Children; Equality; Disability; Integration and Youth | Services for Children with Disabilities

Questions:

To ask the Minister for Children; Equality; Disability; Integration and Youth the extent the efforts in hand  to urgently address the delay in accessing vital services for children with disabilities; and if he will make a  statement on the matter. 

 

To ask the Minister for Children; Equality; Disability; Integration and Youth when it is expected that all  waiting lists for children with special needs/disabilities are likely to be satisfactorily dealt with; and if he  will make a statement on the matter. 

HSE Response:

National Access Policy 

The National Policy on Access to Services for Children & Young People with Disability & Developmental  Delay ensures that children are directed to the appropriate service based on the complexity of their  presenting needs i.e. Primary Care for non-complex functional difficulties and Children’s Disability Network  Teams for complex functional difficulties. Children with disabilities may access supports from a Children’s Disability Network Team or from Primary Care or from Child and Adolescent Mental Health Services  (CAMHS) depending on the complexity of their needs. 

Childrens’ Disability Services  

91 Children’s Disability Network Teams (CDNTs) are aligned to 96 Community Healthcare Networks  (CHNs) across the country and are providing services and supports for children aged from birth to 18  years of age. 

Since 2019, more than 610 development posts have been allocated to children’s disability services across  the country. These posts have been assigned to teams based on a number of factors, including the existing  ratio of staff to the number of children with disabilities in each area. This figure includes 190 posts provided  in 2022 as well an additional 136.3 WTEs to restore pre-existing services in 104 special schools. 

Based on the CDNT Staffing Census (Oct 2022), there are over 700 vacant whole time equivalent posts  in CDNTs. The HSE continues to explore a range of options to enhance the retention and recruitment of  essential staff across all aspects of the health services. 

The HSE is operating in a very competitive global market for healthcare talent as there are significant  shortages of qualified healthcare professionals across the globe. The HSE Community Operations  Disability Services is working collaboratively with the CDNT lead agencies at CHO level to promote CDNTs  as a workplace of choice in a competitive employment market. 

The CDNTs are currently providing services and supports for 45,741 children and strategies and supports  for urgent cases on the waitlist where staffing resources allow. 

Roadmap for Service Improvement for Disability Services for Children and Young People 

Substantial work has been undertaken by the HSE to develop a Roadmap for Service Improvement for Disability Services for Children and Young People which was approved by the HSE Board on July 28th  and was launched by the Government and the HSE on Tuesday 24th October 2023. 

The Roadmap is a targeted Service Improvement Programme to achieve a quality, accessible, equitable  and timely service for all children with complex needs as a result of a disability and their families. It sets  out the overall aim for Children’s Disability Services, provided by the HSE and its partner agencies, that  for every child to have a childhood of inclusive experiences where they can have fun, learn, develop interests and skills, and form positive relationships with others in a range of different settings. 

Implementation of the Roadmap for Service Improvement Actions will: 

∙ Ensure children are referred to the most appropriate service (National Access Policy) 

∙ Reduce the waiting time for children currently waitlisted for CDNTs  

∙ Optimise use of voluntary and private disability service providers for assessments and  interventions. 

∙ Improve HSE’s legislative compliance for AONs as defined in the Disability Act 

∙ Improve outcomes for children and families and their experience of CDNT service 

∙ Enable teams to optimise service effectiveness and efficiencies, and opportunities to collaborate with community networks such as Children and Young People’s Services Committees.  

∙ Improve staff retention on CDNTs in the long-term as a good place to work. A number of actions have been progressed in the interim. For example: 

– Roadmap Governing Structures: Draft TOR and membership for each of the have been  forwarded to DCEDIY for their input. Letters of invite are being drafted for the five working  groups and Service Improvement Board members and Chairs. 

– Roadmap events are being planned in the CHOs including HSE, Lead and Partner Agency staff, and  in addition a dedicated workshop with CDNMs for delivery in the immediate weeks post launch. 

– National Service Improvement Lead has been appointed on September 11^th 2023. 

– National Director of Community Operations has commenced engagement with Chief Officers,  National Disabilities, Primary Care and Mental Health re Integrated Children’s Services.  

The Roadmap includes a Working Group chaired by the National Director of Community Operations  and including Senior Management from National and CHO Disabilities, CAMHS and Primary Care  to drive implementation of the National Access Policy and the HSE Joint Protocol between Primary  Care, Disabilities and CAMHS to ensure children with disabilities access the right service at the  right time and where necessary, shared assessment and shared services where a child has needs  of more than one service. 

– Family Forums: 69 of 91 have commenced meeting, and in turn, 5 of 9 CHO Family Representatives Groups have commenced, and reps nominated onto the CHO CDNT  Governance Group. 

