Joint Committee on Disability Matters debate -
Wednesday, 10 Jul 2024

Apologies have been received from Deputy Ellis. The purpose of the meeting is to discuss general provisions and the implementation of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD. On behalf of the committee, I welcome the Minister of State with responsibility for disability, Deputy Rabbitte, and from the Department of Children, Equality, Disability, Integration and Youth, Ms Margot Loughman, principal officer in the finance and reform unit, Mr. Niall Brunell, principal officer in the disability equality policy unit, Ms Maria Hodson, assistant principal officer in the children's services unit, and Ms Sarah O'Brien, assistant principal officer, assistant principal for disabilities. The Minister of State may call on officials to speak briefly for clarification during the meeting where a specific or technical point arises. Any follow-up questions should be put to the Minister of State because she is the accountable person before the committee. I am aware a wide range of issues will be the subject of today's discussion and, if necessary, more detailed information on issues raised can be sent to the team of the committee following the meeting.

On privilege, members and witnesses are reminded of the long-standing parliamentary practice that they should not comment on, criticise or make charges against any person or entity outside the House 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 witnesses' statements are potentially defamatory in respect of an identifiable person or entity, I will direct them to discontinue their remarks and it is imperative that they do so.

Members who are joining us remotely must be within the confines of Leinster House to contribute to a public meeting.

I invited the Minister of State to make her opening statement.

I am pleased to be able to address today’s session to discuss the general provisions and implementation of the UNCRPD. I acknowledge the cross-party work of this committee and its clear efforts in seeking to drive progress for disabled people in line with its remit to monitor the implementation of the convention. This is an exciting time in the evolution of the disability landscape in Ireland, and I look forward to updating the committee on the range of work ongoing in the Department to ensure disabled people are supported through a coherent policy agenda and joined-up action across Government.

One of the key initiatives is the development of the next national disability strategy, in keeping with a programme for Government commitment to delivering a plan for the advancement of the UNCRPD in Ireland. We have completed a robust and extensive public consultation process that has seen a national survey, town hall meetings throughout the country, engagement with our standing disability consultation and advisory groups, and targeted efforts to capture the voices of intersectional experiences, marginalised groups and seldom heard disabled voices. Informed by the consultation, this strategy will target actions across Government, with a thematic focus under five pillars, namely, inclusive learning and education, employment, independent living and active participation in society, well-being and health, and transport and mobility. Finalising the programme of work under these pillars and developing robust structures for accountability and responsibility are the current focus of work on the strategy. Critically, this is the first time we have structured a disability strategy on the principle of "mainstream first", and I am determined to put in place a framework that allows for co-ordinated and effective whole-of-government action on disability issues, which, as this committee knows, are far reaching.

On the disability action plan, this year has seen extensive stakeholder consultation throughout the sector, most importantly with disabled people themselves, as we work to optimise the implementation of the plan and ensure co-design and collaborative work is enshrined as a core principle in how we work, aligned to the UNCRPD. We are now into the first reporting phase for the plan, meaning that at the end of July, an independent monitoring group will review progress against actions. I look forward to its review of what has been achieved so far and what areas, if any, need additional focus to enable their progress. We got off to a good start, with a budget of €74 million secured through the budgetary process to begin building capacity and enhancing services, but we are now into a crucial period when important groundwork needs to be done.

The committee also requested an update on the progressing disability services, PDS, roadmap. I welcome the scrutiny of children's disability services that the committee has undertaken to date and its report, Aligning Disability Services with the United Nations Convention on the Rights of Persons with Disabilities, published in February 2023. A key finding in the committee's report is the inability of the PDS model to deliver effectively with regard to early intervention therapies, impacting UNCRPD compliance where the convention calls for a transition from a diagnosis-led service to a needs-based service, with assessment at the earliest possible stage and based on multidisciplinary assessment.

Both my Department and the HSE are highly conscious of the need to deliver services, both assessments of need and therapy interventions, and the model of PDS is seen as the most effective. The PDS roadmap is being rolled out to reorient the services from diagnosis-led disability to support UNCRPD and early intervention outcomes for children with complex disabilities. This includes increasing the disability services budget by 10.6% to ensure that children's disability network teams devote more efforts to therapy provision rather than assessments of need. The allocation of funding in budgets 2023 and 2024 came to a total of €16.5 million and the recently announced €6.95 million waiting list initiative has facilitated CHOs to procure clinical assessments through the private sector. The HSE is focused on recruiting more staff with much more aggressive recruitment of new graduates this summer to permanent CDNT positions, agreement on pay increases for section 39 staff and significant expansion in third level places and pipeline from September 2024 and September 2025.

These are just a few examples of the work ongoing across the system to ensure we deliver services and advance our obligations under the UNCRPD. Under the broad umbrella of the national disability strategy, we will implement a framework approach to delivery, providing a coherent vision for the future of disability in Ireland and enabling genuine, co-operative whole-of-Government action. I look forward to any questions members have to ask.

Good evening and welcome to the Minister of State and her staff. One issue that regularly comes up in our constituency offices is the CDNTs and the fact that PDS is not delivering. As was identified in the report and the Minister of State acknowledged, there are significant difficulties. She says the model of PDS is seen as the most effective. Has she looked at other models? Is there a possibility of tweaking that? Has she looked at what is happening in other countries? At the moment, it is not working. Maybe it would be if it was properly and fully staffed. The biggest issue is probably how long assessments of need take. We had this discussion earlier in the autism group. Who determines how long an assessment of need should be? As the Minister of State says, some of them done in the private sector only take about three hours. Have they been accepted by CDNTs in schools? If that is the case, is there a need for this 29- to 40-hour assessment? Maybe there is in some cases but maybe not.

Who is actually doing the assessments? Can we free up more therapists? There is a need to incentivise therapists to join CDNTs. Many opt to go into the private sector. It ends up being a vicious circle where the HSE is now paying private therapists to carry out services or assessments when they should actually be working in the public sector. The Minister of State talked about pay increases for section 39 staff. Where is that at? There is quite a significant pay disparity between section 39 and section 38 or the HSE. Until that is properly and fully addressed, I do not think there will be an end to that problem of staff leaving disability services, whether CDNTs or adult services. I see the Irish Wheelchair Association in Cavan is still not operating as it should be because of staff. Who are the staff in the six assessment hubs? Are they pulling from the same agencies, from primary care and CDNTs? We will not solve the problem if we are pulling staff from one sector to another.

The links with education have to be strengthened. The reason for so many assessments of need at the moment is to get access to an appropriate school placement. Schools are insisting on them. A diagnosis is not always needed for services but to get into a school. There has to be a better working relationship between the HSE and the community supports and schools.

Respite is still a significant issue. As the Minister of State knows, in my constituency, there is only one adult respite centre in Monaghan, one for children and adults in Cavan, and nothing else. We need a second one for children in Monaghan and possibly a second one in Cavan too. There is also the transport issue. The disabled drivers and passengers scheme is still too stringent. I know the Minister of State was chairing a transport group and a report was being done into that. Is anything coming from that? Are there any new models to replace the mobility allowance, the grants, and so on?

