Bríd Smith: Calls HSE SOPs a 'queue to get on a queue' for children
Bríd Smith criticised delays and bureaucratic barriers in the assessment of needs process and denounced the HSE's standard operating procedures (SOPs) as an added obstacle. She argued the SOPs mask failures, leave children on waiting lists and push families into costly private therapies.
Main criticisms
Bríd Smith said the HSE's standard operating procedures are designed to massage figures rather than meet children's needs. She described the SOPs as "an added obstacle and an added process - a queue to get on a queue" and supported a call to scrap the SOPs.
Assessment delays and data gaps
Smith reported constituents facing waits of a year to 18 months for assessments and highlighted stark geographical differences in access, likening them to a lottery. She said parliamentary questions (PQs) revealed the HSE does not compile the data on numbers of children in each CHO and their actual waiting times.
Personal testimony and clinical concerns
She recounted a constituent's experience: Linda's nine-year-old son Shea, who has Down syndrome, received sporadic supports, a three-year wait for an autism referral and minimal occupational and speech therapy. Smith also cited clinicians who say they cannot ethically assess children in 90 minutes but feel forced to recommend further assessment so children will not be denied services.
Two-tier health system and consequences
Smith argued the crisis stems from long‑standing staff shortages and a two-tier public/private health system that drives families toward private, for-profit care. She warned that undermining public services facilitates the expansion of private healthcare and leaves children's needs unmet.
Call for accountability and reform
She accused the SOPs of protecting the HSE rather than acting in children's interests and said the HSE has overseen catastrophic failures despite ministerial rhetoric. Smith called for transparent data, adequate staffing and removal of bureaucratic barriers to ensure assessments lead to timely services.
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I do want to welcome the motion and the issue that Sinn Fein are highlighting here tonight and I think one of the main demands that we should scrap the standard operating procedures is one that we'd like to echo this is a con job designed to massage the figures and give the impression that something has been done about the scandal that is the assessment of needs and how this state treats its most vulnerable so since I came into the Dáil in 2016 I and my colleagues here have had countless numbers of constituents coming to us in exasperation and despair about trying to get their children the care and supports that they need the first obstacle in the long list is the assessment of need process those that are forewarned can simply or most often struggle to go private and those that can't go private will languish on waiting lists and when we've submitted PQs on this issue the replies we have received from the HSE were astonishing dates were set at a year or 18 months into the future for an assessment and often there was a striking difference between various geographical areas almost like a lottery and then the whiz that some genius decided to start was a process called the standard operating procedure to give the appearance that something is being done when in fact all it is is an added obstacle and an added process a queue to get on a queue we know the consequences and the trauma caused by this and we've known this for many years and we have known we've had serious staff shortages and we've had them for many years when we asked for the data on the number of children in each CHO and the time they were actually waiting to get the services identified in the assessment of needs the HSE said we don't compile that information this is extraordinary in my view all of the stats and all of the supposed progress here is about identifying the needs that the children have not meeting those needs or supplying the services that they do need the PQ's explanations for the rationale behind the standing operating procedures also needs to be challenged they claim it's for consistency and that assessment officers and clinicians were erring on the side of requesting a wide range of assessments in as short a time frame as possible that's a quote because they were under pressure from the legislation and it's worth comparing that bureaucratic answer to the experiences of a friend of mine Linda's from Talla she has a son called Shea who's nine he has Down syndrome and she was interviewed in the Irish Times last year and she says Shea has had sporadic supports over the years he was referred for an autism assessment three years ago it's never been acknowledged there is maybe one occupational therapy session per year no speech and language for the first few years and then a block of six hours before he signed off the system when I started fighting for the services since Linda after Shea was born I was told that I have unresolved childhood issues instead of working together it's about blame we've spent all our savings on private therapies and we're in a very precarious position now and in the same article that interviewed Dr Irwin Gill he says this is not a meaningful assessment it does not help children and merely moves them to another waiting list for a more useful assessment for which there is no statutory time limit and therefore no legal recourse the prevailing opinion is this is a cynical attempt by the HSE to protect itself rather than act in the interests of children and clinicians on the ground reiterated this and said they feel disheartened and they cannot stay in the HSE if this is their future it is to quote one of them against all our ethical practices we cannot assess children in 90 minutes as to whether a child has a disability but if we don't they won't get the services so most of us will probably recommend further assessment and say that we suspect a disability I feel despondence as he so the only question is why has this crisis been well it's not the only question but one of the serious questions is why has this crisis been allowed to grow and despite all the rhetoric from this and previous ministers the HSE has overseen catastrophic failures to provide the services needed by our children the assessment of needs issues shows again the deep deep crisis in our national health service in general and the attempt to suggest that somehow this is complex and inexplicable the roots of these causes are multiple crises in the health system and stem from the fact that we have supported and maintained a two-tier health system for years a crisis-ridden public system and a never-increasing and enlarged profitable private system this is the reason we are growing the private system the reason we have a vested interest in private health care is precisely because we have a dysfunctional public health care system and we have a dysfunctional public health care system in order to promote the private system they are two sides of the same coin and any attempt to deal with one without the other doesn't understand this issue and that attempt will flounder we need a one-tier national public health system to understand that when we force nurses or public health doctors out on strike or drive them out of the country out of the service because the conditions are so bad we are deliberately undermining the provision of public health and facilitating the increased need for private for-profit health care We do here and Kelly Chief Administrator has turned in a across-profit health system because we have the next group and we will continue to use considering that Mark Bees is just a transformed university that asks us about
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