Assessment of need reform will not fix wider crisis of accessing care and children will pay the price

The State is once again reaching for backlog management in one isolated part of an overall dysfunctional system. That may create the appearance of action, but it does not answer the most basic question families are asking: when my child needs support, who will actually see them, how quickly, and in which service?

To the layperson, the terminology can sound bewildering: assessment of need, primary care, CDNTs, Camhs. But for thousands of families, this is the system they must navigate when they are concerned about their child and trying to access support.

Primary care refers to the range of services for young people with mild to moderate developmental or mental health needs. Children’s Disability Network Teams are specialist multidisciplinary secondary care teams for young people with more complex disability-related needs. Child and Adolescent Mental Health Services (Camhs) are secondary care teams for young people with moderate to severe mental health difficulties.

The experience of many families is that these services are fragmented and painfully slow to access, if not out of reach altogether. Young people are too often passed from one waiting list to another, with no clarity as to which service should take responsibility.

Under the Disability Act 2005, a child is supposed to have a legal right to an assessment of need — a formal assessment of disability — within six months of the application being made. In practice, however, families are often left waiting much longer — currently more than 20,000 assessment of needs are overdue. Even when an assessment is completed, families are still left facing another punishing wait for supports, if they materialise at all.

Under newly proposed Government legislation, assessment officers would have a stronger early gatekeeping role in deciding whether a child proceeds within the assessment of need route at all. The emphasis shifts towards an earlier threshold decision on disability, with more scope to divert children away from the statutory process and into the general service system instead.

The Government is presenting these reforms as the answer to the backlog. But that misses the real point. The assessment of need crisis is part of a wider failure by successive governments to build properly staffed, integrated child and adolescent services in the first place.

Many families are being funnelled into the assessment of need pathway even where a comprehensive diagnostic assessment is not necessarily in their child’s best interests. That is happening because the services they should be able to access, particularly through primary care, are so severely under-resourced as to be effectively absent.

These families are understandably pursuing an assessment of need because it is the only legal right they have, and the one process that appears to offer at least some guarantee of an outcome within an overall broken system.

That is why so-called reform of this process, without first addressing the core of the crisis through workforce planning and comprehensive recruitment, is misguided. These changes will not reduce need. They will simply limit access to the one lever families could rely on, while unmet need continues to build elsewhere in the system.

The Government insists children do not require an assessment of need in order to access services. That only strengthens the argument these reforms are missing the point. If children are supposed to access support directly, then those services should already be properly staffed, integrated and responsive enough that families can rely on them with confidence.

What is most urgently needed is proper service development, workforce planning and integration between primary care, Children’s Disability Network Teams and Camhs. 

Instead, the State is once again reaching for backlog management in one isolated part of an overall dysfunctional system. That may create the appearance of action, but it does not answer the most basic question families are asking: when my child needs support, who will actually see them, how quickly, and in which service?

There is also a very serious concern about the enhanced role proposed for assessment officers. Despite being vested with greater powers at an early stage in deciding whether a child has a disability, there is no requirement an assessment officer holds a clinical qualification or has relevant clinical experience. 

They will be operating in a system under immense strain and will have political pressures weighing on them to reduce the numbers of children pursuing an assessment of need. All of this is hugely problematic and concerning.

The same concern applies to the much-touted single point of access, a proposed HSE initiative intended to give families one clearer route into services rather than having children passed from one referral pathway to another. It is a sound concept but the HSE is not clear on how this will work in practice, where there is continuing disagreement between primary care, Children’s Disability Network Teams and Camhs as to which service should support the young person.

Real reform would not start by treating one statutory process in isolation as the problem to be solved. It would start by building services that actually work: a properly funded multi-annual workforce plan, clear staffing benchmarks, urgent recruitment and genuine integration between primary care, Children’s Disability Network Teams and Camhs.

What's your view on this issue?

You can tell us here

Until that happens, children and families will continue to pay the price.

• Liam Quaide is a Social Democrats TD for Cork East and the party spokesperson for mental health and disability