Apologies have been received from Senators Bradley and Harmon and Deputy Healy. The purpose of today's meeting is to continue the pre-legislative scrutiny of the disability (amendment) Bill 2025. Today's meeting is split into two sessions. I welcome the witnesses to the first session. From the Health Service Executive, we are joined by Ms Martina Queally, regional executive officer, Dublin and South East region; Dr. Aoife O'Donohue, assistant national director, access and integration disability services; and Mr. John Fitzmaurice, integrated health area manager, HSE West and North West.

As always, I will read the 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 a person or entity. Therefore, if their statement is potentially defamatory in relation to the identifiable person or entity, they will be directed by me to discontinue their remarks. It is important they comply with any such direction. 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.

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. 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 an important issue. I thank them for accepting our invitation to share their experiences with us. I remind all in attendance to make sure their mobile phones are either switched off or in silent mode.

I call Ms Queally to make her opening statement.

I thank the Chair and members of the Committee on Disability Matters for the invitation to meet with them as they consider the pre-legislative scrutiny of the disability (amendment) Bill 2025. I am the regional executive officer of the HSE Dublin and South East region. I am joined by my colleagues Dr. Aoife O'Donohue, assistant national director, HSE access and integration, and Mr. John Fitzmaurice, integrated health area manager, HSE West and North West health region.

The work of the committee in its ongoing oversight of disability policy and legislation, including Ireland's implementation of the UN Convention on the Rights of Persons with Disabilities, provides an essential forum for the HSE to contribute to, and be accountable for, all aspects of our services for people with a disability.

In addressing the committee on this important legislative programme, I wish to emphasise three key points. The scale and nature of demand for assessments of need has changed significantly. A modernised, streamlined, proportionate approach, while maintaining the rights-based framework, is essential to ensuring timely access to assessment for children and adults.

The targeted legislative changes, supported by strong statutory guidelines and co-ordinated operational reforms, present a real opportunity to improve the timeliness, quality and consistency across the system. It is essential that the assessment of need is available to those who require it, while also ensuring that appropriate alternative pathways exist for those who do not need a formal assessment but may still require support or intervention.

Successful implementation will require clear statutory definitions, coherent sequencing with other services, particularly education, and sustained capacity across services so that children, young people and adults receive the right intervention at the earliest appropriate time.

The HSE is committed to delivering responsive, integrated and person-centred disability services aligned with the core principles of Sláintecare. This includes timely access to assessment and intervention, care delivered close to the individual's home by multidisciplinary teams, needs-based pathways of care and early interventions supported by strong co-ordination across primary care, child and adolescent mental health services, CAMHS, children's disability network teams, CDNTs, and adult disability services with education partners.

The HSE recognises the pressures created by delays in assessment and service access for both children, their families and adults with disabilities. As part of our wider reform programme, we are strengthening governance, improving clinical pathways, expanding capacity and enhancing consistency across regions. These reforms are essential to ensuring the Disability Act operates effectively and in the best interests of each person.

The HSE remains committed to working with Government, its committees and all our partners to realise a disability service that reflects the ambitions of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, the programme for Government and Sláintecare.

In 2025, the pressures on the assessment of need, AON, system remained significant. Applications rose to 13,186, which was a 23% increase on the 2024 figures and a 56% increase on the 2023 figures. Some 20,000 applications remained overdue at the end of the year and a total of 5,939 assessments were completed. That was a 43% increase, and it was supported by targeted wait-list initiatives. Since 2024, over 7,700 clinical assessments have been commissioned, representing approximately €27.9 million of investment. Notably, approximately 29% of completed assessments resulted in a finding of "no disability", highlighting the importance of early and effective triage.

The proposed Bill represents an important step in aligning the Disability Act with a rights-based, needs-led model of disability support, as set out under the National Human Rights Strategy for Disabled People 2025-2030. It also advances progress towards a full UNCRPD-aligned legislative framework with further, more comprehensive reforms being scoped, including links to the ongoing review of education legislation.

The general scheme introduces several critical clarifications and operational improvements to streamline the AON process. These include section 7(1), which clearly defines the two-stage AON process. The first is the early determination of disability, which is followed by a second step, namely, the identification of needs and required services. This supports proportionate assessment and avoids unnecessary diagnostic burden.

Section 8(3) ensures referral to the National Council for Special Education, NCSE, occurs after a disability determination, reducing unnecessary educational assessments. Sections 8(5) and 8(7)(b)(i) embed standards and guidelines in officer decision-making and shift reporting toward functional impact rather than diagnostic detail. Regulations 9 and 10 clarify timelines and ensure the six-month statutory period is maintained and understood.

Transitional provisions will apply the amended Act to cases where assessment has not commenced. Between 35% and 45% of cases on hand will transition.

Ms Queally, you are over time so I ask you to conclude.

In conclusion, I reaffirm the HSE's commitment to delivering a modern, integrated and person-centred disability service that meets the expectations of people with disabilities, their families and the wider public.

The reforms in this Bill, together with the operational changes already under way, represent the most significant modernisation of disability assessment pathways since the introduction of the assessment of need, AON, process. The revised legislation and wider reforms will enable the system to move in the right direction, from fragmentation towards integration.

I will now invite members to put questions to the witnesses. I remind members to stick to the agenda items scheduled for discussion today. The first person on the speaker rota today is Senator Clonan.

I thank the witnesses for attending. We have discussed these matters at previous meetings. I want to put the issue of triage into context from the perspective of a parent and carer of a disabled adult. Approximately 29% of those who went through the AON process were found not to have a disability. I do not see that, necessarily, as an issue. I am sorry to use such a vulgar comparison but if, for example, we put a car through the national car test, NCT, and the car passes, do we then say that we do not need the NCT? Should the car not be tested? We are talking here not about the ambitions of the UNCRPD but about our fundamental legal obligations under the convention, which mean that we have to vindicate the rights of disabled citizens.

In our experience, it is very hard to get a diagnosis in many cases. In our case, it is a rare neuromuscular disease but since my son has gone into the adult services, we now have a new diagnosis, which suggests a different prognosis for him. When families get those bits of information in waiting rooms and hospital corridors, they are life-changing in terms of expectations. My concern is about this new level of triage. Dr. O'Donohue said that a grade 7 administrator will decide whether a child goes forward for an AON. Is that correct?

It is more complex than that. What is really important with the AON is that it is about identifying people's needs and supports. Ultimately, in the HSE, our rationale is responding to people's needs and providing timely intervention. That is key. We have spoken to all of our parents and had lots of engagements. What do adults and children want? They want to be supported at their stage of life and those needs and supports vary depending on the age and the presentation of the child. What is critical is that the AON is a completely separate process from other interventions. If people need a clinical diagnosis, we have clinical pathways that allow for that, based on a timeline. In terms of the AON, we have to deal with the applications as they present to us in a sequential manner. However, access to all of our other diagnostic and clinical pathways is based on the prioritisation of the clinicians involved.

Regarding the role of the assessment officers, they accept the applications that come in, be they from a parent or in the form of a referral. They examine the application and engage with all of our clinical teams, depending on what has been reported. A referral that comes in may include diagnostic assessments as well as assessments from teachers or others in the education sector. Depending on that, the assessment officers reach in and reach out of clinical expertise.

I thanks Dr. O'Donohue for that reply and for drawing the distinction between the clinical pathway and the role of the AON process. It is my experience that throughout the HSE and the different regional areas, there seem to be different policies and practices applying in terms of the gatekeeping of disability service managers. Some of them agree with personalised budgets while others do not. Some say that service users must use a particular provider while others allow people to choose their own provider.

Can we be sure that this process will be universal and standardised so there are no areas where it is more arduous or the triage is more rigorous? I am sorry for leaving the witnesses only six seconds.

The point I was making in the opening statement was that the legislation is important but has to run parallel to reforms in the system. That speaks to the Senator's point about the need to standardise our approaches. They will not be identical but they will be standardised approaches so that parents have a legitimate expectation that in any part of the country, they get a similar service from public services. That is a part of our reform. Mr. Fitzmaurice may wish to add to that. It is certainly not a purely administrative aspect; it is clinical and administrative together.

At all times, what is reasonable is that the communication with the family is optimum if someone is going through an assessment of need process. At the same time, we have to focus on the capability in the primary care service or among the CDNTs. We will get the best value from our system if all of those rise at the same time. Our priority at the moment is to ensure that we are routing people and families through the most appropriate pathway. That is where the capability is. There are clinicians working within those teams.

I apologise for arriving a little late. On assessments of need, I will pick up from what Mr. Fitzmaurice said about the consistency of access to assessments of need throughout the country. I am aware that there is no assessments of need officer in County Galway at the moment. There is bouncing between borders. I know of a child who has ADHD and autism, and has been waiting for almost three years to be admitted to CAMHS. That situation became a suicide crisis. The parents have been told that their young adult needs an assessment of need. The relevant CAMHS was in County Roscommon. The young adult is in Merlin Park University Hospital. The family has been told that Roscommon will not do the assessment of need, even though the young adult has been on the waiting list for years. There is no assessment of need officer in County Galway at the moment. He or she is on leave, and I am sure it is legitimate leave. The family is now hoping to get a private assessment of need. This is a crisis situation. It has been going on for six or seven years as they have tried to access services. The family is now being told they might be able to get a private assessment of need in Mullingar, sourced by the HSE. This system is absolutely chaotic and families are at the receiving end.

CAMHS are chaotic. Primary care services are under-resourced, especially in the west of Ireland compared with any other part of the country. The assessment of need system is not fit for purpose. Arrangements have not been made to fill the place when an officer is off on legitimate leave. What sort of a system are we dealing with?

We are not just working with the committee on legislative reform. Part of what we are trying to do with the structural reform we are undertaking in the HSE is primarily focused at the integration and alignment of services to ensure they sit and serve the populations local to them.

I will pass to Mr. Fitzmaurice on the specific issues in the west and the autism protocol, which is obviously important in this regard.

