned across the board. We are hiring many thousands of therapists but it is a challenge and it is one on which we must continue to work.

The court judgment puts the HSE in a position whereby, obviously, it now must consider the assessment of need process. I note the comments by Mr. Paul Reid on the consideration of an appeal. I believe the judgment provides the State with an opportunity. We need to build on the elements of the process that work and we need to eliminate or amend the elements that do not work. I know the Minister of State made similar comments three weeks ago. We need to assess the full picture and gather a lot of information. In this regard, I am conscious of a case in the Court of Appeal, a ruling on which is expected shortly. An independent review of the SOP is under way and is now being finalised. Needless to say, the legal framework for the State takes precedence but it is prudent to gather as much other information as possible.

The core of any future action has to be the delivery of services to children as quickly and effectively as possible in line with the legislation. While addressing the judgment of the courts, which is important and must be resolved, it is worth saying that the assessment of need is only one part of the service delivery. We are very determined to address the standard of that assessment but we also must create a model that ensures the therapies identified, as we have discussed this evening, can be delivered. In that context, the HSE is consulting the chief executives of the organisations designated under sections 38 and 39 of the Health Act 2004, the lead agencies and other stakeholders. In the meantime, the assessment of need will no longer be issued on the basis of a preliminary team assessment. Where appointments have been scheduled, they will form the first step in the assessment of need process.

The initiatives mentioned in the House recently will continue to be developed. As many colleagues will be aware, they include the development of parents' forums. The Minister of State has advised me that she intends to commence the countrywide forums next week, starting in Cork. A major focus for her will be on developing enhanced communication with parents and seeking to build trust in the services provided. We need to listen very carefully to the parents.

Deputy David Cullinane

There are only five forums up and running.

Deputy Stephen Donnelly

The Minister of State is determined to get the rest of them up and running as quickly as possible.

On staffing, there is ongoing recruitment of 375 personnel across the country.

Let me give a sense of how challenging that has been. My figures will not be exact. From a briefing note I read earlier this morning, I believe about one third of the target was met in the first year that the number in question was allocated. I am saying this just to give colleagues a sense that the money is available and that the posts have been sanctioned, but it is proving difficult to hire the therapists. Obviously, we are working on expanding the number of graduate positions and the number of graduates coming through.

In addition to these actions, the Department has agreed to funding of €1.5 million for approximately 1,000 ASD diagnostic assessments. The HSE has said that initiative is now under way. Regardless of any process that the HSE considers to address the concerns over the standard operating procedure, the developments I have mentioned will enhance the capacity of the CDNTs. It is expected that the measures will translate directly into enhancing services to the child and his or her family.

Regarding section 13 reporting, which was also raised, the HSE has presented annual reports for 2007 to 2014 to the Department of Health and is currently working on the annual reports for 2015 to 2020 to bring the process up to date. The HSE intends to submit the outstanding reports by the end of the year. The HSE and officials in my Department are scheduled to meet shortly to discuss the section 13 reports in greater detail. While the HSE has stated it has experienced delays due to the cyberattack last year and found limitations in the assessment officer system database, which was referred to earlier, the lack of reporting cannot be deemed acceptable. The Minister of State, Deputy Rabbitte, has sought assurances on the nature of the statistics and has been advised that the delay has not affected the HSE's calculation in establishing additional resources.

I assure this House and all colleagues that the Government is as determined and committed as ever to providing timely access to high-quality health and social care services for children and young people who need them. This includes appropriate assessment and the right interventions. We now have an opportunity that we must grasp. We must focus relentlessly, invest, and prioritise to give the children the assessments they need and the therapeutic interventions and supports they need following those assessments.

Deputy Matt Carthy

I commend Deputy Tully on her tenacity on this issue and representation of those tens of thousands of families who want nothing more than what their child is entitled to. The High Court has ruled that the HSE's AON process is operating outside the law and denying children with disabilities their rights, as set out in the Disability Act. Let it sink in for us all that an Opposition party is introducing a Private Members' motion that essentially asks the Government to stop breaking the law, allowing an agency under its control to break the law, and denying children their rights.

I do not doubt for one second the sincerity of the Minister or the Minister of State, Deputy Rabbitte, on this issue, but the crux is accountability. HSE representatives appeared before the Joint Committee on Children, Equality, Disability, Integration and Youth, and Deputies Tully and Cullinane were in conversation with them. The officials were asked what they needed and their answer was that we should actually scrap the little protection that our children with disabilities have - the legal provision. As the person responsible and approved by this House to oversee our health services, the Minister should drag all those officials in and threaten them with their jobs unless their attitude changes. If I am correct, he noted the remarks of the head of the HSE on a potential appeal of the High Court ruling. I suggest that he tells the CEO of the HSE that if he wants to appeal the ruling, the cost can be met from his wages. I suggest that the Minister, as overseer of the Department that gives the HSE its budget, tells the CEO and every senior manager in the HSE that the next time they decide to drag the family of a child with a disability through the courts, they can do so at their own expense because they do not have the authority of this House to spend the money of the taxpayers of Ireland to drag families of children with disabilities through the quagmire of the legal system. The message from this House should be unanimous, clear and heeded by the HSE. It should stop breaking the law and treating children with disabilities with disrespect and start providing them with their rights and entitlements under the Disability Act and the services they deserve.

