‘Government failing thousands of families’ over ongoing waits for needs assessments, says Cork TD

A Cork TD has called for a recruitment drive to tackle the rising number of children waiting on assessments of need (AONs) and said the HSE needs to be transparent about the cost of outsourcing the assessments to private providers.

More than €12.5m was spent nationally on such outsourcing from June 2024 to March 2025.

AONs are carried out to identify whether a person has a disability, the nature and extent of the disability, health and education needs arising from that disability, and what services are required to meet those needs. There is a legal requirement that AON should be completed within six months of an application being made, but the HSE consistently misses this deadline.

Response

In response to a parliamentary question by Cork Social Democrats TD Liam Quaide about the cost of outsourcing to private providers, HSE South-West — which covers Cork and Kerry — said that the number of assessments of need applications received has greatly increased in recent years, rising from 683 in 2022 to 1,054 in 2023; 1,716 in 2024, and 1,187 in the first half of 2025.

A spokesperson said: “HSE South-West has progressed a number of waiting list initiatives to improve our compliance with the legislative timeframes for assessments of need.

“We have engaged with private providers to procure additional clinical assessments.”

Data shows the HSE South West completed 741 AONs in 2022; 755 in 2023; 975 in 2024, and 522 in the first six months of 2025, saying this increase was due to private providers, but despite this, “due to the greatly increased number of applications received, the number of overdue assessments also increased”.

Overdue

At the end of 2023, some 796 AONs were overdue completion. By the end of June this year, there were 1,359 overdue, the figure increasing incrementally every quarter for two years.

The HSE spokesperson said service arrangements are in place with service providers conducting assessments on behalf of HSE South West disability services.

“Service provider negotiated pricing structures are commercially sensitive and would potentially provide an unfair commercial advantage if made publicly available,” said the spokesperson.

In response to a previous parliamentary question, the HSE told Mr Quaide that under a targeted waiting list initiative, “3,636 AONs have been commissioned from private providers/assessors from June 2024 to March 2025, at a cost of €12,512,952”.

“This suggests that the average cost per AON is €3,441,” it said.

Mr Quaide, the party’s spokesperson for mental health and disability, said AONs are the one right under disability law that a child with additional needs has, “and yet the Government is failing thousands of families in this respect”.

Increase

He explained there has been a 74% increase in applications between 2022 and 2025 so far in the South West region, which is likely to increase this year.

“Part of the increase is related to the chronic under-resourcing of primary care services for young people, and the continued application of recruitment restrictions through the pay and numbers strategy,” said Mr Quaide.

“There are children who would benefit from low-intensity or short-term intervention who would benefit from a therapeutic assessment followed by timely intervention by primary care services.”

He said increasing numbers of children are getting stuck in the AON pathway, but are left waiting for therapies in primary care services or children’s disability network teams.

“This outsourcing is also creating a ‘perverse incentive’ for clinicians to leave the public service and take on private clinical work — thereby making the problem of under-resourcing within the HSE worse,” he said.

“Between June 2024 and March 2025 alone, the HSE spent €12.5m on AONs.

“That equates to approximately 290 years’ worth of the starting salary of a staff grade occupational therapist.”

Mr Quaide said the HSE needs to be transparent about the costs to the taxpayer of increased outsourcing, calling for a workforce plan for primary care services and a comprehensive recruitment drive.