I am aware of the situation in Galway. A vacancy is in the process of being filled. That is the delay in that regard. Notwithstanding that, it is not a good experience for the family in that situation. That is where the assessment of need officer has a critical role in co-ordinating and ensuring a pathway for the family. The Deputy talked about the under-resourcing of primary care and CDNTs. There are different options. Sometimes our communication with families is not as good as it could be. I acknowledge that. It is critical. A good assessment officer will communicate with the families at all times and give them the options that are available to them. People are sometimes being navigated through an assessment of need process when there may be a more appropriate pathway for them. I acknowledge that when people are trying to access CAMHS or whatever else, there can be communication deficits if we are not talking to the families. There is a priority. I assure the Deputy that the post he mentioned is being filled. One of the key things is that communication is optimal in that process and people are told of the different options available to them.

This is not personal. The family is at the end of six or seven years of what I would call "messing".

There is a very understanding, responsible and well-educated family at the bottom of it, and this should not be happening to them. If you had fewer resources, you would be looked after even better. These people know how to navigate the system. Is there no way to plan for what happens when an assessment of need officer for an entire county is gone? Why are there borders for people with mental health issues and disabilities? These are the only parts of the health service that have borders.

There should not be a delay, but unfortunately there is a delay so all I can do is apologise for that. When we move into the new integrated healthcare area, IHA, structures, things will improve because the community health area will be the basis of delivery. That will break down the barriers that exist because we must acknowledge that there have been barriers. We will see service improvement when CDNTs, CAMHS teams and primary care teams all report through the one line into an integrated system. That is where we have got to see service improvement. I acknowledge the challenges for that type of situation.

The changes we are looking to make ultimately aim to ensure that every child gets a diagnosis in time and that the services are there to back up that need. The reality is that we are way off the mark, and children are suffering and are not reaching their potential because they are not getting the services in time. I know there has been a dramatic increase in the number of people on the assessment of need waiting lists, particularly over the past two years. Are there enough qualified people in this country to carry out those assessments? Assessment through the HSE and the CDNT ultimately consists of 30 to 35 hours because I have been through it. I think over €20 million has been put in place to get private assessments done to reduce the waiting lists. What is the average time those assessments take? I believe the length of time in those assessments is considerably lower. I know there is a new procurement system for those assessments but some of those assessments cost the HSE up to €5,000. Could the witnesses comment on why we do not have enough qualified people? I know people have left the country but we should have been forecasting the number of people we need in advance. I know there have been changes in the past number of years. When the Tánaiste was Minister for Further and Higher Education, Research, Innovation and Science, he brought about an increase but we have not engaged in forward planning at all. That is the role of the HSE. When we look at census figures, we should know that there is an average of 40,000 children with a need.

We have planning processes but they probably need to improve in terms of how we go about this. An increase of 23% and 56% within the two-year timeframe is not something we would have anticipated so that increased demand certainly put very significant pressure on our system. Regarding when a child does not need that level of assessment and speaking to the earlier point about why it is important to remove the children who do not have a disability, that is not to say that they do not need support or help or that their families do not need intervention but they probably do not need to go through this level of comprehensive assessment. We have universal child health screening where all children have developmental screening and clinical pathways are outlined for those children so that they can go on if needed. We are streamlining our assessments of need so that we can meet the demand in a timely fashion, which we are not doing at the moment. That does require us to forecast and improve the levels of staff. To answer the Deputy's question about whether we have enough staff to meet this level of demand, we do not. One of the first tasks of any system would be to remove the demand that should be in a different pathway.

That 30% actually should be streamlined and in the appropriate pathway for those individual children. That then removes that from this AON demand. I do not mean to get over-technical on it.

However, the second tier then is really aligning our CAMHS, CDNTs and primary care teams so that they are working coherently together in units that are well aligned - to speak to the previous questions asked - and where they are organised around the populations they are serving and meeting the child's needs as early as possible in their journey. A lot of work has been done. which Dr. O'Donohue might speak to. on forecasting on staffing and improving the numbers on the CDNTs.

We are enhancing the workforce. We have worked with education and we have also got clinical pathways. It is really important to notice that of the over 13,000 assessments we completed last year, more than 80% of those required an autism spectrum disorder assessment. The finding of that was 43% of those individuals were found to have an autism diagnosis. We are looking at what the assessment pathway and the diagnostic pathway are for that, which would be outside of AON and which would streamline it and make it much easier and more timely. There will be a real focus first on the assessment but more importantly on intervention. For individuals, both children and adults, it is really important that intervention happens in a timely way. We have often heard of that window of opportunity for these children and adults. Timely intervention to support a child in school and outside of school and social inclusion are important.

The same people who give the intervention are doing the assessments.

The Deputy's time is up.

They are the same professional people, including speech and language therapists and psychologists.

We can talk later about-----

We will move on to Deputy Ó Murchú.

I welcome the witnesses. It is not the first time we have had this discussion. In regard to the AON, the biggest issue politically is the size of the list. It is around 22,000. What we have literally done is found a means of moving people off that list. I will ask two questions. We all want to see something that will provide children and families with the services that are required. If we are looking at alternative pathways that would tell us their being on the AON list in the first place is somewhat wrong and which tells us that there is something wrong possibly with the AON that needs to be looked at, maybe we are fundamentally starting in the wrong place. It would be absolutely brilliant if we got a single point of access and if CDNTs, CAMHS and primary care all thought together through the new IHA set up. However, the fact is, if the CDNT and the 400 positions that are at present unfilled are filled, there is no way it is fit to deal with that need that exists out there. At the same time as having insufficient numbers of people recruited, and I am a broken record on this, we are going to start recruiting to CDNTs and primary care at the same time that we are going to fill in-reach teams and we are also going to do in-school therapies. However, we are not going to do in-school therapies properly. We are literally going to put it into special schools. We are not even having the mainstreaming wing. How are we not set up for failure? How is this going to improve the lives of anybody? If there is a failure with the AON, why are we not looking at that straight out? I realise there are about 14 questions in there.

To be truthful, there is no quick fix. There is nothing that is going to say what we are to do. The HSE has committed to look at it from multiple areas. One of the big reforms we have done is the single point of access. Currently, when referring a person to the HSE there are 25 different referral forms. They come in many different ways. From June, we will have one referral form, one system that those children come into down to a community health area which is in line with and close to where the child is living where their school is. We are also establishing networks looking at those referrals and the best pathway. GPs are involved in them as well as education. The importance of that integration-----

What about communication with the family, which has been bad over the years?

Since the introduction of the single point of access, we have had the seven key principles and first and foremost is timely and equitable access. That is what we are committed to doing. We have that coming in. With that is going to be that co-ordination.

We will actually be able to know where the referrals are, who is being referred in, what the needs are for primary care and what our need is in CDNT.

This is being looked at as a means of actually fulfilling a wider review because I am back to that question about the CDNTs. Even if they had those 400-plus positions filled, they could not deal with what they are meant to deal with, never mind the AON list.

Absolutely. That is the referral pathway in, so we are getting the child in. The most important thing is that timely intervention, that parents are not waiting two, three and four years for an assessment. What sometimes happens is they will refer their child into multiple different areas and an AON, and then they wonder who is actually going to respond. We in the HSE need to look at that in totality to say what is the best support. Do we do it directly or can some of our section 38, section 39 or community supports respond to that?

This is only a starting point in real terms. Regarding the assessment officers, the Department said previously that the HSE was looking at it from a point of view of making sure they had the right skill set and then clinical backup. Where are we on that?

We have established a national group overseeing the support of assessment officers. As the Deputy can appreciate, their workload has increased incrementally over the last number of years. What we have done is ensured consistency across that. There is now a monthly webinar with them regarding key learning, what is the development and ensuring consistency. That has been stood up over the last nine months. In testament to that, we can see a 43% increase in what we have done, but we are also increasing with the level of referrals that are coming through. The other thing we are doing is introducing a higher level of grade 8 that will oversee it at a regional level. We have six regions across the HSE, and over that there will be six grade 8s overseeing, ensuring consistency, dealing with issues and ensuring that the system is more responsive, having that data and making timely decisions. Also aligned with that we have 24 new staff coming in. These are additional assessment officers and liaison officers. We have ensured that these officers are going to the areas with the highest level of demand. In some parts of the country there is much more significant pressure on the assessment of need process as opposed to other parts of the country.

They will also be making determination on where the HSE is segueing to, so it is vital they have that clinical backup.

Absolutely. There is clinical support for those teams and integrated with the teams from primary care, CAMHS and disability. They all have to work together.

Thanks very much to the HSE for being here today. In our pre-legislative sessions so far on this proposed legislation we had service providers, Enable Ireland and St. Gabriel's Foundation. We had the representative group, the Psychological Society of Ireland, as well as other experts and advocates all saying essentially the same thing, namely, that the assessment of need pathway has become a bottleneck for many families, because services for children and adolescents generally have not been resourced and families are turning to this one pathway that has a legal guarantee of some outcome attached to it, which is understandable. Even though an AON may not be the best route for their child, avenues to support more generally are blocked off. One of the service providers that addressed the committee pointed to the limitations of what can be offered to children, even by a CDNT that is on paper technically fully resourced.

We know that primary care services in particular throughout the country are operating with threadbare staffing. Their waiting lists are so out of control that, in some parts of the country, for some disciplines, the service may as well not exist. We know that integrated working between CAMHS, CDNTs and primary care is not happening, mainly because those services are guarding their limited resources fiercely. They are unable to think outside the constraints of their own services to more joined-up working. A service cannot innovate or open itself up to wider service development unless it has some bandwidth beyond just surviving or just being in perpetual crisis mode.