I thank Deputy Tully. She covered an awful lot. There is no doubt that the system with the CDNTs is not working. It is not, because they are not fully staffed. When you do not have a fully functioning model, it is hard to see what good looks like, because one is only guessing what good looks like. Could we incentivise therapists more to come into it? I think we have such a crisis in CDNTs that, as I said at the all-party committee meeting on autism, we need to look at innovative ways to support the CDNTs. Maybe we need to look at redeploying from primary care and some of the management of CDNTs. The simple reason is that the teams there are working as hard as they can in some cases, in difficult, challenging times. I have looked for funding before and will continue to look for it.

When I came into this post, it was said that the HSE had too much management, but we do not have too much in our CDNTs. We do not have enough people answering the phones or communicating so that the therapists can do their job. It is difficult to be a therapist on a CDNT that only has 50% of its staff. It is difficult to keep on top of the number of phone calls and emails. There are ways and means to do that better. I believe the administration issue needs to be addressed. I also believe there is a way, in the broader family of the HSE, to support our CDNTs. That should not mean that primary care or acute hospitals should not be able to deploy from their management clinical space of one day a week to support us in delivering therapeutic interventions.

The Deputy talked about incentives. We should absolutely look at a monetary incentive to make it more attractive, since it is a difficult role. We saw how fraught the pay increases for the section 38 and 39 bodies and the HSE were last year. I acknowledge that the Deputy asked the Minister for public expenditure questions last night about staff still not having received their full wages yet. I recently asked Bernard O'Regan how many cases that has happened in. I was shocked to hear that only 500 out of the approximately 1,100 organisations had their KOSI forms returned. The KOSI form is simplified. There is a telephone line to help the organisation to fill it out. There is no reason staff should not be getting the increases allocated last year, at the very minimum, because that is already signed off on. Whatever about the negotiations that start to come into place now, last year's pay negotiations should be done. I cannot understand why they are not paid out at this stage.

The six assessment hubs do not just have people from disability services. People from primary care also sit on them. The most important person in the assessment hubs is the assessment officer. Where there is a full cohort of hubs with the assessment officer in it, the files are processed much quicker.

When we were down an assessment officer, from three to two - we went from three to one at one stage in Donegal - the files were not going through quickly enough. When I refer to Donegal, I mean CHO 1, which is Deputy Tully's area. When the number is back up, however, we have two out of the three there now and when we hit the third assessment officer, the files move quicker, the assessments are done quicker and the families are put on a pathway much quicker. Assessment officers are key, and they come with many skills.

The Deputy is right in relation to the links in education because many of the referrals coming in for assessment of needs are coming through the pathway of education. They are also coming from primary care. I do not want lay it all with education but there is a good cohort coming in from education. In CHO 3, which is the Clare, north Tipperary and Limerick area, a pilot project was run, led by the chief officer, where there was a working relationship between the schools and the CDNTs. Workshops with parents and information evenings were held, which helped to build up resources and people's understanding. It has proved to be an incredibly worthwhile project. It should be in place everywhere.

I met with the Irish Wheelchair Association, IWA, only last Friday to discuss Cavan. The problem we have in Cavan is to do with drivers and ensuring that the staff are there. There is a conversation to be had with the IWA not only in respect of Cavan but also about the entire country. There is a need for funding, specifically on the transport side of things in circumstances where we do not have good links in rural areas. We do not have a Local Link services or anything like them everywhere. We need to be able to work with the likes of the IWA, which is quite dependent on community employment schemes for ensuring the delivery of services. When the people move off a scheme, we need to ensure there is capacity built in to put a person in place for it.

Respite is still a priority in the Deputy's area. We have had long conversations about it. It has not gone off the agenda. If it is okay to do so, I will let Mr. Brunell come in on the working group in the context of mobility, because it is up to date.

As Deputy Tully stated, the transport work has been led by work done under the national disability inclusion strategy, NDIS, by the action 104 transport working group. The latter produced a report. The Department of the Taoiseach is chairing a senior officials group which is taking that work forward and which has met a couple of times.

We are also looking at transport as a dedicated pillar in the NDIS, which will be the UNCRPD implement plan. That is looking at a couple of strands, one of which is a dedicated piece of work around the disabled drivers' and passengers' scheme in respect of which there is a recognised need to change the approach. The other is work on looking at assessments for transport supports. We have been engaging as part of that process, which has been managed by the Department of the Taoiseach. We have also worked closely with the Department of the Taoiseach on the transport pillar for the NDIS. We hope to unveil, as part of the publication for that strategy, a pillar's worth of work looking at transport support, from incentivising and doing better in terms of access to public transport to a whole-of-journey approach to people for whom public transport may not be an option or who might need additional supports to get to and from public transport. There is a great deal of work going on there. We would hope that the NDIS pillar would set out what that looks like over the next six years.

I thank the Chair. I welcome the Minister of State and the officials.

I suppose there are four different aspects that I will ask about. First, in relation to the EPSEN Act, as the Minister of State will be aware, the committee has recommended a review of the Education for Persons with Special Educational Needs, EPSEN Act. I would appreciate any feedback or update in relation to any plans to review the Act and an indication of the timeframe involved. As the Minister will be aware, not all aspects of the Act were implemented. As opposed to implementing the remainder of it, because it is 19 years since it was put in place, we would need to look at that.

I am also interested in the action plan, which includes preparation of a working paper on respite provision, which is extremely important to the families who need it. I would appreciate it if the Minister of State could advise us on the personalised budgets pilot. The evaluation of which would be good to know.

On assessments of need, it would be good to have an update on the current waiting list and the difference across geographical areas. In my area of CHO 7, it is tough working with families who need to have it. I appreciate that the Minister of State announced funding to accelerate an assessment of need waiting list initiative in May and to look at the possibility of the National Treatment Purchase Fund, NTPF. I would appreciate it if the Minister of State could give us an update on that. Is there any opportunity for parents who had to go privately and pay thousands of euro to apply retrospectively?

In the roadmap for service improvements, it was agreed that the HSE would set up six assessment hubs to streamline the assessment of need process. What is the current position in respect of those hubs?

I thank the Senator. On the EPSEN Act, the review, which was instigated by the Minister, Deputy Foley, is ongoing by the Department of Education. We have been informed that it will be done by the end of the year. We are looking at having it by the end of the year.

I hope to launch the respite action plan in the coming weeks. We will see the full allocation. I secured €15 million in last year's budget, but in a full year, the amount involved is €25 million. We will see how it will pan out across the entire country. It will be aligned with the regional health areas.

On the personal assistance budgets, I understand that these under review this year. The review is coming to a close, but it is ongoing as we speak.

