Apologies have been received from Senator Nikki Bradley. The purpose of the meeting is to begin pre-legislative scrutiny on the general scheme of the disability (amendment) Bill 2025. This meeting will be split into two sessions. I welcome the witnesses. For session one, we have the following witnesses: Dr. Amy Hassett, the co-director of Disabled Women Ireland, along with Nem Kearns, also co-director, who is joining us online. From AsIAm, we are joined by Mr. Adam Harris, CEO, and Mr. Michael O'Flanagan, head of legal policy.

Before we start, I must read a note on privilege and housekeeping matters. All witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statement is potentially defamatory in relation to the identifiable person or entity, they will be directed to discontinue their remarks. It is important they comply with any such direction. The evidence of witnesses physically present or who give evidence within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege. I remind members of the constitutional requirement that in order to participate in public meetings, they must be physically present within the confines of the Leinster House complex, so members of the committee attending remotely must do so from within the precincts of Leinster House.

The committee welcomes the opportunity to engage with our witnesses on such a very important issue. We look forward to engaging with them all. I thank them for accepting our invitation and coming here or online to share their experiences and ideas with us. I remind all those in attendance to make sure that their mobile phones are switched off or on silent mode.

I call Dr. Hassett to make her opening statement. She has five minutes.

Nem Kearns is going to make our statement.

I thank the committee for welcoming us for our input. I apologise for technical difficulties. My camera will, unfortunately, remain off for the duration of the session. Disabled Women Ireland welcomes the opportunity to address the committee as part of the pre-legislative scrutiny of the general scheme of the Bill. We welcome that disabled persons' organisations, DPOs, are being highlighted and consulted in this process.

In its current form, the assessment of need, AON, process is not working for many disabled people and their families. For many, it is the first formal interaction a family has with the State when seeking understanding and support for their child or loved one. However, this system is currently characterised by prolonged waiting lists, limited transparency, inconsistent eligibility determinations and significant gaps between assessment and the delivery of supports. Reform is clearly necessary. In Disabled Women Ireland’s view, however, the proposed amendments represent a missed opportunity to make significant improvements. While the stated aim is to improve efficiency and reduce waiting times, the changes proposed do not address the structural weaknesses in the system nor do they fundamentally reorient the assessment of need framework towards a holistic, rights-based understanding of disability consistent with the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD.

We have a number of key concerns with these proposed amendments, which we have outlined in our submission and I will summarise here. The first is the definition of "disability". The Disability Act 2005 predates Ireland’s ratification of the UNCRPD and reflects an impairment focused model of disability. It defines disability as a “substantial restriction” arising by reason of impairment in relation to employment or participation in social or cultural life. The proposed amendments do not update this definition or the outdated understanding of disability, despite the wording changes proposed. As a result, the foundational conceptual framework of the Act remains unchanged. This is a valuable missed opportunity. If changes are being made to the Act, updating this definition should be a priority in bringing us into alignment with the UNCRPD. The current definition locates disability primarily within the individual and retains a high threshold of substantial restriction arising from impairment. In contrast, Article 1 of the UNCRPD recognises disability as arising from an interaction between impairments, different bodies and minds, and societal, environmental and attitudinal barriers. The general scheme does not incorporate this interactional understanding. The AON framework, therefore, retains a medical rather than a social and human rights-based understanding of disability, which therefore impacts how a person's needs are understood.

Second, heads 3 and 4 of the legislation formalise a preliminary determination of whether a person has a disability before their needs are assessed. This strengthens a threshold-based, gatekeeping model at the outset of the process. Instead of beginning with an exploration of needs, barriers and required supports, applicants must first satisfy a high statutory standard which is not entirely clear. A rights-based framework would start from participation and need, not from a restrictive eligibility filter. These amendments reinforce an already narrow threshold rather than modernising it.

Third, head 5 allows applications to be closed where they are deemed withdrawn, including in cases of lack of engagement.

While procedural clarity may be necessary, families navigating the disability system often face poverty, housing instability, language barriers, health crises or may themselves be disabled and lacking in supports, particularly for engaging with the process. The system itself is also complex, confusing and lacking in supports for those navigating it. In such circumstances, a lack of engagement may reflect structural barriers rather than a lack of need. Safeguards are essential to ensure that procedural mechanisms do not disproportionately exclude those already facing multiple disadvantages.

Head 6 proposes that the Minister may require the HSE to issue statutory guidelines on the interpretation of key legal definitions and operational matters. We have significant concerns here. The interpretation of legal definitions is ordinarily a matter for the courts and the Legislature. The HSE is both decision-maker and service provider within the AON system. Allowing the body responsible for administering and resourcing the system to shape how eligibility is interpreted raises concerns about accountability and oversight. Crucially, the general scheme does not require that such guidelines be developed in meaningful partnership with disabled people or disabled persons' organisations nor provide for independent scrutiny. Given the central role these guidelines would play in shaping access to the AON process, this omission is significant.

Head 7 further provides that the amendments will apply to applications already received but not yet commenced. Children and families who have already been waiting may therefore be subject to a strengthened preliminary determination stage. The practical implications of this deserve careful consideration and clarification and I am sure this will cause great concern for families who are on the waiting list.

We have concerns regarding the consultation process. While we welcome engagement at this stage, meaningful participation of disabled people and their representative organisations is a foundational principle of disability rights and of the CRPD itself. Consultation materials were not provided in accessible formats, which limited everyone's ability to engage equally in this process.

DWI recognises the AON system urgently needs reform. However, the proposed amendments refine procedural mechanics without addressing the deeper structural issues. They reinforce a high-threshold, gatekeeping framework rather than transitioning towards a participation-based and rights-based model aligned with the CRPD. A more ambitious reform process is needed - one grounded in a human rights basis of disability that integrates assessment with meaningful access to supports.

Thanks Nem, you have gone way over time.

I apologise.

Go raibh maith agaibh Nem. I now invite Mr. Harris to make his opening statement.

AsIAm’s engagement with this Bill is rooted in a human-rights based and neuroaffirmative approach. We believe legislative reform must be co-created with autistic and disabled people and give practical effect to Ireland’s obligations under the UNCRPD. In proposing to amend the Disability Act the Government has an opportunity to take leadership and strengthen disability rights to align our laws and systems with our international human rights obligations, and to strengthen disability rights by embedding rights-based, neuroaffirmative practices in how we assess and support autistic people. However, these reforms also carry potential risks that can make it even harder for disabled children to be supported to fully participate in society and their community. Our statement will mainly focus on the proposed amendments to Part 2 of the Disability Act 2005, which govern the AON process.

Before we speak about the proposed amendments, we wish to offer some context which speak to our community’s recent experiences with the current process. This debate is taking place in a context of rising misinformation about autism, with 91% of our community reporting a growth in misinformation across the last year. Unfortunately, this misinformation both nationally and internationally has not been immune to undermining both the need for and validity of an autism diagnosis. Equating an identification of autism with access to resources or questioning a person’s need for support or accommodations is not only deeply stigmatising but fails to grasp the transformative impact that access to an autism diagnosis can have for an individual and the opportunity it presents to the State to support and affirm people “as they are” rather than subjecting them to a lifetime of misdiagnosis, mistreatment, masking and isolation. The National Disability Authority has confirmed there is no evidence of overdiagnosis in Ireland and there is also no evidence to support the claim that changes to how resources are allocated in the education system will lead to fewer people seeking access to diagnosis, as is their right.

In 2020, the HSE introduced a standard operating procedure that gave effect to the preliminary team assessment, PTA. The PTA was a controversial 2020 initiative, consisting of a one-hour observation and 30-minute parent consultation, designed to replace comprehensive diagnostic assessments for children's disability needs. This was introduced to mitigate the ever-growing waitlist for the AON process.

A High Court ruling in March 2022 found that the PTA model was not compliant with the statutory framework. This context matters. For many families, the AON process represents their first formal interaction with the State in seeking recognition, validation and support for their autistic child’s access needs. Their experience of the AON process shapes not only access to services but their trust in the State to respect their child’s rights and to meet their needs.

Access to an AON and supports is creaking from the pressures arising from a lack of resources and growing waiting lists. The statutory timeframe requires that an AON commence within three months of application and be completed within a further three months. Over 90% of children who are AON applicants are not seen within the six-month period. As of December 2025, over 20,000 children are overdue an AON.

While the Disability Act creates a legal right to assessment, it does not create a corresponding right to timely access to the services identified in the assessment report. Any reform of the system must align with the UNCRPD. AsIAm is concerned that the proposed amendments risk reinforcing a medicalised understanding of disability and further pathologising autistic people. The continued reliance on the 2005 Act’s definition of the disability threshold does not reflect the social and human rights model set out in Article 1 of the UNCRPD.

We are also concerned about proposals that would introduce an initial determination of disability prior to a full assessment being completed. While we welcome in principle measures aimed at clarifying the AON process, we are concerned this would restrict disabled children from getting the supports they deserve. We must avoid reintroducing, in substance or effect, models previously found to be unlawful.

Similarly, any proposal to expand the pool of clinical professionals conducting AONs must be accompanied by clear legal safeguards around qualifications, clinical expertise and effective supervision. The persistent and worsening failure to meet statutory timelines reflects severe capacity constraints, which have arisen from a persistent lack of resources within the AON system. Rights merely on paper, without the clinical staff and funding to make these rights real for disabled people and families, risk becoming aspirational rather than enforceable and deepen the disconnect between assessment and service delivery.

