Léim ar aghaidh chuig an bpríomhábhar

Joint Committee on Disability Matters díospóireacht -
Thursday, 13 May 2021

Progressing Disability Services Model and Withdrawal of Occupational Therapies from Schools: Engagement with HSE

Apologies have been received from Senator Erin McGreehan. The purpose of today's meeting is to discuss the progressing disability services model and the withdrawal of occupational therapies from schools. On behalf of the committee, I extend a warm welcome to representatives of the HSE, Dr. Cathal Morgan, head of operations, disability services; Professor Malcolm MacLachlan, clinical lead for people with disabilities; Ms Breda Crehan-Roche, chief officer, community healthcare organisation west; and Ms Angela O’Neill, national disability specialist, community operations.

I remind members that they are only allowed to participate in this meeting from within the precincts of Leinster House. In this regard, if members are joining remotely, I would ask them to confirm that they are on the grounds of the Leinster House campus prior to making their contributions to the meeting. For anyone watching this meeting online, witnesses are accessing the meeting remotely due these unprecedented circumstances, so I ask everybody to bear with us should any technical issues arise.

Before we commence formal proceedings, I must begin with some formalities and advise witnesses of the matter of privilege. Witnesses are directed to only give evidence connected with the subject matter of the proceedings and are asked to respect the parliamentary practice to the effect that, where possible, they do not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable. I advise witnesses giving evidence from a location outside of the parliamentary precincts that the constitutional protection afforded to witnesses attending to give evidence before committees may not extend to them. No clear guidance can be given on this matter or on whether or to what extent to which the evidence given is covered by absolute privilege of a statutory nature. Persons giving evidence from other jurisdictions should be mindful of their domestic statutory regime. If witnesses are directed by the committee to cease giving evidence in relation to particular matter, they must respect that direction.

Members are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against a person outside the Houses or an official in such a way as to make him or her identifiable.

I would call on Dr. Cathal Morgan, head of operations, disability supports, to make his opening remarks.

Mr. Cathal Morgan

I thank the committee for the opportunity to meet with it today to address matters relating to the progressing disability services for children and young people, PDS, programme and what was referenced in the invitation as the withdrawal of occupational therapies from schools. I am joined today by my colleagues, Professor Malcolm MacLachlan, clinical lead for people with disabilities, Ms Breda Crehan-Roche, chief officer, community healthcare organisation west, and Ms Angela O'Neill, national disability specialist, community operations.

PDS is a significant programme of reform that will change the way we deliver services and supports for children with complex needs. Children’s disability services in Ireland developed in an ad hoc manner, whereby some children received an excellent service and others received none. The provision of services is currently inequitable and varies depending on a child’s disability, their age, where they go to school or where they live. The reform of services in line with the PDS programme is an integral part of Sláintecare health reforms and is a key policy commitment in the programme for Government.

In essence, PDS will provide a clear pathway and fairer access to services for all children with a disability based on their needs, make the best use of and fairly distribute available resources for the benefit of all children and their families and ensure effective clinical teams are working in partnership with families and with education staff to support children with a disability to reach their full potential.

Further, PDS aligns with two clear objectives of the Sláintecare report, in that it seeks to provide the majority of care at or as close to home as possible and create an integrated system of care with healthcare professionals working closely together. Children’s disability network teams, CDNTs, have been established to provide services and supports for all children with complex needs within a defined geographical area. CDNTs are teams of health and social care professionals, and can include occupational therapy, psychology, nursing, physiotherapy, speech and language therapy, social work and others. The teams work closely together in a family-centred model, focusing on the child’s and family’s own priorities. Once all teams are in place, every child with complex needs will have access to a team, regardless of the nature of his or her disability, where he or she lives or the school he or she attends.

Children and their families will have access to the full range of services and supports of the CDNT, according to their individual needs. This includes universal, targeted and specialist supports, such as parent programmes, individual therapeutic intervention and access to specialist consultation and assessment, when needed. Interdisciplinary supports for children with complex disability needs will be provided as far as possible in the child’s natural environments - their home, school and community.

There are 136 special schools across the country, of which 33 have an on-site health-funded service provision, which equates to approximately 85 whole-time equivalent staff working in the area, at an approximate cost in excess of €6 million. The children attending these 33 schools represent approximately 6% of children with complex needs in the State. The level of service available in these schools varies widely. Many children with equally complex needs attend mainstream schools or special schools that do not have dedicated on-site services.

This committee specifically referred to occupational therapy services. Some 15 special schools have an on-site occupational therapy service. The level of service available varies from one occupational therapist to 30 pupils to one occupational therapist to 460 pupils. This is a huge variation. There are approximately 320 occupational therapists working in children’s disability services. The average ratio of occupational therapists to children with disabilities is 1:126. It should be noted that in the existing model, on-site services, where they exist, generally provide a unidisciplinary model of service. Ten special schools deliver only speech and language therapy with ratios varying from one speech and language therapist to 125 pupils to one speech and language therapist to 425 pupils. The average ratio of speech and language therapists to children with disabilities in the wider community is 1:115. There is widespread inequity in both the distribution of and access to specialist health and social care supports for children with complex disability needs.

The clear aim of the progressing disability services model is to address these inequities so that children access services based on their needs. Children's disability network teams have already been established in many parts of the country and the remaining children's disability network teams will be established by the end of quarter 2 of this year. These interdisciplinary teams work with children in schools, including special schools, and provide a service for all children with complex needs in their geographical area. They deliver a child and family-centred model of support, working with children, their families and within school settings as required.

Supporting staff to be members of children's disability network teams ensures that they can benefit from appropriate management and clinical governance support. This will allow the health services to ensure that staff have the necessary skills and competencies to meet the needs of children with disabilities, and that they can benefit from interdisciplinary working and complementary insights from other professions, to which they will often not have had access previously.

Working closely with government, the HSE has been reviewing the services in special schools to ensure that these schools fully benefit from the enhanced provision afforded by children's disability network teams. The HSE confirms that existing supports provided to the small number of special schools will remain in place, delivered in line with the progressing disability services policy and via the children's disability network teams. The HSE and our section 38 and 39 lead agency partners are mindful to reassure parents with children attending special schools of our commitment to build the capacity of these network teams to give greater levels of interdisciplinary supports.

In summary, the Minister and the HSE remain committed to the implementation of the progressing disability services model and are anxious to ensure that children in special schools as well as children with complex needs in special classes or mainstream education can access the full range of services provided by children's disability network teams as appropriate. Our services are for all children with disabilities regardless of their type of disability, their location or the type of school they attend. We are happy to address any questions the committee may wish to ask.