The Senator referred to the assessment of need, AON, and the NTPF and asked what exactly is going on. The Senator asked about the figure. At present, there are in excess of 10,000 people waiting for an AON. The breakdown is as follows. Within current funding for our teams and everything else, the HSE predicts that approximately 3,200 AONs will happen naturally throughout the year within its 91 teams. Of the extra funding of €6.89 million allocated for the wait list initiative, 2,500 of our longest waiters will benefit. Believe it or not, there was another €5 million there as well. The HSE is also outsourcing that. It is the equivalent of 1,850 other additional people as well. It is all being streamlined towards the longest waiters, bar what is within the CDNT gift of the 3,200. That is where children will need to have that assessment if they need to access education or other parts of it. That, in itself, is the guts of 6,700 AONs to be completed and it is being broken down on a percentage basis to every CHO across the country.

Senator O'Loughlin asked about her own CHO. I do not have the figures in front of me but I remember that in excess of 4,500, between current assessment of needs and PTAs, needed to be done in CHO 7. Am I correct that it is CHO 7?

That is my understanding of what is required in the Senator's area, where an action plan is being put in place. In fairness to the disability manager Margaret O'Neill, who is in charge and who is only new into post in the area, she is awaiting some posts to be signed off as we speak so as that she can enable the works to be done in her area.

In terms of those who were waiting, the Minister of State rightly says there are approximately 4,500 in CHO 7, which, when one thinks of 10,000 across the country, shows that CHO 7 is a significant laggard in terms of getting AONs. I would be aware of and have worked with some families who, not being able to access anything because they did not have the AON, scrimped, saved and borrowed to enable themselves to have it done privately.

Could there be a cut-off date from last Christmas for parents who sacrificed other things within their household? If they would be able in any way to retrospectively get some of that funding back, it would be a very good thing to do.

The Minister of State and her officials are very welcome. I am delighted to see her. I will raise a few matters. The Government announced funding to accelerate the assessment of need waiting lists. This sounds like a very good idea. I am perplexed as to why it is taking so long because there is a waiting list. I understand it takes time, but the National Treatment Purchase Fund has been very successful in other areas. I very much welcome the funding. It is an area we need to push as fast as possible but I appreciate that these things take time.

The programme for Government, Our Shared Future, committed to develop an implementation plan to ensure delivery of Ireland's commitments under the UN Convention on the Rights of Persons with Disabilities, UNCRPD. Will the Minister of State outline the progress to date on that? Have persons with disabilities been included in this process?

On the UN process, to be fair to the HSE it tries to do both an intervention and an assessment. Clearly, the capacity requirement means that when there is not enough staff, it is very hard to do both. That is why the funding that has been sought is for the long-waiters. There are also resources to access private capacity. That is there to do it. As I said to Senator O'Loughlin, a percentage basis has been put on all the different CHOs for all they need to achieve with the money that has been allocated for long-waiters. I am looking at two sets of figures. Of the overall figure of 10,000, every CHO should deliver 3,200 assessments as part and parcel of, and within, its current staffing requirements. I am also looking at the long-waiter list. Two lots of lists are being addressed.

It appears that there is capacity out there. Deputy Tully hit on a very important point. Within the public system, it takes up to 36 hours to do an assessment, but nobody questions the timeline or how long it takes to do an assessment in the private sector. It is a conversation that once private assessments are within the framework, the funding will be paid once the assessment is provided. That framework is devised by the HSE. It ensures that people have the right CORU regulation and registration, and have the experience to be able to do those assessments of need. Once they fit into that framework, nobody queries the length of time it takes to do it. One thing is certain, however. The delivery of assessments within the public sector is, on average, 30 to 36 hours per child. That is the standard.

The way the system is developing is unfortunate. As we do not have enough staff and needs are building up, more of an ask is coming to the private sector to deliver. That ask is driving the system within the private sector as opposed to getting the public sector more developed. We need to crack the nut on that.

I thank the Minister of State and all her officials for coming in. Before I ask my questions, because of the time of year and the fact that we may be in recess very soon, and it is not certain what will happen in October and November, I will say the following. I first met the Minister of State in 2020, after she had been appointed to the role. I thank her for all the work she has done. She has done it sincerely and against incredible odds. I am sure her officials have had to work very hard as well. I wanted to put that on the record. I thank her for all the support she has shown me, both personally and as a Minister of State, in not opposing my Bill. I really appreciate that. I know her absolute integrity regarding all these matters. I wanted to say that before I ask my questions.

On the CDNT PDS model, the reason it is not working is not just due to a recruitment issue. My understanding is that there was no clinical sign-off of this at the design stage. Who designed the CDNT model? A number of academics were before the committee recently who said that there is no evidence base whatsoever to support the CDNT model as it is currently operated. It is not based on evidence. It is just something that somebody made off. My understanding is that there was no clinical sign-off or risk assessment on it. We are now in a situation where 10,000 children are on that list and people are being harmed for want of timely interventions within the therapeutic window. It is a very serious question to find out who designed that model.

The committee was also introduced to a person who was described as the clinical lead of the CDNT PDS model, Mac MacLachlan. As far as I can see, he is a full professor of psychology in the National University of Ireland, Maynooth. By what mechanism was he recruited and appointed as clinical lead of the CDNT PDS? How did that happen? Is he remunerated for both positions or is he on secondment? How does that work? Quite rightly, there was some disquiet and many questions asked when it was suggested that the Chief Medical Officer, Tony Holohan, be seconded to Trinity College as a full professor. This is the other way round. Here we have a full professor who suddenly appears before the committee as clinical lead. He is not a medical doctor. In addition, he appears to have disappeared. I do not know where he is. Where has he gone? Who is the clinical lead of the CDNT PDS model now?

In other areas of provision, for example, child and adolescent mental health services, CAMHS, I know that the clinical lead is Dr. Amanda Burke. She is a child psychiatrist with higher specialist training and has done all her courses. She is clinical lead but is also amenable to the Medical Council. We are looking at a system that is not fit for purpose, not simply by virtue of the fact we have difficulties with recruitment but that we are told by the experts that the CDNT PDS, and I do not know who designed it, is not based on any evidence model. It has caused a great deal of harm. I am trying to tease out who is responsible.

My other questions relate to assessments of need. In other jurisdictions, assessments of need are often provided on a two- or five-year basis because of the developmental profile of children, and they also provide the services and supports. The suggestion that the two are somehow mutually exclusive has been a slightly recurring theme in recent interactions. It has been suggested that we cannot have, or need to move away from, providing assessments of need together with services and supports. In other jurisdictions, and even based on the circumstantial logic of it and common sense, of course a person should have an assessment of need and then have the services and supports that are identified as necessary. How come they can do that in other jurisdictions? Could it possibly be that it is because they have models of service provision and assessment that are based on evidence and people who are qualified to make such decisions?

I have a final question for Mr. Brunell.

Could he let me know when the transport working group last had an update on developments in that area?