AsIAm broadly welcomes the Government’s intentions to amend the Disability Act. However, any reforms to the Act must strengthen the rights of disabled people and reassure families they will get timely access to the supports they need, at the point they need these supports. Trust is a rare commodity in our community that all too often has been excluded from conversations about our lives, and non-legislative promises fail to protect our rights. We are concerned that since the announcement in December there has been a lack of coherence in communications around this issue, particularly as they pertain to the role of assessment in terms of access to an autism class or special school places. Where communication is not clear or transparent, our community will be rightly sceptical and fearful of any proposed reform. We look forward to engaging with the committee and answering any questions members may have.

I thank Mr. Harris. I now invite members of the committee to put their questions. When I call members to speak, I ask that they adhere to the agenda item scheduled for discussion. Given the time constraints, I would like everyone to be focused in their contributions.

I thank all of the representatives from the DPOs for their opening statements. I also thank the Library and Research Service for all of the supporting documentation, and the committee secretariat. The more I read everything and cross-reference it, I will not say I am becoming more confused but I think the limiting factor is the number of qualified personnel, which impacts on the time limit. Given the recent budget, money has not been an object; there has been a substantial increase. At the end of the day, however, to assess the needs and ensure rights are upheld, we need people to carry all of that out. There has been a common theme in the communication coming from all of the organisations we have heard from and those to follow regarding what an AON is and what it is not and the timeframe.

Considering their members' needs that have been communicated to them and leaving aside the six months wherein an AON should commence within three months of application and be completed within a further three months, would the parties like to comment on what they think is a workable timeframe for delivering an assessment of need in the current environment with the current cohort of personnel engaged by the NCSE and the HSE?

A huge challenge we have in terms of answering that question is a lack of clarity from the HSE around, for example, what a fully operational assessment of need process or children's disability network team, CDNT, process looks like. I note that there is work under way in terms of a review of the CDNT system in that regard at present, but that is a huge challenge in that we actually do not know what the capacity of the system is. It is very clear that the system cannot address the huge demand that exists at present and, obviously, that is a significant concern. It is important for us to say that we welcome any proposal that would make the assessment of need process operate more efficiently. We think it is very important that there is equal preference given both to the right to access assessment and the right to access supports. What we would be concerned about is amending the disability Act in such a way that it would weaken the right to assessment without actually providing any right to supports. It is important to say that while there may be different means by which a more efficient autism assessment can be provided, we are very concerned that the need for an autism assessment is being equated purely to the idea of access to resources where, in actual fact, an autism assessment should inform all of the supports a person receives following on from that assessment.

Do Dr. Hassett or Mx. Kearns wish to respond?

I just have one point. I think Mr. Harris raised this and explained it. One big concern I have with these proposed amendments is that they do not fundamentally address that challenge. We need to look at how we can increase the number of professionals working in the field with the appropriate qualifications and how we can resource those teams. However, this is fundamentally not going to do that. Essentially, what the aim of this appears to be is to reduce the number of people on the waiting list, which is not what we want to see. We want to see a more holistic system. We do not necessarily want to increase thresholds. I agree that this is absolutely where the crux of the matter is. That is why I do not feel that this is the appropriate means to address that particular challenge.

I thank the Deputy so much for the question. Yes, we are with her on that. It is quite confusing and non-transparent in the exact details even on the ground, but it is definitely changed by these amendments. I would also like to say that while we warmly welcome that the AON process needs to be reformed, there could be exploration of parallel processes but this Bill does not attempt to do that. It just attempts to introduce another step at the start of the process, which I am personally quite unclear on as to how the determination is made before any assessment is made of that child's needs and whether it is appropriate.

I thank Mx. Kearns.

I thank both groups for their presence today in person and online. I congratulate Mr. Harris on his wedding since I saw him last. I am glad he picked the real capital in which to get married. I have a couple of questions. AsIAm's statement stresses that children are often diagnosed without immediate help or therapies. What statutory amendments or accountability mechanisms could be introduced so that a diagnosis means more or less immediate therapy?

I thank the Deputy. Our statement is quite strong on that and not just our statement but our submission as well. It speaks to the fact that while we all agree that the assessment of need needs reform and that is taken as a given, one absence within all this consultation process or in looking at those amendments is the absence of the follow-up supports. I know there are members of this committee who have been actively calling for a pathway for a legal right to accessing psychology, occupational therapy or speech and language therapy. As Disabled Women Ireland, DWI, outlined as well, this Bill or this consultation process is creating a missed opportunity for including any statutory provisions to those entitlements. If we look at the figures from the HSE and so on, there has been a reduction. The current vacancy rate with the CDNTs is 18%. In 2024, I believe it was 29%. There is, therefore, a welcome move in the right direction as such. If we look at the court cases that were announced in 2023, however, we can see there is certainly a gap between providing the assessment and then the follow-up support. This Bill has many gaps in it, but one thing that is certainly missing is the fact that we are not legislating for that right to access appropriate pathways to support post assessment, if that makes sense.

Yes, perfectly. I thank Mr. O'Flanagan.

I thank the Senator so much for her good wishes. I might add one thing to that I think is important. There is a reality that very often the only support autistic children receive from the State is through the education system. It has caused significant concern that one of the proposals within this announcement was removing the link between an autism diagnosis and access to supports in special schools and special classes. At the same time, there is a proposal, for example, to bring therapeutic services to special schools. This is one of the issues that families are most concerned about because, again, it would appear to be removing any sort of transparent link between the child and the right to access any support from the State.

I thank Mr. Harris. As we lead up to International Women's Day, I acknowledge and congratulate the ladies on the fantastic work they do. With regard to their definition of disability, I agree with them that it is very impairment focused. If the witnesses could word it, what words would they use for the definition?

That is always quite a difficult question to answer. We would look for a definition that is basically in line with what is set out in the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. It is the best definition we have at the moment. It is much more human rights based. The only thing I want to add following on from AsIAm's point is that when we are looking at needs and access to supports, we know that the AON does not guarantee access to supports, but people can also get supports without an AON.

The other thing we need to think about is how we can holistically support children. The definition of need used in the legislation is quite restrictive. It looks at employment and access to social and cultural aspects of society. When we are thinking about supports and if we are really thinking about moving this to being more CRPD compliant or something more in the spirit of the UNCRPD, we need to start looking at children and disabled people as holistic human beings who have a lot of different needs and how we can support them to live good, dignified lives of their own choosing where they get to have choice over what they do and who they are. We also need to look at what supports there are and how we create that wraparound system.

I thank Dr. Hassett.

The witnesses are very welcome to the House. I thank them for coming and for their great presentations. I am delighted to see the women's disabled persons' organisation here. Theirs are the most important voices in the room. In other jurisdictions throughout the European Union, they routinely carry out assessments of need and they repeat them throughout the individual's life to take into account developmental and other changes and so on. They also provide people with the therapies, supports, surgeries and whatever else they need and accessible accommodation. We are different. We do not do that. I agree; having had an assessment of need in our family, it is just a piece of paper. We have no right to anything that is set out there. The fundamental difference between us and everybody else is that we are the only country in the European Union where our disabled citizens have no legal socio-economic rights. The only legal right we have is the legal right to an assessment of need. I heard the Minister, Deputy Naughton, on the morning show on Virgin Media say that the assessment of need is the problem and that it is using up all the resources. It is a perverse argument. It is like saying that household accidents happen on the first step of the stairs and the top step of the stairs, so the solution is to remove the top and bottom steps of the stairs. It is nonsense. Do the witnesses think the Government is going to seek to remove the only legal right that disabled citizens have in this ableist State? Do they think that is what it is about?

It is clear within the heads of the Bill that it is proposed that an individual will have a right to an assessment of need and the timeline will remain the same, even though it is not being fulfilled as of now. Our concern relates to a scenario where someone does not receive an autism diagnosis should they need one through that process but, rather, is told the autism diagnosis is subject to resources. We are concerned that it is watering down that right. While it may not remove it on paper, our concern is that it removes many of the protections people have through recourse to the courts by giving the Minister the power to create statutory guidelines. That is our concern. It is the Trojan horse of which we all need to be mindful, not just in the here and now but in the context of how it could be interpreted in five, ten or 15 years.

If we look at the heads of Bill, particularly around the educational element and so on, this could potentially be challenged in the courts. Under the Constitution, children have a right to a primary education but also to access the curriculum. Accessing the curriculum requires an individual to have access to the necessary supports to enjoy that right to school.

If we look at the initial determination piece within the heads of Bill, the initial decision will be made by an assessment officer, but we do not know what their qualifications will be to make that determination in the first instance. Children could potentially fall through the cracks at the first hurdle as a result of that. They would then be in no position to get access to those necessary supports they might need to access the curriculum. Parts of the Bill that are, on the face of it, unlawful constitutionally.

I fully support and agree with the other witnesses. Senator Clonan knows well the lack of a right to supports and how these proposals do not address that. What Senator Murphy O’Mahony asked about is very much linked to this. We also have a concern about the prescriptive list approach that has traditionally been taken in Irish education legislation and areas like this, such as the former mobility grant Instead of looking at the need of the individual and using that as the identifying eligibility criterion or definition, we have prescriptive lists that try to list out impairments. They do not identify need, however. They skip over many people with unsupported need and fail to account for the fact that disability is broader and more intersectional than a list set in legislation. We need to look at ensuring that those who have need have a right to support from the State and use that as our definition and basis. That is the UNCRPD approach. I wished to tie those two issues together and highlight how the Bill is failing on multiple fronts in that regard.

I apologise for joining online but I must go to the Chamber in a few minutes. I thank everyone for their opening statements. Everyone has mentioned reducing waiting lists. What is representatives' vision for how waiting lists could be reduced?