I confirm that I am in Leinster House. As today's first speaker, I welcome the witnesses and thank them for their submission and time. The proposed progressing disability services programme is positive in that services will no longer be accessed through separate organisations and access will be based on children's needs as opposed to their diagnoses. This has been a recurring issue in my constituency of County Clare. A number of distressed parents have been in contact with my office about a lack of access to services as they have not yet received an assessment of need for their children, which has caused great difficulties for children and families.

I am eager for more definitive information about the progressing disability services programme's roll-out. The programme was established in 2010. We know from the submission that not all of the required children's disability network teams have been established. That concerns me. Is there a timeline for when all children's disability network teams will be configured and in place? I can see how families and school settings may be nervous about the implementation of this programme as seems there was no foresight in evidence recently. We saw plans to remove on-site services, which would impact negatively on these children. For this reason, there is not much confidence among parents. Schools will need significant assurances from the HSE that the level of on-site services for special schools will not be reduced. How does the HSE plan to manage the progressing disability services programme? Will on-site services stay in place during a transition period? What is the long-term goal? How are schools with no on-site services being assessed with regard to their service needs?

Dr. Cathal Morgan

I can respond to the majority of the questions. I will also include my colleague, Ms O'Neill, about the assessment of need. I welcome what the Deputy said and the positive welcome for progressing disability services. We and our lead agency partners believe that it is the right thing to do. It has been in development and implementation for more than ten years. To answer the direct question about timelines, we will have implemented all 91 networks by the end of quarter 2. Over 40 are now in place and all are to be in place by the end of quarter 2.

We agree with the Deputy about providing reassurance for schools. We are concerned about making sure that parents, principals and education staff can be assured. It is critical that we work with them in a co-operative and collaborative manner. I gave a commitment in my opening statement that existing on-site arrangements for resources will remain in place.

Regarding how networks will work with schools more generally, we have a national access policy. That facilitates the education sector, parents and the community healthcare organisations, CHOs, which are responsible, with the lead agencies, for agreeing how best to deliver the services. It is important to say that each of the 91 networks has a network manager, all of whom are clinicians by profession. They are leading these interdisciplinary teams and one of their key functions is to ensure that these arrangements are clearly articulated to parents and teaching staff. We have local structures for implementation which include staff, because the input of staff as well as parents is critical to successful implementation. We cannot overemphasise the communications issue because one cannot communicate enough on this. We accept that people are worried and we will do our best to ensure that we address those concerns.

The assessment of need is important. It is a complex area in which the networks will be involved. Ms O'Neill will give an update on it.

Ms Angela O'Neill

Assessment of need is one of the ways in which children can access services. It is not the only way. Our preference is for children to access services directly through the children's disability network teams, which is what many children and families do. The Deputy will be aware that there have been significant waiting lists for the assessment of need process and that there was significant investment late last year to clear those backlogs. The Minister of State, Deputy Rabbitte, secured €7.8 million to eliminate those backlogs. At the end of June last year, we had 6,500 overdue assessments of need. That number has been reduced and at the end of April, we had just over 1,400 overdue assessments of need. The Deputy referred specifically to Clare. The mid-west area is one where the backlog is almost eliminated. There are approximately 60 assessments of need outstanding, all of which are in process. Significant progress has been made on assessments of need in recent months.

Our priority is to ensure that children are able to access timely assessments and interventions through the children's disability network teams and that, rather than seeing children based on their position on a waiting list, we should see them based on their needs. The children's disability network teams allow us to do that. We are not focused on diagnosis or doing something because of a court order.

We are prioritising children based on clinical needs. That is what we are working towards with our CDNTs.

Dr. Cathal Morgan

The Deputy also referred to resourcing. Briefly, we received funding for an additional 100 posts, which were fully implemented. Another increase of 100 therapy posts will be implemented this year. We are clear in saying that these 91 networks will need year-on-year investment. We are conscious of the fact that the Government is committed to what is called the capacity review report. In that report it is clear to us that there is a need for dedicated funding streams to build the capacity of those networks. We are not shy in saying that. We are happy that we got an additional €100 million from the Vote for this year and also with the 100 posts we are getting this year. We must build on that, so I am not shying away from the fact that those networks need additional posts, and to be upfront and honest about that.

I thank the witnesses for attending the meeting today. First, I commend the Minister of State, Deputy Rabbitte, with regard to the occupational therapists. There was a pause in that area and it was withdrawn. This service is very important so I commend her on that. Families and children with special educational needs suffered most during the pandemic. The rug was pulled from under them time and again. I met families who wondered what else would happen to them or what else they would have to fight for. Unnecessary stress and anxiety were put on these families and the children really lost out. Last month, the Ombudsman for Children said: "Children with disabilities are not seen - they are overlooked in laws, policies and programmes. Children with disabilities are not heard - they are not actively or effectively involved in consultations." I would like a response to that. He continued:

Children with disabilities are not counted - they are relatively invisible in data. Looking at the delays and the barriers facing children with disabilities, it is clear that they are always at a huge disadvantage. ... It is high time that children with disabilities and their families stop having to battle to overcome barriers. Our laws and policies must serve all of our children and allow them all to access the best education possible.

As has been said, the provision of services is currently unfair and varies depending on a child's disability, age, where the child goes to school or where the child lives. I welcome that we all appear to agree that this has to change urgently. Families in Carlow should be able to access the same support as families in Donegal.

On the issue of staffing, Dr. Morgan spoke about funding. When we discuss funding it is important that we get the breakdown of the funding in all the areas. My area is community healthcare organisation, CHO 5. How many professionals have left the system? Are we struggling with recruitment? What steps are being taken to recruit - the witness spoke about recruitment - and also to retain staff in this area? We need more clarification on that because we must do all we can to make life easier for these families and children.

This brings me to my next point, which is full inclusion. All students in New Brunswick in Canada are educated together in their local schools. Every child, able and disabled, students with complex needs, talented students, thriving students and disadvantaged students all study together. They are all learning together, living the same experience with their own tailored experience. In 2019, the National Council for Special Education, NCSE, spoke about this idea to fully include all students. It suggested examining this model. Since that suggestion in late 2019, we have had the coronavirus and we have lost ground, but is this a model that we will consider piloting? Is there any hope we might examine such a pilot scheme? It is important that we work with everyone. The witness spoke about the 91 networks, which are very welcome. We all have to work together, but it is also important that we see the results. Families and children have been so affected by this, so perhaps the witnesses can respond to my points.