– Individual Family Support Plan template and Guidance has been issued to CDNTs to drive a consistent approach to application of this foundation for family centred practice 

– CDNT supports

– National CDNT Training Programme, building team competencies, is now 70% delivered with the remainder  to be completed by Q1 ’24. 

– Monthly lunchtime webinars for CDNT staff on topics of their choice continue with the purpose to share and  spread good practice models of service in place across the country 

– Framework of Approved Providers: 

A call for submissions proposal for this grant scheme has been sent to DCEDIY for approval. The scheme is  applicable to organisations currently providing services for, or that are appropriate for children with disabilities,  and will be accessible by Children’s Disability Network Teams to offer waitlisted children and families  additional supports whilst they await CDNT services 

– First Intervention for Waitlisted Children:  

National Guidance for CDNTs and families has been drafted, to provide clarity on its purpose and to ensure this  support is meaningful and empowering for families whilst the robust Retention and Recruitment plan for CDNts progresses. The draft has been circulate to the 9 PDS Leads and a sample of CDNMs and then to parent reps  on the National Steering Group from feedback. 

– CDNTIMS has now been rolled out to 24 teams, and it is anticipated that full roll out will be achieved in Q2 2024.  This extended deadline is due to staff vacancies and CDNM turnover, impacting on team availability for migration  to the new system. 

– Independent Review of CDNT service model: 

Project Outline drafted with the NDA has been submitted to DCEDIY for approval. Researcher interview  completed and successful candidate has been panelled. This Review will be completed in 12 months from  commencement. 

– AON Administrative Hubs:  

AON Administrative hubs are now in place in CHOs 1, 4, 5, 7, 8 and AON Assessment hubs have been established in CHOs 3, 6 and 9. 

CHO 3 is utilising existing staff reassigned from CDNT service. 

CHO 6’s hub is pending recruitment of clinical specialist posts and in interim, the AON process is outsourced to  a private service provider. 

CHO 9 has recruited 2 of its 3 clinical specialists and recruitment of the 3rd is in train. 

–A webinar was delivered on the Revised AON SOP including Interim Guidance for Assessors on Replacement  of the PTA and the document widely circulated. An AOs workshop was delivered which included a presentation  by legal services updating AOs on the AON and implications of recent court cases. An AON FAQs document is  now being developed. 

– A National AON tender process will be completed this month to put in place a Famework of Service Providers  as a Waiting List Initiative to support CHOs to achieve their targets. However, it is anticipated that this is not  going to add significant additional capacity beyond what CHOs have already sourced directly with private  providers. Learning from this tender process will be shared with CHOs to support standardisation across CHOs. 

The actions also include a robust suite of CDNT Retention and Recruitment targets, the majority of which are now in  train. For example; 

– National Team Development Programme (delivery of the 2^ND extensive two year programme prioritised by the  CDNMs will be completed by Mar ‘24) 

– Online lunchtime staff webinars (on-going monthly) 

– Online basecamp account for staff and team managers to share innovative programmes, practices and  resources across the country 

– Confined Senior grade competition for CDNTs – completed 

– Marketing CDNTs as a workplace of choice 

– HSE HR engagement with graduates in person and via webinar 

– Recordings of CDNT staff and parents on benefits of working or receiving services from a CDNT, used for  recruitment of staff off national panels

– HSE Recruitment, Reform and Resourcing has featured CDNTs on their “Service in the Spotlight”, hosted on  the HSE Career Hub. The 16,000 individuals now registered on the hub will receive notice of the targeted  recruitment campaign for CDNTs and be encouraged to share with family and friends, extending our reach into  the market. 

The HSE acknowledge the current challenges in the recruitment and retention of staff and work is also progressing to  commence the following; 

– Student Sponsorship Programmes 

– Targeted recruitment campaigns for 462 HSCP including clinical specialists, senior and staff grade therapies  will commence in Jan 2024 to fill existing vacancies on HSE, S.38 and S.39 Lead Agency teams. 

Actions also being led by national HR and/or National Disabilities, are for example; 

– Increasing number of new clinical psychology trainee placements per annum 

– Return to Work incentivised programme for recent therapist retirees 

In addition, Minister of State, Anne Rabbitte, has convened a Disabilities Workforce Enhancement Group, including  National Disability Operations Team, National HR and NCPPD representation, focused on the immediate, medium and  long term sustainability of Disabilities workforce, including CDNT 

HSE National Disabilities is working with NCPPD and the National HSCP Office to increase student clinical placements  on CDNTs with appropriate support structures to ensure an optimal learning experience as a priority. As an interim  measure, National Disabilities are drafting a baseline for number of students per discipline per CDNT (filled posts) based  on filled posts and the experience of teams over the past year in this area. 

Yours sincerely,

Mr Bernard O’Regan, 

Head of Operations – Disability Services,  

Community services