2026-04-23

121. Deputy Liam Quaide asked the Minister for Children, Disability and Equality the number of staff assigned to each regional single point of access referral pathway for children's disability and mental health services, including primary care; the number of single point of access units established to date per health region; the disciplines represented on each; and the governance arrangements in place to adjudicate contested cases. [29469/26]

The Taoiseach told us this week that the single point of access initiative is being rolled out across child and adolescent mental health services, CAMHS, children's disability network teams, CDNTs, and primary care so that young people are not languishing on one waiting list after another. There is serious concern, however, within the services that buy-in to the single point of access is not consistent across all parts of the system, including psychiatry, and that there is an absence of a clear adjudication mechanism for contested cases. What procedures are in place in each region to make this work on the ground?

The Government and I recognise the importance of early intervention for children with disabilities and ensuring they receive the right services at the right time. The HSE has been developing a single point of access, SPoA, referral model. As Deputy Quaide has said, this will ensure that children are referred to the appropriate healthcare service, whether that is primary care, disability services or child and adolescent mental health services at an early stage. As a result, children will not be put on multiple waiting lists or be passed from one service to another. I am sure the Deputy has had the same feedback from parents and families, as I have from constituents. Sometimes parents feel they get to the top of the waiting list and they are told they are on the wrong referral path and they go to the bottom of another queue. This is to solve that problem because we know that is not fair. The roll-out is expected to commence on 24 June and will continue throughout this year. The SPoA model will be supported by the Health Service Executive's community care record at that time as a key enabler for the administration and delivery of services. A national oversight group and six regional implementation groups are leading the programme. The single point of access referral model across all six regions will be achieved through resourcing, partnership and collaboration, and the design and development of a single integrated pathway and streamlined referrals process. It is not expected to give rise to an additional staffing requirement but local areas will deploy existing resources in a way that best suits the needs of their area. A standardised, online, publicly available children and young people’s services referral form has been finalised by the HSE and that single form and will replace over 20 manual forms that have been used until now. It is now being digitised to optimise the referral pathway and timelines for signposting each child to the service or services most appropriate to meet their needs. Following the receipt of a digital referral form and engagement with the person who made the referral, the referral will then be reviewed and triaged, and this triage will continue to be locally led.

The single point of access is a sound concept and I fully support it. Young people are, as the Minister of State said, getting passed from one waiting list to the next and that is happening mainly because services have been understaffed for years and they respond to this by becoming more rigid in their gatekeeping of referrals. There is also an issue of power imbalances that we need to focus on. For instance, it is very difficult for a basic grade speech and language therapist or a basic grade occupational therapist to hold the line with, for instance, a consultant psychiatrist, that CAMHS is a more suitable service for a young person even when, objectively, that is clearly the case. I am hearing of concerns within services that psychiatry has not fully bought into the single point of access model in each region. I ask the Minister of State again whether there is an ongoing dispute between CAMHS, primary care and CDNTs about which service best fits a young person's needs. Who has the authority to make a final decision in that instance? Is there a named adjudicator? Is there a formal escalation pathway? Is there a timeframe for determination?

The Deputy is right that more complex cases will often require further clinical interventions or reviews to ensure the most appropriate pathway of care. Decisions on how this is managed will continue to be made at a local level. Once the work for a single point of access is complete, the outcome of the referral will be communicated to the referrer, and the child will then be assigned to the appropriate service. In recent weeks, the HSE access and integration team, which is leading the single point of access programme, has developed a high-level standard operating procedure, SOP. That sets out the core processes and requirements necessary to deliver on the single point of access commitments. This is currently under review by the six regions. It has gone to the six regions for their input and based on their feedback, regional implementation plans, which were developed in late 2025, may require further refinement to ensure full alignment with the agreed national approach and with the supporting digital infrastructure. Ultimately, and this is the important bit and goes to the nub of the Deputy's question, clinical governance for each area will remain under the remit of the regional executive officer. Local areas will continue to exercise their clinical and professional judgment to manage and find resolutions to cases in line with existing HSE policy, practice and procedures.

The HSE has repeatedly told committees in the Oireachtas that the single point of access will stop children from being moved around the system, between primary care, CDNTs and CAMHS. It is still far from clear how this is meant to work when services fundamentally disagree. That disagreement continues about responsibility for a young person and that is the real test of this reform. Will the Minister of State now set out whether the Department or the HSE has formally engaged with the College of Psychiatrists on the single point of access, whether the college has indicated full support for the model and whether it has expressed reservations, particularly around disputed referrals or contested cases, and whether she will publish the governance and adjudication arrangements that are meant to operate when these disputes arise? It is not realistic to expect a basic grade occupational therapist to make a referral to the regional executive officer. Without that clarity this risks becoming another reform that looks nice on paper but leaves clinicians arguing and families stuck in limbo. It is fair to say that all this is happening against a backdrop of services remaining severely compromised by a long-standing failure to engage in proper workforce planning and comprehensive recruitment to disability and mental health services.

I thank the Deputy for saying he feels that the single point of access is a sound concept. It is something I am very much committed to and I know it is something the Ministers, Deputy Foley and Deputy Carroll-MacNeill, are very committed to also. The HSE has done a huge amount of work on this. Ultimately, the rollout of a single point of access will be supported by the HSE community connects ICT system and by the regional implementation plans, which are now with each region so they can be fully refined. We expect this to be implemented soon. In terms of the HSE and the College of Psychiatrists, if the Deputy would like to suggest to the college to write to me or the Minister, Deputy Foley, we would certainly take on board its feedback and be a conduit to the HSE if it feels there are any roadblocks there. Ultimately, what we all are committed to - the HSE, our Department and every person working in our CDNTs across the county - is ensuring families receive the supports necessary to meet their children's needs. Systematic changes have to happen in order to do that and the introduction of the single point of access, along with the 19% increase in the HSE's disability budget for this year to more than €3.8 billion, are clear steps that show we are very serious about this.