Dr. Cathal Morgan

The Deputy's points are very well made. I will address each of them and I will ask my colleague, Professor MacLachlan, to respond because it is relevant to some of the models of support on which he can speak.

The piece in terms of the Canadian model and the inclusion model is absolutely fundamental and is something we all should support from the point of view that, as I understand it, we are trying to implement a policy of mainstreaming where children with disabilities would be included fully in mainstream education settings. We must do all we can to support those children and their families to make that real. That is a challenge in the context of how we move from special education settings because there are conflicts in people's views on this as to whether it should be purely mainstream as distinct from a special education setting and as distinct from the mainstream setting with supports as required, but in the policy it is important that we drive towards that. I am confident that our networks, when fully resourced and bedded down and working well, can complement that in a real way by working conjointly with education partners. There is a difference of approach from the point of view that therapies provided in classroom settings are to do with educational attainment. What might be a distinction from the health and social care point of view is working with children and families on specific complex needs, whether it is behavioural supports, speech and language and so forth. The point is to put the child at the centre of the process with the family and let us work together to see what is best in their interest.

I will provide the Deputy with a report on staffing. I will mention a couple of matters. In response to the last Deputy, I referred to the additional 100 posts from last year and another 100 posts for this year. That is not enough; we need more. Again, I referred to the fact that, for us, the capacity review report is the basis on which we can build on these networks. There are a few other items from a resource point of view that are important to note. The Deputy mentioned the Minister of State who, I must say, has been strident and very energetic in getting behind us on making change. She is doing real work in respect of bringing investment. There is an additional €100 million in this year's budget. Our budget on disability this year is €2.2 billion. It is a specialist service. Again, the capacity review report identifies that we need more. There is no doubt about that.

The other piece I wish to mention relates to the pandemic. The Deputy is correct that we have been going through unprecedented times. Some children and families, quite a lot, have been much more impacted than others for a variety of different reasons. It is important to say that. We have been trying to do things differently, and Professor MacLachlan might refer to this, which we think will help in terms of changing how we do our practice on remote interventions and how we can work with people safely. This relates to another area the Deputy mentioned, staff leaving the disability services. From our experience, we feel there is a great deal of support from staff to work in these networks. It has been clear to us that staff benefit more when they are in an interdisciplinary team. We have been concerned that some staff have been working in silos - I know it is a dreadful term - and almost in isolation in school settings without the benefit of their peers working with them, if that makes sense. From a welfare point of view, that is not good. It is not good either from a clinical governance perspective. It means that the clinician is working in isolation and does not have the benefit of interventions from other disciplines working conjointly with him or her, along with education colleagues.

Professor MacLachlan might wish to address some of the points.

Professor Malcolm MacLachlan

I thank the Deputy for her questions. I fully agree that the New Brunswick model she described is very attractive. It is also consistent with the development of the children's disability network teams. One of the ideas behind those teams is to deliver on the ethos of the UN Convention on the Rights of Persons with Disabilities, CRPD, which stresses delivering services to people in their community so that children with disability can live fully as members of their community and interact with other children like them. The introduction of the CDNTs is a key element of that. Clearly, we are talking from the health service side, and there is also an education side. From the health service perspective, the New Brunswick model would be entirely consistent with what we are interested in doing.

The Deputy mentioned some concerns about consultation. In the last year the HSE established the new national clinical programme for people with disabilities. That programme's function is clinical design - designing how services should be delivered. This programme is different in a number of ways from other clinical programmes in the HSE.

With regard to consultation, for instance, we have three service users, four service providers and several different professions. We have the confidential recipient and our chair is a person with a disability and is independent of the HSE. We have designed the system like this very deliberately to have good consultation and representation of other voices. Our clinical design is very much grounded on identifying the needs of people with disabilities. In the future, members will see a significant level of interaction and consultation with people with disabilities. That has been going on for several years so it is a question of it being built on and formalised by the clinical programme. The symbolism of formalising it is really important.

Dr. Morgan referred to some work that the National Clinical Programme for People with Disability has been doing on remote working during Covid. I absolutely agree with the comment that Covid has really hit children, their families and their carers incredibly hard. We have clinicians who were not very familiar with remote working before Covid. When we surveyed staff, we discovered that of the 88 respondents who were clinicians working on the front line, fewer than one third had experience of doing remote work. Now, at this point in the Covid pandemic, all but two are working remotely. Remote working is not in any way a substitute for person-to-person interaction but it does have some benefits in that it has allowed us to reach out to a broader range of people. It has allowed parents to attend sessions that they were not able to attend before, for instance. In future, we want to take on board some of the lessons and benefits. These relate very much to inclusion value and the participation of people with a disability and their supporters. The model of care we are trying to promote involves putting children and families first and seeking to serve them in the community rather than in a specific location.

I confirm I am in Leinster House. I warmly welcome the witnesses from the HSE who have addressed the meeting and thank them for their submission. Deputy Wynne referred to the fact that the progressing disability services model was established in 2010. How come it has taken so long to roll it out? Was it a funding issue? What were the issues arising? It was indicated that 31 of 91 intended children's disability network teams have been established and that all of them will be established by the end of quarter 2, which is welcome. How come it has taken so long?

After housing, the issue I am most contacted about is that of waiting lists associated with assessments of need or accessing therapies, supports and interventions for children with a disability. While I welcome the progressing disability services model on paper and believe it looks brilliant, I note that many parents are very sceptical as to whether it will improve circumstances. I really hope it does. Some parents have told me waiting periods for some Enable Ireland and HSE services can run into years. How is this backlog going to be addressed? Have extra staff been recruited? Maybe the witnesses will confirm whether some therapists have been diverted to carrying out assessments and that the waiting list for interventions has grown longer as a result. Regardless of whether this is true and irrespective of the answer I am given, the waiting list for interventions is long. How will this be addressed?

Many parents tell me that even if their children receive supports, they receive very little. They might have a speech and language therapy session only once every few months, or a couple per year. Will the frequency of interventions increase? Will a behavioural analyst be part of the team for children with autism, especially if they are non-verbal? There are individuals with qualifications in analysing behaviour and working with children with autism. Are they part of the team?

Speech and language therapy comes up a lot, especially regarding children with Down's syndrome. Many parents say to me that their children really need intervention in this regard before they go to school but that it is often two or three years into school before they have access to any such support.

I welcome the fact that the witnesses said assistive supports for special schools are going to remain. I welcome that. It is excellent. Will there be a link with schools anyway? Will there be a strong link between the team and the school, be it a special school, a unit within a school or a mainstream school? Will there be a link with CAMHS? How does the National Educational Psychological Service, NEPS, fit into it? Will it be part of the team or will the service still be based within the school?

