Oireachtas Joint and Select Committees

Thursday, 28 February 2013

Joint Oireachtas Committee on Health and Children

Child and Family Support Agency: Discussion

11:40 am

Mr. Gordon Jeyes:

There has been very good engagement with the HSE on this. Nobody has been transferred yet but we have alerted 4,000 staff that they are liable for this transfer. The numbers in dispute at that point were in single figures. I will come to the issue of psychologists separately.

We want an holistic approach. The view of the child at school, in the family, in the community, with his or her peer group and in social work are all different and all make up the full picture. I come from an education as well as a social work background and we need to work together to maximise the impact we will make. We will take an holistic approach.

An important issue was raised with regard to information sharing. Uncertainty remains in Ireland about information sharing and we need further examination of it. I am often told that data protection is no obstacle but then I find that it is and issues still arise. I have never known children to be at risk because information about them has been shared. I have known children to be at risk because information has not been shared. Sometimes the way legislation is phrased means one can share information if one knows a child is at risk of significant harm, but unless one has all of the information, one may not know the child is at risk of significant harm. There has been talk of legislation yet to come on a duty to share information as opposed to holding it back, and this needs further encouragement. We are too precious about this and it should be considered.

Child and adolescent mental health services are being reformed, and reform of adolescent health services is badly needed. Some adolescents have been very poorly treated as 16 and 17 year olds do not fall within the domain of child services but adult services do not want to treat them because they are children. It was a case of heads, they lost, and tails, the other side won. I support the task force recommendation that community child and adolescent mental health services should be within the agency. The timing was not right with regard to other reforms. There will be a review and a final decision will be reached.

I am surprised by the various references to phase one and phase two. Perhaps with so many announcements one can get confused. Leaving the task force aside, which did not refer to phases, when the Minister announced her response she referred to two phases. She stated she would start by dealing with the many people doing several jobs at once. She also stated stability was required to get it started and listed the essential components for the first phase. The issues for phase two are child and adolescent mental health services, speech and language therapy, public health nurses and detention schools. This has been the Government's position since responding to the task force. It has also always been stated that there will be a phase two; it is just that the response to the task force recommendations is not specific. I share Deputy Ó Caoláin's concern at the delay and I am sympathetic about the uncertainty it causes but I want to get it right.

With regard to a turf war because psychologists are so popular and nobody should leave home without one, we all want psychologists and I support the task force recommendation. The relevant Ministers have a group studying the impact of the most effective deployment which is nearing fruition. I cannot say too much. It is important to emphasise that as we look at a health service with clear and separate components to increase accountability and transparency, we do not think this is the end because we will need systems to ensure we work across these components. The components should be part of acute primary care along with the other carer groups. Mental health services, public health services and ourselves will not be islands and some of us will have services which will reach into other roles. As chief executive designate of the new agency I want to be a provider to mental health services, care groups and others as well as a receiver from them. If any of the component parts are only receivers it will be weaker and therefore I welcome hosting community psychology within the child service. As we create the warp and weave, let us focus on families and customers and not on professional boundaries.

With regard to public health nursing, the person who first mentioned the two phases was the questioner, who obviously knew there would be two phases. It is important that we stay aligned with the rest of the health service. The detail of the health reform is important as is ensuring we strengthen incrementally so we have stability and the capacity of the newly-formed leadership team is not stretched too far.

I visit as many family resource centres as I can and community consent is absolutely crucial. I would like to see initiatives which build on their strengths and I am particularly keen on the contribution children make to the community in sports and the arts because these activities bring out a community. We always think of children as a blight in our community because they are only ever in the newspapers as perpetrators or victims, as opposed to us celebrating the Christmas show or their performance in sports. It is about systems of entitlement and building up their capacity in the arts. Good work is done in the theatre in Ballymun and elsewhere throughout the country.

The role of children in families and supporting the life of families in communities are crucial. We will take this into family area pathways. As of yesterday every area manager will identify a lead manager. We will ensure an audit of all services which contribute and we will have detailed discussions with every provider to the €100 million in the voluntary and community sector. I have stated there will be no reduction in the first six months of this year while the review is being done. I then want to make it more fit for purpose so we fit in with the research work conducted by NUI, Galway which states that what matters is what works. The activities we will fund will enable a community response, which will then mean engagement of social work is less necessary because we will be building on the strengths of family. I expect local area pathways to be operating in the second half of the year, but it will be gradual as we build on strengths and bring more people to the table.

I am struck by the sheer range of voluntary and community activity in Ireland. Much has flowered from the ground up and there could be some harvesting, but for the maximum impact the sector must do it for itself. Perhaps some areas have too many separate initiatives to have the best impact.

There is a need to finalise the complementary work in child sex abuse cases, but I must revert with the exact figure, as I do not want to read into the record a figure in respect of which my memory might not be serving me correctly. We need assessment centres in which children's needs are met, for example, acute health care, and where social workers and organisations such as CARI have a presence. The Garda can also be involved for evidence-based purposes so that as few interviews as possible need be conducted.

As is appropriate, the sexual abuse treatment units remain with the health service. It is an area that needs boundaries. I expect further announcements in this regard. I share people's impatience, as we should be doing more. There is an inconsistency across the country. I hope that we will shortly roll out the sort of model that I have described, one in which a service is available 24/7. Clearly, resource limitations cause some difficulties.

The component parts of the agency are, in the first instance, the services to ensure that children at risk of significant harm are protected; services for alternative care, both trained and registered foster carers and relative carers who are supported by the State; and high-end alternative care arrangements, for example, residential care right up to and including high support and special care. In excess of €100 million in the voluntary and community sector is associated with the family support prevention and partnership work that we do with our colleagues. I retain my lead HSE role for services in response to domestic sexual and gender-based violence. The agency presents an opportunity in that regard to reconsider matters. It is not always about refuges and escape. It is about dealing with the 80% of partners who have suffered violence and are in the community. We can get better community and family-based solutions.

We are not operating in the absence of legislation. We are a part of the HSE. We are more an agency within an agency with our own accountability than last year. However, the only legal and governance route for the children and family services agency is to the board. We will build these services with the 106 family resource centres across the country and the education welfare services.

I welcome the question on social work reform. I do not wish to be misunderstood here but the reform has taken up a great deal of activity. We have tried to put in place a coherent programme, but it is a work in progress and is nowhere near finished. I would happily supply more details of our prioritisation list and the activity that is under way. I do not want people to believe that the agency is merely a continuation or another aspect of social work reform. That reform will continue within the agency, but the agency is far greater than that. I am aware of the challenge of being a social work add-on. We must not let that happen. I come from a community background. We must do this work in a more holistic way, as questioners have mentioned.

The last point raised was on accountability. The accountability of four steps has been in place since May. I am pleased with the progress made by the 17 area managers in a brief time. Previously, those colleagues did not have responsibility for human resources and finance. They are stepping up to the plate following some detailed management training. That makes the liaison with the likes of the Garda Síochána all the more reliable. I meet the 17 area managers on a monthly basis. Overall, it is a significant step forward. The efforts to create an integrated service approach had become a little cluttered.

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