Many of the witnesses mentioned how assessment and supports are not working. How can stage 1 of the process around assessment and support be strengthened?

The Disabled Women Ireland representatives referred to a rights-based focus, particularly around needs. They feel that the consultation process was not good enough or that they were not consulted enough. Will they comment on that?

I did not mean to give the impression that the consultative process was not enough or that we were not consulted enough. Rather, I wished to highlight that there were accessibility barriers for us and other representative organisations, such as people with intellectual disabilities. Groups representing parents have also had issues with the AON process. There are a lot of perspectives and voices and it would be great to strengthen this process. We welcome the fact DPOs have been invited to participate.

I am not going to say I can fix the AON process, the resourcing issues and all of these things but having a rights-based focus is part of the solution. I know it is scary to undertake such a significant change but a fundamental change is here. The AON process has been tinkered with and has gone through the courts over and over again, and it has been found not to be working over and over again. We need that fundamental shift.

In my day job, I provide administrative support on AON referrals for a contracted clinic. There are issues when it comes to trying to meet these eligibility criteria of impairment, rather than looking at the needs of the individual. Some families, while grateful to receive an assessment after being on the waiting list, sometimes for a decade, feel their child needs more support in another area but they are not able to get that. They are told they have to go through the assessment with our clinic before there is any possibility of that. There is also no guarantee of it, even if it is highlighted as a need in the assessment outcome report our clinic provides.

We should not reduce waiting lists by taking people off waiting lists. We do not want to see a situation where the threshold gets higher and higher. That is not the most appropriate way to fix it. We need to put resources into it and properly invest in fixing the problem. We cannot take people off the waiting lists. That is not the way to do it. I am sure the witnesses from AsIAm have a suggestion in this regard.

In respect of the consultation process, I emphasise the importance of the documentation. Although helpful and useful, neither the general scheme of the Bill nor the FAQ document was provided in a plain English format. While we appreciate the opportunity to engage with the committee, the documentation available online about this consultation process is also not in plain English. We need to ensure those documents are published in plain English and accessible formats, including in Word for those using screen readers. This is step 1 of an accessible consultation process. Having multiple means of engagement is also useful. We appreciate being here.

I will be quick and build on a point that Dr. Hassett made about not taking people off waiting lists. One of the key concerns we have about the proposals relates to this concept that seems to be raising the threshold of what defines disability. Unfortunately, even within the current context, we have seen scenarios in which, on the one hand, people are being told they are autistic but, on the other hand, they are told they do not have a disability. It feels like gaslighting autistic people in respect of the barriers they face daily and failing to understand how pervasive those barriers are.

Building on the question of how we fix the problem, sustained investment over time is needed. We need to look at the fact that, for example, year on year we are not training enough therapists. Year on year more people are choosing to go abroad while we fail to recruit enough people from abroad. Year on year we see a scenario where people become so burned out working within the public system that they leave it. The more we spend in the private system, the more people we are attracting to work in it. It is a self-fulfilling circle. Every time there is a crisis or a recession, we put a recruitment embargo in place. When there is a pandemic, we take away therapists and send people to do contact tracing. We need to see this as an essential service that we build up over time and prioritise at all costs.

I have to move out for a few minutes. The Leas-Chathaoirleach will take the Chair.

I need to make a declaration. I solemnly declare that I will duly and faithfully and to the best of my knowledge and ability execute the office of Leas-Chathaoirleach of the Joint Committee on Disability Matters without fear or favour, apply the rules as laid down by the House in an impartial and fair manner, maintain order and uphold the rights and privileges of members in accordance with the Constitution and Standing Orders.

I thank the witnesses from Disabled Women Ireland and AsIAm for being here today and sharing their expertise. Mr. Harris mentioned in his opening statement that the Disability Act created a legal right to an assessment of need but not a corresponding right to timely access to services that are recommended in the assessment report.

This is a key point that Senator Clonan in particular repeats very strongly at these meetings. We know that assessments of need are the one legal right families have. From consulting with clinicians working in the area, it seems that some children who may not require a comprehensive diagnostic assessment and whose difficulties could perhaps be addressed with a short-term therapeutic assessment in primary care followed by short-term intervention are getting stuck in that assessment of need route, mainly because primary care services that see children with mild to moderate difficulties have been under-resourced for many years. It appears that the Government has at least tried to resource children's disability network teams, but successive Governments have seriously neglected primary care services. To my mind, this proposed legislative change seems to be focussing very narrowly on assessment without in any way reckoning with that wider service development failure and the failure to resource therapies across all services.

Regarding all of that, if we had a right to timely intervention enshrined in law, as we have a right to an assessment of need, and if we had proper resourcing of services for young people, does Mr. Harris think there would still be a need to change the threshold for accessing an assessment of need?

I thank the Deputy. To pick up on the point about it being very narrow, that is one of our main concerns. It is welcome that in the programme for Government, there is a commitment to overhaul and review the Disability Act in full. What is concerning is that we are starting with this very narrow piece without any clear indications of when we might see deeper reform. We are particularly concerned that we are moving forward with a proposed definition of disability that contravenes the UNCRPD. That is concern number one. It is important to recognise that where a child's needs are not met in disability services, those needs do not just disappear. They just move to a different part of our health system. The north Kerry child and adolescent mental health services, CAMHS, report published last week points to that very well - 46% of the caseload was autistic people who either had an assessment or autistic people awaiting assessment. Those are people who disabilities services had failed, with them then reaching crisis point.

It is very clear to us that there needs to be a no wrong door policy. We do not see it as an either-or in terms of your right to access supports in primary care, mental health services or disability services. From listening to our community, we are also very clear that assessment in and of itself is really valuable. Unfortunately, growing misinformation has led to the view that people only get an assessment to access services. The data points us in an entirely different direction. If you have an autism assessment, you face more barriers to getting mental health supports, a school place and securing employment. The idea that people go after an autism assessment to unlock doors simply does not stand up to scrutiny. People get it to understand themselves, inform support and find their tribe. We really need to protect that right as a well-being support in and of itself.

On this question, the definition is too narrow. Of course, we want to see something that is much more in line with the UNCRPD. Right now, it is a requirement that somebody must have a substantial restriction as a result of their impairment, which is not UNCRPD compliant or necessarily in the spirit of what we are trying to achieve here. For me, this would be quite a significant concern. It is also something we see when we look at needs. The needs are still being defined in a very restrictive way relating to employment and not even relating to education.

We know there are many people who do not meet the definition of disability as outlined in the Act. A number of Ministers have talked about the number of people who are not deemed to have needs. These are very likely still disabled people because there is still something that is being identified by family members, caregivers and teachers to say that a child or young person needs support in some way. To my mind, the high rate of a need not being recognised reflects a problem with our definition of what disability is and what substantial restriction is under the legislation. That is the core piece we need to change as an immediate first step.

I thank both organisations for being here today and I thank Mr. O'Flanagan, Mr. Harris, Mx. Kearns and Dr. Hassett for their contributions.

A few things have stood out to me. Recruitment and retention of staff is a huge issue, in general. This committee has discussed how private assessments will not solve the problem. It is just a Band-Aid. AsIAm's comment in its statement that an autism diagnosis cannot be devalued struck me. What Mr. Harris said about an autism diagnosis closing doors as opposed to opening doors is a really stark thing to say and for us to face as a society. Both organisations said that there were wider structural issues here in terms of disability and health and that communication with those affected was key.

I have some questions for Disabled Women Ireland initially. I want to ask for some clarity on its statement. Does it recommend that we proceed with the proposed changes here or is it recommending a full reform in place of this Bill with a more rights-based approach? It also referenced the HSE having a role in decision making and service provision but also in oversight and accountability and that there may be a potential conflict there. What does Disabled Women Ireland see as a solution to that?

I thank Senator Harmon. Obviously, my colleague and I are not lawyers, so we are very concerned about the implications. I believe the word "interpretation" is used in relation to this. It is quite standard for the HSE to issue recommendations, guidelines and codes of practice around various processes but we are very concerned about the interpretation piece, in that the HSE would actually be interpreting the law rather than the courts or anyone else. We would very much urge this committee to consult lawyers, get that expertise in and clarify that. We are very worried about that remaining in the language, particularly without clarification, and that it could potentially be interpreted in that way.

I apologise, as I have forgotten the first question, so I will let Dr. Hassett come in.

I think the question was on what else we asked for in our submission. The choice of what happens next is the committee's, not ours, but our point is that we do not have confidence that the changes to this legislation will bring about the changes that are intended. We are not entirely confident, or confident at all, that this will actually make the system more efficient or reduce waiting lists. If there has to be an intermediate step where someone is assessed as having a disability, that is halfway of the process anyway. Will it really make a difference? I am not convinced. I also feel it is not necessarily getting to the heart of the issue. I know there is a big review of the Disability Act coming, which is important and will be something we will be engaging on. That is a decision for the committee.

On the HSE piece, in terms of the legal interpretation of definitions, that is not something I am super confident in the HSE doing. That would perhaps require a question to be put to the Centre for Disability Law and Policy, CDLP, when it appears tomorrow or something like that. The only thing I would like to see in the development of those guidelines is the inclusion of really robust safeguards where DPOs, disabled people and other bodies are involved in the oversight of guidelines and making sure there is accountability and a bit of safeguarding in place.

I am fairly sure I will repeat what everyone else has said because I was in the House where we were dealing with assisted decision making. Having waived pre-legislative scrutiny on that, it is an emergency-type scenario. With AON, though, there was not a chance that anyone would have considered waiving it.