Parents often say to me that the biggest issue is when their child, on reaching the age of 18, is transitioning from children's services to adult services. Has any work been done on making that an easier process?

Dr. Cathal Morgan

I thank the Deputy. I will address her really good queries. I will include my colleague, Ms Breda Crehan-Roche, because she specifically mentioned the ASD element of the challenge in the system. On the matter of why it has taken so long, the development of the progressing disability services policy, based on what we were talking about earlier, has been about consulting and bringing together children and staff to understand what is needed, examine models in other jurisdictions and agree on how best to provide child- and family-centred supports. It took time to get people to coalesce around what would be the best model for Ireland. We often look to models overseas but we need to think about how they work in an Irish context so we can contextualise them. We placed very heavy emphasis on trying the initiative out. Several regions piloted it. The mid-west and Kerry, in particular, went through a reconfiguration process. We wanted to see how the initiative worked and to refine it as we were going along. The significant changes we have been making involved multiple organisations and agencies, including the HSE, that were delivering supports in their own way, not a joined-up way. Bringing together all the entities, including the State, to agree on whether the system could be organised to make it simpler for the child and family to access one team rather than multiple organisations required a significant level of negotiation and mediation with the trade unions and other organisations on the question of how, if the child and family were to be put up front, the service could be delivered in a manner that was seamless for the children. I am delighted that we have done that. It is not perfect. I am not saying it is all rosy in the garden; it is not at all but we are absolutely on track to have the 91 networks in place by the end of quarter 2. The Deputy should note that there are over 40 in place, as distinct from 31. We will clarify where they are so she will have sight of them for herself.

I will ask Ms O'Neill to address the waiting lists initiative. The Deputy should keep in mind that an additional resource of 100 posts was given to us last year. There are another 100 posts for this year. It is not enough so we will be relying on the capacity review report to build the competency of the teams, as in having more staff come in.

The Deputy mentioned the connectivity between CAMHS, primary care services, education services, NEPS and so on. I will provide the committee with a copy of our national access policy, which I referred to before. The policy helps to determine how we assess children and stream them into the right service. That includes how children can access CAMHS because that is a key concern for us, particularly regarding behavioural supports.

The Deputy rightly identified this matter as being a significant concern for families. Behavioural management supports will be a key part of what the networks will do. Children will have access to psychology services.

ASD is a significant concern for us. We have an improvement programme that includes parents as well as people with autism. It will determine how we will develop more and better supports. It will align and dovetail well with the work being done by Ms Crehan-Roche, the chair of the initiative and the chief officer in the west. She might talk us through what that initiative is about.

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. Assessment is ongoing. Professor MacLachlan has a great deal to say about this matter because he will be leading an initiative on how we might work with clinicians on doing things differently with children and families.

To summarise, there are two elements: the autism programme board and capacity building among clinicians. Ms O'Neill might discuss the assessment of need element.

Ms Angela O'Neill

I thank the Deputy for her questions. She mentioned CAMHS, NEPS and so on. Under the national access policy, we will set up an integrated children's services forum in each area. It will comprise primary care, social care, mental health services, the acute sectors if they are required, Tusla and many other stakeholders. It will cover decision-making and entail everyone looking at the needs of children and their families and how to work together to best meet those needs.

In respect of the autistic community, we have a service improvement board, which I chair. It comprises people with lived experience, parents, other family members, various clinicians and many other stakeholders from fields such as primary care, mental health and disability, as required. The board is examining matters such as awareness. It is important we educate people and make them aware of what autism is. People with a lived experience have a crucial part to play in that respect. We are also examining pathways for diagnosis and assessment. Recently, the Minister announced a knowledge hub and phone line. We are working closely with various colleagues in that regard.

The Deputy mentioned the progressing disability services, PDS, programme. Behavioural support is very much a part of that. When people work in interdisciplinary groups, they have access to many other disciplines. This is important and is the beauty of PDS - we share and have all of these colleagues helping one another in the best interests of the child and the family.

Professor Malcolm MacLachlan

I thank Deputy Tully for her question. She hit the nail on the head in terms of the relationship between intervention and assessment. Historically, this has been a difficulty because we have not had a standard way of performing assessments. The way one clinician in one part of Ireland does an assessment might be entirely different from the way another clinician in another part would do it. This has led to clinicians being conservative and spending a great deal of time doing assessments. Sometimes, they have had concerns there might be litigation against them if the assessment is not done in an appropriate way. Some of the work that has been ongoing in this regard for a number of years has been to introduce a standard operating procedure that indicates the appropriate way clinicians should perform assessments. It gives them guidance and helps to streamline what they are doing. It also gives them protection so that they feel safer about doing shorter assessments. Since they can do shorter assessments, more clinical time is available to perform the intervention.

Long waiting lists for assessment and even longer waiting lists for intervention were building up. That was an unsatisfactory way to approach this issue. As such, we have various initiatives under way to encourage clinicians to see initial assessment not as a one-off activity, but as something that is continuous and is informed by the consequences of the interventions and supports they offer someone.

As the committee has been hearing, the money the Minister has made available has made a significant difference in reducing the waiting lists. We do not want intervention waiting lists building up. Often, targeted interventions can be simple and cost efficient and produce a significant difference. Until recently, however, we were blocked from being able to do those because so much emphasis was placed on assessments.

Some of the work we are doing has to do with trying to build confidence and evidence-based models of service. As my colleague, Ms Crehan-Roche, stated, the models are informed by the views of service users. There is a great deal of activity under way on the autism model of service that we are in the process of developing. For instance, it has representation from CAMHS. We will also consult NEPS.

We are aware of the considerable sensitivities around transitioning. Transitioning is a problem created by our services. A person's life is a continuum, but the way in which we orchestrate our services causes problems for transitioning. We are aware of those and addressing them in a number of different models of service we are developing.

I thank the witnesses. I have a couple of technical questions. Will moving to a direct provision of services entail HSE direct delivery or will it still involve section 38 and 39 organisations? Recruitment for 100 additional posts following a capacity review report was mentioned. Additional resources, including personnel, in this area would be welcome. I was concerned by the initial presentation's emphasis on the amount of money being spent on school supports. If we get into a dynamic of money being taken from here and put there instead of recognising this as an area that needs different resources, it will be dangerous. It is important we signal that additional resources are needed.