I am formulating my answer based on the Senator's questions because the questions are very well-founded. Sometimes as Minister of State, I am often found guilty of jumping into answer a question without thinking it through completely, and on this one I am thinking it through. PDS was formulated ten or 12 years ago but it finally became operational on my watch. The lead referred to by the Senator was the clinical lead at that time on the delivery of it. I remember at the time when it was coming to the final completion of it about a choice-based approach for parents. We have had this conversation before - closest to home or closest to school. At the time, the HSE would have said there was no choice, but when you went back to the foundation documents of it, which Noel Byrne did and read through, it was very clear that 12 years ago, the basis of it involved a choice involving closest to home or closest to school. You could choose where you accessed that service. Regarding the clinical piece referred to by the Senator, the risk assessment and the evidence base, I genuinely think we should have that answer. The new clinical lead within disability services is Dr. Rosie Gowran.

Frankly, that is extraordinary. In terms of any of the questions the Minister of State cannot answer here, because I do not want to put her unduly on the spot, will she provide me with a written explanation of how that competition was run to a point where the individual I will not name was appointed to the position of clinical lead? I ask this because, in other areas, it is a medical professional - a clinician - who is amenable to the Medical Council. They are the people who are clinically and legally responsible. It is no disrespect to the individual. I had a discussion with the former clinical lead - I presume he is now former lead - about this and he said some pieces of research suggested it should not always be the medical person who is the clinical lead. You would not say that about oncology, cardiology or orthopaedic surgery. It may in part inform why this thing is not working.

I was about to address that piece. I have a note in front of me regarding it. Witnesses appeared before this committee a number of weeks ago who spoke about this. The HSE knows that the evidence base for the PDS includes the lived experience of health services of children with disabilities and their families, gathered through family representation, surveys, observations, assessments, knowledge and experience of professionals who support children with disabilities and their families, evaluation of pilots, and demonstrations by national and international published research. I do not have here the published research that references but I have no doubt we will provide that.

The assessment strand met this morning. If I say there is ongoing engagement, I mean it in the context of weekly and daily engagements on the NDS. I would struggle to remember the last time we met on transport but I can describe the engagement as live. I cannot remember when we last met because we have met them so frequently. The assessment strand of the senior officials group I mentioned had a meeting this morning.

My question is directed at the officials and concerns implementation. The Department is the oversight body for the implementation of the UNCRPD. Unfortunately, the Minister of State does not have control of all Departments and she cannot implement the UNCRPD across the different Ministries. I spoke to Mr. Brunell about this previously. How is the interaction and communication between the different Departments moving forward? How is it working logistically? Are we seeing results? The UNCRPD is about every aspect of our lives and the Minister with responsibility for disabilities is a siloed job.

Why has the HSE failed to deliver therapies in school as it has been asked to do? My preference would be for the schools to be the place where therapies are delivered so that they are part of a child's education and development and it is an integrated process.

Has the HSE considered signing-on or retention bonuses for CDNT staff? The Department of Education is looking at these. A significant gap in progressing disability services involves people and we need to push the boundary on everything to get staff into our CDNT teams.

How can the HSE outsource assessment of needs to the private sector that can be completed in less time, for example, five or six hours, but not assessment of needs completed in the public system, which takes more than 30 hours? There is a significant gap there in terms of time.

Should primary care and CAMHS be offering therapy time to tackle that assessment of need backlog? How many assessments of needs come from recommendations from the education side?

I thank the Senator. I will skip straight on to schools and will let the team answer some of the other questions. First, on why the HSE has failed to deliver on putting therapies back in to the schools, in 2021, PDS was being rolled out and therapists were coming out of the schools in Dublin. There was also the school of the deaf in Cork. The exact time was May. At that stage there was an extraction of 88 therapists out of schools around the country. I can remember putting a halt on it. The press release is there. Halt the removal of therapists. I was not long enough in the job to realise that "halt" did not mean halt because it continued in some cohorts around the country where the therapists continued to be removed. We got the funding, however, in June from the now Tánaiste, then Taoiseach, to ensure that the therapists went back into the schools. To be fair, in some schools on the east coast, they did go back in. I am thinking of Carmona as an example of where they did go back in. In 2021, we faced into budget 2022, and an additional 134 therapist posts were secured. It was solely secured that therapists would be back-filled, that is, recruited, filled and back-filled, back into education. It would be ring-fenced for special schools and within education. From there, the battle continued and continues. The most public of it all is in relation to the Cork schools where the therapists never went back in. It is not because the money was not allocated, because it was. A clear commitment was given to the then Taoiseach, Deputy Micheál Martin, that the therapists would go back in to the schools. That was a clear ask and a direction: not aligned to but "put in". Language is important here. It was not "aligning to" but "put in". That is where the funding was secured. It was 88 plus 125. That was then and to this day, I have continued to battle to ensure that therapists would be returned in. I had some success. I talk about the Wexford model where, under the leadership of Bernard Gloster and Grace Rothwell, the special school in Wexford was able to recruit the therapists and to work with the local CDNT, that is, they were able to have the conversation. The clinical governance was provided by the local CDNT. Unfortunately, we could never crack that nut in Cork. That is culture.

On whether I have considered the sign-on bonus, absolutely. I was delighted when I saw the Minster, Deputy Foley, looking at it. I have certainly raised my eyebrows as to why we could not do something similar. We do bonuses or we give relocation packages to the value of €4,300 to bring people back from abroad. That is the relocation package we pay. It would be ten times nicer if we did not have to do the relocation and we could just second them or capture them as they leave college.

On how the HSE can outsource to the private sector, first and foremost, I cannot stand over children not getting access to assessments. I have to beg, borrow or steal and do it wherever I can do it and with whoever is prepared to work with me. I would prefer if it was all within the public system. I would prefer if I was growing the public system and if the staff members were within it and could do both models at the one time, as Senator Clonan said, that is, to have intervention and assessment. That is the way it should be but when I cannot get that delivery or KPI, I am left with no choice but to ask my senior Ministers, the Minister, Deputy O'Gorman, the Tánaiste and the Taoiseach to ensure that funding is allocated so that the job can get done. It is not exactly how one would want. In every other element of the public sector, everybody wants to go to work in the different Departments. The only part of the public sector that nobody wants to work in is in my CDNTs.

The conversation here today is almost making me a little nervous because I am terrified that someone will go and challenge that and that if it ends up being challenged then everything ends up having to be 36 hours. That would slow down delivery again because I have no other mechanism of it. However, at the same time the HSE and the Department of Education accept them as long as they are under the framework. A child can access that classroom space based on the private assessment they have received, so long as it is covered off and signed off by the HSE. Does Ms Hodson want to explain this a little better?

What we outsource is clinical assessments rather than a full assessment of need. Once the clinical assessment, which might be done by a physiotherapist, is done, it has to go back to the HSE and an assessment officer still has to review it. Then they will take account of the education report to do the completed assessment. That is where a lot of the time comes in. The three- or four-hour assessment is not the final assessment of need.

However, everything has to come back to the HSE because it holds the legislative requirement to ensure that we sign off on everything. We can do it one way and not the other.

I think there was a question about the Departments playing their role.