Dealing with AONs, 22,200 was the last figure we got in relation to the waiting list. I think everyone would say that the setting up of AONs and the CDNTs was far from perfect. It was not evidence-based and I gather, if we were starting again, it would not look like that. There is also the move away from in-school therapies and all those other considerations. I get Mr. Harris's point around co-creation and whatever. I have my worries. Let us be clear: this is about how large that waiting list has become. It has become about, for want of a better term, shunting citizens in particular directions. If that means they can get a particular type of autism assessment they want or need, that they can get the therapies, and this improves the life of the child and family, nobody will have a difficulty with that. We know what the intention is at this point. Can I ascertain how AsIAm sees this? This is not something that was co-created by engaging with those with disabilities to a sufficient degree. We have heard the percentages from the Department's point of view. Some 29% of those who have applied for AONs were found not to have a disability. This does not mean they did not have a need for occupational therapy or speech and language therapy. The Department also talks about 35%. Last year, 45% of those who had been through the AON process were assessed to have autism. We can see where the Department is coming from. We all have our worries. Where do we go from here? Will Mr. Harris make an assessment on what is happening? We also know there is an issue regarding schools and there is no clarity yet as to how the assessment process will deal with that issue of correct school placement.

I will come in briefly. Deputy Ó Murchú has hit the nail on the head when we look at the waiting lists that are there. The elephant in the room is why these changes have been rushed or are being expedited in a way. It is somewhat absent-minded to look at this legislation without looking at the wider Disability Act or the UNCRPD. As legislators-----

Without looking at the CDNTs either, or all of this.

If we were to look at the UNCRPD and hold that up as the gold standard, as a State we need to take that very seriously. The engagement during this whole process has been quite short and terse. Many families did not know there was a public consultation process ongoing around the assessments, and they are the ones who are directly impacted by the waiting lists of over 22,000 that exist at the moment. The issue is systemic and structural. It is certainly not financial because we know we are a very wealthy country. However, there seems to be a laissez-faire approach to supporting or dealing with the caseload or the waiting lists that exist. This proposed deal-----

We have set up a bad structure and we have not addressed it.

Yes, absolutely. The proposed amendments and heads of Bill are a way of creating a system that is efficient but not necessarily comprehensive. If we look at the scheme that was published, there is no reference to it being comprehensive. If we go back to the judgments which struck down the PTA as being unlawful because the assessments being carried out were not comprehensive assessments, I would be concerned that these proposed amendments are removing that person-centred element and comprehensive assessment. The devil is in the detail. The fact that this is absent is something the committee certainly needs to probe the HSE officials on as to why that is not central or at least referenced within the proposed general scheme.

This is the assessment officer aspect. We are hearing now that there will be some sort of clinical backup and whatever else to ensure the supply mix is also correct. We would need to see what that looks like before we could make an assessment on the assessment officer.

If we look at things as they currently are, and we can only speak to what we know is happening, we know from our casework team that someone goes through the assessment of need process, they are identified as having a disability, their health needs are identified, their educational needs are identified, if applicable, and in some cases they receive the service statement or they do not. I was only engaging with a family today who had not received the service statement six months after they went through the initial process. There is certainly an inconsistency in the standards that are currently being approached and I fear that will be replicated in this initial determination.

Mr. O'Flanagan is nearly as good as me at going over time.

Regarding Ms Justice Phelan's finding on the PTA, do the witnesses think the proposed format of the assessment officer having access to clinical supports meets the previous ruling as things currently look? I know the witnesses have kind of answered the question already but I suppose I need to hear something a second time.

Our concern would be that this issue is being taken away from the courts and, as a result, the protection is being lost.

I also mention, as I was just referring to, the consistency of those applications and the qualifications of the assessment officer. Ms Justice Phelan's comments on how the assessment is integral to how the State discharged its duties in vindicating the rights of the individuals. That should be the mantra we should be working off when it comes to the assessment of need process in what it delivers for families in the here and now but also into the future.

Regarding the assessment of need, inasmuch as there has been a statement because of the likes of Cara Darmody and many others and the protection will still be there for the six months, the fear is that this process is going to undermine that to some degree. We have often said we would have no difficulty in looking at the assessment of need and the entire process. That would be fair enough. However, to a degree, we have just decided the assessment of need does not work and we will go straight to-----

Our concern is not that people would lose their right to an assessment or that it would be lost within six months but that the quality of the assessment people come out with or the ability to access a diagnosis would be lost without any corresponding increase in a right to therapeutic supports.

If the representatives from either organisation were able to design the assessment of need process from their point of view, what would it look like, say, for a child aged five and their family, where the child is experiencing significant emotional, cognitive, social or behavioural difficulties? What would it look like from the first engagement through the process?

That is probably a long answer but we would point to one thing mentioned in both our submission and our opening statement, which is the fact that it is deeply concerning that we have no statutory guidelines as to what constitutes a good autism assessment. While there have been publications, for example, by the Psychological Society of Ireland, in England there are NICE guidelines and in Scotland there are SIGN guidelines, the HSE has failed to actually define what constitutes a good assessment but now is undermining the right to say.

That is a bigger question but I will mention two principles; one for the child and one for the family and those supporting the child. First, I would like to see a system that looks at a child as a rights holder, looks at all articles of the UNCRPD, which essentially outlines pretty much all areas relating to a person's development, and that looks at how a child can have access to those same rights on the same basis as every other child. That means thinking about their educational needs but also their social development, their emotional development, their access to sports, culture, music and all of these different things. I would like to see a system that looks at the child's need in an holistic fashion. The second principle is that we need a system that is as easy as possible for the families to go through.

It needs to be transparent, clear and well supported. It is about that element of support in a holistic sense, both in terms of providing information and guiding families through a process, being really clear what documentation is needed and when. Ultimately, it is a system that gives people the right to access the supports that they need to access and fulfil those rights that are guaranteed to them by the UNCRPD.

Gabhaim buíochas leis na finnéithe. It is good to see them all again. One of the things that stuck out to me this evening was Mr. Harris speaking about autistic people feeling gaslit around wanting the diagnosis only for supports and that not being the case. It is a really poignant thing to say. For many people, even if they get their diagnosis at two or three and they do not understand it, when they are a bit older they often look back and they go through those documents or people in later life, nine, ten or 11, that diagnosis can be an "Aha" moment or even in later life to understand that they were not different or this or that, that it is a different neurotype and this is the way their brain works and this assessment and report means so much. That is an important thing to say.

Both organisations welcome the reform. They have pointed out what is wrong with the current reform. On the fact that we have a global shortage of therapists to provide both support and assessments, while I understand they have not had the co-creation in this that they wanted, if they had a magic wand and wanted to shorten the waiting list for the assessment of need within the next two to three years while we are building the capacity for more therapists, what would they do? Would they offer an option at the first door to go for that simplified diagnosis? Maybe simplified diagnosis is not the right way but sometimes, people going for a diagnosis in some respects want to access home tuition. You cannot get home tuition unless you have an autism diagnosis. If you do not get home tuition before you are entitled to the ECCE scheme, that opportunity runs out. At the moment, you need an autism diagnosis to get into an autism class. I know that might be changing. In the short term, what would the organisations do, given the shortage of therapists on a global level?

It is quite a difficult question. In an ideal world, I would look at that diversification and that wider context, which I am concerned is not being done here. While it is very true that the assessment does not equate to support, unfortunately for a lot of people, as in the cases the Deputy highlighted and in other educational supports or access to services, it still is the only option available to a lot of people. It is all interlinked because there are huge issues in the allocation of SNAs and resources to schools. We would view it as a progression of rights, informed by the UNCRPD and human rights. We are looking on that progressive scale, rather than saying we have a fix for every detail in a system in terms of resourcing, retention and allocation.

It is also that some of these barriers are to do with the fact that we still are trying to put a Band-Aid on. We are trying to put a Band-Aid on here and in education rather than making meaningful progress toward inclusive education. We are putting these things where they are not necessary, where the only access to support is based on diagnosis because we are still viewing things from the impairment lens rather than the needs lens and whether those needs can be supported in the short term without the need for a full diagnostic assessment and report.

There has been somewhat of a discussion that we do not know what it would be like if we had less of an emphasis on assessment. If you came to work in our organisation, you would see that Ireland has already happened, where you meet people in their 40s, 50s, 60s and 70s, who grew up in an Ireland where there was not an autism assessment, who spent a lifetime masking, engaging with mental health supports and without accessing the workplace or struggling in the workplace. We have an opportunity not to go back there. That is what this legislation must protect. For us, in terms of the reform, it is very clear the current system does not work. We would want to see the new legislation be explicit that the right to assessment and diagnosis is protected within it. We are very open for more collaborative or dynamic ways of working.

There is clearly a huge lack of consistency across the country in terms of between how private and public practice approach autism assessment and how long it takes. We are very open, as a result, for streamlining and improved ways of working once that fundamental right is not undermined. Critically linked to that, we would be very concerned due to the complete lack of trust families have in any scenario in which their right to access an autism class or special school was undermined by the changes in this legislation. It is quite clear, as we saw with the SNA system, if people do not have a tangible right to something, they will not have recourse if the Department chooses to cut back at a later date.

Why do the witnesses have a fear in relation to the school piece? I accept that we could do with seeing something from the Department of education on how that process is going to work.

The best way I could speak to this, if we just look in the last few months alone, first, we had a scenario where families began to see the drip feed of information around where autism classes in special schools were going to be. We then saw a scenario where families were the last to find out about SNA access. Right before Christmas, a single line in the announcement by the Department of disability around this change in legislation spoke about a fairly fundamental reform of how families would access special schools or classes.

