Taoiseach says legislation on assessment of needs should be changed

The Taoiseach has indicated that legislation on the assessment of needs should be changed to help cut growing waiting lists, which are projected to soar by the end of the year.

Micheal Martin said a decision by the High Court “necessitates” a change in legislation to ensure therapists can provide services to children more quickly.

It comes as teenage campaigner Cara Darmody, 14, began staging a 50-hour protest outside Leinster House on Tuesday morning, against the backlog of assessment needs in the system.

An assessment of need (AON) is carried out to identify if a child, children or young person has a disability, and is designed to identify their health needs as well as service requirements.

Once the HSE receives an application, there is a legal requirement for the AON to be completed within six months.

The total number of applications overdue for completion at the end of March 2025 stood at 15,296 – an 8% rise on the end of 2024.

The HSE anticipates that by the end of the year there could be as many as 24,796 AONs due for completion.

On Tuesday evening, the Dail debated a combined opposition party motion during Sinn Fein private members’ time demanding the Government provide children with assessments of need within six months.

The Government did not oppose the motion which was carried.

Sinn Fein TD Pearse Doherty told the debate that the current situation was a “shame on Government”.

Minister for state with responsibility for disability, Hildegarde Naughton said the issue was complex but the Government was “determined to get it right”.

Sinn Fein leader Mary Lou McDonald said that at the heart of Cara’s protest is a demand that the Government complies with the law and ensures that no child is left behind.

“Cara is an exceptional and amazing young woman who stepped forward to fight not just for her brothers, Neil and John, but for all of the children so badly failed by Fianna Fail and Fine Gael governments,” she said.

“Children with disabilities are legally entitled to an assessment of needs within six months. Yet 15,296 children are left well beyond this timeframe, some for years, delaying their access to vital therapies and appropriate school places.

“One mother got a letter on Friday to acknowledge her application for assessment of needs, and was informed that the waiting list is in excess of three years.

“Even then, when you get your assessment of needs, the fight continues, the fight for therapies, for school places, for very, very basic services. Taoiseach, you have broken the law over and again.

“There is a legal requirement on you to provide an assessment of needs within six months, and you have broken that over and over again.

“Our motion tonight lays out the clear, concrete steps needed if you are serious about tackling assessment of needs, waiting lists and complying with your legal and your moral obligations.

Ms McDonald made the comments during Leaders’ questions while Cara sat watching proceedings in the public gallery with her father, Mark Darmody,

Mr Martin said that disability issues are now represented at the Cabinet table by a full minister.

“I am in the process of establishing the first ever disability unit within the Department of Taoiseach to troubleshoot and to co-ordinate across all government departments the provision of services for people with disabilities,” he added.

“The need is increasing all of the time.

“The 2022 census is indicative of that, in terms of the increase in the numbers of people identifying with a special need, and fundamentally in education, there has been an exponential increase in investment.

“Huge increase in resources in terms of special needs assistance, at about 23,400 now, we have 20,800 special education teachers, SNA alone is about a billion a year, and that’s the way it should be.”

He added: “In relation to the assessment of need, quite fundamentally, we need to change the legislation, the High Court decision necessitates, in my view, a change in legislation to ensure that therapists are directed and streamlined to provide services to children more quickly than currently is the case.

“We have a finite number of therapists currently in the country. The real objective has to be to use those therapists optimally in providing services to children.

“I say that very clearly, because I’m looking for solutions here, and I think that is one level we have to grasp, and it will be challenging, but it’s one that we have at the Cabinet.

“I do believe the legislation needs to be changed, because to be fair to the court’s ruling, it’s then up to the legislature to deal with that ruling in terms of either amending the Act and so on.

“Because given the finite number of therapists we have, we can pass all the motions we like, but we have to deal in a very pragmatic solution-based approach right now.”

Labour leader Ivana Bacik said: “It’s not tenable for the many thousands of children, 15,000 children nationally, who are now languishing on waiting lists, awaiting an assessment of needs. In breach of your government’s own law.

“When the HSE receives an application Taoiseach, it’s set out in law that the assessment of need must be carried out within six months.

“My colleague, Deputy Alan Kelly, has received responses to parliamentary questions which reveal that in the first quarter of this year, that legally binding six-month deadline was missed in a shocking 93% of cases.”

Mr Martin said the issue was not one of resources but one of capacity.

“But in my view, the standing upper rating procedure model that the HSE adopted was struck down by the courts, and the rationale behind it was to prioritise establishing the needs of children rather than providing the diagnosis immediately,” he added.

“I think we have to facilitate more recruitment of therapists from overseas, and I think the regulatory body needs to be flexible in that regard.”

Social Democrats deputy leader Cian O’Callaghan said that Cara has been highlighting the crisis in assessment of need and disability services since she was 11.

“No child should have to spend years campaigning and protesting for basic services. Cara should be in school today, like other kids her age, but she isn’t,” he said.

“She’s here in the gallery and outside the building during the day to highlight that services are getting worse, not better.

“She’s watched her two younger brothers, Neil and John, who have additional needs, being repeatedly failed, and she’s made it very clear that she’s undertaken her protest for every child in the country that has been left behind.”

“Taoiseach, the Dail motion that the Social Democrats and other parties have tabled isn’t asking for bells and whistles, it’s asking for the Government to comply with the law.

“It should not take a 50-hour protest outside the Dail by Cara, just 14 years of age, to shame this government into action to provide assessments of need within the legal time limit of six months.”