Regarding the capacity review, one of the main issues is not just that we do not have the 91 teams in place but also that we do not know what is required for assessments of need on a full scale. The assessment of needs mechanism does not include diagnosis, proper intervention or planning. People are waiting for a period. Is it not the case we not only need to get the 91 teams in place but we also need to clear the backlog, possibly through those teams, of people waiting in the limbo between having an initial assessment and getting a plan and, in some cases, diagnosis before we know the capacity needs of the 91 teams?

That is really important because it points to why we cannot remove supports that are currently there when not only is the new system not in place but we do not yet know what the pressures and capacity needs on it will be.

On that, I note and welcome the statement from the Minister of State, Deputy Rabbitte, that there will be a pause on the removal of supports from special schools. That is appropriate. This year, we saw how a few months can have an impact in terms of regression. We need to avoid gaps in the system which children carry in their development. It is good that we have places where there is a ratio of 1:30 because it sets a bar towards which we should aim and there should be no backward steps.

Is there still a danger that speech therapy and other services may be removed from non-special, mainstream schools which have made an effort to put additional supports in place through the school system for those members of the school community who need such supports? That is a concern I have because the pausing message we have heard is only on special schools but there are those other schools. I would appreciate a comment on what we mean when we talk about the UNCRPD and the social model. The social model is not simply about where the intervention takes place - it moves it from solely being about the individual and their access to supports to a responsibility on society to redesign and change itself. Mainstream schools have tried to take a lead in bringing supports within their school system to show that those who might need additional supports, such as speech therapy, are part of a school community. Is that not a model we should be pushing so that our schools are responding to UNCRPD rather than simply seeing that the individual can access it another way?

I have a practical question which the witnesses might be able to answer, given that they have had these pilots. I am concerned about some of the assumptions and the possibility that the administrative burden being placed on families who have a child with a disability could increase under this model. Will these new centres be open during working hours only? Will they be open at weekends? Will they be accessible by public transport? Is there an assumption that a full-time parent is free and available to advocate for their child, get them into the systems, deal with the administration and arrange appointments and gaps from schools? Sometimes there is a huge assumption that families can undertake a massive administrative piece, but not all families will have the capacity, and in some cases the willingness, to do this. With school interventions, at least, children may be advocated for in accessing supports through that setting also. What measures are in place in this regard? I worry that children will fall through the gaps between existing supports. I would rather that we doubled up on supports rather than risking those kinds of gaps.

Dr. Cathal Morgan

I will share a response with Ms O'Neill on the evidence available to us which we feel is worth sharing. I absolutely agree with the Senator on the administrative burdens on children. Professor MacLachlan referred to this earlier. We need to make the service simple for people to access. If one looks at our national access policy, and I mentioned this in my opening statement, there is capacity and flexibility around where children can be met. We want to make this choice-based with families making decisions. In other words, it may be appropriate for some families to meet with teams in the home. It may be appropriate in primary care settings or equally in mainstream and special school settings as well. At a national level, we do not want to be absolutely deterministic about this because we feel that regional community health organisations should be able to sit down with the providers and families to see how best we can provide it in a flexible way with the resources we have. I have no difficulty with the Senator's point of principle. I think she is spot on.

On the Minister of State's intervention on the pause, I mentioned in my opening statement that as far we are concerned the resource that is in the existing settings will not be removed. I will clarify a few points on that. The Senator is correct in saying that we should not be using the €6 million investment as a type of leveraging, pitting one setting against another. The point I was trying to make in my statement was to draw attention to the inequity in the system. I said in previous inputs that we believe more investment is needed. It should be done in a way which brings education, families and health services together to meet needs, rather than an approach of "how does your problem fit our solution?" because that just does not work. The UNCRPD is a fundamental driver of how that should change. To be fair to the Minister of State, her concern has always been that there should be no diminution of the existing resource in the existing settings. Our key concern is around equity - we need to make sure we can provide an equitable distribution of the service and build on that with additional resources because there is no doubt that more resources are needed. I made the point in my opening statement that this is not going to change.

The Senator is right about mainstream school settings. We have mapped all of the speech and language therapy, SLT, supports going into mainstream settings. They are primarily delivered through primary care. Ms Crehan-Roche might speak to this from the perspective of the chief officers in the nine regions, who have agreed that this will remain in place. We understand that it is fundamental for SLT professionals to work jointly with the teaching profession around language acquisition and curriculum attainment. That is important.

The Senator asked a direct question around the involvement of section 38 and 39 organisations. We have granular detail on that which Ms O'Neill will share. We will follow up with the committee on the break-out of that. Professor MacLachlan might come in after that.

I have a final question on the roll-out of ASD supports within mainstream schools. Will that fall into a bit of a limbo?

Dr. Cathal Morgan

I will ask Professor MacLachlan to address that. Ms O'Neill has spoken about the ASD strategy we are implementing at the moment. We will take it that Ms O'Neill will address the role of lead agencies and section 38 and 39 organisations, and Professor MacLachlan will pick up on the other points.

Ms Angela O'Neill

The Senator asked specifically about the section 38 and 39 organisations, as opposed to services delivered by the HSE. She will know that historically, services were delivered on an ad hoc basis. Section 38 and 39 organisations were developed for specific diagnoses, age groups, geographical areas and so on. With the PDS and the CDNTs, each team will be managed by a lead agency. Those lead agencies are the partners that have been working with us historically. I refer to section 38 organisations such as the Brothers of Charity and the Central Remedial Clinic and to section 39 partners such as Enable Ireland or Ability West. We have already agreed a process whereby those organisations will take a lead responsibility for managing the CDNT in an area. The HSE will be the lead agency for 41 networks, section 38 organisations will lead for 25 networks and section 39 organisations will lead for another 25 networks. There is granular detail within that about how many networks the Brothers of Charity and Enable Ireland, for example, will lead on but that is broadly where we are.

I would appreciate that granular detail. I am also wondering about HSE direct recruitment in each case.

Ms Angela O'Neill

As we are reconfiguring the existing staff, there will be a mix of staff on the teams from ranges of expertise and backgrounds and also from different employers. As people move from posts, the recruitment of the new person will be done by the lead agency.

If I were a HSE speech and language therapist working on a Brothers of Charity managed team and I were to go off into the sunset in the morning, the Brothers of Charity would recruit my replacement.

Professor Malcolm MacLachlan

I thank the Senator for her questions. There was one issue in particular she raised which I want to clarify, which relates to diagnoses and problems accessing diagnoses, etc. It is important from the point of view of the national clinical programme for people with disabilities to emphasis that our programme is orientated towards the implementation of the CRPD, and, therefore, we tend not to use medical terminology when describing people with disabilities. We talk about classifying or identifying people with disabilities rather than diagnosing them.