We had diabolical communications where the Department of children did not know what the Department of education was saying and the Department of education did not know what the Department of children was saying. It was quite unbecoming in terms of how significant an announcement this was on the lives of autistic people and their families, that this communication was weak. It is worrying that this has been tagged on. A major resource issue has been tagged on to this change in legislation, without a lot of coherence or clear communication.

There is a lack of trust - borne out of history - and it means we are starting from a very bad place.

Correct.

We also know that first and foremost this is about reducing the AON list. While we all want to see that happen, I am not sure that this is a great starting point.

I fully concur. We highlighted a real missed opportunity in our submission is for a lot of families. I work with families going through the AON process. There is a complete lack of information and clarity for them. That is something that would really help in those families supporting their loved one or child, and in reducing pressure. Being able to access support or alleviate some of the issues that they are facing right here and now day to day while sitting for years on waiting lists. Having information available and accessible is an achievable aim, as is having support. There is also complete disregard for the fact that a lot of these families are also disabled. Disabled parents are fighting for their disabled children in a completely inaccessible manner.

This point is not entirely related but I do not know where to put it in. Again, as someone who processes and does administrative processing for AON referrals, another thing I encourage the committee to do in its future work is probe the withdrawal and work on it. I totally understand the need for there to be a process to withdraw and close cases. However, I am also very familiar with the fact that cases have not received contact details for the families, where there have been incorrect contact details or where a child has changed custody and legal guardianship and that has not been tracked through the system. The AON officers I have worked with have been fantastic, but it is a huge caseload with human error and with lots of moving pieces. I would like to try to probe into exactly what that would look like. The last thing we need or want to see is children and families who need the support having their cases closed and being removed due to human error.

Very quickly, on the school aspect, one of the big concerns we have in relation to that announcement, the one-liner Mr. Harris referred to, is where it will lead. If diagnosis is removed from the school system for autism classes for special schools, how will the Department of education plan for the children coming down the tracks? Back in 2021 and 2022, we saw the hotspots around the country, where the Department obviously did not have the data it needed to be able to plan. We then had the introduction of the portal, which allowed for some planning to foresee the children coming down the tracks who needed access to an autism class. Removing that diagnosis element, in the absence of an inclusive education model or centralised data, is a concern. This aspect needs to be probed a little more with the relevant officials to determine how they see it materialising. At the end of the day, it will be the parents who will be looking for the classes and the schools, and who will have the worries, concerns and consternation that come with doing that.

I thank Mr. O'Flanagan very much. That concludes our discussion. I thank Disabled Women Ireland and AsIAm for attending today's meeting and providing the various briefing materials in advance, which assisted the committee in its deliberations. The insights and expertise provided today are critical not only in terms of knowledge but also in shaping and improving our legislation. I propose that we now suspend for five minutes to prepare for our next session. Is that agreed? Agreed.

I welcome Dr. Emer Begley, director of advocacy and Ms Treasa McAuliffe, member, Disability Federation of Ireland DFI; and Ms Gillian Darrer, head of services, south and west, Dr. Claire Milner, principal psychologist, north east and Dublin west, and Ms Frances Fitzell, director of services, Dublin and the south east, Enable Ireland.

Before we begin, I will read a note on privilege and housekeeping matters, as I always do. All witnesses are reminded of the long-standing parliamentary practice that they should not criticise or make charges against a person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to an identifiable person or identity, they will be directed by me to discontinue to their remarks. It is important that they comply with any such direction I make. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected pursuant to both the Constitution and statute by absolute privilege.

The committee welcomes the opportunity to engage on such an important issue. We look forward to engaging with all the witnesses and thank them for accepting our invitation to come here and share their experiences and ideas with us.

I ask all those in attendance to ensure their mobile phones are switched off or on silent mode.

I call Ms Begley to make her opening statement.

I thank the Cathaoirleach and members of the committee for the opportunity to appear today on this important matter. I am joined by Ms Treasa McAuliffe, who is the CEO of St. Gabriel's Foundation. I will share my time during the question-and-answer session with her.

We welcome the committee's examination of the proposed reforms to the assessment of need process under the Disability Act. DFI has a broad membership of organisations working in children’s services. Among these are those that work directly with children and young people across a wide range of service areas, as well as family-led and often voluntary groups formed by parents. We have a children services advisory group, which facilitates our consultation with members. The insights and lived experience contributed by these family-led organisations, alongside the professional expertise of our service-providing members, have strongly shaped and informed the perspective we are sharing with the committee today.

We recognise the intention of this Bill to address well-documented shortcomings in the AON system, including high application volumes, administrative burden, delays beyond statutory timelines and ongoing confusion experienced by families navigating access pathways. The Bill contains welcome proposals, such as clearer definitions, statutory guidance for AON officers and streamlined procedures. These are all critically important and badly needed, and, in time, we hope will help reduce administrative barriers.

Our members, however, repeatedly emphasise that legislative and procedural reform alone will not achieve their objectives without adequate investment, workforce planning and system-wide alignment across health, education and social protection. This will be exacerbated by the creation of any independent structure that risks detaching assessment from the family-centred model of care delivered through the HSE Progressing Disability Services for Children and Young People programme. As a result, we urge a focus on joined-up assessment and service delivery, grounded in strong resourcing for existing services.

I will briefly turn to family-centred practice. We must start from the perspective and appreciation of the children and families who experience the AON process. There is a risk that the Bill is siloed out of context to wider children’s disability services. Any reform must ensure meaningful engagement and clear, coherent communication so that families are not left in limbo, directed towards additional assessments or new waiting lists. The first interaction matters greatly. If families experience AON as merely a signposting exercise toward more assessments, they feel disenfranchised and unsupported. The proposed model also risks being implemented without recognising that most children will require further clinical assessments to access education, health or social protection services. Without clarity on these pathways, families may experience more, not fewer, barriers.

Many of DFI’s members providing services and supports operate with persistent staff shortages and limited clinical capacity. While the reforms aim to increase assessment throughput, this may widen the gap between assessments completed and the availability of interventions, therapies or family supports. Without parallel investment, there is potential for increased pressure on already overstretched front-line teams, raised expectations that cannot be met and reputational risk when organisations cannot follow through on identified needs. This challenge stems from the broader national constraints in the disability workforce, coupled with the lack of a coherent and fully costed resourcing plan aligned with the forthcoming legislative changes and the timeline required to implement them.

While AON officers validate applications, clinical assessments fall largely to the children’s disability network teams, CDNTs. AON work is one part of CDNT responsibilities, yet statutory deadlines and high demand can create disproportionate pressures, which include: prioritisation of AON assessments over standard referrals; delays in routine assessment, intervention and family supports; duplication of engagement with families due to a lack of integrated pathways; and inconsistency in AON practice across regions.

From a practice perspective, to address this we recommend: a statutory AON team working alongside CDNTs to protect intervention capacity; integration of AON and the single point of access, where possible, to avoid repeated retelling of family need; and timelines that allow CDNTs to respond to priority needs. Expanded clinical recruitment and dedicated administrative support, without parallel investment and shared responsibility across services, poses a risk that reforms will deepen current pressures rather than improve access or timelines for families.

Furthermore, families may fear that any reforms will dilute their entitlement to a full AON. Under the Disability Act, children have a statutory right and families an established appeals mechanism. Assurances are required, therefore, that any proposed amendments will not reduce access to comprehensive assessments, weaken legal remedies for delays or increase reliance on costly private assessments, adding further to deep inequalities. Despite assurances that an AON is not required to access supports, lived experience indicates otherwise. Narrower documentation may limit access to educational placements, school supports, domiciliary care and other social protection measures.

Procedural reform is necessary but must not be viewed as a neutral technical exercise. These amendments reshape rights, expectations and responsibilities within a system already under strain. DFI urges the committee to ensure that reforms ultimately strengthen the rights, supports and opportunities available to children with disabilities and their families.

I thank the Cathaoirleach for this opportunity to meet with the committee today. I am the head of services for the south and west with Enable Ireland. I am joined by Dr. Claire Milner, head of psychology, and Ms Frances Fitzell, director of service for Dublin and the south east, and by colleagues in the Gallery.

Enable Ireland provides services to over 13,000 children and 400 adults across all six regional health areas, RHAs, and employs over 1,600 staff. As lead agency for 20 CDNTs, and the second largest provider of CDNTs in the country, the AON process has been part of our practice since the commencement of Part 2 of the Disability Act in June 2007. Our teams, while striving to meet our statutory obligations, aim to maximise accessibility to services, accepting direct referrals by or on behalf of the family and via the AON process. With 18 years’ experience, we share our learning and how we believe the AON process can be improved to ensure the best outcomes for families.

We have learned the importance of value alignment. The spirit of the Act, the principles of progressing disability services and our values are all aligned in keeping the best interest of the child and family at the centre of what we do. Whenever change is introduced, it is imperative that our collective focus remains on keeping the best interests of the child and family at the centre of our practice. We fully recognise and support the families' right to apply for an AON. Information on AON must be more accessible. Experience has told us that most families are unclear on why they request an AON, what an AON will deliver and, more importantly, what it will not deliver for them. Many families mistakenly believe that an AON is required to access services or that it will deliver intervention for their child. A misalignment between families' expectations of AON and the outcome of the process causes confusion and frustration and can lead to a breach of trust and often adversarial relationships.