Two roles are set out under the convention. There is the independent monitoring role and the focal point and co-ordination role. In the Irish context, since we ratified in 2018 the independent monitoring role rests with the Irish Human Rights and Equality Commission, IHREC. That was put on a legislative footing when we commenced the assisted decision-making Act last year. In terms of assessments, where we are strong or weak, where we are compliant or where we are not, that is where that work rests. There is also the periodic review process where the committee in Geneva itself receives reports from the State and from civil society. The State appears before the committee in Geneva and the committee will do its own assessment of Ireland's compliance. We submitted our State report in 2021 and we are awaiting a review date now.

On the Department of Children, Equality, Disability, Integration and Youth's role, we are the focal point in the co-ordinating mechanism. Therefore we are not the monitoring body but it is our responsibility to pull the different strands of Government or the State that need to work towards the UNCRPD implementation together and then produce a collective, cohesive and co-ordinated set of policies, strategies, interventions and so on to ensure that we are meeting our UNCRPD obligations. That is probably most strongly being done in the national disability strategy now as it would have been done under the national disability and inclusion strategy previously.

IHREC is under the Department's aegis. It is independent but the legislation that underpins it was under the Department. It is the monitoring body. I can easily count loads of circumstances where different State bodies have failed in their obligations, whether, first, in their public service duties and second, under the UNCRPD. IHREC has the right and power to bring people and public sector bodies to court for failing their public sector duty. It could bring the HSE to court or a Department for failing its duty. We do not see a robust monitoring of that public sector duty. That is under the Department too. Has there been any monitoring of that and what IHREC has not been doing? It is not the Department's role to do it but we have written and passed the legislation. It has the role and it is has failed to do it.

I will not speak for IHREC because it is independent in its function and I do not think it would be appropriate.

Broadly, I think the issue the Senator is really getting at is where things are not being done where the lever is to make sure that things move along. We are extremely conscious of that in developing the NDS. What we are looking to specifically design coming out of previous strategies where there may have been delivery issues is to ensure we have robust and credible monitoring mechanisms so that alongside the independent monitoring role and alongside relying on individuals taking cases to prod the system along, we have systems, procedures and structure in place to make sure that where something is stalling, there is a process there to bang heads together. We are seeing that even in the development process where we have huge assistance in leadership from the Department of the Taoiseach and where we have had really strong ministerial engagement on the strategy as well. We will look to build that into the structures under the next strategy.

Generally speaking, because this is an issue that comes up with regulatory bodies, they are separate from Departments in their function by necessity and so I cannot say too much. There is a degree of oversight, maybe particularly in terms of such issues as budgetary oversight, but "independent" has to mean independent in those contexts.

We need to pay them another visit when we are finished here, maybe to get money for disabilities.

I thank the Minister of State for coming in. I will not detain her. My questioning will not be too long. I believe that in trying to do everything right, we still are struggling to get the basics right. I can see it on a day--to-day basis - I am sure the Minister of State can and every other politician in the room can see it - where parents are coming to us where they cannot get assessments for their children. I had a case last week where somebody was brought in, they were asked the child's name, date of birth, PPS number and whatever else. They were effectively registered and that was it. They asked when would they have an assessment and they were told it would be at least two years. The child is two-and-a-half years old and is non-verbal. The problem is that child cannot progress any place until an assessment is done and must wait two more years. On the other side of the coin, I had a woman who rang me yesterday. She got her assessment. The boy is aged ten and for his next step, he has to go to CAMHS. They have been struggling for five years, if not longer, to try to get the assessment done. The timeframe to get the assessments does not seem to be improving and they are coming to politicians to try and speed up the process.

I then had the experience of meeting a young speech and language therapist who had been working in the HSE for three and a half years and was not getting a permanent contract and is now in New Zealand. We talk about getting people back into the country but when we have them, there is something missing when we do not take care of those we have and give them permanent contracts. If they cannot get a permanent contract, they cannot apply for a mortgage. They cannot do anything like that. We are saying we cannot find people, yet we are losing them out the door.

It is frustrating and I know well the Minister of State knows what is going on. It is a question of how do we start putting this right. We are putting money now into letting parents get private assessments done but when I listen to what she is saying, it is only the start of it and it all has to come back into the HSE. I thought disabilities had been taken out of the HSE and gone into another Department, which took maybe two years to get done, but it seems we are still being dragged into something or back the way again all the time.

It is a big challenge but, at the end of the day, the young children who need the interventions earlier are not getting them. The young girl who has been protesting for the past two weeks outside the gate was looking for us as legislators and the Government to do what is a legal right for these children, which is to provide an assessment within six months. Is that not it? Commitments are being given on that but what I would love to know is what will change so that these commitments can be met. People keep telling me it is a question not of money but of trying to get people, but I believe there is a game going on within the HSE and Departments or wherever at the expense of providing the services when I see a young person saying she was being refused a permanent contract after three and a half years and she was happy enough to go travelling. I am probably talking to the converted.

I thank the Deputy for discussing that point. I will share openly with him that I chair our workforce planning and what he said is really important to me. We are trying to increase the number of places. To be fair to the Minister, Deputy Donohoe, and the previous Minister, Deputy Harris, they were really good at increasing places. The point is that if we do not capture them when they are exiting just like that young lady or when they are finishing after their four-year course, we have them lost because they will travel and they might not come back, or they will go into the private sector. I keep saying we need to capture them in the public sector. What is really soul-destroying for me to hear the Deputy say that is I sit in front of the HSE officials and they tell me that they are offering permanent contracts to everybody. They tell me that there is nobody not offered a permanent contract. They tell me that, as we speak, they are running recruitment fairs and telling people, "As soon as you finish, you have a job with the us. Come and work with us. We will even give you that time off to travel and you will have a job to come back to." It is so dishonest to tell me that is the practice and the Deputy is telling about the lived experience. It is dishonest that the model that I am led to believe under which we are giving permanent contracts to people is not happening. As a mother of a child who is going into her third year as an occupational therapist, as any of the people who are putting their young people through college, there is a great opportunity for them at present to seek opportunities in employment but we should not mislead young people either by going to the recruitment fairs and still not honouring that permanency at this moment in time. That is wrong. The parents of that young girl who went to New Zealand would have educated her and would not want to see her go permanently. That is wrong. The HSE will have to answer to this one. Why tell the Minister one thing, which is that we do not have a recruitment embargo and we are offering all opportunities for everybody exiting the class of 2024? Of the class of 2023, how many were given permanent contracts? I am told all and the Deputy has had a different experience. I do not doubt what he is saying.

We know that. The Minister of State said she chaired a workforce planning group. I do not know what the purpose of that group is. This is where I am getting at. We have to get around what is wrong. We know what is wrong. I believe the day of reckoning is coming. It happened in Tuam where the parents, when they got into a forum, realised what way they were all being treated. They thought it was isolated that one person was being treated. They ended up on the streets last December protesting outside the brand new CDNT building, which is probably still only half-staffed. The key to it is that they are not being staffed.

