Mr. Bernard Gloster:

I thank Senator Black for her kind comments. This is something that has to be particularly close to us and a focus of our attention. The regional executive officers will have to now mobilise all of their services to make sure that there is a much more positive discrimination in favour of people with disability, in particular children and those who find themselves in vulnerable positions like being delayed in hospital.

I have met the Ombudsman for Children several times since coming to this post. I have a very good working relationship with him. Obviously, having been the CEO of Tusla, I understand both sides of that dynamic in the memorandum of understanding. I have now agreed with my colleague, the new CEO of Tusla, Kate Duggan, that there was a get-out clause, if one likes, on the health side of that memorandum of understanding, which was subject to resources. We have now removed that. Where a case is agreed as a joint case between the HSE and Tusla, the decision is made quickly on which one is to lead. That will depend on whether it is a protective measure or a health measure. Whichever agency is leading the case has to source the care support or care placement for the child and both agencies jointly fund it under the protocol. We have agreed that. We have some loose ends to tie up in terms of how we drive that message back out into our own system. There are parts of the country where it has worked very well and there are other parts where it has not. In some of the cases the ombudsman was talking about, it was not a question of money; it was actually a question of the skill set not being available in the country to provide the type of service or care that was needed, or at least to do it easily. Ms Queally, who is present, dealt with some of these cases in Children's Health Ireland.

To put in place a bespoke placement for children with the most complex needs can take anywhere between three and nine months. I have no difficulty mentioning a case I dealt with at Christmas that was in the public domain where a child spent something like 50 days being cared for in a hospital emergency department although the child did not have any acute illness need whatsoever. It is just shocking for us to see that and not be able to do anything about it. We have done something about it but it does take time when it is complex. I can absolutely state that there is no obstacle to interagency work between ourselves and Tusla.