In that context, why would we proceed with legislative change now before the wider reforms the legislation points to, including the single point of access, are fully in place and working properly and, crucially, before the resourcing that underpins that single point of access initiative and any kind of reasonable operation of services is pursued and is in place? There have been narratives from Government and the HSE implying that clinicians cannot be found, but there has not been an attempt at comprehensive recruitment in primary care. I know that. I have had to do an awful lot of digging to have that confirmed in parliamentary questions. Should those reforms not happen first? Is that not the elephant in the room here: workforce planning and joined-up, integrated working based on proper recruitment?

In terms of integrated working, those reforms are happening right across the country and the new structures Mr. Fitzmaurice referenced are being put in place. That integrated working between primary care, disability services and CAMHS is under way and beginning to work.

I agree with the Deputy that we have gaps in certain areas in primary care that we need to address. There is no-----

That is quite an understatement.

Yes. There is no denying there are gaps. However, we will be in a much stronger position when we align our teams and look at the population they are serving and the needs within that population to proceed in an orderly fashion to address some of those gaps. Both the legislative reform and the organisational and structural reform are required. I said that in my opening statement. One of those reforms will not fix this without the other. They can happen in unison and provide a better future for the people we are working with.

When does Ms Queally expect the single point of access to be fully in operation, with all three of those core services integrated?

Our ambition is for it to be live in June of this year. As Dr. O'Donohue said, one of the big things we had to do was look at our referral process. Automating a single point of access with 25 referral forms is problematic. The work Dr. O'Donohue and the teams nationally have done on standardising those referral pathways in one form is very significant. We are also introducing an electronic system, called the community care record, which we have spoken to committees about previously. That is really important and will certainly help us with the electronic referrals system because when we are dealing with the numbers I outlined earlier, having electronic systems is really important.

I thank the witnesses for being here so early the day after St. Patrick's Day. We really appreciate it.

Sticking with the community care record and electronic referral, the single point of access will be a big game-changer. I am excited to see it get up and running and I know the timeline is coming fast. A cultural shift also needs to happen, with shared care. Can the electronic referral or community care record be used after that? Sometimes, after the initial referral, the person will be referred to primary care services and if primary care does not make a diagnosis of autism, the person could be referred to CAMHS and then referred back and put at the bottom of the list. Often, there are challenges after the referral as well. Rather than a single point of access, there should be a single point of care. Would the community care record help with that integrated care?

It will facilitate it but the staff on the ground are the people who will need to work with the single point of access to ensure that integration. It should not be for the families to work out the pathways of care. Once the referral comes in, it is up to the services to support the family on its journey to the right service. That is the big issue. We do not want to see multiple referrals. That creates confusion and administrative burden and the risk of people falling between stools is very high. We want one single point of access so the adult gets into the service and is then signalled and signposted to the right area to support their needs.

Frequently, people with disabilities will need more than one service, so it is not that they will just need one element of the services. They will often have to interface with more than one element.

Absolutely. It would be great to see the National Educational Psychological Service brought into that. I know NEPS is under the Department of education but we often see that in order to get a dyslexia diagnosis people are referred back to NEPS, which is another referral.

There is the electronic and technology side. What training is being done on the ground? What training has occurred, or what is planned, between primary care, CDNT and CAMHS teams? Is area-focused training or national training under way? How are the people on the ground being supported to work in a more integrated way?

At an organisational level, the IHA managers are very much working on building those teams in an integrated fashion. That has been a huge proportion of their work. Mr. Fitzmaurice might want to say something on having organisational design and training and development for those teams in an integrated way, which is very important.

On specific training, Dr. O'Donohue and the national team have done quite a bit.

We had an engagement in September, which was critical. It was attended by families, education representatives, key stakeholders, Tusla and our teams, which comprise section 38 and 39 HSE organisations. They are all part of the community health area. It is important that the people supporting children in local communities are consulted.

We are also developing a standard operating procedure, which is important. If a referral is submitted in Cork, Dublin or Donegal, the same process will take place for the team concerned, including engagement with the family. Parents have said they want transparency, to know what happens when a referral goes in and continuation in communication. That will be set out in the standard operating procedure.

A lot of training will be done with people managing the referrals. There will be clinical triage. If it is not clear that a child's pathway is clear for primary care, CAMHS or CDNTs, we have committed to a clinical triage involving clinical expertise that will examine the case. That may be done jointly with CAMHS and CDNTs or CAMHS and primary care jointly assessing a child, agreeing on the best intervention for that child and working collaboratively. One of the frustrations we have heard is from GPs who have told us referrals come in or are not accepted. That will no longer be an option. We have to provide support to a child based on what has been presented to us, namely, what their need is and how best we can serve them. We are committed to doing that.

I thank the witnesses for meeting with us. I thank the Library and Research Service for providing us with background information. I sincerely wish the witnesses well in their endeavours in trying to solve this problem because it is massive for the future of children in this country. I will base my questions on the opening statement. The strong statutory guidelines are being prepared between the HSE and the Department of Children, Disability and Equality. Will they go to a public consultation so that different bodies can be included, along with the voices of parents and children? Is that the next step?

Absolutely. With any change or reform we carry out, we have to talk and engage with people with lived experiences because that is the essence of what we want to do. We want to try to do something and if that does not respond to their need, then we need to take their input, consider it and ensure the process is signed off together in a collective manner.

Super. I thank Dr. O'Donohue. Can the witnesses give an indicative timeline for that process and next step?

The current timeline is that the statutory guidelines will be developed in quarter 2. There will be a process of engagement following that.

I will not get into the national picture, but I ask for that information to be supplied after the meeting. I refer in particular to Dublin and the north east. As the witnesses have said, and as we all agree, timely intervention and supports are critical. With, and separate from, the assessment of need process, what is the national vacancy rate of clinical posts in the most recent data?

I will have to come back to the Deputy on that. I do not have the numbers with me. I would not want to-----

That is fine. We have assessment of need on one train track and timely intervention and supports on another. The key piece is the workforce and people who will deliver the support services. With reference to that and the judgment from the High Court in 2022, and linking this to the UNCRPD and United Nations Convention on the Rights of the Child, UNCRC, is the determination that there would be appropriate and indicated diagnostic assessments? In terms of what we are now embarking on, are we likely to contravene the High Court ruling through the making of a diagnosis of disability or not and the onus that will put on assessment officers? In a survey of 31 assessment officers, 22 participated and 45% were not confident in declaring a no disability outcome. Some 29% had concerns about the lack of guidelines. Will there be very clear guidelines for outcomes where there is no disability?

Is that being cross-referenced and proofread against the High Court judgment? I am sorry, that might be a little long-winded.

We have webinars once a month with our assessment officers, which is supported by our legal team. There is learning and development. That gives them the opportunity to ask questions, while also ensuring consistency across that, which is very important. It is also bringing them together so that they do not feel isolated. That has been stood up over for the past nine months. Previous to that, the forum was not there, and if that survey was done again today, we would have a different perspective from the assessment officers.

The transitional provisions in regulations 9 and 10 under section 8(3) relate to cases where the assessment has not commenced. For example, in County Meath, we are dealing with psychological services with approximately a nine-year wait-list. With other services, it is two to three years of a wait-list.

Will those who are waiting on assessment receive priority ahead of new applicants coming through the SPOA? Can the witnesses give any detail on that? There is a lot of worry, bordering on anger, among parents not alone in Meath East but in all of County Meath. Where will that transitional arrangement sit?

I cannot comment on a specific part of the country at this point but we can come back with further details on that.

An important point to make here is that we have to deal with the applications through the assessment of need process as they come in incrementally but the single point of access is done on prioritisation. That is a parallel process. To assure people who are waiting on assessment of need, we have received funding to prioritise those assessments to try to reduce that waiting list. We are doing that with our own clinicians and staff first and foremost and, second, we have established a framework for autism spectrum disorder assessments to ensure consistency. With regard to private provision, whether we do them in-house or outsource them privately, we want to ensure there is consistency in that approach.

That has been stood up since February, which is a welcome change to the consistency across the assessments.

With those parties who complete the assessments under the outsourcing route, are they going to have any type of standardised guidelines to operate under?

I might to pass that to Mr. Fitzmaurice because he can speak to the autism protocol.

We are in the latter stages of finalising and bringing the autism protocol into operation. That will give us a standardised process for assessments. Anyone within our own system, the HSE system or any assessments that are outsourced will be asked to comply with that and that will be a key requirement. That will give us a standardised approach across primary care and disability, and CAMHS or outsourced assessments.

That is great to hear. I thank the witnesses.

Currently, the only right disabled citizens have in law is the right to an assessment of need. Do the witnesses believe disabled citizens have a legal right to the services, supports and accommodation set out in an assessment of need? Do Irish disabled citizens have a legal right to those interventions?

They have a right to services. It would be disingenuous to say we are here and people are getting timely access. They are not getting timely access. Our ambition is to improve our services so that people get access to their service in a timely fashion and what they need.

I feel strongly that people feel compelled to use the assessment of need to exercise a right to service and a statement of service, etc. It should not be like that. We should not have to use the AON for that purpose. The AON is an important legal framework and a very important part of our disability legislative framework.

I am sure the witnesses confer with their colleagues across the European Union because they are all operating at a very senior level. In other EU jurisdictions, people have an assessment of need that is repeated during different transitional pathways in their development and they get the services and supports that are indicated.

Why is this not happening in Ireland?

I think it does happen here. We have often heard that once you are in the system, it is very effective. It is trying to get into the system that can be the problem. We have a logjam in the assessment of need; there is no doubt about that. Fundamentally, to resolve that there has to be effective communication and that is where sometimes we fall down.

What makes Ireland different from the other European Union jurisdictions is that we do not have a legal right to these things. My fear about this legislation, which is nothing to do with the witnesses, is that it will further dilute the rights of disabled people and disempower them. These are not ambitions; they are obligations we have towards disabled citizens. They have a fundamental right to services and supports, in the same way as somebody with cancer or who needs cardiovascular intervention has rights. In terms of Mr. Fitzmaurice's observation that the problem is access to the system, we have been in the system for 24 years and there is no meaningful physiotherapy, occupational therapy or speech and language therapy. There has been none in the past 24 years.

