Assessment of need reform is just rhetoric without a workforce plan for children’s disability services
Cara Darmody: 'The staffing is going to have to be right for this to work, because if it’s not, there’s going to be a big problem.' Photo: Leah Farrell / © RollingNews.ie
The Government’s latest “targeted reforms” to the assessment of need (AoN) process, announced last week by ministers Norma Foley and Emer Higgins, arrived with familiar fanfare. Promises of faster reports, freed-up therapists, and a system finally beginning to work as it should.
But for families facing years-long waits, and for the Children’s Disability Network Teams (CDNTs) trying to hold the service together, these reforms arrive with an uncomfortable question. How many times can we re-engineer a broken system before we admit that the real issue lies elsewhere?
In March this year, the Health Service Executive (HSE) said it would finalise a ‘Pay and Numbers Strategy’ specifically for disability services, intended to set out current staffing levels and planned growth. Nine months later, the HSE has yet to produce anything.
Instead, there is growing concern among Fórsa members working in children’s disability services that current vacancies (close to 450 whole-time-equivalent posts) will be decommissioned. The HSE has form here, having erased Department of Health-funded posts in 2023. If this happens again next year, it would be catastrophic for CDNTs that are already under-resourced.
The absence of a workforce plan is not a technical oversight. It actively undermines every reform announced last week. A workforce plan is not an optional extra. It is the basic strategic tool that ensures services have the right clinical staff, in the right roles, at the right time, in the right place.
Without a plan, reform is just rhetoric. So let me be blunt. Reform of AoN, as announced by the minister last week, can only be realised if a workforce plan is agreed for children’s disability services. Any reform attempt is doomed to failure without one.
Efforts at reform are necessary, and the aspiration to speed up and improve the delivery of AoN reports is widely shared. It would be music to the ears of the multi-disciplinary CDNTs that carry out this crucial work, but only if it were accompanied by meaningful resources.
Staff have been here before, witnessing repeated policy re-workings designed to address process while avoiding deeper structural problems.
I believe the minister when she says: “We want the AoN process to be faster, so that therapists are freed up to provide therapy rather than writing endless reports.” It’s the sort of progress we all want to see.
But good intentions cannot substitute for staffing. In the absence of an agreed workforce plan, last week’s reforms amount to little more than re-arranging the workload of teams already stretched beyond capacity.
Take the introduction of 11 new “in-reach” teams to provide expert clinical guidance to staff undertaking assessments. This is nowhere near enough additional capacity for the level of demand and is a classic case of robbing Peter to pay Paul.
Staff for these teams will be drawn largely from the existing workforce, reducing capacity within CDNTs, primary care, and Child and Adolescent Mental Health Services (Camhs).
Data from the 2022 Census shows that slightly more than one in five people in Ireland, or 22% of the population, have a disability. Approximately 130,000 children live with disabilities, just under 11% of the population aged under 18.
Access to disability services for these children is closely associated with the AoN process.
Until it was announced last week that AoN will no longer be required for children seeking additional educational supports, many families were forced to find money they didn’t have for assessments they couldn’t wait for, paying privately to bypass a waiting list now exceeding 22,000. The change will also mean that educational assessments no longer compete with CDNTs for scarce resources.
But we should not mistake this for a solution. At best, it is a mild easing of pressure on services already in crisis. The wider challenges facing families seeking disability supports continue to mount, driven not just by population growth but by a persistent failure to measure demand accurately, plan staffing accordingly, and direct resources to where they are needed most.
CDNT staff see the consequences of this failure every day: exhausted families waiting months or years for help, and clinicians unable to provide the supports they are trained to deliver.
Teenage campaigner Cara Darmody captured this reality starkly in a recent RTÉ radio interview. “The staffing is going to have to be right for this to work,” she said, “because if it’s not, there’s going to be a big problem.” Cara sat on Kildare Street for 50 hours during Storm Bram because, as she put it: “Without enough therapists, we are dead in the water.”
Cara gets it. Staff get it. Parents get it. Why can’t the Government? This is the nettle the HSE has so far failed to grasp.
Without a workforce plan, targeted reforms are not a pathway to improvement. They are a holding exercise that creates the appearance of progress while leaving the underlying crisis untouched.
Families will continue to wait, clinicians will continue to burn out, and ministers will continue to announce reforms that cannot deliver what they promise.
If the Government is serious about fixing the assessment of need process, it must start with the basics. No more announcements without staffing. No more reform without a workforce plan. Anything less is simply setting the system up to fail again.
- Linda Kelly is national secretary for Health and Welfare at Fórsa trade union
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