The crisis in assessments of need sits within a much broader picture of chronic neglect, by successive Governments, of the disability sector generally and, within that, the front-line disability services and children's disability network teams, as well as, more egregiously, the primary care services. We cannot meaningfully address the crisis in assessments of need in the absence of a reckoning with that context and without acknowledging the undeniable fact that primary care services had been under-resourced for years prior to the HSE recruitment embargo of 2023 and 2024 and the pay-and-numbers strategy, both of which have impacted so drastically on those services. The pay-and-numbers strategy continues to prevent primary care services from rebuilding to a level where they can meaningfully be seen to provide a timely adequate service. In most parts of the country, primary care services do not really exist. If you are on a waiting list for three, four or five years, that essentially means being left without a service. Many thousands of families are seeking an assessment of need for their child. They languish on that particular waiting list for months or years only to then languish on a waiting list for intervention. Over 18,000 of those children are overdue an assessment in respect of the six-month threshold. There is a lot of legitimate concern among disability representative groups and families about the potential change to the right to an assessment of need proposed by the Minister, Deputy Foley, today because it is the one right that has a legal safeguard. Many families are stuck in an assessment of need avenue unnecessarily at the moment because the therapies they should be accessing through primary care services are tragically under-resourced in many cases. Lots of families are seeking an assessment of need when they may benefit much more from timely therapeutic assessment in primary care services followed by timely intervention. As we know, an assessment of need is only useful insofar as it is an access point to interventions. Pouring €20 million into assessments of need in the absence of workforce planning and comprehensive recruitment across all children's services is a dead-end policy. We need our child services to be joined up and working together, not disconnected and drawing up the shutter to each other due to the strain they are under. It is for this reason that the HSE single point of access proposal is sensible. It should assist child services to work in a more co-ordinated and integrated manner. A major issue in those services is what is known in clinical circles as defensive practice, which refers to a service having overly rigid exclusion criteria, basically repelling referrals of children in an unreasonable and inflexible manner. The human cost of that is children being passed from one waiting list to the next. The main reason for these patterns of defensive practice is that services are so overstretched, they understandably become territorial and guarding of their own limits. The reason they are overstretched is they have been drastically under-resourced. While the single point of access proposal is welcome, it will not paper over the cracks of this chronic neglect and the ongoing imposition of recruitment restrictions. Another historical and, in some parts of the country, more recent factor that has placed unbearable strain on primary care services is the significant number of children transferred en masse from children's disability network team waiting lists onto primary care waiting lists in the context of the roll-out of progressing disability services. This occurred without the necessary recruitment to meet the additional demand on those primary care services. It reflects a fragmented and disjointed approach to service development. Earlier this year, HSE figures released to me highlighted the dire state of these services across disciplines and throughout the country. Primary care services are in deep crisis, with children routinely waiting two, three or perhaps five years, and in some instances, far longer, for essential therapies. I only came upon that information through very persistent follow-up parliamentary questions because initially the HSE only released a figure of 52-plus weeks for long-waiters. In some cases, it was many hundreds of weeks. The first step in addressing this crisis in services more generally for children and, in particular, primary care is acknowledging its existence and the interplay between the Departments of Health and disability in resolving it. As a matter of urgency, we need to see the Government devise a workforce plan for primary care services based on a clear number of clinicians per population size in each health region, with increased staff ratios in areas of social deprivation. This plan needs to be followed immediately by a comprehensive recruitment drive. If pursued, this would provide much greater continuity of care for young people. It would reduce dependency on expensive outsourcing of assessments and improve retention of staff in services struggling at the moment and have been for many years with out-of-control waiting lists.

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