In support of Senator Clonan, I believe these are fundamental rights and they need to be put on a legislative footing. I was involved in the autism innovation strategy, as Chair of the Joint Committee on Autism, and it is an issue we are very strong on. It is contained in the programme for Government and we need to see it implemented.

I think Ms Queally referred to the "use" of the AON system. Will she expand on that? The reality is that for the parents on the ground who I talk to, there is no alternative and that is why they try to get an answer to an issue or problem from an assessment of need. They are not getting supports and are lost. I attended the recent opening of the community support hub in the Liberties in Dublin with AsIAm. We need to see more of those hubs around the country, so parents have somewhere to go to get the right information, support and help.

In some ways, the AON has been required in the past for parents to get access to certain things. I would prefer to see parents getting access in a timely fashion, rather than being compelled to go through an AON process for those requirements. If they need an AON, that is absolutely fine, but 29% of parents feel the need to go through this process when, in actual fact, their child may not need a 35-hour assessment. The child may, however, need access to timely treatment, intervention and support. We want to get to a point where children get timely access to treatment, intervention and support, and if the AON is necessary that it, too, is timely.

There is something mentioned in the paperwork. The PSI, AOTI and the ISCP, the clinical bodies which are key to empowering this, oppose letting the HSE statutory guidelines reinterpret the law and stress that multidisciplinary assessment, assessor competence training and workforce expansion are preconditions to success. Will that happen?

Will the Deputy repeat the question?

These organisations oppose letting HSE statutory guidelines reinterpret the law and stress that multidisciplinary assessment, assessor competence training and workforce expansion are preconditions to success.

That is what we are doing as regards the competency of our assessment officers, liaison officers and clinical teams. One thing we have done to expand our clinical understanding has been to develop in-reach teams. It is really important that people understand this. In-reach teams will be on an IHA level. It consists of a principal psychologist, specialist occupational therapist and specialist speech and language therapist. These teams will lead on the assessments and will, predominantly, lead on autism assessments. That will reduce the timeline and the wait for those assessments for people.

I will go back to assessments of need, which all of us believe children should have an absolute and fundamental right to. The AON process is not working. Does the way in which assessments of need are delivered need to be changed at this point? Last year, I think 45% of people needed autism-only supports and it was 35% over the past number of years.

While 29% of those assessed had no disability, they were still in need of services. Is there a fundamental problem with the AON anyway, outside of the huge numbers that are on the list?

The challenges that we have are multifactorial. No organisation wants to see 20,000 children overdue their assessment. The truth is that for disability, we need to transform the way we are doing things. We need to respond, not only in terms of our assessments and interventions but we also need to enhance and build capacity across residential and respite services. It is not just one factor; it is a multitude of factors. However, the welcome additional investment in disability in budget 2025 has made a difference. We have seen a €25 million increase in funding for respite. That will support both carers and families.

Yes, I understand that but is there a fundamental problem with the AON process?

There is a challenge in that this is the first time there has been any reform of this Act since it was written in 1995.

Yes, but Dr. O'Donohue is saying that further reform is needed.

Yes. Further reform is needed-----

The CDNTs are-----

-----but this is a good initial step.

Okay, but the CDNTs are not the means by which we are going to be able to provide the full suite of services to those who need them, are they? We are attempting to do the in-school therapies but I do not see how we can do everything, all at once.

The fundamental point, and Mr. Fitzmaurice might like to come in on this, is that it has to be about primary care, CDNTs and CAMHS working together. It has to be about that integration. That is what will work.

It might be useful to give an example. In Sligo-Leitrim we have a reasonably good record with regard to AON but we still struggle to comply with the timelines. However, we are very clear in our communication with families around our struggles and they generally accept that, once they know that we may go slightly outside of the time limits. The key is a primary care system that is responsive and a CNDT that is responsive, as well as the use of outsourced assessments of need where we can procure them. That is a key point that Dr. O'Donohue mentioned earlier. What we have seen is a reduction in our timelines and waiting times. Now we are down to around six weeks for those who are waiting for autism assessments. We need all of the elements to align. If they all align, we have a better opportunity to address the AON problem. That said, the timeline is a challenge. There is no doubt about that but families are generally accepting if we communicate effectively with them around that.

Will we see single point of access by June?

That is fundamental to it. A single point of access is essential.

As has been alluded to by Deputies Carrigy and Ó Murchú, there is a question as to whether the AON process is fit for purpose. Does it need to be reformed? How long does an AON in the public sector take and now long does one take in the private sector? Is there a material difference between the two?

That would very much depend on the child and his or her needs.

We are really short on time and this is really important. How long does an AON take in the public sector? How many hours does it take to conduct an AON?

It varies. It depends on the child.

Is there an average?

I would not have that detail. What is important is that some of the children who are private-----

Has it been reviewed and is it open to reform? I have been told that it takes between 35 and 40 hours to do an AON. Is that right?

They are the figures I have.

This is not personal but I have difficulty with the fact that Dr. O'Donohue is unable to tell me the average time and whether there is a difference between the public and private sector. I am picking up on a point made by Deputy Carrigy. Is there a difference between productivity in the public and private sectors? This is really key.

If someone applies for an AON, he or she already on a CDNT waiting list and-----

My information is that it takes between 35 and 40 hours to do an AON. What is the average, approximately?

The AON, when one opens the process, may require a varying number of assessments to be done, under the terms of the Act. It is not a question of saying it will take exactly a certain amount of time.

I will take that as meaning that Dr. O'Donohue cannot give me an answer. Is that fair?

Yes, it really does depend.

I will come back to the issue of productivity. There are significant resources going into disability and into the health services more generally. In terms of digitalisation, why are we so far behind?

We certainly are far behind and that is the bottom line. We have not had-----

If there are 25 different types of paper referral, then one can understand why people get absolutely frustrated-----

Yes, completely.

-----and why I have no hair.

This is part of the challenge.

We have had an underinvestment in digitalisation, particularly in community services. We are very reliant in community-----

Does Ms Queally think AI will have a part to play in streamlining appointments?

In time it will, but we just need to get to first base with a lot of the community digitalisation-----

I am out of time. If this happens, it is welcome that there will be direct communication with the NCSE because that is another bone of contention with a breakdown and a siloisation of disability.

How will the point of access operate where there are unresolved disagreements between services as to where a child with complex needs should be supported? For instance, there may be a combination of developmental and mental health difficulties. I am hearing on the ground of some CAMHS teams having fairly rigid inclusion criteria and a tendency to bat referrals away even though they appear to be very much within their clinical domain. What happens if a CAMHS team decides that a child is not for it, and that it is for primary care and the CDNT to decide on the referral? In such an instance where primary care is very clear that it is a child with moderate to severe difficulties, who adjudicates on that? Who has the clout to direct a CAMHS team to take on a client if it is refusing to do so?

Is the College of Psychiatrists fully signed up to the single point of access initiative?

I might get Mr. Fitzmaurice to talk about the organisation and reorganisation under the general manager of CHAs because that a really important point. Those teams will not be managed in divisions as they were in the past; they will be managed under a single unit of management. That will be very important because ultimately decisions have to be made as to which team sees the children.

Dr. O'Donohue might want to take the point on the College of Psychiatrists.

As Ms Queally said, fundamental to the success of the single point of access is the integrated governance structure. We will now have the CDNT, the CAMHS team and the primary care system all reporting through the one line. In an ideal world we would agree as to the most appropriate pathway for the child. There is no doubt that there are sometimes disagreements on that. If a call has to be made, that will have to be made by the general manager within that CHA because ultimately the needs of the child must be paramount. Those two will go hand in hand and that structure has now been embedded in the regions. That will be absolutely critical.

Dr. O'Donohue might be able to advise on the College of Psychiatrists. We have certainly had a lot of engagement with the College of Psychiatrists, specifically on the autism profile. We have also been involved in work on competency frameworks. There certainly has been a lot of to and fro with the College of Psychiatrists in that regard.

The clinical operations guide, COG, for CAMHS was updated last year and there was a lot of engagement on that. That is to ensure consistency among CAMHS teams so we do not have one CAMHS team deciding this is the bar and someone else deciding it is a different bar. Ultimately, it is all about timely access and reducing the level of uncertainty and frustration, and increasing the transparency regarding access to our services.

What happens if a psychiatrist says, "In my clinical opinion, we should not even be considering an assessment of this child with the other services". If the other services are very clear from their point of view it is within their domain, how is that sorted out?

The Deputy is out of time. I will allow a very brief answer.

The integration of the teams is really important. Psychiatry and primary care have really important roles as well. We need to strengthen the capability in primary care so that there is a stepped model of care for psychology.

Is it just down to the primary care clinicians to ask the general manager to intervene in such a case or how-----

That may happen at times. The general manager may have to call the team around. Occasionally when that happens, we need to find a solution and we will have to find a solution ultimately.

Will the community care record be integrated with other IT systems? For example, currently parents may attend hospitals with their child, carrying paper records. Something may be missing or the information may not have been sent on in advance. I am aware of several different platforms within the HSE. Will the community care record for the child be integrated seamlessly at the various stages of the journey?

The element of the community care record that is being applied to CAMHS is very much a full record. In primary care, it is not a full electronic record. We will not have that until we have the full patient electronic system and that is a number of years away. However, it will still make our administrative approach to the child and to the management of appointments more streamlined. There is a slight difference between what is on offer for the CAMHS teams on the community care record and what is on offer for the primary care and disability teams, but it will make all the administrative and referral pathways more automated and it will be easier to manage them.

Budget 2026 includes a figure of €20 million for targeted wait list reduction. We do not know yet - or maybe the witnesses do - whether there will be a PNS to this. My concern is the timely intervention and supports are dependent on the front line. How will that €20 million be used? Will integrative therapies be considered as well for the timely support?

