Dáil Éireann Debate, Tuesday - 29 May 2018
47. Deputy Margaret Murphy O'Mahony asked the Minister for Health his views on concerns being expressed by occupational therapists in relation to new assessment of needs procedures for children with disabilities. [23505/18]
Amharc ar fhreagraThe Minister of State is very welcome to the Chamber. I ask him for his views on the concerns being expressed by occupational therapists in respect of the new assessment of need procedure for children with disabilities.
I apologise to the Leas-Cheann Comhairle and Deputy Margaret Murphy O'Mahony for the delay. As the Deputy is aware, a revised standard operating procedure for assessment of need has been developed to ensure that there is a standardised approach to assessment across the whole country. The purpose of this procedure is to ensure children with disabilities and their families access appropriate assessment and intervention as quickly as possible. Under the revised procedure an assessment of need will comprise a preliminary team assessment that will identify initial interventions and any further assessments that may be required. The assessment will usually be undertaken by a children’s disability service. This service is composed of a number of health professionals, including occupational therapists, who will be tasked with delivering interventions. While not required under the Act, diagnostic assessments will continue to be provided, as appropriate, and any diagnosis will be captured in the child’s service statement as part of the assessment of need process.
These changes will alleviate the current situation where children in some parts of the country may wait a number of years before they can access an assessment. During this period of time they often have little or no access to intervention or support. It is intended that these changes will facilitate children with disabilities to access assessment in a more timely fashion. This represents a significant and positive change for children with a disability and their families.
The Association of Occupational Therapists of Ireland, AOTI, has outlined concerns about the HSE's standard operating procedure for assessment of need. Specifically, occupational therapists are very concerned about the HSE's implementation from 30 April 2018 of the standard operating procedure for the assessment of need. Among other things, they say that "90 minutes is not a sufficient period of time to adequately assess the needs of children with disabilities and we are particularly concerned about the negative impact this aspect of the system will have on children and their families." They say that "[i]t will also place undue pressure on occupational therapists being asked to carry out these assessments and may place them in conflict with AOTI and CORU codes of ethics." Disappointment has also been expressed "that HSE management has failed to properly consult with AOTI on this matter" and AOTI appeals "for them to engage with AOTI and other professional bodies to address our concerns with the new system for Assessment of Need".
I thank the Deputy for raising this important issue. I share her concerns about what is going on in this sector. I will engage with anybody here who wants to sit down and talk about the issues. I accept the genuine concerns about this matter that have been raised by the Deputy. Since the commencement in 2007 of Part 2 of the Disability Act 2005, the HSE has endeavoured to meet its legislative requirements as set out in the Act. As a consequence of a High Court ruling of December 2009, the effect of which was to open eligibility to all children born after 1 June 2002, the number of children aged five and over and of schoolgoing age has increased steadily as a percentage of all applications received. The relevant figure was 26% at the end of 2011 but it had increased to 51% by the end of 2017. This reflects how the number of children seeking access to the assessment of need process tends to accumulate. The number of new applications for assessment under the 2005 Act has increased steadily since it was introduced. Some 1,138 applications were received in a six-month period in 2007, whereas 5,839 applications were received in 2017. Some 43,521 completed applications have been received by the HSE since 2007. I accept the criticism that this is a numbers issue. Substantial work was undertaken during 2017 to address waiting times for assessment of need under the Disability Act 2005. The additional funding secured by the HSE for therapeutic purposes has been invested in the progressing disability services for children and young people programme. The roll-out of this programme since 2014 has entailed targeted investment of €14 million and the provision of 275 additional therapy staff to increase services for children with all disabilities. I will engage with this issue and ensure it is a priority during the negotiations on the Estimates.
I thank the Minister of State for his answer. I appreciate that his heart is in the right place in this regard. His intentions are good. I ask him to keep in mind that consultation is imperative if anything is to work. I ask the Minister of State to comment on the suggestion in the standard operating procedure that referral information will be sufficient in terms of birth and development history, medical history, family history, social and behavioural functioning and current concerns.
Under the revised standard operating procedure for assessment of need, a preliminary team assessment will identify initial interventions and will be followed by any further assessments that may be required. The preliminary team assessment will provide sufficient information to determine whether a child meets the definition of "disability" under the 2005 Act. A child who meets the definition will receive a service statement outlining the services to be provided and the timeline for those services. Children with less complex needs who do not meet the definition or do not have a disability can continue to access services through primary care. A child will receive initial interventions while awaiting further assessment if this is deemed necessary following the preliminary team assessment. This arrangement, which will deliver best practice standards of early intervention for children, was not previously available. I emphasise that we need to invest in these services if we are to develop them.