Relationships are key. Working with families requires a relationship of trust with the clinical team. The value and benefit of building that relationship from the earliest possible point in the child and family’s journey is key to providing the right supports at the right time within the available resources. The timing and process of assessment is central to effective therapeutic relationships. To adequately support children with complex needs and their families, it is imperative that we recognise and support them as being on a journey with their needs evolving and changing over the lifespan. Some families need support for a specific reason at a point in time, perhaps to answer a question such as, "Does my child have dyslexia?" Other families may need support for a season of their life. They might need early intervention to support the child in his or her preschool years. Other families may need a professional support system for a longer period or over a lifetime.

Being child-centred means being truly curious and wanting to understand that child or young person. This cannot be captured by one standardised assessment as often occurs under the existing AON system. There is a risk that the statutory timeline becomes the focus rather than the appropriateness of what is right for the child at each point on their journey, and, therefore, not addressing their needs. How can we, as a country, do better to address AON? In respect of communication, the provision of accurate, accessible and easily understood information in relation to the AON process for families is essential to ensure those who wish to avail of it are fully informed.

Key questions that need to be addressed include: what is assessment of need and what is it not? What do children and families need it for and what will they have at the end of the process? What can children and families access without going through an assessment of need process? What can be expected from health and education services following an assessment of need?

The statutory timelines need to be considered. Assessment of need timelines can overshadow clinical needs with assessment becoming process driven and not child centred. Families need clinicians to be able to respond at the right time and in the right way.

CDNT and primary care need to be resourced to do the assessment. CDNT and primary care teams are best placed to undertake assessments. Clinicians and services that have the knowledge and expertise require both adequate resources and a legislative framework to respond at the right time and in the right way. This is in keeping with the Sláintecare principle of right care, right place, right time.

Building on the work currently being undertaken within the HSE on a single point of access to services for children, consideration should be given to processing assessment of need applications through the same single entry point. This could ensure families are directed to the right pathway at an earlier point in their journey.

There should be input from all stakeholders into the development of the guidelines for assessment. We recommend that the proposed guidelines in respect of the assessment process be developed in consultation with the stakeholders and note the importance of ensuring representation by those with lived experience as well professionals involved in completing assessments.

I now invite members of the committee to ask questions. When I call members to speak, they should adhere to the agenda item scheduled for discussion.

I thank the witnesses for joining us this evening, for their informative opening statements and for effectively spelling out what best practice could and should be. I will be the devil's advocate. We have established from the previous budget that money is not really an issue because the allocation to disability services is up approximately 20%. The human resources and relationship building piece both groups referred to is critical in order to build the relationship and trust, etc. In the absence of an adequate number of professional personnel and guidelines, etc., do the witnesses think the process of amending Part 2 is premature? Should we hold on until the single point of access is in place, recruitment is complete and there is clarity or should we change for the sake of change and perhaps have unmet needs, hopes raised and expectations unmet? As I said, I am being the devil's advocate. I am just trying to get my head around everything.

Whether change happens or not, the primary point we are trying to make is that our teams need to be resourced to do the work. Whether a child comes through an assessment of need process or not, we need the staff to meet their needs, whether for assessment, intervention or any manner of support, resourcing all the way through that chain from university graduates all the way up. We need the staff.

Amendment of the Act would be great but it needs to be consistent. If we cannot provide the intervention afterwards, we are not providing anything meaningful or making changes in outcomes for families. There is a concern that by amending it now, all we are doing is moving deckchairs and families will be left in a worse state than they are already, not getting a full assessment or anything meaningful and we still cannot give them the follow-up. An assessment is great but one of the most devastating things for a family is to be given an assessment and told this is what their child really needs but we cannot provide it for them and they have to wait two years for us to be able to deliver on it. While they are delighted to get the assessment, it is demoralising. It is so disrespectful and disingenuous to families. We need to amend across the whole review of disability services. We have two children's disability network teams. One has long existed since the reconfiguration and the other was set up in 2021. In 2021, we had eight staff on that team and 121 children and families. Every child was seen within 12 weeks, delivered with an IFSP and was able to get follow-up. For two years, there were no delays in service delivery. There are now 628 children on that team with six extra staff and there is a two-year waiting list. It can be delivered. The model works but it is about how it is delivered and the resourcing. That is proof of what happens.

To put this in context, even when a team is considered fully resourced, all posts are filled and there is a full complement of different disciplines - we looked at what that would equate to in whole-time equivalent posts and how many children within the service. Across a year, it equated to, per child, 6.45 hours of psychology provision, 11 hours of speech and language therapy, 9.37 hours of occupational therapy, 2.99 hours of physiotherapy, 2.46 hours of social work support and 2.5 hours of liaison nursing support. Even when there is an increase in money allocated to services, a team is at full capacity and all posts are filled, one can see how paltry it is in terms of what will meet the needs of children with very complex needs. We recognise not every child in our service within a year might need access to psychology or speech and language therapy but even if one quarter of those children did, it would probably still only amount to one comprehensive assessment that gives us a holistic understanding of what a child or family's needs truly are. We need to be curious about what is considered a well resourced team and what it looks like in practice.

I thank the witnesses for coming to the committee this evening, for what they submitted beforehand and for the great work they do. The witnesses from DFI suggested a dedicated statutory assessment of need team working alongside CDNTs. How would that be structured? How could both sides be protected if this were to happen?

St. Gabriel's runs the assessment of need team in the mid-west. Ideally, assessments of need would be done through the teams if they were properly resourced. The therapists who know the children best would provide the assessments and would then be able to do the follow-up. That would be a consistent pathway, developing relationships with parents. Due to the statutory regulations, assessments of need done with CDNTs were prioritised because of complaints and legal requirements. Therefore, if a child or family was referred for an ASD assessment or assessment that was not an assessment of need, they never came up on the list because assessments of need were prioritised because there were always complaints and due to the resource level. If we do not have properly resourced teams, we need the assessments of need to run alongside them and collaboration with assessment of need teams so when it comes to handover, the therapists who know the children best are the people to follow up on interventions going forward. It works but ideally they would be done within the teams. In light of such a long waiting list, children in teams who do not apply for an assessment of need are disadvantaged. There is also a delay in the delivery of interventions because the assessments are always going to be prioritised due to the statutory obligation and the legal obligation that goes with it.

They come first. Enable Ireland noted families often misunderstand what an assessment of need is and what it is not. I fully agree. In a former life, I dealt with families.

There is a misunderstanding and a bit of a misconception of what it actually is. What would Ms Darrer do to correct this? What would she deploy? Who would author it? How would she measure whether it was working?

We have some lived experience of that. In one team, for example, the waiting list for services was about six months prior to the commencement of the assessment of need process. After the assessment of need process commenced, we had many applications for assessment of need coming in from children who were already with the team as well as from children outside the team. They had been encouraged to make those applications by their schools, GPs and public health nurses. There was a misunderstanding within the system of what an assessment of need was and was not. The waiting list went from six months to over two years. Much as Ms McAuliffe mentioned, because of the statutory obligations on us, work then pivoted to addressing the assessment of need demand and, at times, maybe redoing assessments that we had already done in order to meet those obligations.

There was a recognition that this was a problem and that people were misunderstanding what it was about. There was a targeted piece of communication done with those key stakeholders, such as schools, GPs and public health nurses as well as with families, so that when a family first made an application, whether it was for services or an assessment of need, there was a full and frank discussion with them about what they were looking for, what their concern was and what the various routes were for them to address that worry.

With that piece of work, waiting lists came right back down again to six months because families understood what they were getting and what they were not getting, and clinical time was being used appropriately. We went from over 70% of the work being taken up with assessments of need to it coming right down to 25%. The rest was then focused on meaningful intervention and support. Whether that was assessment, actual hands-on intervention or group supports, it was meaningful and what the child and family needed at that time. That really shows that communication is key here. A nationwide approach to that would potentially help the situation.

I apologise for not being here earlier, but I read the witnesses' opening statements, and I thank them very much. I welcome them here, especially Ms McAuliffe. I know her very well from something I was previously involved in. I compliment the witnesses in terms of the different roles that they have and the work that they do.

Dr. Begley referred to reducing administrative barriers. She also talked about education and social inclusion. Will she paint a picture as to what that would look like? How can the reduction of those barriers happen? She also stated that the proposed model risked being implemented without recognising that most children would require further clinical assessments to access education, health or social protection supports. Will she provide a little bit of clarity around that area?

The Enable Ireland witnesses spoke about how the children coming in may have needed access to other services or whatever. Will the representatives from both organisations comment about that joined-up thinking piece?

I have always been a firm believer that one size does not fit all, but that may be what is being considered with the proposals or reforms. Will the witnesses comment on that?

I can take the question that relates to additional clinical assessment. The nature of children is that they grow, change and develop, so they will have changing needs over their childhoods and clinical assessment may need to be done in another way. In addition, you may have someone who goes through the assessment of need but it may not address all of their needs at that time or later and they may need to have additional assessment for access to some educational supports.

Ms McAuliffe will take the question on reducing barriers.

This speaks to what we have already addressed. Families are applying for an assessment of need because they feel that it is the quickest way to access a service. Not only that, but they are applying to everywhere for access. They are applying to primary care and to CAMHS. Therefore, there are a huge lot of administrative resources being used up and children on waiting lists who do not necessarily need to be on waiting lists. However, if I had a child in the morning and you asked me what I would do, I would apply everywhere and see where it landed because what all parents want is the quickest way to get the needs of their children met. They know what their needs are and they need them to be met. If families could be directed to a single point of access, it would be huge. It is soul destroying for families when they get rejection letters telling them that their children do not meet the criteria.

We all need to start working together. Assessments of need to be done through primary care, CAMHS and disability services, but we all need to work together. Unfortunately, and as the Senator said, one size does not fit all. A lot of our children have comorbid disability. They need an assessment and supports. Their assessments of need should be joint assessments between disability services and CAMHS so that their needs are properly assessed. It should not be that we are doing two separate assessments and then we are coming up with a comprehensive plan to meet the child's needs.