With the PNS for disability, we will see a growth in our workforce of 1,050 staff across respite, residential and therapeutic supports, which is welcome. The fund will be used, first and foremost, to enhance and support our clinicians and to offer overtime, if that is possible and if there is increased capacity we can use. Second, we are looking through the private framework. We have done a whole tender process on it. We have a set price but we also have a set practice to make sure the process is uniform, both in-house and externally. We are monitoring that on a monthly basis and will be able to provide further data on the benefits of the fund later in the year.

Moving towards the standardisation of the service to the child or teenager is critical.

As is the experience for families.

Absolutely.

That concludes our session with the HSE. I thank its representatives for attending and providing briefing materials in advance, which will assist the committee in its deliberations. The insights and expertise provided are critical to our knowledge and, hopefully, to improving the legislation going forward.

I welcome the following witnesses to today's meeting: from the Department of Children, Disability and Equality, Mr. Mark Considine, principal officer, Ms Sarah O'Halloran, assistant principal officer, and Ms Nicole Dyrssen, clinical specialist and therapy adviser.

Before we begin, I have 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 statements are potentially defamatory in relation to an identifiable person or entity, witnesses will be directed by me to discontinue their remarks. It is important they comply with any such direction. 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 with the witnesses on such an important issue and I thank them for accepting our invitation. I remind all those in attendance to make sure their mobile phones are switched off or are on silent mode. I call Mr. Considine to make his opening statement.

I thank the Chair and members of the committee for the opportunity to discuss the targeted reforms to the Disability Act 2005. The proposed disability (amendment) Bill sets out legislative enhancements to help streamline key elements of the assessment of need, or AON process, through changes to Part 2 of the Act. Part 2 of the Act describes the AON process and provides for a determination of a disability as defined under the Act; the identification of health and education needs, if any, occasioned to the applicant by the disability; and the health services required to meet the needs of the applicant. It is very important to emphasise that an assessment of need is not required for a child to access health services.

The number of AON applications has grown considerably over the past two decades. In 2008, just over 2,500 applications were received by the HSE. By the end of 2025 that figure was over 13,000. The increase is likely due to an increase in the population together with a broadening of awareness of disabilities among parents, guardians and caregivers. It also reflects the challenges faced by parents and caregivers in navigating a complex and, at times, fragmented health services system. Parents want to source the right kind of supports for their children at the earliest possible juncture in their lives and will pursue all avenues. This increasing demand is outpacing the capacity of the system to respond, and there were some 20,200 assessments overdue for completion at the end of 2025.

The HSE has made considerable efforts to increase the rate of completion of AONs. It has completed 5,900 assessments in 2025, a 43% improvement on the previous year. Although this is very welcome, demand is continuing to rise and the Department recognises that further improvements to the assessment of need process are critical. This will require a combination of both legislative reform as well as improved operational capacity and efficiency to ensure that the system can deliver for applicants now and into the future.

On 9 December 2025, the Government approved a memorandum for Government setting out the parameters of the targeted legislative reforms. The overall aim of the reform is to ensure that all children who apply for an assessment of need are directed to the appropriate supports at the earliest possible juncture, consistent with their needs and regardless of the determination of disability as set out in the Act. Additionally, these reforms will help ensure the use of appropriate and proportionate assessment for those children who have been identified as having a disability under the Act.

To this end, the targeted reform will enable the following measures. The Department will work with the HSE to develop statutory guidelines that will support and strengthen the decision-making capacity of assessment officers. The aim is to enable assessment officers to make an earlier determination of disability, where appropriate, and reduce the need for unnecessary clinical assessments. The Act will support the use of proportionate levels of assessment. This can include diagnostic information from previous health engagements and other reports to help ensure a more streamlined assessment process for the applicants. These reforms will support the earliest possible provision of an assessment report to applicants. The Act will also make provision for applications to be closed or withdrawn within narrow parameters to be set out by the Minister for Children, Disability, and Equality.

Importantly, these changes do not impact eligibility or entitlement to the assessment of need. Neither do they impact the wider definition of disability within the Act as we are solely targeting Part 2 of the Act. It is worth noting that over the past three years, 29% of completed assessment reports had a finding of "no disability". It is likely that a number of children may have undergone some form of additional assessments where it may not have been necessary. Determining disability at an early stage of the process should ensure that applicants, most of whom are children, will undergo an appropriate level of clinical assessment. It is anticipated that these targeted legislative reforms will bring improved quality and clarity to the assessment process for both those working within the system and those relying on it.

However, legislative change is only a part of the picture. Substantive responses to the challenges affecting assessments of need outside of legislation are required to achieve the level of change needed. This requires collaborative working across Government to bring about real change, with a particular focus on removing the demand drivers for AONs through reforms to elements of the wider system that have leaned on the assessment of need process, such as within the education system. It will require the introduction of a single point of access system by the HSE to ensure that children are referred to the right service, whether that is primary care, mental health services or children's disability network teams. It will also require the implementation of the autism assessment and intervention pathways protocol by the HSE, providing funding for clinical assessments from private providers through the targeted waitlist initiative and a continued focus by the HSE on the recruitment and retention of staff across all services to address waiting lists for those services.

Collectively, these legislative and non-legislative enhancements to the health services system will help to relieve pressure on the assessment of need process and, over time, they should reduce the length of time it takes to receive an assessment report. My colleagues and I look forward to the committee's questions.

I thank Mr. Considine. I now invite the members of the committee to put their questions. When I call members, please adhere to the agenda items scheduled for discussion today. Given time constraints, I ask everyone to be focused with their contributions.

I thank the Cathaoirleach and the witnesses are very welcome. In his introductory statement, Mr. Considine said that, over the past few years, 29% of assessments reported no disability. The reality is those parents put their children forward because there is a need there.

How does the Department intend to address the need for supports that those children who do not have a disability have?

Mr. Considine made the point that the Act will make provision for applications to be closed or withdrawn within narrow parameters to be set by the Minister. What parameters are being proposed? Professionals are needed across the therapies to do the assessments and give supports afterwards. Where are we going to recruit those staff and what are we doing about it because we have not forward-planned enough to have enough qualified staff to work within the system?

Regarding the 29% who received a diagosis of no disability, it is within the definition set out in the Act. Children who may be found to have no disability under that definition may and probably will need services given that they are approaching for that purpose. Then it is about making sure that they engage with the appropriate service through the single point of access and directing them to the appropriate service, be it primary care, mental health or CDNTs, and making sure those are appropriately resourced and supported to respond to those needs. The recruitment issue certainly plays into that. Additional funding has been given this year to CDNTs to increase by 150 the number of staff in that system.

Are those staff there to take up those roles?

The other part of the picture is making sure the supply is there. That includes bringing forward training placements. A piece of work is ongoing with the Department of further and higher education to increase the number of places and increase the output of qualified staff across the disciplines - occupational therapy, physiotherapy and speech and language therapy. That is a key point. Even with the funding, actually sourcing those individuals is proving challenging. The HSE has initiatives in place to increase recruitment and retention levels within the service but increasing the supply will also be key to addressing these. The CDNTs have made good progress. Waiting lists have reduced. They are still not where we want them to be but considerable progress has been made. We just need to keep that going and sustain it.

The Deputy asked about parameters regarding applications being closed or withdrawn. It came up because sometimes families engage with the services through the CDNTs, for example, and are getting the service required, but some may disengage with the assessment of need process and the application can lie dormant for a long time, or the family can leave the country or something else happens and there is no way at the moment to decide whether we will close the application. The 20,000 figure I mentioned probably includes some applications that are dormant, and it is in those instances. It is not a measure to cut people off from services. It is where the HSE really cannot progress because the families have disengaged. That is the main purpose of that.

Mr. Considine mentioned the protocol on autism. It ties in with education and different Departments. Is there sufficient knowledge and training across Departments regarding autism in particular because a significant percentage of those on the assessments of need list are diagnosed on the autism spectrum? We carried out a programme in the Oireachtas a few years ago. Is that across the public sector? Is it across the various Departments such that there is awareness of autism?

The national disability strategy and the work on the autism strategy were designed to look at those cross-departmental issues and raise awareness. I cannot speak for all Departments in terms of their level of knowledge. Our main engagement is with the Department of education, where for obvious reasons there is considerable pressure, knowledge and interaction with families of children with autism. Building that up will be key. The autism protocol is designed to do that within the HSE, to build the expertise supported by the in-reach teams. The Department is funding the HSE to commence recruiting these teams in this calendar year. This will provide a key expertise and support base to enable implementation.

Fáilte romhaibh. What is the size of the AON waiting list? Are there 22,000 people on it?

The last figure we had was for 22,200 people.

What cohort was the AON system initially set up for? What was the age bracket and what was the initial reason for creating it? What was it specifically testing for?

The stated intent was around need, identifying the need and identifying the overall service that-----

Was the need initially specific to schools?

No, it was not specific to schools. It is about the health and education needs of children. There is a provision within the current Act which links it to the Education for Persons with Special Educational Needs, EPSEN, Act, some elements of which were never commenced. I understand that there was an intent that those two Acts would interact at the education level.

My notion of it is that it started at one thing and has become something else. It is probably even a different cohort, age-wise, that is on the list for an AON at this point of time, but we are where we are. Will Mr. Considine tell me how the number managed to jump so significantly? I get that more people are coming and whatever, but the system fell down on some level when it came to dealing with this. The numbers went from 2,500 to 13,000 and then to more than 22,000.

It is difficult to get underneath such large numbers. My understanding from engaging with parents and some of the representative bodies is that the knowledge and awareness of the legislation and the right that exists under it began to spread quite rapidly over a given period.

I get that. The main reason for that was that people could not access services. We all want to see people accessing services, but I cannot get away from the fundamental idea that if we were starting today, the AON is probably not the testing system that we would set up. That is fair to say. We need to make sure that assessment officers have sufficient training and clinical backgrounds to be able to make determinations. It is then about making sure that we can provide services. We have already heard the arguments that have been made relating to the Bill. How will it improve things?