The headline suggesting that money is going towards allowing parents to get private assessments done is not the full story. Private assessment is not complete until it goes back into the system, which is failing people. That is where we have to clear the decks and start anew.

I thought disability was no longer the responsibility of the HSE, but it is still well and truly rooted in it. We should not be blaming the HSE; this should be a Department of disabilities issue and everything should be within the power of the Minister in this regard. If not, I do not know what we are at.

I hope we are not depressing people but I do feel there are many people who cannot understand what is going on and why things are not being put right quickly. There could be little games going on within different public sector areas to keep these things where they are-----

Let me reassure the Deputy, who knows me quite well, that there are no games on the side of the House and none in the Department of Children, Equality, Disability, Integration and Youth. To be very fair to the team here, to Mr. Colm Ó Conaill, the assistant secretary, and to the Minister, Deputy O'Gorman. We want nothing more than a functioning system. To be very fair to Mr. Ó Conaill, who is not here, he has put in place a number of working groups to ensure that we can try to get under the bonnet on this. Many conversations are taking place.

The chain of command so long that things are not actually getting through it. Mr. Bernard Gloster is a really good CEO, he is a good guy and he is well-intentioned, but there is no doubt that when he beats the drum by way of giving a direction, that direction is not received to the same extent in all areas of operation. This goes back to the difficulties I had with getting therapists but back into special schools that were funded. The chain of command was not followed through on. It is the same with delivery, assessment, intervention, the key performance indicators, accountability and determining what the output looks like. Until such time as we understand output, we will not address this, but at the moment I cannot do output or hold to account the part I would love to hold to account because I do not have fully functioning teams. At all times when I try to appraise the delivery of a service, I do so with one hand behind my back because I do not have fully functioning services.

Regarding the young lady outside the gate whom the Deputy talked about and who is a very strong advocate, we are failing everybody with the legislation insofar as we are not able to hold ourselves to account. I am referring to the State but also to those we task with delivery. Legally, the task of delivery sits solely with and is central to the HSE.

That is very strong. I agree with the Minister of State. We have nine CHOs. With regard to Carlow and Kilkenny, all the districts are changing. Who is the HSE accountable to? As other Deputies have said, the system is not functioning. There is no functional system. I can speak only about my own area, Carlow–Kilkenny.

I thank the Minister of State for her work and commitment. No one has worked as hard as her as she always comes back to you and does what she can. I welcome the €74 million in the budget. The Minister of State spoke about the public consultation process and all the town meetings happening around the country. I am aware she has spoken about the disability action plan and has said she expects an update at the end of July. That involves the independent monitoring group. However, I have spoken to parents at meetings and noted that some of them had tears in their eyes because they felt there was no support at all. Their children were waiting to be assessed and could not get their assessment. I learned the CDNT was not answering the phone and that children could not get school places. We always speak about early intervention here. It is crucial for a child. Like other members, I have had parents come to me who were so upset because the system was failing them. How do we work on a system that has been so failed for so long that parents are so disheartened? Children are being left on waiting lists and not being assessed. I have major concerns about private assessment. While I welcome it, I am concerned about the loops parents seem to have to go through. Maybe we need to consider this. How we address it will be crucial.

I have major concerns. With regard to the capital plan, two years ago we were told the CDNT building would be built at Kelvin Grove, Carlow, but there is no word about that now. I realise it will happen. Again, we are announcing things and they are taking time. We need to get the new CDNT building built. I know the Minister of State was very good in this regard. Holy Angels is part of this. It is another excellent school in Carlow. We have great facilities. About three weeks ago, Joe Meany from Delta Centre in Carlow spoke before this committee. The centre is absolutely excellent, but Mr. Meany cannot get staff because it is a section 39 organisation. The biggest barrier for any service now is getting staff and retaining them. Staff are leaving the section 39 organisations to go to the HSE. We have many excellent facilities around the country, including Delta Centre and Holy Angels, and there are many great schools, including St. Laserian's; however, we must ask where all the staff in the section 39 organisations, such as Delta Centre, are going to. This is a worry. Why would you do the same work as those in another organisation, and to the same standard and with the same qualifications, if you did not get the right pay? The first thing we have to do is sort out our section 39 organisations. We have no choice. The first huge failing within the system concerns the section 39 organisations. While I am aware of what the Minister of State is calling for, there is anger among the workers, who love what they do and want to stay where they are. Like others, however, they have mortgages and bills to pay. They need proper pay for proper work, which they are not getting.

The CDNT in Carlow is very understaffed. I know some of the staff and they are absolutely excellent. I am not here to criticise any staff because many of them are at burnout level. When staff are at burnout level, who will pay the price? It will be the children and parents. It is a case of getting the CDNT staffed, recruiting occupational and speech and language therapists and sorting out all our other services, such as that provided at Delta Centre.

Perhaps the Minister of State will provide an update on the report from the monitoring group that is due to come out at the end of the month.

The committee recently met the Minister of State responsible for special education and inclusion. At the meeting, the importance of the NCSE being aware of children who require special classes was highlighted. Can the Minister of State provide an update on whether everyone is working in conjunction with one another? While we have all the various areas, I wonder whether we are all on the one page. Is there joined-up thinking?

I am really going out disheartened today. How do we sort out a system that has failed our children and families so much?

I know the Minister of State has the six assessment hubs to streamline the assessment of needs process. Where is the nearest one to Carlow and how is that working? According to the most recent census, County Carlow has grown by nearly 10%, and we now have a population of 62,000. The population of Kilkenny is well over 100,000. Therefore, we need a hub. Maybe the Minister of State could come back to me on that.

I see the Minister of State trying to knock down the doors and break down the barriers that are there. Those doors are not being opened. If we do not start to open them, we will have protests throughout the country in the next while because parents are at breaking point.

I thank the Minister of State. She is always willing and she always comes back to us. Perhaps she might come back to me some of these questions.

I thank Deputy Murnane O'Connor. She asked about action plan reporting and monitoring progress to date. The action plan will be monitored by an independent monitoring group, drawing on the membership of the disability stakeholder strategic advisory group and chaired by me. The group will meet twice a year to ensure that we are delivering what is set out in the action plan. The latter covers a number of areas. For example, within it are housing, respite and supported independent living. The purpose of this is to ensure that we are able to hold the Department of housing to account over the period the houses are being built and the it does what it has signed up to do and meet its commitment in the context of the plan. While that Department has taken ownership of the delivery of the housing, I have to fund the services involved, be they for individuals or for supported independent living. I need the properties to be developed, and the Department of Housing will do this.

It is the same with respite services. When we allocate our respite plan budget, we have to monitor that the number of houses and bed nights envisaged are delivered and that those responsible are working at full tilt. The position relating to residential decongregation is the same. Many of the providers are getting to the stage where they have been in operation for 40 years. In Deputy Murnane O'Connor's area, SOS has been in operation for 50 years. These are mainly services operating on the basis of a social model, with only five nurses supporting 80 individuals in residential care. They need extra funding to meet the changing needs, and this is the nursing allocation. Deputy Canney and I have Ability West in our area, which is also a social care model that needs to be a medical model in order that it can meet changing needs. This is so that we can continue to support people. This is what the monitoring group does. The report at the end of the month will show how the first six months of it have gone.

