Disability Services

Dáil Éireann Debate, Thursday - 9 February 2023

Thursday, 9 February 2023

Ceisteanna (61)

Peter Fitzpatrick

Ceist:

61. Deputy Peter Fitzpatrick asked the Minister for Children, Equality, Disability, Integration and Youth if he will outline the changes he plans to implement in order to improve and to fulfil the rights of children and adults with disabilities, specifically in respect of access to assessment of need, AON, tests and required services come 1 March 2023, when the remit will transfer to his Department; and if he will make a statement on the matter. [6396/23]

Freagraí ó Béal (6 píosaí cainte)

Deputy Peter Fitzpatrick

Will the Minister for Children, Equality, Disability, Integration and Youth outline the changes he plans to implement in order to improve and to fulfil the rights of children and adults with disabilities, specifically in respect of access to assessment of need tests and required services come 1 March 2023, when the remit will transfer to his Department, and will he make a statement on the matter?

Deputy Roderic O'Gorman

I am taking this question on behalf of the Minister of State, Deputy Rabbitte.

A Government decision in December 2022 confirmed that the transfer of policy, functions and funding responsibility relating to specialist community-based disability services from the Minister for Health to me, as Minister for Children, Equality, Disability, Integration and Youth, would take place on 1 March of this year.

The colocation of disability equality policy and community-based disability services functions in a single Department from 1 March will facilitate strategic policy development, including the implementation of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, and the advancement of the disability capacity review through the Action Plan for Disability Services. This will ultimately enhance the fulfilment of the rights of children and adults with disabilities in respect of a number of critical UNCRPD articles.

As for assessment of need specifically, I am committed to delivering real and tangible solutions to enhance services. I will focus on addressing challenges as regards the resourcing of children's disability network teams and implementing effectively the progressing disability services programme in order to target long waiting lists and to enable the provision of timely and appropriate therapies.

The revised assessment of needs standard operating procedure, once approved, will be implemented with a clear focus on clearing the assessment of need backlog, although it is important to note that children do not require an assessment of need under the Disability Act to access health services. Many children in receipt of therapy services have not gone through the assessment of need process.

It is anticipated that the interim clinical guidance will be finalised shortly. The HSE has been allocated funding in budget 2023 to facilitate additional assessments through a suite of measures, including the establishment of dedicated assessment of need teams, private procurement, overtime initiatives for existing staff and the recruitment of administrative resources to free up therapists in order to assist with assessments of need.

Deputy Peter Fitzpatrick

Families of children with autism and moderate learning disabilities, dual diagnoses, are in crisis in counties Louth and Meath. I am aware of 15 families who have adolescent children with autism and moderate learning disabilities who urgently require a psychiatrist's review while being told by the HSE that that service is unavailable as there are no psychiatrists on the HSE team. In addition to no psychiatrists being available, the only paediatrician available in Louth and Meath is Dr. Maeve McCormack. Dr. McCormack will see only children who are 16 years of age or younger. There is a four- to five-month waiting list to see Dr. McCormack. CAMHS will not see teenagers who have a dual diagnosis, while these adolescent children cannot be seen by mental health teams until they are 18 years old.

Assessment of need is a statutory process under the Disability Act 2005, whereby the Health Service Executive reports on the health needs and, more recently, the education of a child. That is not being done. There is a loophole. We need a bit of help. I have raised this with the Minister and the Minister of State, Deputy Rabbitte, over recent years and we are getting nowhere with it. Our health service is in crisis. If a child goes into an accident and emergency department or a hospital and there is a sudden diagnosis of a disability, nobody wants to look after the child. The child is left in limbo. The family is left in limbo.

Deputy Roderic O'Gorman

I know that the Deputy has advocated very strongly on these issues. I am looking forward, from 1 March, to taking on the responsibility for delivery of disability services for children and adults. The Deputy is absolutely right about the crucial issue of the assessment of needs. He knows the history of this. He knows that a new process had been adopted over a number of years. That was challenged in the courts. That process was found not to meet the requirements under the Disability Act, and that requires a reassessment of a very significant number of children and a new assessment process to be in place. We want to ensure that the new assessment process meets fully the criteria of the Disability Act. We do not want this same thing happening again. That is what is taking place now. There is an understanding in not only clinical terms but also legal terms that the new standard operating procedure for the assessment of needs is clinically and legally robust. That will allow us to tackle the backlog and, going forward, will allow children newly presenting to seek assessments of need.

Deputy Peter Fitzpatrick

The Minister knows and I know that the suicide rate in Ireland is probably one of the highest in Europe. I have parents coming to my office regularly. They go to CAMHS and everybody is trying to help, but they are not getting the help. What happens, as I mentioned a few weeks ago, is that parents end up taking their children to accident and emergency departments. If the child is 16 years of age, he or she is put into an acute ward. Then, all of a sudden, the child is in limbo. People automatically think that if they contact a Deputy, a Senator or someone else involved in politics, that person will be able to help. We cannot help. The amount of money being spent in the HSE at the moment is unreal. What do we tell parents who come in to us and whose children are self-harming, with suicidal thoughts and everything else? Where do they go? They go to CAMHS and, especially if they have some kind of disability, they have nowhere else to go. They come in to us looking for a bit of help. We come here to ask the Department for help. This has been going on for a long time. We have been told that even some accident and emergency departments are supposed to have special services for people under the age of 18 who do present as suicidal. It is not happening. What system can the Minister put in place that will help parents who come in to us in order that we can comfort them and tell them the system will work? It is not working.

Deputy Roderic O'Gorman

I am not trying to avoid responsibility but, for the sake of clarity, CAMHS will not be moving over to my Department. CAMHS will continue to fall within the remit of the Department of Health. It is not moving over with community-based specialist services. I do, however, take the Deputy's point about the issue of dual diagnosis, that is, cases in which there is a disability diagnosis and a mental health diagnosis as well. It has been an issue that one or two of my constituents have raised. We will have to engage on that with the Department of Health and work with the HSE to give parents absolute clarity as to who takes on the primary responsibility of treatment in that situation.

The Deputy spoke to the staffing pressures he is experiencing in Louth and Meath, and that is a huge issue. We have set up the CDNTs across the country, but too many of them are understaffed. The Minister of State, Deputy Rabbitte, and I, working with the HSE, will bring forward a roadmap on progressing disability services. That will, among other things, seek to tackle the issue of retention and recruitment of staff, which is where the biggest vulnerability is right now. Where we do not have staff, we have backlogs in terms of not only the assessment but also the delivery of those much-needed therapies.