Disability (Amendment) Bill 2026: Second Stage
Dail Éireann — 2026-09-23
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Liam Quaide (SD), Cork East

The central problem with this legislation is that it changes the assessment of need process without addressing the issue at play here, namely, the chronic under-resourcing of our services, compounded by the recruitment embargo in 2023, followed by the pay and numbers strategy, which was another form of recruitment restriction. We can change the eligibility for an assessment of need and we can change procedures or produce new guidelines, but if a child who does not proceed through the full statutory assessment of need process is then directed toward primary care, child and adolescent mental health services, CAMHS, or a CDNT that cannot see them for months or years, we have not solved the problem. We have simply moved that family into another form of purgatory. That is not simply my assessment. The report of the disability matters committee from the pre-legislative scrutiny process stated very clearly: "Across virtually every submission and hearing, the strongest operational theme was that delay and dysfunction in the AON system are inseparable from workforce service-capacity problems." That is the kernel of the issue.
The Psychological Society of Ireland said that legislative reform alone could not resolve these delays without investment in staffing and retention across primary care, CAMHS and disability services. We heard the same critical message from professional bodies, disability organisations and service providers that the AON crisis cannot be separated from chronic workforce shortages and inadequate service capacity. They are different organisations with different professional perspectives, but they had essentially the same message, namely, you cannot legislate your way out of a capacity crisis.
That is why our committee recommended that implementation of this legislation would have to be accompanied by a funded workforce and service-capacity plan, including multidisciplinary staffing, so that legislative reform is actually matched by operational capacity. Yet the Government is determined not to look at the elephant in the room. Where is that plan? By that plan I mean a credible, funded, multi-annual plan setting out the staffing that primary care, CDNTs and CAMHS actually require; what number of whole-time-equivalents are currently in post; where the shortfalls are; and when those posts will be filled.
The Government repeatedly makes the point that a child does not need an assessment of need in order to access health services. Formally, that is the case as a child can be referred directly to those services but there is an enormous difference between having a pathway by which somebody can be referred to a service and actually being able to get assessed and receive an intervention from that service within a reasonable period.
I have expended an extraordinary amount of effort over the past year trying to establish the true extent of waiting lists in primary care services for young people. Frankly, it should not have required the volume of parliamentary questions or hounding of the HSE that it did. I had to repeatedly ask not simply for broad waiting time categories of over 52 weeks, which is what the HSE kept giving me, but for the longest actual waits, and the numbers of people waiting more than two years, three years, four years, etc., because broad national figures can completely obscure the experience of the children at the far end of these waiting lists. What eventually emerged was jaw-dropping. In July of last year, a child on a primary care psychology list had been waiting 13.5 years. In June of this year, almost a year on, the longest wait for psychology was still over ten years. Also, this year, a child waiting for an occupational therapy assessment had been waiting 509 weeks - almost ten years. The longest physiotherapy assessment wait was 346 weeks - more than six and a half years. These are for very short blocks of intervention. This is not wrap-around supports over the long term.
Given that primary care is supposed to provide early intervention, these waits would be farcical if they were not so consequential for the young people left waiting. Therefore, when we say to families, "You do not need an assessment of need to access services," we need to ask a much more important question: when will their child actually get the service? That is one of the reasons families pursue an assessment of need in the first place. For many, it is not simply because they have some particular attachment to a statutory assessment process; it is about pursuing the only part of a fragmented system where there is a clearly defined legal entitlement.
That reality came through repeatedly during our committee meetings and it is against that background that we have to look at what this Bill is changing. The legislation makes clear that an assessment officer will first determine whether the applicant meets the statutory definition of disability. Where the determination is that they do not, they do not proceed to the subsequent part of the process assessing the health and education needs arising from a disability. That is a hugely consequential decision and my particular concern is about the child on the other side of a "no disability" determination. That child may still have very significant needs. Where do they go? Who has clinical responsibility for working with the family? How quickly are they going to be seen? Who makes sure that they have not simply disappeared from the statutory AON process into another queue that could last years? Our committee specifically recommended that the Government publish data not simply on AON waiting times but on no-disability outcomes, closure decisions, reviews and the impact of implementation. We need to know what happens to these children afterwards.