Sometimes we can be overly negative. To be fair to Bernard Gloster and Ciarán Devane, over the past 12 months they have met the Minister, Deputy O'Gorman, and me every three months. They take on board a lot of the feedback we bring to them. To be very fair, they meet us and listen to our concerns. Our primary concerns are always assessment, recruitment and retention. The board of HSE has given this priority. We must remember that when I was in the Department of Health, I did not have this access to support. While we were in the Department of Health, we did not have access to this frequency of meeting the CEO or the chair of the board.

A focus has been placed on disability within the HSE and it is part of its strategic plan. Much of the commentary to date has been negative but honest. When an embargo was put on recruitment Bernard Gloster did not put an embargo on the HSE. It is unfortunate that we have not capitalised on this to the level we should have done. We have to ask the questions that Deputy Canney asked, as to why we could not capture more staff. It is a fair question to ask when it comes to what is the process that is not working in HR and what is the process that is not working whereby we are losing young qualified speech and language therapists who are not getting permanent contracts. We have to have to ask what is happening within the broader church of HSE recruitment.

Deputy Murnane O'Connor asked whether all Departments work well together. Every Department is a silo. It is only when we moved out of the Department of Health and into the Department of disability that the team got working groups and began building very strong relationships. The new national disability strategy has the various pillars, which means various Departments will take responsibility for disability within their areas. It will be a game changer. We can see this engagement. As Mr. Brunell said earlier, there are so many conversations on transport we cannot say when the most recent one was because it is that fluid and they are happening all of the time. This is the positive space we are entering but Departments have to come to the table.

There is an element involving inclusive education, mainstream education and specialist education and what these services look like. It is not just about making an intervention. What about the child who needs respite, after-school care, transitional care or a day service? It is not just about looking at it through the lens of therapy in a school. We need to adopt a holistic approach for children in specialist disability services. This is what my remit is. It is specialist disability services. It is how children will have a pathway into services such as the Delta Centre.

I will ask Ms Loughman to speak about section 39 organisations. This is an ongoing issue, as Deputy Murnane O'Connor said, but saying that does not mean that it is not getting the full support of the Department, because it is.

As Deputy Murnane O'Connor knows, with regard to section 39 organisations there was an agreement on an 8% increase last year. Recently, the Department along with others went into discussions with the unions and employers on the next round. The agreement was that a process would be in place to look to further rounds. An offer was put on the table but, unfortunately, the unions rejected it and left the talks but we are hopeful there will be further engagement in the very near future.

It is critical, and they deserve proper pay. Everyone is doing their best. The biggest issue we see daily is recruiting staff. We need full staff for full services for everyone. What is the uptake of private assessments for children for speech and language therapy and other services? Has anything been done on this?

For those waiting the longest, the HSE will go out to the private market to secure assessment for them. This will be done very clearly through the assessment officer so there is no interference with the process. A child waiting two and a half years or three years will be assessed. It will be those waiting the longest who will get the opportunity to access assessment. We will start in a very systematic way with those waiting the longest and it is only right that they would be served first.

Let us be clear. In 2020, I cleared a list of 6,700 in a 12-month period. This was for completion of a full assessment of needs within the 36-hour period. We cleared the list then. That was during Covid times when therapists could not go into schools or meet families. It was all online. There were some lessons from this whereby we were able to do some of it online. There was a hold-up because we could not access schools. We need to take what was good from that period, which was some of the online approaches. At the same time, we were able to crank through it. We were able to offer clinicians opportunities for overtime. They were offered opportunities for Saturday work. This market is no longer there.

I also thank the Minister of State and her officials. I missed her opening statement for which I apologise. I have a few questions on matters I am looking to get an update on. There is an issue in respect of filling vacancies in CHO 3. When I asked about that in May or June, 2.1 posts were not filled at that stage. Have those posts been filled or are there still vacancies?

As the Minister of State knows, the assessment of needs issue is one issue about which many parents contact me. In general terms, there is a lot of confusion over the first initial contact and the actual assessment of needs. In responses to parliamentary questions, it sometimes looks a little confusing even to me. On 5 June, there were more than 500 young people waiting in CHO 3, which equated to approximately 64 children in County Clare, with the longest waiting period on the list at that point being 32 months. Is there any movement in that regard? From listening to the Minister of State's responses, I recall she was able to significantly reduce the assessment of needs list four years ago. She also mentioned that CDNTs are the teams where people do not seem to want to work. She has already gone over this with Deputy Canney, but it has been mentioned to me that it is very hard to compete with the HSE when it comes to staff. That has been relayed to me time and time again. What is the situation in respect of the positions not filled on the CDNT for CHO 3?

I will also raise reimbursement for assessment of needs. A number of parents with children who have been waiting more than a year for their assessment of needs have reached out to me. It can be imagined what pressure, stress and everything else that is putting on their household because they do not know when the assessment will come. Many parents are asking whether they will be reimbursed. There is this messaging or idea out there that if parents go down the route of a private assessment, they may be reimbursed in future. However, I have received responses to parliamentary questions that state very clearly there is no option or opportunity for the HSE to reimburse parents. I said I would get clarification for those parents, in particular, today. I will raise one case because the parent asked me to do so. This parent has twin boys, one of whom has been with the service for more than a year, while the other has been added recently. Their mother is looking at a loan of €2,400 to pay for their assessments. These children are due to start preschool in September. Will there be any issues for those children in accessing their preschool place if they have not had their assessment and diagnosis by then? This is the question that has been put to me.

In respect of the complaints around assessment of needs, I know of one parent who has been chasing up her assessment. She has had to get a loan of €1,600 for it. Through the process and pathway she has gone down, she has been told that it will be €1,600 for an autism assessment that will be done on a particular day. However, if the child does not fit the criteria for autism, that parent is looking at a further assessment and maybe a specific ADHD assessment. Is this something the Minister of State is hearing of? That is another €1,600 parents then have to fork out. In many cases, they are getting loans for that on which there is interest. It leads to an awful lot of difficulties, especially for lower-income families. As I said, this parent was trying to chase it up. The phone was not being answered. She submitted her complaint formally. When she finally did get someone on the phone, that person confirmed to her in May of this year that only complaints from June 2023 were being addressed. She was quite surprised because, as most parents do, she was reading up on assessments and looking at the news. While they understand that lists are very long when it comes to assessment of needs waiting times, they were not expecting any issues in respect of logging complaints and those complaints being addressed. Are there personnel issues in that regard or is it a case of so many being in a desperate situation and they are complaining?

I have the Deputy's figures in front of me. In CHO 3, a total of 336 young people are waiting more than three months. That is how many applications are overdue for completion as of the end of quarter 1. I do not have the breakdown for County Clare, but that is how may are overdue for assessments in CHO 3.