Deputy Martin Browne

I, too, congratulate Deputy Tully on introducing the motion. She has done so because the Government cannot be trusted to live up to its responsibilities to children. It is great to hear that the Minister understands the position. These are famous words we hear over and over from the other side of the floor regarding everything that comes up but families want action, not statements that the Government understands and knows what needs to be done. Our children have been failed owing to unmet obligations on the part of the Government and the HSE through the manipulation of the system that is meant to put children's interests first. There has been a betrayal of trust that was supposed to be reinforced under the Disability Act 2005, which placed a duty on the HSE to provide a comprehensive AON within six months. To avoid its obligations, the HSE introduced a preliminary team assessment in 2020, its purpose being to skirt around the obligations set out under the Disability Act. This created another waiting list that does not fall under the Act and lacks any legal requirement to provide the comprehensive assessment within the timeframe set. The recent High Court ruling showed that this is in breach of the Disability Act 2005. This reflects what parents, disability organisations, Sinn Féin and the Ombudsman for Children have said, but it does not stop there because not a single one of the 91 CDNTs around the country is fully staffed, which results in children going without the full suite of development services they need. Can the Minister now see why neither families nor we believe the Government when it says it understands and wants to do what is required?

The Association of Occupational Therapists of Ireland, the Psychological Society of Ireland and the Irish Association of Speech and Language Therapists have said a significant number of front-line clinicians have left or intend to leave their posts in child disability services as a result of the implementation of the new assessment procedure. That paints a picture of children's disability services under the Government.

We introduced this Bill to ensure that the Government and the HSE would stop breaking the law and cutting corners and provide children with the services they need. Given the seriousness of the High Court finding, we want an assurance that any review of the Disability Act will not be used to undermine the current rights of people with disabilities. We demand that the Government live up to its moral and legal obligations.

Deputy Pauline Tully

I thank all those who contributed to this debate and support the motion. All of us have children and families in our constituencies who have been waiting for years for services and assessments. We have heard from parents who have letters telling them their child will be seen for an appointment in November 2024 or four years' time. That is outrageous and has to be urgently addressed.

While I welcome the fact that the Government is not opposing this motion, can I assume it is supporting it? I wish to reiterate what we are calling for in the motion. The Minister talked about the High Court ruling, the preliminary team assessment and the reason the latter was introduced, namely to assess the needs of children to ensure they receive therapies or interventions quickly. That was not happening, however. Children were getting the preliminary team assessment only to be put on another waiting list for a proper, full assessment of need and services and interventions.

Some Members have talked about a review of the Disability Act. I agree it should be reviewed to bring it into line with the UNCRPD and to ensure it is based on a rights-focused model, but the rights of children must not be undermined or deleted in any way when reviewing it. In fact, the review should be used to strengthen the right of children to gain access to services and interventions.

Deputy Matt Carthy

Hear, hear.

Deputy David Cullinane

Hear, hear.

Deputy Pauline Tully

The database the HSE was using, which was mentioned a few times by the assessment officers, is, by its own admission, outdated and not fit for purpose. That needs to be addressed urgently. The Minister mentioned that the reports up to 2014 were published but that those since then have not been. We are calling to have the outstanding reports in the autumn session, in September. We will return to this if they are not provided.

We have talked about engaging in proactive and joined-up workforce planning to develop a strategy to address the staff shortages in all the services.

Something should be done to try to entice those health and social care professionals who left services because of their discomfort with the preliminary team assessment. Many of them have stated that is why they left the services. Now that a High Court ruling has stated that preliminary team assessments will not be continued, we should consider whether people can be enticed back to services.

I have heard of problems with CORU and the time it is taking for it to accredit the qualifications of people coming from the North to work in this State. The process is taking up to ten months. That is something that could be addressed quite quickly.

We need to talk to people not just in third-level colleges but in secondary school about working in the sector and do something to entice them into the sector. Perhaps there could be a reduction or waiver of fees. A job guarantee with a contract that ensures that those who qualify in these areas do not export their skills and knowledge is vital. We are also looking for a report before the summer that outlines in full the number of whole-time equivalents that will receive jobs in 2022 and the other supports and resources being given to the children's disability network teams to address the backlog of assessments, carry out proper assessments and provide the therapies children require.

Every effort needs to be made to ensure that the networks are up and running at full capacity without delay. The Minister mentioned family forums, which are important. The Minister of State, Deputy Burke, made a reference to parents having to do training to support therapies. Parents are not objecting to doing training in any way whatsoever. However, they are objecting to doing it alone. Children are not receiving therapies. Some parents have told me that even though they have done the training, they are being asked to do it again, and are being told that if they do not do it their children will be removed from waiting lists. That is absolutely outrageous and should not happen.

The ongoing disparity between staff in section 39 organisations and those working directly for the HSE has to be addressed. Those agencies are haemorrhaging staff to the HSE and cannot retain staff in any form. Staff need the same pay and working conditions across the sector.

I also want to use this opportunity to call on the Government to ratify the optional protocol to the UNCRPD, something that is still outstanding. Refugees are coming to Ireland from other countries. We are expecting a large number from Ukraine. Many of them may be qualified in these professions. We need to examine whether we can engage those people and allow them to work here. They will have PPS numbers and be allowed to work. Let us get them into our teams to fill the need that is there.

Question put and agreed to.