There is then the very significant question of who makes that initial disability determination. Some assessment officers have clinical backgrounds and considerable relevant experience but the Bill does not require an assessment officer to have relevant clinical qualifications or clinical experience before making this determination. This issue was examined in detail by our committee. Department officials told us that the assessment officer role is currently an administrative role, that the work at this stage is typically desk-based and that assessment officers are not operating in a clinical capacity, yet they are making clinical decisions. A survey of 22 assessment officers found that 59% had a clinical background. That also means that a substantial minority do not. This was not just an Opposition concern. A Fine Gael Deputy, Micheál Carrigy, questioned how somebody without a clinical background could make such a significant early determination before a clinical assessment had taken place. His Fine Gael colleague Deputy Keira Keogh rightly asked the very basic question of whether there would actually be eyes on the child before a decision was made not to proceed further. This is why the committee recommended minimum qualification, competence and experience requirements for assessment officers, including relevant clinical qualifications. It said that where an assessment officer is making a determination that someone does not meet the statutory threshold for disability, that should either be underpinned by relevant clinical qualifications or be subject to review or sign-off by an appropriately qualified clinician. That is a sensible safeguard. Why is it not provided for in the Bill?
The Government may say that clinical advice will be available and point to the development of in-reach teams but access to clinical advice is not the same thing as a requirement for clinical oversight of a decision which can stop a child proceeding through the statutory assessment process. We need to bear in mind that these assessment officers will be under enormous political pressure in an overstretched system to reduce referrals for assessment of need.
I also want to address the single point of access initiative. I fully support the principle behind it. Families should not need to understand the internal architecture of the HSE before their child can get help. They should not be passed between primary care, CDNTs and CAMHS, with one service saying the child belongs somewhere else and the next service sending them back again. A genuine no-wrong-door approach would be a significant improvement. However, the single point of access does not resolve the underlying problem which is the failure to adequately staff services. A more efficient referral pathway into a ten-year waiting list is still effectively referring a child into a phantom service. I am hearing varying reports from around the country about how single point of access is functioning in practice.
There is also a serious unresolved issue around contested cases. What happens where primary care believes a child requires CAMHS? What happens where CAMHS believes that child is more appropriately supported through a CDNT? Who adjudicates that? From what I am hearing among clinicians around the country, psychiatry is not fully signed up to how these contested cases will be resolved. This is not some peripheral concern of mine. The final report of the Committee on Disability Matters specifically identifies "the absence of a clear and timely HSE mechanism for adjudicating on contested referrals or service-boundary disputes". It says disputes over whether primary care, CDNTs or CAMHS should take responsibility can leave children and families without a clear service response. This has to be resolved because a single point of access is only a meaningful reform if there is also a clear point of responsibility.
These safeguards are particularly important when we are making changes to the point at which somebody can be stopped from proceeding further through the statutory process. The deeper point remains: the assessment of need crisis cannot be separated from the crisis in the services surrounding it. If primary care were properly staffed, if CDNTs had the multidisciplinary teams they require, if CAMHS and CAMHS-ID had sufficient capacity and if single point of access genuinely meant that children could no longer fall between services, then families would have far less reason to pursue an assessment of need simply to get their child assessed. If those services remain severely underinvested in, changing the statutory process risks changing where children wait rather than ending the waiting.
Therefore, I want the Minister to address four fundamental questions to bear in mind as we proceed with this Bill. Where is the funded workforce and service capacity plan recommended by the committee, particularly for primary care? Why has the committee's recommendation on clinical qualifications, experience or clinical sign-off for assessment officers not been provided for? What is the final national mechanism for adjudicating contested single point of access cases and are all of the relevant clinical disciplines fully signed up to it? What happens to the child who receives a no-disability determination? Who follows that child through the system and establishes whether they actually receive the assessment and intervention they need?
The measure of these reforms cannot simply be whether the AON waiting list becomes shorter. We need to know what happens to these children. Were they assessed? Did they receive therapy? Did they receive the right service? Most importantly, did they get that help while it could still make the greatest difference to their development and well-being?

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Record URI: https://data.oireachtas.ie/akn/ie/debateRecord/dail/2026-09-23/debate/main
Retrieved: 2026-09-28T05:50:49+00:00
Sitting date: 2026-09-23