It is also about education. We need to start getting out of our silos and working together. Everybody is working to different policies. Disability services have a policy to say they will not see a child for a certain reason and primary care says that the child does not meet its criteria, and then you have a series of children who are not getting any services. A service provider may say that a child has a comorbid mental health difficulty but it cannot see them for two years. Unless we can address these things together, we will not get better outcomes for families. We need to start looking at where the outcomes for families can be best addressed. Unless we all start working together, then reforming the assessment of need process or the whole thing will not lead to better outcomes. Getting better outcomes for families is what we are about at the end of the day.

Go raibh maith agaibh go léir. If we go back to the previous session, there is a lack of trust, given the history of families and those others who have engaged with services. We all want to see a single point of access. We constantly talk about it.

The witnesses made a couple of very important points. As to communication, Mr. Bernard Gloster got it. Those who speak reasonably favourably about CDNTs are those who have had direct communication, and that is why they are happy. It is a fairly obvious thing.

In a perfect world, you put the assessment and therapies where the need is and that will deal with the majority of things. That is why we never should have moved away from in-school therapies. Unfortunately, how we are getting back there is piecemeal. In real terms, that might mean that it will be a very different sort of CDNT that we will need for those who need more acute care and circumstances.

The problem is with the AON process. There are 22,200 on the list and this legislation is about, to a degree, dealing with that. That is probably the primary focus of why it is happening. I would like it if it was not, but it is. That is also accepting that 22,200 is a ridiculous number of people to be languishing on the list.

In a perfect world, we would have constant assessment. It would not be locked into the AON process and how that was set up. As much as we have heads of Bills and everything else, what should we be aiming for at this point of time to create a system that would actually work? In fairness, the best line we heard was that it equated to, per child, 6.45 hours of psychology provision, 11 hours of speech and language therapy and 2.99 hours of physiotherapy. That is the reality. We have about 400 to 500 positions unfilled within the CDNT system. If we filled all of those, it would still not be enough to deal with what was out there. We have never had a proper conversation about how we can best provide services. That is also while accepting that we cannot give every kid one-to-one support for an indefinite period of time. Some of it is a means of ensuring that everyone uses best practice, whether that is in a school setting or whatever other setting, giving support to parents and ensuring that assistive technology is used. We are not really having that full conversation. We are dealing with a bit here and a bit there. Again, people are absolutely-----

Does the Deputy want to get some answers?

It would be a good answer, if the witnesses can give it.

Would anyone like to comment?

I will always come back to resourcing being key. We can see the figures across the country and there is huge variance in what is resourced. Some areas have one clinician for every eight or nine children in the team and some areas have one clinician for 72 children on the team. There is a massive variance. Can we even the playing field so at least we can make best use of the resources we have? That would be a big starting point.

Returning to something the Deputy and the Senator said, and referring back to what Dr. Hassett and Mr. Harris said earlier around how the goal should not be about taking people off waiting lists, equally, we would caution against the goal being about timeframes or focusing on a timeframe to support a person through an assessment process. As a clinician, I would very much see, when I meet a family, that it is an interwoven process between assessment and intervention. When children come directly into our children's disability network team, CDNT, our first point of contact is intervention support. We may be introducing them to a new process they have not had experience of before. Maybe this is their first time meeting with clinicians. Perhaps it is their second or third time, depending on their family composition, but we are starting that point of assessment, intervention and support at that very first point.

One thing that can be a little concerning with assessment of need is that it sees assessment and intervention as two discrete processes and that assessment can be reduced to the following binary question, with a "Yes" or "No" answer: does my child meet criteria for a diagnosis of autism, intellectual disability, developmental co-ordination disorder, DCD, or whatever? In CDNT, on the other hand, what we would see is that we are starting at the point to build that - Deputy Ó Murchú said the word "trust" - relationship of trust with the family. We ask them to tell us about their child. We are looking at the UNCRPD in terms of a biopsychosocial model of understanding of a child or a young person and their family, what are their relative strengths and what are their areas of need. As Mr. Harris said, we should not be getting to the end of a diagnostic process and that it is simply a gateway to a diagnosis. What it is is creating a comprehensive formulation of a child or young person and their family system around what are their needs and how can the services - we talked about joined-up working - start meeting their needs across their lifespan. If we have a three-year-old coming in to us, the question from the parents might be whether their child is autistic and how they would like that question to be answered. When that child is held and supported by a fully-staffed CDNT, however, what we can be saying is let us answer that question but we do not need to be waiting for support and our speech and language therapist and occupational therapist are ready to start supporting their areas of need, be that a total communication approach or supporting their sensory system. Our nurse will be coming in at the same time to note the parents may be concerned about toileting or a paediatric review and will ask to support the family with that. Psychology might be stepping in at that time and starting to talk about school options.

I thank all the witnesses for coming in.

What if we had proper resourcing of the primary care services, CDNTs and CAMHS, if we had a single point of access working properly between those services, if we had clear staffing benchmarks for primary care in particular and a comprehensive recruitment drive there because that is the most crisis-hit part of our child services, if we phased out the private outsourcing of assessments of need, which is fragmenting services as far as I can see and creating perverse incentives for clinicians to leave the public sector where you have newly-qualified psychologists now being offered the equivalent of senior grade salaries to take up posts in the private sector? If all of that was dealt with, would we still need reform of the assessment of need process? Is this proposed legislative change really just about rearranging the deck chairs on the Titanic of service development failure over many years and failure to integrate services or does there need to be, separate to all of that, a change in the eligibility for a assessment of need?

If you resource primary care, CAMHS and CDNTs, you are not necessarily going to get integrated working. There needs to be an effort about how they work in an integrated way to support good outcomes for children. How you do integrated working takes dedication, commitment and people having a willingness to step out of their silos. There has been a lack of resourcing that has put undue pressure across the whole system. A focus on integrated working will see improved outcomes.

Ms McAuliffe mentioned rearranging the deck chairs. It really has to be about looking at outcomes for children as the primary objective. All the clinicians, all the family members and everybody involved in services want that as their primary objective, but outside of the current system you also have community organisations which have specialist knowledge on different conditions which are part of this as well and they are another untapped resource for the system.

Do they agree that a lot of the siloed working and a lot of the difference of practice are due to the fact that services are so under-resourced and they are necessarily drawing up the shutters and trying to make their admission criteria rigid?

In years gone by, there certainly was a lot more willingness and openness to work together. We are very protective of trying to provide for our clients, primary care no doubt is trying to protect its clients but if there was more capacity in the system, the willingness and the openness certainly would be evident. We certainly need to look at that.

It comes back to the example that I said at the start of the new team that started. When we were properly resourced with the number of children, when you had eight clinicians and 125 children, you had a full team for 125 children, every child was seen within 12 to 16 weeks and the system certainly worked. Definitely, we can all work together if the teams were properly resourced. Were there equity across the country, as Ms Darrer said, around the resourcing of teams, it could even start there. Part of PDS is that there is supposed to be equity of access and certainly, at the moment there definitely is not.

Are we on a bit of wild goose chase with this legislative change then? The elephant in the room is the lack of resourcing and the lack of integration of services that has resulted from that. Is there a separate need to change the eligibility around assessment of need?

If they were adequately resourced and if the parents were getting the services that they needed and their children were getting what they need, they would then be getting their assessments in a timely manner and there would be very little need for the assessment of need. The assessment of need demand is driven by the fact the family see it as the quickest way to get services for their children.

I thank everybody for coming in. I will pick up straight at that point, with Ms McAuliffe. Enable Ireland, in its opening statement, stated, " Many families mistakenly believe that an AON is required to access services or that it will deliver intervention for their child." Both are on the same point. At times, I would be on that same point as well. As a behavioural psychologist, I have often sent people towards the AON in that short timeframe knowing that it is their only access to the home tuition. It is for ten hours between the age of two and a half and three and 20 hours when between three and four years, and is probably the only real chunk of intervention you are going to get because if you do get into the CDNT team or the primary care team, as the witnesses have outlined, even with a fully-serviced team, you are not going to get that level of intervention. The figure of €900,000 to keep somebody in residential care was put in here a few weeks ago and I am thinking about probably 900 hours of tuition across a couple of years. Anyway, both of you made those statements and I have often made that statement as well, that some people go for the service.

Adam Harris clearly outlined the feeling of gaslighting that is going on towards the autism community to the effect that they are only going for access to services. Mr. Harris outlined that the National Disability Authority has confirmed there is no evidence to support the claim that changes to how resources are allocated in the education system will lead to fewer people seeking access to diagnosis, as is their right. Are we at risk of maybe perpetuating this theme that people are going for the assessment of need to get services? Are we at risk of this becoming the narrative? Lots of people want to understand. They have had this child and they have planned out this life for them and then they start to see that they are not meeting their milestones and they want to get a full picture and understanding of their needs.

I suppose our point is that families mistakenly believe that it will lead to services. We widely acknowledge that it does not. Also, to speak to Mr. Harris's point earlier, and to that of the Deputy, diagnosis at times is itself a therapeutic intervention. Dr. Milner may come in on this as well. That "Aha!" moment of explaining one's life and why one is experiencing things one has experienced is really powerful for people.

Therefore, we absolutely would not want to minimise the importance of that, but within the system, there is a miscommunication or misunderstanding that if I go for an assessment of need, it will lead to services. It will not, albeit that in some parts of our systems, people need a label or diagnosis to access supports, for example, home support or under the Department of Social Protection, different allowances may be available to families. There is a disconnect in some of our systems.