In addition, rather than this being just a semantic point, there is a more important element to this. Let us consider the condition of a child with autism. As members know, autism is now described as a spectrum disorder. To say that someone has autism does not actually tell us about what his or her needs are. There is significant heterogeneity among people's experience of autism. Not only is there a difficulty in saying when autistic experience starts and stops, in terms of a spectrum, but there is also a range involved. Two people could have autism and have completely different experiences. That is why there is such an emphasis on needs-led intervention. It is a great point because many clinicians overvalue the idea of a diagnosis because there is safety in diagnosis. There has been a tradition of seeing that as an end point of a process. That was what I was describing earlier. In the assessment and identification of people's needs there should never be an end point; it is a continuing process. In the identification of needs, looking at transitions across the life course, etc., should be an on going challenge for us.

The Senator raised another point but on my screen her image froze at the key point of her last question.

I talked about the importance of mainstream and other schools having spaces that are inclusive and, in terms of awareness, the importance of being able to see that part of a school community includes members who are getting additional supports in the school setting. That is part of the UNCRPD. It is not simply siloed access for those individuals who need it; it is about changing all of our systems and the importance of developing that in parallel with more specified services. The issue in that regard was not really the word "diagnosis". In the needs assessment, in terms of capacity and staffing issues, it is more about the fact that because there is a backlog, the level of need is not being fully assessed so the capacity and requirements of these teams might need to increase. It is not just about an end point; people are not getting a proper start point in needs assessment. I am happy to get a written answer on that.

Professor Malcolm MacLachlan

Absolutely. That is why we talk about services and support now. We do not talk about treating people. It is about the environmental supports a person needs. I take that on board.

I thank the witnesses for coming before the committee. I will start with one question and come back in afterwards. If there is time for that, that would be great. Regarding the children's disability network teams, CDNTs, can the witnesses highlight where they are in place and the numbers of areas that still have to be reconfigured? What is the timeline for the full implementation of the teams? If possible, even in a written reply, can I get an update on that in the CHO 4 Cork-Kerry region?

Dr. Cathal Morgan

I will ask Ms O'Neill to address that.

Ms Angela O'Neill

It is a very easy question to answer in terms of CHO 4. Kerry and west Cork reconfigured to CDNTs in 2013. The remaining areas in Cork reconfigured at the beginning of April. CHO 4, Cork-Kerry community healthcare, is one of the areas that has completely reconfigured. In terms of the rest of the country, CDNTs are in place in CHO 3, Clare, Limerick and north Tipperary, and in Kildare west-Wicklow. They are the places our CDNTs, our nought to 18 teams, are in place. All other areas will have their teams in place by the end of quarter 2, the end of June.

When Ms O'Neill says reconfigured, has it been implemented in Cork-Kerry?

Ms Angela O'Neill

Yes, it has been fully implemented in Cork-Kerry.

Just to let Ms O'Neill know, that is not actually the case in a number of areas in Cork and Kerry. People are still waiting for those teams to come in and are looking for updates from the office. Perhaps that is something that can be followed up on separately.

Ms Angela O'Neill

There are obviously some crossed wires there. The west Cork child development service has been in place since 2013 and the rest of Cork in early April. The fact that it was early April, there might be some confusion in the system since, but Cork is certainly reconfigured.

Okay, I will follow up on that separately. Regarding the assessment of needs, the children's committee oversees some of disability matters as well and we had the Minister of State, Deputy Rabbitte, in recently, which was great. I want to highlight to the witnesses that there was some discrepancy between what she said and the standard operating procedure, SOP, for the assessment of needs. The SOP specifies that the assessments shall take from one to one and a half hours. The Minister of State clearly stated that was not the case. There is probably a need to update the SOP in relation to assessment needs. Any comments on that are welcome.

With regard to speech and language therapy in schools, we were talking about the different ratios ranging from 100 to 400 depending on the area one is in. I do not mean to only talk about Cork and west Cork, but I do not know of any other area that is in the same situation. I have raised this issue at this committee and at the children's committee. There is no access to speech and language therapy in west Cork so people have to travel. It takes people on Mizen Head or the Beara Peninsula in excess of two hours to get to Cork city for 30 minutes of essential therapy. Many of the people who have been in touch with my office have said that sometimes the people who are accessing the service cannot spend that long in an enclosed space in a car. That journey is up to three hours each way. Perhaps that is the case in other areas in the country but I am not aware of that and I have not heard it mentioned. I know it sounds ridiculous but perhaps west Cork should get special treatment. I think it might be in a special situation which I wanted to bring to the witnesses' attention. If anyone has comments on the points about assessment of needs, SOP and speech and language therapy, that would be great.

Dr. Cathal Morgan

I will come in on the speech and language therapy and resourcing, and Ms O'Neill will address the assessment of needs. I know this concern was raised with the Minister of State, as the Deputy said, yesterday.

On speech and language therapy, what would be useful is if we provide this committee with a report on the distribution of the networks in the various geographical areas they are located in, and an update on where they are in terms of being operational. We will also provide the committee with a breakdown of the 100 posts we got last year and this year. There are posts yet to be allocated so we are in discussions with CHOs on those remaining posts which will be provided to them. We can link back with CHO 4 on the specific concern raised about west Cork. I understand what the Deputy is saying from the point of view of access issues and people being that distance away. We will come back on the CHO 4 question separately, if that is all right.

I appreciate that.

Dr. Cathal Morgan

That is no problem at all. Ms O'Neill can address the assessment of needs.

Ms Angela O'Neill

As Professor MacLachlan said, we have had for a number of years an issue with resources being targeted almost exclusively towards very detailed assessments because of people being overcautious about the level of assessment required. That was causing huge problems for us in supporting children and families to access services and in being able to meet our legislative obligations under the Disability Act. That is why we introduced our standard operating procedure, SOP. Members familiar with the procedure will know it is a fairly thick document. It contains the standard operating procedure, which is the gospel, and a number of appendices. The SOP defines an assessment of need as a preliminary team assessment. Instead of the comprehensive assessment, it is an assessment that will determine whether or not a child meets the definition of disability in the Act and identify the child's needs as required by the Act. One of the appendices is a guidance for assessors. That guidance for clinicians gives a suggested timeframe for assessment and suggests the types of assessment tools they may use. It is, however, guidance, and it is up to each clinician to determine, based on his or her clinical expertise, what the individual child needs. It would be impossible for us to define what every child coming in will need in terms of the length of time and the assessment tools to be used because it varies based on their age, their presenting needs and so on. It is therefore a very general guidance and it is for each clinician to determine himself or herself what format that preliminary team assessment will take. What we are saying very clearly is that it is a preliminary screening. It is a once-off assessment rather than the 100-plus hours that were being devoted in some areas and the system getting totally clogged up.