To pick up on the service issue, even though there is a service statement within the Act, the assessment of need is not in itself a route to services. In fact, many families who have higher levels of need will experience speedier support through the CDNT system because the AON system prioritises based on the date of application. The CDNT system looks at need and can accelerate those with higher levels of need. I want to be clear on that.

Even if we deal with the AON issue, I do not see the CDNT system having the capacity to deal with the need that is out there, even if all of the unfilled positions are filled. I do not think the Department will get the best bang for its buck. The HSE, when it was here earlier, said this would allow for a review. How are we going to deal with that situation and these circumstances? We can talk about in-school therapies, but we will be talking about them for a long time before we see them. Will Mr. Considine answer that question? Also, when will those in-reach teams be in position?

I mentioned the children's disability network teams because they are funded from our Department, but it is about the wider picture. The Deputy mentioned the education therapy service and we also have the primary care and mental health services. When those services-----

It will be a long time before we see in-school therapies, particularly in mainstream schools. That will be an issue. People will be reliant on CDNTs and the CDNT system will not be fit to deliver the service, even if we deal with the AON issue.

The CDNTs have made good progress on reducing the waiting lists. Having a more effective and efficient system is not the be-all and end-all. They need additional resourcing, supports and investment to meet the increasing level of need that is being provided. Also, the introduction of the autism protocol and the single point of access is getting people the services a lot more efficiently.

There are process issues we can work on with the HSE and which the HSE can deliver to make for a more effective system. With the wider engagement, we are working closely with the Department of Education and Youth on the design and interaction between the two systems. It will take time but they are a key response.

When will the in-reach teams be in place?

I would have to check what the schedule is. I think they are due to commence recruitment shortly but I would have to double-check with the HSE on the specific timeline in that regard.

I thank our witnesses from the Department for being here today. This proposed legislation seems to rest heavily on the idea that children who do not proceed through an assessment of need, AON, pathway will instead be signposted or routed to appropriate alternative pathways. It is very clear that those alternative pathways are not functioning in a timely, integrated, reasonable or dependable way right now. In the opening statements it was mentioned that 29% of children who have had an assessment of need do not meet the criteria for disability, and surely a large proportion of those children would have their needs met in primary care services, which are for people with mild to moderate difficulties, and usually requiring fairly short-term intervention. Mr. Considine mentioned recruitment efforts in children's disability network teams, CDNTs, but that is not really relevant to this cohort because if a child is with a CDNT, it is pretty certain that he or she will have had a diagnosis of a disability. Do the witnesses accept that there is a crisis in primary care waiting lists throughout the country and that the main reason for this is under-resourcing of those services for many years, aggravated by the HSE recruitment embargo and by the subsequent pay and numbers strategy, and severely affected by the roll-out of Progressing Disabilities, where large numbers of children were redirected from disability services to primary care without follow-on recruitment, and that this under-resourcing and poor service planning are the main reasons we have so many families trying to avail of an assessment of need for their child even if it is not necessarily the right thing for their child?

Primary care resourcing is under the Department of Health. We look at it from how all the parts of the system interact, engage and support the assessment and need, from the CDNTs to primary care. There certainly are challenges in recruitment and retention across the system, not just in the CDNTs-----

In primary care there has not been. I accept it is a different Department but it is so key to what we are looking at and it is so entangled. I think the Department of Children, Disability and Equality needs to be as fully abreast all of that as its colleagues in the Department of Health. It is really core to all of that. There have not been efforts to recruit in primary care. That is a fact. It does not go anywhere near the degree of need. Recruitment has pretty much ground to a halt in many services for years.

We are working with our colleagues at departmental level in the Department of Health on the wider picture of how families move through the system. We have a cross-sectoral group which is looking at that, with education as well as health. The group I mentioned earlier that is looking at how to increase the supply of the necessary therapists is looking at the needs across the system, in education, in health and in our Department. We are not fragmented-----

The worry with this legislation is that it is putting the cart before the horse in that the Department is narrowing eligibility to an assessment of need before the elephant in the room is addressed, which is poor service development, poor workforce planning and poor integration of services because the services are operating in crisis mode much of the time.

I do have to be clear that we are not narrowing eligibility on this. The eligibility remains the same and we are making no changes to the definition of disability or how and when people can access. The challenge is that making for more proportionate use of assessments and supports does provide the opportunity to reduce the overall burden on the system and then it frees up resources to actually deliver services across the-----

There is not even a recognition on the Government's part that the crisis exists in primary care. The Government has repeatedly denied the scale of it. The Minister for Health, Deputy Carroll MacNeill, will not commit to any staffing benchmarks in primary care services even though there could be threadbare staffing in place for a population of tens of thousands and waiting lists that are many years in duration.

I cannot speak to the Minister's position on that. I can just say that we are working closely with our colleagues because it is an integrated picture. We are not looking at a singular pillar of these in isolation.

There is now a focus on making sure the systems work well together, that the experience of families as they move through it is clear and that they are informed.

It cannot work without resourcing, though.

Coming back to the CDNTs, there has been investment this year in increasing resources through additional therapists, additional supports for the assessment of need process and the in-reach teams for the autism one-to-one protocol. That operates across the three service areas: primary care, mental health services and CDNTs. It is an integrated support in that sense.

Sticking to the point on the CDNTs, we had witnesses in here a couple of weeks ago who said, even with a fully staffed CDNT, there may not be the level of intervention we would want. CDNTs are still quite new but there was definitely a shift away from one-to-one therapies and towards parent education. As a former therapist, I have seen a lot of burnout where therapists are not getting to do the work they trained for and wanted to do. I am just back from America where they still very much provide one-to-one therapy. The model parents are getting now is not what they want; they still want one-to-one therapy. We probably need a mix of both. They do not necessarily have confidence that the HSE will recommend to them what they need, given that resources are thin on the ground. Somebody attending primary care might be told the assessment will not be done yet but rather to wait and see until the child is two or three. Online, parents are reading conflicting information. Even though parents do not need a diagnosis to access HSE services, some parents are still looking for that. When we remove the diagnosis requirements for special education placements, does that also reach to home tuition?

That matter would be under the Department of education. Generally speaking, that Department informs us it is moving towards a needs-based model across the system. How that will interact with individual components, including special classes, special schools, home tuition and the home tuition group scheme, would be a matter for the Department of education. My understanding is it is looking at it holistically.

Obviously this is pre-legislative scrutiny of the legislation but changing the legislation will have huge knock-on effects on kids accessing those supports as well as on the forecasting of school places and the pipeline needed of SNAs, autism classes, special classes and special schools. What engagement is Mr. Considine's Department having with the Department of education? This is a whole-of-government approach and an integrated approach. Is Mr. Considine having or planning to have those conversations with the Department, rather than working in two silos?

Yes. We have a cross-sectoral group which looks at the interdepartmental issues that arise across services for children with disabilities. That includes looking at special schools, special classes, the continuum of engagement families have through HSE services, and pathways into specialist-supported education services. We are having those conversations with the Department.

This legislation does not change anything with regard to the eligibility for special classes and special schools. The point I was making in the opening statement is that one of the drivers of demand is parents being required to get a professional report. Sometimes they opt to go for the assessment of need as a route to that report. They may also purchase it privately or find other routes. While the legislation does not make a change, we need to look at the system holistically and at how families are engaged.

This is a point on a journey towards a needs-oriented model consistent with the UNCRPD. The Department of education is looking at it through that same lens, if I can speak to that. We have to look at the system as an entire entity and at the family and child's journey rather than from the service looking out perspective. Those are the conversations that are happening. We are due to meet with the Department of education again in the coming days to discuss what-----

We are doing it to become needs based. That is good but we need to be clear. This may come into effect soon and we are not clear on whether an autism diagnosis will be needed to get home tuition.

When will people not need an autism diagnosis to get into a special school or an autism class? Then there are the repercussions on forecasting and pipelines. If we are not going to have as many diagnoses, will we know how many special classes, autism classes and SNAs we need going forward?

We understand that there will be communications and consultation. There is an absolute understanding of the anxiety that this might cause and the need for engagement. The Department of education informs us that this is going to be a key part of whatever those next steps are.

I thank the witnesses for meeting with us this morning. I will raise a couple of concerns and questions and, hopefully, the witnesses will be able to allay the concerns. First, will there be a review period for monitoring the impact of the amendment Bill 2025? Second, in relation to families “disengaging”, the fluctuating conditions and that phrase “high threshold”, I note the correspondence we have received from the HSE office of mental health engagement and recovery. It also draws our attention to the issue of children and young adults who may have psychosocial disabilities requiring CAMHS services. What regulations or guidelines will be in place for the disclosure of files? I see a red flag regarding the high threshold and the determination. What level of detail will there be in the form of guidelines or through regulation to ensure that no child falls through the net?

The third piece is in relation to due diligence. I trust that this has taken place. The High Court ruling of 2022, in line with the UNCRPD and the UNCRC, upheld the right to appropriate assessments and diagnostic tools. What level of diligence has been done regarding the removal of the statement of the nature and extent of disability from the Bill? What piece has been done around that? We know from that 2022 judgment, and a follow-on judgment in 2023, that the assessment process, the PTA, was found to be in breach of the Act. My approach would be to measure twice and cut once. I wonder what diligence has been done around all of that, and around the monitoring piece that follows on.

With regard to the review period for the monitoring of impact, we have ongoing monitoring of the assessment of need through the HSE reporting to us. We will be monitoring the outputs and some of the activities arising from this over time. It is important to note that because the system is based on the order in which people apply locally, we are going to have a situation where some areas start implementing this at a different time from other areas, depending on the nature of the backlog. We have to take that into account. It is going to take time to see the effect because of the current backlog and the transition requirements. People are already on a journey in that regard, and we cannot step in and say that we are changing it. We have to manage that transition carefully and monitor its impact in that regard.

