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In 2023, the number of children applying for an Assessment of Need (“AON”) for suspected disabilities saw a sharp 25% increase, reaching a record high of 8,472 applications. This marks the highest level of applications since the Disability Act 2005 was introduced.
The latest annual report from the Health Service Executive (“HSE”) revealed that nearly 1,700 more children were waiting for assessments in 2023 compared to the previous year, highlighting the growing demand for disability services.
Surge in Applications for Assessments
The AON is a legal entitlement under the Disability Act 2005, and the substantial increase in applications reflects rising awareness of disability services and a growing population. However, despite the record number of applications, the HSE reported that only 13% of assessments were completed within the statutory six-month timeframe.
Compliance rates varied significantly across the country. For instance, in areas such as Kildare, West Wicklow, and South Dublin, only 0.4% of assessments were completed on time, whereas South Tipperary, Carlow, and Kilkenny achieved a much higher compliance rate of 30%.
Read our prior Article: Assessment of Need Judgment Has Important Implications for Children
Delays in Assessments and Service Demand
The report also revealed that 3,205 assessments were completed in 2023, with 74% of children being diagnosed with a learning disability. The average waiting time for an assessment was approximately 20.5 months, underscoring the significant delays in the process. Notably, half of all applications were made for children aged five and under, with more than a third of the cases involving children with Autism Spectrum Disorder (“ASD”).
The report pointed out that the most common service needs identified during assessments were occupational therapy (70% of cases), speech and language therapy (62%) and psychological support (57%). The HSE attributed the surge in applications to both population growth and the increasing number of families seeking services for their children.
While the increase in applications highlights the growing demand for services, the HSE cautioned that many families mistakenly believe the AON is a shortcut to accessing health and social care services. It clarified that the AON process does not expedite access to disability services or primary care. Additionally, the HSE emphasised that an AON is not required for education supports such as special education teachers or special needs assistants. However, it is needed to access special classes or special schools.
Controversy Surrounding the Preliminary Team Assessment
The report also addressed the controversial Preliminary Team Assessment (“PTA”) process introduced by the HSE in 2020. Professional associations, including the Association of Occupational Therapists of Ireland, the Psychological Society of Ireland and the Irish Association of Speech and Language Therapists, criticised the PTA process, claiming it was inadequate. They argued that the PTA often resulted in children being placed on additional waiting lists for further assessments without statutory timeframes.
In defence, the HSE stated that the PTA process was designed to ensure resources were used effectively and was not intended to deny children their legal entitlements. Legal advice obtained by the HSE and the trade union Fórsa indicated that the PTA process complied with the legislation. However, a High Court ruling in March 2022 determined that the PTA approach did not meet the requirements of the Disability Act, ruling that full diagnostic assessments must be provided where necessary.
Addressing the Backlog and Funding Allocations
Following the High Court ruling, the HSE has been working to address the growing backlog, with an estimated 5,000 PTAs still awaiting reassessment. To combat the increasing demand, the Irish government allocated €11 million in 2023 to help reduce waiting lists, part of which was directed towards procuring diagnostic ASD assessments from the private sector.
Conclusion: A Strain on Resources and Growing Need for Reform
The record number of children seeking disability assessments in 2023 highlights the strain on Ireland's disability services and the challenges faced by the HSE in meeting demand. While efforts are being made to reduce waiting times and address backlogs, the growing number of applications calls for continued investment and reform to ensure that children receive timely and appropriate support.
Addressing misconceptions surrounding the AON process and improving access to services will be essential in meeting the needs of children with disabilities across the country.
Further Information
Lavelle Partners have extensive experience in representing clients in respect of issues and complaints concerning assessments of need, access to services and challenging state decisions in respect of care and welfare allowances.
For further advice on any Assessment of Needs matter, please contact Avril Scally, Partner and Head of our award-winning Medical Negligence & Personal Injury Team.