The reimbursement piece is not actually a reimbursement piece but is about addressing the long-waiters issue. That is how we are bringing equity to the system. It was a Labour Party motion that showed how much inequity was in the system. We cannot reimburse because a wedge is then being driven between affordability and non-affordability. We have addressed the issue through addressing the long-waiters list so that equity is in the system. That will be determined by the assessment officers and all the CDNTs. It is not based on money but on the long-waiters list. There is no reimbursement. It is important to say that is not happening. The issue is being addressed through the long-waiters list.

The story the Deputy told is a very real story about going for one assessment for which the child does not meet the criteria. That child then goes for another assessment and might possibly need another assessment thereafter. That in itself tells us of the need and clear pathways required within the framework of that early intervention. It is about early intervention, which is the critical piece we talk about, and the national access policy, NAP, approach, where disability, CAMHS and primary care are working in conjunction to understand exactly the correct pathway of assessment and intervention for that little child she talked about. That is why the assessment hubs are crucial. Primary care, CAMHS and disability are included in the assessment hubs so whether the assessment is being outsourced, or whoever is completing it, it will be the right trajectory for that family. That is why the assessment hubs are critical.

I genuinely feel for the family the Deputy mentioned. Sometimes people are in a good CHO, but when one element is not playing its part it is very hard. That is why we need to have every element working, including primary care. Education needs to be part and parcel of it. The reason parents absolutely lose the will themselves is they are fearful of needing to get access to a special class. To be fair to the Minister, Deputy Foley, she removed the criteria for accessing education; assessment is now just for a special class. However, young people do not need any diagnosis at all when they enter the ECCE programme. The programme will work with a child to get the AIM support worker to the level required, but by no manner or means is the ECCE model driven by a diagnosis.

The reason for delays in the complaints process is so many people are pursuing cases through the courts system. There is such a backlog in getting the complaints workload prepared for court that, in some cases, the process is a year behind.

I thank the Minister of State. At a recent University Limerick Hospitals Group briefing to this committee, representatives mentioned that they noticed that there has been an increase in the number of people with disabilities presenting to the emergency department. I think a new respite house may have opened in the interim but what they said at the briefing was that there was a need for an additional four respite houses for the region. I just wanted to mention that to see if we are on track for that in the near future.

In respect of the issue of reimbursement messaging, we have all mentioned Cara Dermody and the fantastic work she has been doing. I know she will continue to campaign. She went to the media and highlighted the issues involved but she did not have any issues when it came to the HSE being able to pay for the assessment to be done. It was not the case that her family were reimbursed directly. The arrangement that the HSE came to seemed to skip them but ensured that the child did receive an assessment of need. If I am wrong about that, the Minister can correct me. A lot of parents would have paid attention to that particular case and wondered if that was something they could arrange for their child, for that payment to be made and the assessment to be done.

I thank the Deputy and without getting into any specifics, it is within the gift of every CDNT manager and every CHO disability manager to decide how to operate and manage their assessment of needs process. They get a budget and they know themselves if they have the capacity within their teams. If they do not have the capacity within their teams, they know how they can procure services because they have funding allocated for that. To be fair to Bernard Gloster, he no longer has a limit on what is being procured. He gives the managers the opportunity, if they do not have the capacity, to go out and purchase. If a child is on a particular team that does not have the capacity, the disability manager can procure an assessment of need for that child. It is within the manager's power to do that. To be honest, managers have done that, not just in one CHO but in a number of them. There has to be a system of equity and fairness in how that is done.

On respite, since 2020 there has been a significant increase in funding for respite, equating to a 57.8% increase or €49.3 million, bringing the budget to €134 million in 2024. A huge amount of money has been spent on respite. This goes back to the issues of forward planning, services knowing the age of service users and their changing needs, the number of young people needing respite, the number of ageing families, the number of people who are over 20 days in respite care who need to go to residential care in order to create more capacity and so on.

To be fair, I have been in the Deputy's area of CHO 3 three times, opening three different houses. We are expanding services and CHO 3 is one of the most progressive in the country when it comes to respite care. That said, there is not enough of it and I acknowledge that. There is more to do but it is one part of this Department that we have been trying to get right for the last four years. It is down to the good management of Ms Loughman, from an accounts point of view, and to the direction of travel within our Department. Respite is critical to family stability and the keeping together of the unit. It is also really important for young people to be able to be with their own peers.

I thank the Minister of State and her the team in the Department. There is huge unmet need and a capacity issue. Following on from the Minister of State's response to Deputy Wynne's points, some of the section 38 and 39 organisations are coming to the State and to the HSE with ideas on ways of meeting the unmet need. They are meeting the families and parents in communities that are looking for respite and other therapies and are looking to develop or expand their services. They meet the HSE and outline their plans but the HSE goes away again and unless it is vigorously pursued by the service provider or someone acting on the provider's behalf, the idea disappears into the ether. In terms of the unmet need, some communities or individuals would come to the HSE with ideas that would not cost a lot of money. The difficulty I see is that there is no real urgency. There are some very innovative things that could be done to address the chronic shortage of respite places.

If one looks at residential places for people with very profound needs, a lot of that is being farmed out to private companies and private providers at this stage. It is going to cost the State continuously and we are going to be paying more for it. It does not seem to be good value for money. I will not go into specifics but I am dealing with a family in the south of Ireland who have been given a placement in another province.

I know the Minister of State and her officials are very earnest about their work but surely they understand the level of unmet need and the challenges that exist. There does not seem to be an urgency when ideas are put before the HSE or the Department.

On the transport issue, I was heartened by the response from the Minister of State. It came up three or four times this week with various Ministers but a whole-of-government approach is needed. Does the Minister of State think a conclusion will be reached on that in the short term?

The Minister of State spoke about the culture and attitude. Does she think it is changing? As I speak, I see that a vote has been called in the Dáil.

Yes, saved by the bell. Before I finish, I thank the committee secretariat for the work it has done during the session. I particularly want to thank our team because they are superb people to work with. There is no job or task too big for them. I come up with some crazy ideas from time to time, so I want to thank them sincerely for the work they do. I ask the Minister of State to respond briefly to those points before we adjourn and go to vote.

I thank the Cathaoirleach for his openness at all times, and for the way in which he treats me and my officials when we come in here, letting the conversation flow. It is greatly appreciated. One of the points he made relates to residential places. There is a review of high-cost placements under way. The spending review for services is being led by Ms Loughman and is a valuable piece of work. Before coming into the meeting, I had a conversation about how many residential places will be brought on stream in 2024. There will be the guts of 200 places whereas four years ago, I would have been talking about 100 to 103 places. It is clear that we are adding capacity.

We want to build capacity closest to home and to people's communities in order to be true to the UNCRPD. I will say it for the last time: that is why the Department of Housing, Local Government and Heritage has a housing strategy for disabled people - The National Housing Strategy for Disabled People 2022-2027. I have it here with me. It will be led by that Department, as it must be in order to build houses. Sometimes, when we-----