With regard to family disengagement, for the past couple of months, we have been engaging with the HSE through a steering and advisory committee on the development of guidelines, including the closures issue. We are very conscious that if there is a vulnerability within the family, the HSE needs to ensure that that vulnerability was not the cause of the closure. It should be because of some legitimate purpose that actually necessitated it. The HSE should make sure it has the appropriate care and response in place if there is a concern. It is not about closing the AON. It is very much an administrative measure rather than any kind of control measure in that sense.

We will make sure the guidelines reflect the actions that need to be taken to ensure there is no underlying issue that needs a secondary response outside the assessment of need.

On due diligence, the genesis of some of these changes was based on the findings of those court cases and looking at how the courts interpreted the legislation as was and as is and what we might do in response to that while maintaining the principles set out around the access to assessment. This is not the PTA - the PTA was something else entirely – but it is about making sure there is the appropriate level of assessment. A lot of the reports inside the HSE suggested those decisions created an anxiety among assessment officers about what is appropriate. A lot of what we are about is communicating to assessment officers what is appropriate, informed by those judgements and by clinical practice within the HSE, so it is striking that balance.

On the assessment officers and strengthening their decision-making capacity, what qualification has an assessment officer? Will the witnesses describe that role? This person will be making very early determinations on whether someone has a disability under the Act.

The assessment officer role is currently an administrative role. It is based on what is in the Act. The HSE could probably answer this better in regard to its process and I am sure it has provided useful information. An assessment officer is the co-ordinator and evaluator of the evidence as compared to the definition of the Act. Their job is to gather and collate all the evidence they can from various sources. They have the ability to meet a person if they need to although that is done less frequently. It is usually based on a desktop exercise at the beginning. They are not operating in a clinical capacity.

It seems to me we are making a very strong determination of somebody being identified as having a disability under the Act by someone who is not a clinical person at all. What is the view of the representative organisations, psychologists, etc., with regard to that position having such an important say at an early stage?

I cannot speak for all the organisations-----

I am sure the Department has spoken to them.

Yes, of course, but I would not presume to speak for all those organisations.

Mr. Considine might take that part afterwards.

What is important is that there is the proportionate collection of information to make the decision. In some ways, the assessment officer is at the end of a series of engagements that are based on the clinical practice. You have the individual clinicians who are following the guidelines and rules, and Ms Dyrssen will speak much more eloquently to this, on what should be done to perform the assessment or to look at the disability or needs of the child. The assessment officer draws on that information and evidence. In many ways the clinical work happens to inform the decision that is taken by the assessment officer.

I am just going to read from Mr. Considine’s opening statement: "The aim is to enable assessment officers to make an earlier determination of disability, where appropriate, and reduce the need for unnecessary clinical assessments." They are making decisions ahead of clinical assessment so how can they make a decision using clinical knowledge if no clinical assessment has taken place?

The way the Act sets out the process, and we are building out from that, it is a case of establishing the disability, then establishing the health and education needs of the child and then the services.

The health and education needs element requires clinical input, but that process is not necessary if the disability does not exist in the first place. We are clarifying that. If the assessment officer decides that they need clinical input or a clinical input is absent to establish whether the disability exists, they will still seek it. It is not about saying they cannot do it. It is about creating a more proportionate response depending on what level of disability is established and whether they meet the threshold. It is not a binary system. A lot of the changes we are making reflect the fact that each individual child has these individual circumstances, not just for individual disability but the journey they have been on, how many reports they have got or how many assessments have taken place before this. They can come in with very little or a file. It is about making sure that everything necessary is there for the assessment officers to make that disability determination, which could include clinical assessments if it is warranted in the individual circumstances.

When officials from the HSE were before this committee previously, they spoke about assessment officers having an element of clinical backup, which is part of that wider theme. I am still trying to find out how that works because it can include diagnostic information from previous health engagements and other reports. The problem is that, in a lot of cases, there will not be a huge number of reports. There might be a number of people who suspect a child has autism and they may or may not have the correct training. I also get that at some point a child will be put in front of somebody who will make an assessment. How exactly will that work? What does the clinical backup look like for an assessment officer?

I will ask Ms Dyrssen to come in as she has direct experience of this.

In terms of clinical backup, assessment officers often might have access to clinicians who provide advice and support and who can look at the information that is in front them and maybe ask more questions. One of the things assessment officers do is make phonecalls to families. They follow up. They might get an application and there might be gaps in that information, so they seek that information. They are filling in any sort of gaps there. It is important to differentiate between what determining disability means versus reaching a diagnosis versus an assessment. They are different activities.

That is it. I am repeating myself, but I cannot help thinking that, in general, the AON system is flawed. It was set up for something and it has now become something else. The big issue is that we need to ensure that people can get access to the service they require. I do not think they will have any complaints as long as they are treated properly and the people who are making the initial assessments and then wider assessments have the capacity to make them. Beyond that, it is about their being put into a service and their getting it. Even if we get this AON part right, we all accept that there are a significant number of people who will need autism assessments. The autism protocol may sort them out. They will be happy enough and they will still have a right to go back to the AON system, but it is then a matter of them being able to get a service. While the Department may save some people who are caught up in the AON process, I still do not see how the CDNT system is fit to provide the service that is required by all the families out there at this time. How are we going to address that? I am an utterly broken record on this. We are going to need to start recruiting for absolutely everything from primary care to CDNTs to in-reach teams as well as for school therapies, which will not be in all schools for a hell of a long time. How do we deal with that problem?

On the CDNT issue, there is a road map to enhance the system that has been running for about two years now.

It has brought forward a number of initiatives to support and enhance the quality, delivery and accessibility of that. In June 2023, there were 16,000 children on the CDNT waiting list, and in January 2026, there were 9,248. We have also seen falls in the numbers in that category waiting longer than 12 months.

We are starting from a bad place. We are still in a terrible place. We are nowhere near having everybody who needs the service getting it within the timeline that is required. We are far away from early interventions. We will welcome anything that deals with huge waiting lists and get us to where we need to go. At least the HSE stated there would be a review of how families and children are dealt with. We need to see major movement. There are flaws in how we structured this in the first place. If we were starting now, we would not have set up the AON as it is and would not have set up the CDNT as it is.

There is a wider question around the orientated model. The reform taking place now relates only to Part 2, but there is a need for a wider review of the Disability Act. That is commencing and there will be consultation shortly in that regard. That looks at the wider concept and nature of disability as a current needs model versus what might have been conceived at that time. That changes the nature of assessment of need as well. There is a much bigger picture that needs to be looked at through that process.

An Oireachtas briefing paper that we received on this proposed legislation cites a national clinical programme for people with disability review that shows that while most assessment officers felt confident deciding where a referral for clinical assessment was warranted, fewer than half felt confident making a no-disability determination at stage 1 and fewer than a third felt that the supports were adequate. Given that, how can Mr. Considine reassure the committee and the public that expanding the importance of stage 1 determinations is safe and robust?

Further to Deputy Carrigy's questions on this, how can we justify assessment officers not having a clinical background when they are making what is essentially a clinical judgment at an early stage of this process within a system that is under so much strain? There are all kinds of systemic and political pressures weighing on those assessment officers to reduce the numbers of children accessing an assessment of need. Should it not be a requirement for assessment officers to have relevant clinical qualifications and experience?

As I think I mentioned earlier, the court cases have dented confidence in the assessment of need decision-making. They have given rise to questions such as, what do I do now when I am making these decisions and how do I establish disability? The purpose of introducing the statutory guidelines was to bring about that kind of consistency and confidence within assessment officers to apply that closely. It is taking from the court cases and the legislation, and putting it in a manner that can be understood by the assessment officers and applied in their day-to-day work. That will be foundational in rebuilding that confidence and making sure there is consistency of application.

Why are assessment officers, as part of their role, not required to have a clinical background and clinical qualifications?

The origin of that lies in the Act. The Act did not require it and the secondary legislation did not require it. Assessment officers function as administrative statutory officers and they are informed by clinical judgment. No decision would reasonably be taken without private, external or internal input from a clinical perspective.

Is Mr. Considine saying that for every decision they make, they are consulting with clinicians?

Information will be provided to the assessment officers. It may not be a consultation. There may be forms. They are based on the information that is presented. Even if we said they have to be clinicians, the children involved tend to be on the more complex end.

If they are found to have a disability, there may be a need for different inputs to assess the health and education needs of the children. Even a single discipline clinician in that role could not operate solely.

It is better than having no clinical experience or clinical qualifications. If someone has worked in the system as a clinician and worked with other disciplines, that is surely better. Even if it was part of the Act originally, surely the point of this process is to enhance safeguards.

It is important that same NCPPD report pointed out a large number of respondents had a clinical background and that did not entirely lead them to confidence or clarity in their determination. There is also the fear-based bit where they have been subject to questioning or the courts have made rulings. It has not to date led to entire confidence in decision-making. It is also important to note the role of the assessment officer is not to clinically interpret the information they are given. They review the functional evidence in place.

That is a clinical determination.

We have asked the HSE to look at the training, supports and qualifications of the assessment officers and at how that has transacted in practice. We have engaged with the HSE and discussed this. It is not a linear process whereby these people will, by being clinicians, somehow improve the system. There is a collection of issues that require the support.

It is one glaring omission that could be addressed.

It is.

How could it be argued that it would not be beneficial?

What qualification would we apply? That is the first question. The second question is-----

You could make a minimum standard of qualification and experience as you would with any job description.

Thanks, Deputy. You are out of time. I call Deputy Keogh.

Staying with the point on decision-making capacity, what exactly is the plan to strengthen their role? I am still not clear after that conversation what will be strengthened in the role.

There is a national induction programme. There is a programme of continuing professional development and peer support and supervision. The HSE implements that already and it needs to be built out. There is a group looking at training supports within the HSE. Regarding the legislative change, the statutory guidelines provide a key underpinning document to support this development and experience.