I agree that CDNTs and primary care teams are best placed to undertake assessments. What is Ms McAuliffe's view on private practitioners carrying out assessments? Does she agree with that practice or does she think it should not be happening?

To clarify another point, I do not mean that it is the easiest way for families to get it because families need to understand their children. They will look for anything they can get to support their children. People just want the best for their children and they will go about it any way they can to make sure they can support them in the best possible way. That is what families do and it is what they have to do.

On the private assessments, at the moment they are the only way families can get that service and it is better that families are getting the assessments. It is not the ideal way to get them, but there is a responsibility on the CDNTs to support private providers to make sure the assessments families are getting are within the standards and that if families are paying for the assessments, they are the right assessments, the practitioners are using the right tools and families are getting something that is meaningful for them. In the situation we are in, it is better than families not getting an assessment at all.

I thank all the witnesses for their contributions and for sharing their in-depth knowledge and experience of working in this area, the on-the-ground experience of it. There are some useful and measured recommendations and feedback in their statements. Something that stood out to me from both the statements was that a narrower documentation requirement could limit access to supports down the line. That could be a risk. There is an obvious inconsistency across the regions. Mr. Bernard Gloster was before the committee previously and he highlighted that the south west, including Cork, was a particular area of concern for waiting lists at that point. Other areas are also of concern. There is a recommendation that there should be statutory assessment of need teams alongside the CDNTs and that we need a family-centred and child-centred approach to communication. Towards the end of its statement, DFI said that without safeguards, role clarity and substantial resourcing, there is a risk that reforms will normalise inadequate provision rather than resolve it. Does DFI want to expand further on what those safeguards would be?

The concern is - and this is a lived experience - that several years ago the Disability Act was reformed, the AON was reformed and the preliminary team assessment, PTA, was introduced. That did not work for families. They did not get what they needed. They did not get a full assessment and there is a fear with this that what will happen again is the recommendation from the AON will be that further diagnostic intervention is needed. It was tokenistic. We feel that at least when families get an AON now, they get a comprehensive assessment. They get something meaningful that they can use for resourcing. Our concern is that it might be a watered down assessment. At least if families wait, when they get the assessment, it should be something they will get something meaningful from.

The amendment of the Act has a focus on AONs. It is the pathway for children afterwards and support for the child after assessment. Without reform or review of the broader system, there is a danger this will be seen as a kind of panacea or of the system being reformed when the amendment is very narrow. It is a commitment in the programme for Government and in the National Human Rights Strategy Disabled People 2025-2030 that the Disability Act will be reviewed and reformed.

Dr. Begley took the word out of my mouth. The word "panacea" came to my mind. Getting the assessment is one thing and it provides great clarity, information and validation for people, but it is about the supports afterwards. The elephant in the room is recruitment and retention of staff working in these CDNTs. That is a huge workforce planning issue we need to tackle as a country. Does Ms Darrer want to come in on that?

We have to commend the HSE in this regard. It has put significant resources into workforce development for CDNTs and we have seen an overall increase of 10% in our workforce since October 2024. With that, we have also had new development posts, including 143 WTEs - when I say "we" I mean the whole CDNT system, not Enable Ireland - and we have also seen initiatives like student sponsorship schemes. That has yielded 45 new recruits into the system. A lot of work has gone into initiatives such as overseas recruitment and different types of recruitment campaigns and that has yielded positive outputs for us.

This year, the HSE is also undertaking a retention study to look at why staff stay and what we can do to latch on to that and make improvements to our system. Other positive things that have helped our staff include investments in clinical support for them, the interim discipline manager roles and investments in clinical training and development. All those serve to recruit staff to and retain them in our system. In any of the initiatives the HSE has undertaken, it has willingly engaged with section 38 and 39 agencies. We have all been part of that and benefited from it so we must commend the HSE on that.

My question might be a little off point, but one issue concerns me. My background is in healthcare so I am a divil for looking at possible causes. If someone lands into the pharmacy, I ask what the reason for X, Y or Z symptom is. The figure in 2020 for AON applications was approximately 4,700. Then it jumped to 13,000 in 2025. In 2020 and 2021, I recall asking at the regional health forum for an extension to the cut-off of 48 months for children's developmental checks by 24 months. However, it was not to be. That was followed by the 2022 and 2023 pay and numbers embargo in the HSE. Let us take an average of 4,000 for each of the four years, not to lay blame, but to prevent it occurring again, to ensure we get adequate resources, teams are supported and, more important, the needs of children and families are met going forward. Do any of the witnesses have an opinion on that?

The increase in time was around the time of the PTA. That PTA did not stand up legally. The standard operating procedure, SOP, was changed and it did not stand up legally. All the assessments that were done under that PTA had to be redone so the numbers increased dramatically. That is one of the things we are concerned about so that it does not occur again.

I cannot remember which of the papers mentioned the single point of entry the HSE is working on and made a suggestion that children could be in the same system for their assessment of need.

Do the witnesses have any comments on that?

I will speak to the example I gave earlier where we saw assessment of need applications dramatically increasing waiting lists because of families' misunderstanding of what such assessments would yield for them and the work done to bring that number back down by having discussions with families. We could bring something like that into the single point of access system. As Ms McAuliffe mentioned, families were being bounced around. That is why we are implementing a single point of access, which will bring applications for assessments of need, primary care, CAMHS and CDNT support all into one central area where families can have a real conversation about what they are worried about and what they need before being signposted to the correct area. If I apply for an assessment of need today, if everything goes well and wonderful, I will have an answer as to whether my child has a disability at the end of six months. I will not have services. If I apply for services today, I will be six months down the line in terms of accessing them. A child whose parents have applied for an assessment of need will have to go back into that system.

Dr. Milner spoke about the idea of a child entering the care of a team, that team starting interventions straight away and then there being assessments as to what works and what does not. That is the perfect scenario. How do we reach a point at which that is happening for every child? What do we need? It is all well and good to talk about adequate resources but what would resources need to look like in the CDNTs and in primary care in this regard? Our Turlough was between the two at different times. I mean only the best when I say we did not get a service. With regard to speech and language therapy, we took him somewhere, but it would have been a hell of a lot better if that therapy had taken place within a school setting because the school would have also got the benefit of it. I have mentioned assistive technology. What sort of resources are needed? I have no problem saying that assessments of need and the CDNT system are not working at the minute.

To pick up on what Ms Darrer said, whatever reforms are made to the process, which is not necessarily a question for those of us here on the panel, we are meeting families at a vulnerable point in their journey. The Deputy just alluded to that. As clinicians working within services, we would hope that, when a family starts to feel concerned or worried, that family is not lost in the system and left wondering whether to go to primary care, the CDNT or their GP. They should be able to pick up the phone and for the person at the other end to offer to guide them so that we can start to build that relationship of trust. The team must then be in place with resources to meet that child. It will look different for every child. We gave quite crude figures, the six point whatever hours, but not every child is going to need that. Some children will need a lot more. However, the team must be resourced so that, when a family comes in the door with their precious child, we can provide them with support, interventions or assessment based on that child's needs. If that evolves into a formal diagnosis, that is part of the journey. I went on a little bit earlier but where I was going with it was that, for children in CDNT services, it is very rarely a case of just one assessment. Ms McAuliffe alluded to that. A parent might come in with a particular question, perhaps as to whether their child is autistic. As we go along that journey with them, we need to be very mindful of the differential diagnosis. We know that 40% to 50% of all children have a co-occurring diagnosis or neurodevelopmental condition. We need to be responsive to that and to look at assessments much more as part of the journey.

Will our guests from St. Gabriel's and Enable Ireland comment on what it was like to work in disability before the roll-out of the progressing disability services programme and afterwards? What is the level of morale among staff? What discrepancies are there between what they are able to offer clients and what those clients need? Is it very challenging to retain staff at the moment?

In the year or two after reconfiguration, our teams were very demoralised, as were families. It was a very difficult period for families and for our staff. Our teams have started to come out of that. There is recognition within the country of the demands being placed on teams and what that means for families. I refer to the paucity of resources. The publication of census reports and so on has really made how difficult things are understandable and accessible for the whole country. That has helped our teams' morale.

We are in a different situation in that we were one of the first teams to be reconfigured. We were reconfigured in 2004. We have been through cycles of reconfiguration. Deputy Ó Murchú asked about resourcing. When the reconfiguration started, the figures given were that there would be a whole team, comprising physiotherapy, occupational therapy, speech therapy, psychology, social work and nursing, for 120 school-age children and 100 children in early intervention. When we were working to those figures, there was certainly more job satisfaction. Over the past two years, I have lost six of my clinicians, who had been working in disabilities for over 20 years, because they feel they have been through the cycle, worked through it and can no longer deliver the same services they were able to deliver before. They feel like they are letting families down. While the system works and they are very happy with the model of service - we have got past the whole thing of people not liking the model of service and everybody now believes in it - they are just seeing too many families. They have moved onto different services because they feel they cannot deliver. These were really committed and really qualified people into whom an awful lot of investment had been made but they have recently left because they feel the pressure of the caseload is just too much. The caseload is the only reason they are citing. They would have been very happy to keep working, they are very disappointed to be leaving and they like the model of work.

That concludes our discussion for today. I thank the Disability Federation of Ireland and Enable Ireland for attending and for providing briefing material in advance, which assisted the committee in its deliberations. The insight and experience provided today will be critical in terms of providing knowledge and will also shape improvements to the legislation that is being presented. I propose that we publish all opening statements to the committee's website. Is that agreed? Agreed.