The National Disability Authority (NDA) was commissioned by the HSE in 2024 to conduct a review of the Children’s Disability Network Teams (CDNTs) service model. This is an action in the Roadmap for Service Improvement 2023-2026, Disability Services for Children and Young People.
As part of this project, the NDA conducted an in-depth review of all available literature about workload and caseload optimisation in children’s disability services and other similar services. This literature review is available on the NDA’s website: https://nda.ie/publications/literature-review-on-determining-appropriate-caseloads-and-workloads-for-childrens-disability-network-teams
‘Caseload’ generally means the number of children that are seen by the therapist over a specified time period, while ‘workload’ refers to all activities required to effectively manage a caseload.
The aim of this literature review was to examine the international literature for guidelines or best practice recommendations for determining appropriate caseloads or workloads for interdisciplinary teams that deliver children’s disability services.
A variety of electronic databases were searched. The research team also contacted member organisations for Physiotherapists, Occupational Therapists, Speech and Language Therapists, Social Workers and Psychologists in Ireland, the UK, the USA, Canada, Australia, and New Zealand to seek out relevant materials.
Most of the existing literature or guidance comes from the professions of Occupational Therapists, Speech and Language Therapists and Physical Therapists. A small number of tools and guidelines that various professions use to calculate or determine caseloads and workloads were identified, although these were primarily for individual therapists rather than for multi-, inter-, or trans-disciplinary teams.
The NDA advise that the findings of this review add to their previous findings that there is no conclusive evidence as to what constitutes an appropriate caseload for therapists providing children’s disability services.
The literature identified a clear shift towards adopting a workload rather than a caseload approach to service planning. Caseload approaches are generally not accepted as accurate or effective measures of therapists’ productivity, as they do not recognise the complexity of therapy roles in current best practice and other influencing factors. The workload approach, on the other hand, has been promoted as a means of enabling more efficient and effective service delivery that aligns with best practice. The literature also highlighted the numerous consequences of unmanageable caseloads and workloads, including high levels of stress and burnout among staff.
When service planning, it is recommended that a workload analysis is conducted first, and this information is then used to determine appropriate caseloads.
The NDA concludes that work needs to be conducted on the ground with CDNTs, to establish current workloads, caseloads and current workload/caseload management practices. Data can then be used to develop and implement appropriate improvement strategies.
‘Ireland’s Future Health and Social Care Workforce’, published in December 2025, sets out how the Department of Health is taking a comprehensive approach to long-term health and social care workforce planning. The report provides the results of workforce planning projections conducted by the Department of Health for the health and social care sector as a whole, including for the disability sector. It represents the first iteration of workforce planning projections, with the intention that the Department of Health’s modelling work will produce projections for a broader range of professions over time, as data access and quality improve.
The report sets out twenty actions under five interconnected pillars, including that of ‘Optimise Performance’, below, which acknowledges the importance of ensuring an appropriate skill mix within teams to ensure that skills and training match the roles and responsibilities required:
Optimise Performance: Reform, maximise capacity and optimise health service performance to support the development of innovative models of care as envisaged under Sláintecare. Having the right mix of healthcare professionals with the right skills, supported by the right technology is essential
Further work to update forecasted demand for disability services is currently underway in this Department via an updated Capacity Review for Specialist Disability Services, due to be published in Q3 of 2026. The updated review will provide projections of demand across different service areas by users age, region, disability types, and estimated support requirements to 2040. Findings from this work will feed into strategic planning for disability services.
