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High Court Rules Against HSE SOP on Assessments of Need
The HSE SOP for Assessments of Need (AON) introduced in 2020 faced legal challenges after families argued it failed to meet statutory requirements. The High Court ruled against the SOP, stating it did not comply with the Disability Act 2005, impacting thousands of children nationwide.
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How the HSE’s SOP decision on assessments of need impacted thousands of families
In January 2020, the Health Service Executive (HSE) made the controversial decision to implement a new Standard Operating Procedure (SOP) HSE SOP, for conducting Assessments of Need (AON) for children under the Disability Act 2005. This decision introduced a Preliminary Team Assessment (PTA), a team-based approach to alleviate resource constraints and reduce waiting times. However, adopting the Preliminary Team Assessment (PTA) was controversial. It was opposed by the expert representative bodies of the professionals working in the sector: The Irish Association of Speech & Language Therapists, the Association of Occupational Therapists of Ireland and the Psychological Society of Ireland, who described the PTA as “not fit for purpose”. Despite early warnings from the professionals conducting the PTAs, the HSE trudged forward with implementing the PTAs as part of the HSE SOPs in January 2020.
The PTA has come under scrutiny, not only for its perceived rushed approach to diagnosis but for its failure to comply with the statutory requirements of the Disability Act, the result that it has potentially impacted thousands of families nationwide. More alarmingly, a significant number of children and young adults have been faced with the likelihood of a potential missed diagnosis, incorrect diagnosis and the unavailability of HSE services and interventions.
The Preliminary Team Assessment Approach
The HSE SOP implemented in January 2020 introduced a two-stage AON process:
- Desktop Review: This involves a preliminary review of a child’s needs based on available information, such as medical records, a statement, and/or an interview with the child’s parents.
- Preliminary Team Assessment (PTA): A purported one-hour observation of the child at play and a half-hour consultation with parents.
This brief PTA assessment, as described above, replaced the comprehensive evaluations traditionally conducted under the AON framework. Essentially, the PTA approach did not provide a formal diagnosis or specify the extent of the child’s disability. Instead, it referred families to local services for further assessment. While this understandably expedited the initial evaluation process, it left families without the detailed information required for timely and effective interventions.
Legal challenge and High Court ruling
The legality of the HSE SOP was challenged in a 2022 case, CTM v HSE [2022] IEHC 131, where the High Court found that the new PTA approach failed to meet the standards required under the Disability Act 2005. The Act stipulates that AONs must:
- Identify the nature and extent of a child’s disability,
- Assess the necessary services to meet the child’s needs and
- Be conducted without consideration of financial or resource limitations (as per Section 8(5)).
The court held that the PTA approach diluted these statutory requirements, resulting in incomplete assessments. Justice Phelan emphasized that the PTA’s failure to diagnose or fully assess disabilities frustrated the statutory intent of the Act.
Consequences for families
The implementation of the HSE SOP has likely caused significant harm:
- Delayed Diagnoses: Children subject to the PTA approach between 2020 and 2022 may not have received accurate or timely diagnoses, delaying interventions crucial for their development.
- Access to Services: Families were left without the comprehensive reports needed to secure essential HSE services and/or educational supports.
- Emotional and Financial Strain: Parents faced increased anxiety and financial burdens as they were forced to seek private assessments and interventions.
HSE’s response and future implications
Following the High Court ruling, the HSE stated that the purpose of the PTA was “to ensure that available resources are being used in the most effective way.” However, the judgement in CTM v HSE [2022] IEHC 131 resulted in significant growth overdue assessments, which has been acknowledged by the HSE. The Families affected by the PTA process have begun receiving communications offering revised assessments. However, the consequences of the HSE’s decision to introduce the PTA continue to impact families across Ireland, potentially hundreds of children requiring comprehensive reassessments.
Advocacy and support
For families impacted by the HSE SOP, a clear understanding of their rights under the Disability Act is essential. Advocacy groups urge affected families to seek answers from the HSE to ensure that their children’s needs are fully addressed. The case also serves as a stark reminder of the critical role of judicial oversight in safeguarding the rights of the most vulnerable people in society. As Ireland continues to navigate the challenges of providing reasonable healthcare services, the lessons from this case will hopefully inform future policies to prevent similar systemic failures.
At Coleman Legal LLP, we have a team of highly qualified solicitors and legal executives with extensive experience in medical misdiagnosis, medication mismanagement and deficits in care. We are available to speak to the parents of the affected children in addition to people who are now 18 years of age or older and may have been impacted by failures of the PTA introduced by the HSE. We are here to support you.
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