Letters to the Editor: No sticking plaster for the waiting wounded

HSE logo. File Picture

The most recent reflex response to the perennial, nay eternal, Assessment of Need (AON) quagmire misses, as usual, the key contributors to the stagnance pertaining.

Minister Ann Rabitte’s proposal that families should be reimbursed for specific private psychological assessment seems on the simplistic surface of it to be a decent response to the quandary, but it absolutely skims over the prevailing corrupted situation, avoiding the core elements which build and sustain the monstrous waiting lists ad infinitum. So much so that waiting-list ‘membership’ becomes some sort of ‘achievement’. It’s a sticking plaster approach to a gaping wound of service logic, protocol, and delivery. But sure what’s new?

Waiting lists are de rigeur all across the healthcare orbit and are viewed by the higher echelons as some sort of ‘action’.

There are three main issues at play here. Firstly, there is a nonsense abroad that all children seeking appropriate developmental /educational supportive services warrant an AON in the mode that it is currently deployed. Many of them simply need early therapeutic intervention as worthy cover for their developmental needs.

The current fashionable urge and surge to secure an ASD diagnosis is totally skewed, exaggerated, and abused. Families are being “sold a pup” when fed the notion that an ASD diagnosis will be the golden bullet for them to acquire appropriate support/service. The distorted pressure to get an ASD label frequently belies the child’s ‘real’ individualised issues and the appropriate therapeutic intervention package worthy of their specific needs.

ASD has become the catch-all diagnosis for nearly all presentations of developmental deficit, so much so that it has become a meaningless diagnostic emblem. Sad, for sure, since a nuanced appraisal of each child’s specific aptitudes/needs is quintessentially paramount, rather than a blinkered, narrow corralling, evolving only an inappropriate therapeutic schema of response.

Secondly, the flooding of the AON system with referrals on a whim and a whiff of any developmental issue ensures that the system cannot cope... ever!

The reconfiguration of the children’s disability services network over the past few years has not been able to streamline the process required to galvanise therapeutic services towards efficient or timely delivery for good reason. It’s been on a hiding to nothing since its flawed and inept introduction tried to paper over so many blatant shortfalls of service protocols, administrative fudge and folly, coupled with the usual HSE middle and higher management gross inadequacies.

Ms Rabitte could better use her time by forensically addressing the HSE ‘swamp’ that allows careerist pseudo-managers to be born and reborn within the system, wallowing and wandering in the sure knowledge that there will never be performance assessment visited upon them. Meanwhile, the coalface therapeutic teams are dwindling in spirit, staff, and support, having to front-up a systemised pattern that is inherently flawed. No wonder so many of the frontline therapists and their therapeutic team managers are leaving.

Thirdly, farming out diagnostic assessments to private psychologists just to placate forlorn and frustrated parents is simply a wrong priority and fosters a false sense of progressive action. It is so typical of Government/HSE ‘panic’ machination when under severe and fully-warranted pressure for its service failures.

Of course, the whole statutory AON ‘merry-go-round’ carousel was initiated years back as a notional sop from the Government to cover over the cracks back then, with little basis in reality or practicality. Thus, private psychologists will now be tasked and richly funded to absorb the slack, by completing expensive, protracted reports for the system to accept, thus pretending that the lists are being dwindled. More like ‘swindled’.

Bonanza time for private psychologists, yet the child will still have to be therapeutic-team assessed, for treatment planning etc. How’s that for wastefulness and duplication? We must remember of course that psychologists don’t deliver any therapy. They merely observe, assess, and write reports. Nice work if you can get it for around €1,000 a go.

Having worked for many years on disability therapeutic teams as a clinical music therapist, I’m fully aware of the malaise that festers in perpetuum. It all highlights the fact that disability care is never ever afforded the priority profile and streamlined service delivery it fully deserves, despite being perhaps the most needy of all. 

HSE ineptitude lurks large.

Jim Cosgrove 

Senior Music Therapist 

Lismore 

Co Waterford

Support of repeal for political gain

A little over five years ago, Micheál Martin and Simon Coveney were among the politicians who shook the hands of and looked into the eyes of exhausted Repeal the Eighth campaigners and solemnly agreed that no Irish person should have to travel abroad for reproductive healthcare. On the day the referendum result was announced — 66.4%, a landslide in favour of abortion access — Simon Harris cavorted on stage in Dublin Castle like it was his own personal victory.

Simon Harris with Catherine Noone and Leo Varadkar at the 2018 abortion referendum count. File picture: Gareth Chaney/Collins

Last Wednesday, Mr Martin, Mr Coveney, and Mr Harris were among 64 TDs who voted to retain the three-day wait for abortion and to keep abortion partially criminalised, two measures that continue to force hundreds of Irish people abroad for reproductive healthcare — mostly couples facing a diagnosis of fatal fetal anomaly and people who have been given the runaround by anti-abortion medics. This has confirmed that their support was political expediency, built on the back of decades of grassroots activism.

The default position of these three conservative men is anti-abortion, anti-feminist, and anti-woman. We will remember this at the next election.

Lucy Boland 

Rebels For Choice co-convener 

Dunmanway 

Co Cork

International law not fit for purpose

John Fitzgerald’s letter on June 2, ‘Russia’s leaders should face a war crimes tribunal’ raises very important issues of international laws and accountability for war crimes. International laws are so inadequate that accountability for war crimes is usually only applied to the losers in wars and seldom applied to those perpetrators of genocide who are protected by the most powerful states. Stalin is reputed to have said: “One man’s death is a tragedy. One million deaths is just a statistic.”

Neither Russia nor the USA have signed up to the International Criminal Court (ICC), so there is little chance of Russian leaders being prosecuted by the ICC for war crimes in Ukraine, and little chance of US and other Western leaders being prosecuted for recent war crimes and unjustified sanctions in the Middle East that caused the deaths of several million, including up to 1m children. I agree with Mr Fitzgerald’s statement that he is against the death penalty, and capital punishment is prohibited in all European Union states.

Yet many EU countries actively participated in the US-led wars in the Middle East. This includes Ireland, due to US military use of Shannon Airport. This amounts to large-scale capital punishment by means of unjustified wars.

Far too few were made accountable for the Holocaust and other acts of genocide. Idi Amin died of old age in Saudi Arabia. Mengistu of Ethiopia is still living in retirement in Zimbabwe, and Pol Pot died of old age, supported by several Western governments.

In 1994, the French government actively supported the Rwandan government while it was perpetrating the Rwandan genocide and then helped the Rwandan army to escape into the Democratic Republic of Congo.

All criminals, especially war criminals, should be held accountable for their crimes.

The system of international law and jurisprudence is no longer fit for purpose, and needs to be urgently reformed.

Edward Horgan 

Newtown 

Castletroy 

Limerick