Sexually abused children are being subjected to a form of "postcode lottery" when it comes to receiving the assessment and therapy they need, with many parts of the country having no dedicated therapeutic service at all, a confidential HSE audit obtained by the Sunday Tribune has revealed.

The report was compiled by a high-level working group set up to examine children's access to counselling services in the wake of the landmark 2005 Ferns Inquiry.

It castigates the government for failing to ensure all abused children have access to services aimed at helping them to come to terms with their abuse. It also notes that many early and pre-teen sexual abuse victims have to go through the trauma of referral to local A&E departments for medical assessment.

This is because while children aged 14 and older can be medically examined for forensic evidence purposes in adult Sexual Assault Treatment units, there are still no standardised arrangements for younger children.

Despite ongoing government pledges to improve the situation of vulnerable victims of sexual abuse, the report makes clear that there remain glaring gaps in the provision of services throughout the state.

It stresses that children need to be linked to a therapeutic service as soon as possible after they have been assessed for child sexual abuse. But it finds that there are no dedicated therapy services in counties Wexford, Waterford, Carlow, Kilkenny, and Tipperary north and south, Leitrim and east Limerick, while most other parts of the country also only have partial services.

These can entail as little as one member of staff working on a "sessional" basis.

"There are no designated therapy services outside of the two Dublin hospital-based units, St Clare's in the Children's University Hospital and St Louise in Our Lady's Hospital," it continues. "Some HSE staff provide different types of therapy services within their own [local areas]. In others, reliance is placed on child and adolescent mental health services, most of which operate significant waiting lists."

The confidential report was finalised last autumn and submitted to government shortly afterwards.

A HSE spokesman said the recent allocation of some 265 additional posts on foot of the Ryan report showed that "as a society recognition has been given to the needs of victims".