That makes complete sense. It makes sense that this would be more of a suggested guideline. It sounds like it is being misinterpreted in lots of instances in respect of the 90 minutes. Perhaps that wording along the lines of "shall take up to one to one and a half hours" is kind of misleading. We could look at changing that. I thank Ms O'Neill. I appreciate the response.

Ms Angela O'Neill

A review of the SOP is ongoing, and those are the types of issues we will look at as part of that review.

I am sorry I am late. I was in the Dáil and am just coming in to join the meeting now. I have been listening to the debate for the past few minutes. I have read Dr. Morgan's opening remarks as well. The biggest issue with disabilities and children is that not every child is the same and the culture of putting children into specific categories does not seem to work because what can help one child may not constitute the measures that will be helpful for another child, and this creates a difficulty for parents.

The other big issue I come across a lot is that people talk about early intervention, early intervention, early intervention. Then there is follow-on from when children are, say, six years of age. They go from the early intervention into another service and there seems to be a gap in the service - perhaps not a gap, but the stepping stones are not there. It seems that when they are finished with that, it is a case of "somebody else will deal with you after this". That happens again at age 18 or whatever. The difficulty is that we probably do not have the resources to provide a tailor-made service for each individual child. In the ideal world, what more do the witnesses need to make sure we do things right for all the children? The submission states that PDS will do certain things. However, when it states "will do it", how can we see the tangible results coming through such that there are more therapists and clinicians on the ground in primary care centres dealing with these children who need the help? One of the greatest traumas is for parents to find out there is something wrong with their child, whether autism or whatever else, and a lot of stuff goes over their heads for a while. Then there is denial on the part of parents for a while, which I myself have seen, because this is their nightmare. What is the witnesses wish list to make the service better and to have more resources? What are their big asks?

Dr. Cathal Morgan

I will ask Ms Crehan-Roche, who is the chief officer of community healthcare west, to come in on this as well. As for the big asks, first I wish to acknowledge the fact that we have had record investment, and I am not just saying that. We have had record investment this year of an additional €100 million, which has brought our overall budget to €2.2 billion this year. That is very significant. In the context of children and their needs, I mentioned previously that we had an additional 100 posts last year and another 100 this year. I am full sure the Minister of State, Deputy Rabbitte, is keenly aware of the need for new resources and I think is banging down a lot of doors to bring them in. I emphasised what is called the capacity review report. It is a programme for Government commitment. In that report there is significant emphasis on year-on-year investment, which has been costed. That includes year-on-year investment in new therapies coming into these networks. The investment has been costed.

Second, the Deputy mentioned quite rightly the experience of families of going from the nought-to-six early intervention team, then heading off to another team. The networks are seeking to collapse all those teams into one team in order that early intervention happens from the get-go and, as Professor MacLachlan said, that we journey with the child and the family through the life cycle, including when children become adults. That is the policy we are trying to implement. The important thing to refer to in that regard is this: we could pour significant amounts of new resources into this but unless in parallel we have change in how we actually work with families, it could be to ill effect from the point of view of what Professor MacLachlan said earlier. We want to move to a scenario in which interventions happen first such that we do not build up lists of assessments followed by another waiting list for interventions. Intervention starts straight away and keeps going. The change of practice and having standards and norms as to how we do intervention, with the child and the family being at the centre of the process, are what we are trying to work at through this progressing disability services policy.

It would be useful if the chief officer gave some practical outline to the Deputy as to how the policy has been working in community healthcare west as an example.

Ms Breda Crehan-Roche

I thank the Deputy. It is vital that the early intervention school-age, nought-to-six and six-to-18, teams are one streamlined service. If we can have the teams colocating, even better. It is important when we move from a young child to adolescence to a young adult that there is proper planning and that it dovetails in order that people work together and with the family on what that child will require. In the west, for example, which the Deputy knows very well, we have nine network teams and we will have all nine absolutely implemented and in place by the end of this quarter, that is, the end of June. We are working with the HSE and the likes of the Brothers of Charity, Ability West, special schools and special classes, Western Care Association and Enable Ireland. We are pooling our resources in order that there are therapists working together and getting advice from their colleagues, not working in silos on their own. I am thinking of schools like Ábalta, which the Deputy will know well. Ábalta has 0.2 of a speech and language therapist, which is one day a week, and 0.2 of an occupational therapist, OT, and they will be left in place. They will have access in the progressing disability services and children's network teams, which will be led by the Brothers of Charity, to more than 26 whole-time equivalents. Those are people such as speech and language therapists, OTs, behavioural specialists and physios, again depending on what the child needs.

The Deputy referred to when a parent finds out his or her child has different needs. Informing families is certainly very important. The committee will be aware that work was carried out by the National Federation of Voluntary Bodies, funded by the HSE, in terms of how best to inform families. The Deputy is quite right that people may find it difficult and that it can take time. We are on that journey with them because this is about the child and the family. Their interests are paramount and first and foremost. We need to consider and work with people and listen to their fears and needs. The will and preference of the young adult or adolescent will, of course, be taken into account. Families know their child best and we are on the journey with them to enable them and their child to reach their full potential and to work with the various elements and services and pool those resources to get the maximum for the person and ensure he or she will live a valued life. That is the important thing.

Dr. Cathal Morgan

Would it be possible for Professor MacLachlan to come in on this issue? There is a specific point he wishes to make to Deputy Canney.

Yes, absolutely.

Professor Malcolm MacLachlan

I could not resist trying to answer Deputy Canney's question because it is very appealing when you are asked what is it that can be done for you. What the committee can do falls on two levels. Pone is the policy level and the other is the sort of systems change level. As I am sure members are aware, sections 3 to 13, inclusive, of the Education for Persons with Special Educational Needs Act have never been commenced. Section 13 relates to the provision of resources. The Assisted Decision-Making (Capacity) Act 2015 has not yet been commenced. Members will be familiar with the report of the ombudsman that calls for a revision of the Disability Act. Many of the things we have discussed this afternoon actually stem from that Act because it gives a legal entitlement to an assessment but it does not give any entitlement to an intervention. That has been one of the channels that has caused the blockages as many people want an assessment because they think it will lead to an intervention. There should be a legal entitlement to intervention, which is of primary importance.