Where there is an issue or consideration around autism, we will also have the in-reach teams and the autism protocol. It is not the same process, but they interact and are mutually supporting, where appropriate. There is a collection of issues involved in increasing the confidence and knowledge and understanding and it is not just clinical-----

Exactly what extra decision-making capacity will they have?

We are not changing any of the criteria for the-----

Mr. Considine said the statutory guidelines will "strengthen the decision-making capacity of assessment officers". My understanding is they can determine if a full assessment is not needed. Am I correct in that understanding? Is that the strengthening of the decision-making capacity?

Some 29% of those who get to the end of the process, which includes the needs and education element, are found not to have a disability. That means the parents get decisions later and are not redirected to the service area. One of the key elements of the statutory guidelines will be looking at how disability is described and measured within the Act. There are a series of terms used within the Act relating to establishing whether a child has a disability.

We want to support the assessment officers to apply those in practice and consistently.

Will they have eyes on the child if they are going to decide that a child does not need an assessment or will it just be from parent questionnaires and other clinician reports? Will there be eyes on the child before he or she is referred elsewhere?

I will turn to Ms Dyrssen again on the practice issue.

Is that in terms of assessment officers?

Yes.

There is a function that assessment officers can meet children, but typically it is done on a desk-based activity and they may have clinical support for that decision.

Has the Department had advice from the Attorney General as to whether this will hold up in the High Court? When we tried to make reforms previously, we ended up in this position. It does not sound like it would hold up in the High Court if we are potentially referring people away from a full assessment if there have not been eyes on the child.

We engaged extensively with the Attorney General in drafting the heads of the Bill. Obviously we cannot say in anticipation whether something would be successful or challenged but we tried to design it so it meets the requirements as we understand it. It has also emerged from some of the precedents that have arisen.

I have just one more question if I have time remaining. What removes a child from the CDNT wait list?

As in when they move into the-----

It is great to hear that there was a big reduction in the HSE wait list. I think Mr. Considine said it went from 16,000 down to 9,000 or something. I am just wondering what constitutes the criteria to remove a child from the waiting list. Is that just having one meeting with somebody? For example, I know a two and a half-year-old child who is no longer on a waiting list but she has only been seen twice in a six-month period and cannot access preschool because she is too young for AIM support. She does not have a diagnosis yet and so cannot access home tuition. I would say she is probably not on a waiting list even though she has not had any one-to-one therapy. Her mum has just had two meetings with the speech and language therapist. I am guessing she is no longer on a wait list but I do not know what constitutes coming off the wait list.

I will turn to Ms Dyrssen again in a moment. I do know the engagement has to be substantive and meaningful. It is not just a one-off activity. There is a complex and lengthy list of engagements, several of which will ultimately constitute that meaningful engagement.

Typically, different teams operate in what they would call an intake pathway or an induction pathway where families are met and perhaps the individual family support plan is created. The supports happen after that. There might be some time between each element of those supports that are identified through the family support plan.

Does the family get a copy of the family support plan?

Yes.

Following on from colleagues, the key piece to this is the availability, the recruitment and the retention of front-line clinicians and that overlap with the assessment officer. Currently, 77% of assessment officers are nursing professionals. I am not sure whether it is known if they are intellectual disability nursing professionals or what the breakdown is there. The provision of service and timely intervention is dependent on the clinician. Will there be flexibility in the budgetary piece of €8 million for 150 posts and then €20 million for targeted wait list initiatives? Information we have received from the National Disability Authority, NDA, Inclusion Ireland and other excellent professional organisations shows the emphasis is on multidisciplinary teams. How is going the route of targeted wait lists and down the avenue of private providers considered multidisciplinary? I know there are different moving parts to it but again it is to ensure that piece. Will there be flexibility? Will that be through the Revised Estimates process?

There is another question on the awareness of what is the assessment of need. Will there be a public information campaign to go alongside? While there is a delay in the recruitment of the front-line professionals for the supports, the issue of misinformation is huge.

It is why we have arrived where we are at. What will happen on that?

Mr. Considine mentioned a cross-sectoral, interdepartmental review group. Pardon my ignorance, but are those reports available? Do we go to each Department's website to get updates on that? Is it something that could be communicated to the committee? I understand the Department of the Taoiseach is involved. We are trying to move away from silos. We are probably in one, so, to negate that, is there a mechanism to share that information?

On the last point, it is not a report. There is a standing group that meets between the HSE, the NCSE, NEPS - this is a bit of an alphabet soup - the Department of education and the Department of Health. I may be missing one or two in there. That is trying to de-silo the engagement and make sure it is family orientated. Children's progression can involve the HSE, the family context and the school or early years context. Early years is in that group as well, now that I think of it.

The multidisciplinary piece is about purchasing the supports required in the context and aggregating them with other supports. The basis of the CDNT is the multidisciplinary element. If there is a need for additional clinical input to the wider process, the initiative supports that measure. The multidisciplinary principle is key.

Is there a cap with the €8 million and 150 jobs? Is that PNS? Will there be any wiggle room or flexibility on that?

Flexibility in what sense?

The 150 posts and the €8 million in budget 2026. Correct me if I am wrong but my interpretation is the €20 million for targeted wait-list initiatives is outsourcing-----

It is.

-----beyond CDNT and primary care. That seems to be at odds with the UNCRPD. Children will need ongoing assessments. Will we not invest in in-house multidisciplinary teams for lifelong assessments of children to comply with the UNCRPD?

I will ask Ms Dyrssen to come in. The 150 posts and the €8 million are for recruitment of staff within the teams. The wait-list initiative is a specific temporary measure for the assessment of need, reflecting the pressures on the system now.

Best practice would be to engage in a multidisciplinary assessment process, if that was the question.

It is really about getting the investment right in CDNT and primary care so that outsourcing is at an absolute minimum. Will there be flexibility in the €8 million? Can the €20 million come back in or is it capped at 150 posts, as per budget 2026? Can more clinicians be hired to fill CDNT and primary care posts, as necessary?

They are subject to budget decisions year on year. The budget decision for 2026 was the €8 million and the 150. The €20 million is for purchasing outsourced, generally around autism to address some of the wait-list issues, which are immediate and acute at the moment.

Long-term capacity is not currently possible.

Long-term capacity is the priority but it is about that for the moment. We need that initiative.

I have just one question. I am sorry for being late.

On CDNT posts, I asked at the previous meeting about the position in Clonmel. I did not get a response yet and that is quite some time ago.

I appreciate the Deputy arrived late and has made his apologies but the witnesses are from the Department and may not have the answer to that question. It would be more a question for the HSE, I imagine.

Maybe they do have the answer to it. There are serious vacancies in Clonmel. When the CEO, Mr. Gloster, was here the last day, I asked him about the position on that and on filling the vacancies. Do the witnesses have anything on it? If they do not, will they please come back to me as soon as they can? It is creating serious difficulties in south Tipperary.

We will work with the HSE to arrange a response to that query. I do not have it, unfortunately, to hand.

We will chase up a response as well.

Thanks, a Chathaoirligh.

I am looking at a briefing document. The role of the assessment officer is causing a bit of concern. Some 23% of people in that role have clinical experience. That is in a survey. Some 59% have a clinical background, of which nursing, at 36%, is the most prevalent. It has become a more significant decision-making role, having been previously an administrative role, as the witnesses have said. I have a concern. I mean no disrespect to anyone in that role but the role is changing. There needs to be stronger clinical support for the role when making an early determination ahead of clinical assessment.

Absolutely. We have written to the HSE asking it to look at the underlying qualifications, at the support structures and at how the statutory guidelines will translate into a more robust system. We have asked it to look at the role and individuals in place.

The earlier determination we are describing does not change the criteria for determination. They have always been making that decision but it has tended to go a longer route. We mentioned earlier the 29% figure, whereby 29% have been found to have no disability. It just took longer to get to that point. It is not in the interests of the parents or the children to be on a route which ends up diverting away. They have been making those decisions and supported in making them. We need to make it more robust and to stand up more support through the HSE. They have been doing this until now with clinical inputs.

Mr. Considine is saying no decision will be made by an assessment officer where it does not have some element of clinical backing. In real terms, it is still a desk exercise, possibly with phone calls but not necessarily involving contact with the family.

Not necessarily, no.

Right. We are also being told there will be improved communications with families. That will not be carried out by the assessment officer but somebody will be the liaison in place for families to make contact with.

They do, currently. When-----

Families would say at times probably-----

Sometimes there are long delays because the assessment officers are six months behind, or a year or whatever. However, they typically make contact with the families to explain the process. Whether it is from an admin person or the assessment officer, families receive communication that their application has been received.

There is the wider issue of communication and of having someone they can constantly stay in contact with. That has happened at times and in places but not everywhere. Bernard Gloster said those who have said the nicest things about CDNTs are those who have had constant engagement.

Is the Deputy talking about CDNTs now or about-----

I am just talking in general.

Of course. Communication is the thing we probably do not get right a lot of the time and it makes the biggest difference. There is communication with the assessment officers in terms of letters and phone calls, typically. With CDNTs, they usually have access to communication through multiple means. In how well each area does that, there is probably variability.

With single point of access, it would be seen that there would be someone who would maintain communication with the parents, so they do not fall-----

I cannot speak to the specifics of that because each area is to develop its own plan.

We need to ensure that happens because that is one of the major areas where this falls down and we then end up with court scenarios.

I have a last question.

Very quickly, please.

How much has the State spent in the last while fighting court cases around AONs?

I imagine that is a question for the HSE. It would be interesting to get a response to it.

Before we finish, we have an answer to Deputy Healy's query on Clonmel. We can hear it in our private meeting later or we can forward it to the Deputy afterwards. I saw it in the documentation.

I thank the officials from the Department of Children, Disability and Equality 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 will be critical in shaping and improving the legislation. With members' agreement, I propose to publish all the opening statements on the committee's website. Is that agreed? Agreed.

The committee will now adjourn and we will meet again in private at 12.30 p.m.