Martin Daly: Assessment gaps leave Galway families in crisis
Martin Daly details a case in County Galway where the absence of an assessment of needs officer and cross-border barriers delayed access to CAMHS, contributing to a serious crisis. He warns that vacancies, poor communication and fragmented services are leaving families without clear pathways to care.
Immediate case and failings
Martin Daly recounts a family’s prolonged struggle: a child with ADHD and autism who waited almost three years for CAMHS, deteriorated to a suicide crisis, and then faced problems getting an assessment of needs because the relevant post was vacant in County Galway. Daly emphasises the human cost of staffing gaps and administrative borders between counties such as Galway and Roscommon.
Structural issues in the HSE
Daly argues the problems stem from a fragmented system: CAMHS, primary care and children’s disability services are not sufficiently integrated, leading to inconsistent access across regions. He highlights under-resourced primary care in the west of Ireland and inconsistent communication with families seeking help.
What Daly proposes
He says the structural reforms underway in the HSE - including community health area alignment and integrated reporting lines for CDNTs, CAMHS and primary care - should reduce border barriers and improve service coordination. He also stresses the immediate priority of filling vacant assessment of needs officer roles and improving communication so families know the options available to them.
Consequences and next steps
Daly acknowledges the current system has caused avoidable harm and apologises for delays experienced by families. He calls for quicker staffing fills, better interim arrangements when officers are on leave, and fuller implementation of integrated HSE structures so that local services truly serve local populations.
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I'm sorry I'm a little late, I apologise. Just on the assessment of needs, just taking up again maybe where John was talking about there, about the consistency of access to assessment of needs throughout the country. I mean I'm aware of a situation say in County Galway at the moment where there isn't an assessment of needs officer and there's bouncing between borders and a child who has been admitted to a CAMHS service, has ADHD and autism and has been waiting for almost three years to be admitted to CAMHS, eventually became a crisis, a suicide crisis, and they're told that their child needs, or their young adult needs an assessment of needs, even though their CAMHS service was in County Roscommon, they're in Merlin Park, and they're told Roscommon won't do their assessment of needs even though there'd be a years waiting list, but there's no assessment of needs officer in County Galway at the moment because they're on leave, whatever, I'm sure it's legitimate leave, and now they're hoping to get a private assessment of needs. This is a crisis situation, it's been going on for about six or seven years, trying to access services, and they're now being told that we might be able to get a private assessment of needs in Mullingar, sourced by the HSE. This is a system that's absolutely chaotic, and there are families at the receiving end of this, so we have CAMHS chaotic, we have under-resourced primary care services, especially in the west of Ireland, compared to any other part of the country, and we have an assessment of needs that's not fit for purpose. Like not having even arrangements made if someone has gone on legitimate leave to have someone to fill their place, like what sort of a system are we dealing with? So certainly part of what we're trying to do, not just through working with yourselves on the legislation reform, but on the structural reform we're undertaking in the HSE, is primarily focused at the integration and alignment of services, that they sit and serve the populations local to them. I might go to John on the specific issues in relation to the west, and maybe the autism protocol as well, which is obviously important in this regard. Yeah, no, I think I'm aware of that situation in Galway, and that's where there's a vacancy that's in the process of being filled, so that's the delay in that situation. Notwithstanding that, it's not a good experience obviously for the family in that situation, and I think that's where the assessment of need officer has a critical role in terms of coordinating, ensuring that the family's pathway, in terms of whether it's true when you talk about primary care under-resourcing or CD&Ts, there are different options there, and sometimes our communication with families isn't as good as it can be, and I would acknowledge that, and that's critical, and that's where a good assessment officer will do that, they will communicate with the families at all times, and also give them the options that are available to them, because sometimes people are being navigated through an AON process where there may be a more appropriate pathway for them, and I acknowledge in terms of maybe people trying to access, whether it's a CAMS service or whatever, there's a communication deficit there if we're not talking to them, so I think there is a priority, that post is being filled, I can assure you of that. I think one of the key things is that communication is optimal in that process, and that people are told of the different options available. Can I ask you, John, because that's the end of six or seven, this is not personal, this is at the end of six or seven years of messing, I would call it, but there's a family at the bottom, there's a very understanding, responsible family, and well-educated, which shouldn't be the case, I mean, if you've less resources, you'd be looked after even better, but I mean, so these people know how to navigate the system. Is there no way of planning that if someone is an assessment needs officer for a whole county is going to be gone? And the other thing is the borders, what's this with borders for people with psychiatric, mental health issues, disability, they're the only parts of the health service that have borders. Look, unfortunately, yeah, there shouldn't be a delay, there is a delay, so again, all I can do is apologise for that. I think when we move into the new structures, and we are in it in terms of the IHA structures will improve that, because you will have your community health area as the basis of your delivery, and that will break down the barriers that exist there, because we have to acknowledge there has been barriers, so I think where you have your children's disability network team, your CAMHS team, and your primary care team all reporting in through the one line and into an integrated system, that's where you will see service improvement, that's where we've got to see service improvement, and I do acknowledge the challenges for that situation.
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