Standing back from that, members are aware we have been advocating for many years for more resources and that will be really important, but perhaps even more important than the issue of resources is the fact we currently have a system that is fragmented, unco-ordinated, inequitable and unfair. The children's disability network teams, CDNTs, are about addressing those problems, so they are disrupting the way in which some resources are currently distributed. Of course, some people will benefit more and others may benefit less or, indeed, may lose something, but we wish to be fully accountable to the committee in terms of what we do. We would love to have its backing in terms of trying to be constructively disruptive within the system so that we can have a non-fragmented, well co-ordinated and, above all, fair system for all children with disabilities.

I thank our guests for their responses. The contribution of Professor MacLachlan was very important in terms of recognising that no system is perfect. What we wish to do is to try to ensure that when we take charge of things, we leave them better than how we found them. What the committee wishes to do is to work with people to make sure we contribute in a positive way. Parents in particular sometimes get frustrated by the sometimes fragmented nature of things. That is not a criticism of anybody.

The other part of it is the challenge in respect of respite services for parents of children with disabilities. There does not seem to be enough overnight respite available in localities. I know it is costly, but it is something we might consider how we can best provide because I believe parents need that respite and break. I know it is there if they need it. As I stated previously, when we are in public life, there are certain things we see happening that we may not be very proud of. I am involved with this committee to make sure that if there is anything we can do to improve the situation, that is done in co-operation with the witnesses. That is why this engagement is very important. I thank all our guests.

All members who are present have contributed. Several points have been raised. The written submission provided states the level of services available in special schools varies widely. The witnesses have been upfront regarding the challenges that exist. Many of the discussions the committee has had relate to the issue of the level of services available depending on the area in which you live or your postcode. That is not acceptable. It is one of the big challenges for the committee and the witnesses to lead in trying to ensure there is fair and equitable provision and that each child has universal access, no matter what their challenges or the part of the country in which he or she lives. The traditional methods of delivering services are not fit for purpose going forward. It is vital that access is universal rather than anything else.

There is no doubt that, for children with additional needs who do not have family resources behind them, the services they should be accessing, such as occupational therapy and speech and language therapy, are simply not available on the public system at the moment. There are children going to special schools or other educational settings and who have not had sufficient access to services. They may have seen an occupational therapist or a speech and language therapist three or four times in the past 12 months. If a person had cancer and the treatment prescribed by the clinicians was to be administered three times a week or a month or whatever, that would be gone after hammer and tongs to ensure the service was delivered. The challenge we have in the context of assessments of need is the waiting list that exists and the frustration parents and young kids experience when trying to get an assessment of need. When the assessment of need is completed, there is almost an expectation that there would be services available for the kids from the public sector but that is not the case. Such services are certainly not universal. According to the statement submitted by the witnesses, the level of services available varies widely. It is not acceptable in 2021 that we have to admit that services for young kids vary widely depending on where the child lives.

Our guests have been frank and open in their discussion. There is a significant amount to be done. As we go into the next period, there was a significant amount of work done. I refer to the work of the Minister of State, Deputy Rabbitte, in the context of securing the extra €100 million and the extra moneys found with regard to various aspects of it. We are going into a new budgetary term. The budget will be presented in four months or five months and the committee needs to advocate as strongly as it can. There is a need to be resourced on the side of the witnesses to identify the challenges facing us. We must accept that many kids who undergo an assessment of need at which a need is identified are depending on the public purse to provide services but that, for many of them, those services are not available. Many families in such a situation have contacted the offices of members and we try to scramble services on their behalf but the services are not there.

There is frustration among the service providers, the HSE, the therapists who are providing the therapy, the families and, most important, of the children who need it. We all have to work extremely hard to improve that service.
Would Mr. Morgan like to respond?

Mr. Cathal Morgan

I concur with what the Chairman said. If I were to leave the committee with three points, the first would be that we would like it if the committee could become a champion for the progressive disability services model because if we agree on the principle, then there should be no argument. The second point is about how we resource it. I mentioned support to Minister of State at the Departments of Health and Children, Equality, Disability, Integration and Youth, Deputy Anne Rabbitte, and to services on the ground around implementing the capacity review report. Much effort by the officials of the Department of Health has gone into costing this. There is a plan that will help us from the point of view of publishing and implementing the report. That tells us what resources we need. The final piece is around the change that comes with the model. That brings change for us all, including for my colleagues around this table, but also for our colleagues who are on the front line. It is a different way of working; it demands change. Sometimes it demands that one leaves one's professional hat at the door and one puts the child and the family first. Change is difficult, but that is what we are asking our clinical colleagues to do, namely, to put the family and the child first.

I really hope it is not inappropriate but when we are through this pandemic and when things have settled, we would be delighted to facilitate the committee if it wished to go and see a network team in operation. We feel there is nothing as good as getting out there. I know members do this as political representatives but when the time is right, we would like to facilitate members if they wanted to see a network that is in operation and that could be an exemplar that we might have in all our community healthcare organisations, CHOs. We will leave that with members.

I thank the witnesses. I have two quick questions. Does Mr. Morgan believe the introduction of the standard operating procedure, SOP, is resulting in children accessing therapy sooner? Has there been any feedback from the clinicians on the SOP? If Mr. Morgan could respond, that would be great. They are just two things that came to me when he was speaking. I thank the witnesses again. It is so important that we all work together to get solutions for children and their families.

Mr. Cathal Morgan

I absolutely agree with the Deputy. I will address this briefly, but we will provide members with a report, because we have very solid results on children moving quickly in intervention. We have solid results on that which we would like to share with members. Feedback is a continuous piece and Ms Angela O'Neill mentioned before that it is in a formal review with all key stakeholders. That is about making sure we learn from what we are doing, adapt and change and refine how our approach is going. That is inclusive of clinicians, as well as management and families themselves having an input into it. The Deputy's question is a good one, so it would be useful for us to include in our report back to the committee the outcomes achieved so far from the SOP, if that is okay with her.

I thank everybody. We will get back to witnesses and we certainly will take up Mr. Morgan's offer when conditions allow. We want to engage and raise this issue in the period ahead. The committee was united yesterday when it said we need to start advocating for resources. The key is to try to get sufficient resources because every child, no matter where he or she comes from or no matter his or her family background, should have access to proper services. That is what we aim to advocate for.

I thank the members and witnesses for their contributions this morning. Our next meeting will be a private one at 11.30 a.m. on 20 May 2021. Our public meeting will be at 12.30 p.m. on the same day.

The joint committee adjourned at 1.45 p.m. until 12.30 p.m. on Thursday, 20 May 2021.