Alan Farrell (Dublin Fingal, Fine Gael)
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I welcome members and those viewers who may be watching the proceedings on Oireachtas TV to the public session the Oireachtas Joint Committee on Children and Youth Affairs. The purpose of the meeting is to discuss the recruitment and retention of social workers. In the first session, the committee will hear from representatives of the Health Information and Quality Authority, HIQA and, in the second session, we will hear from representatives of Tusla. In the first session, we are joined from HIQA by Ms Mary Dunnion, chief inspector-director of regulation, and Ms Broghan Gibson, regional manager of children's services.

Before we commence, in accordance with procedure, I am required to draw the attention of witnesses to the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.

I remind members and witnesses to turn off their mobile phones or switch them to flight mode as they interfere with the sound system and make it difficult for parliamentary reporters to report the meeting. Television coverage and web streaming may also be affected adversely.

I advise the witnesses that any submission or opening statements they have made to the committee will be published on the committee's website after this meeting. Following the witnesses' presentations there will be questions from the members of the committee. I invite Mr. Ms Dunnion and Ms Gibson to make their opening statements.

Ms Mary Dunnion:

On behalf of HIQA, I thank the Chairman and the members for the invitation to address the joint committee this morning. I am accompanied by my colleague, Ms Bronagh Gibson, regional manager of HIQA's children's team. I will keep the opening statement brief to allow more time for questions at the end.

HIQA is an independent statutory authority established in 2007 to improve Ireland's health and social care services. Our role is to develop standards, inspect the safety and quality of caring services and support informed decision making about how these services are delivered. We also conduct a wide range of health technology assessments, provide advice on Ireland's eheath infrastructure and carry out the National Patient Experience Survey.

HIQA's children's team monitors and inspects a range of services provided to children by both statutory and non-staturory providers. These services include children's residential centres, foster care services, special care units, child protection and welfare services. and Oberstown Children Detention Campus. Most of these services are statutory and are provided by the Child and Family Agency (Tusla).

The provision of safe, effective and reliable child-centred care relies upon a well-trained, supported and motivated workforce. However, as repeatedly cited in our inspection reports, including the recently published report on the child protection and welfare services in the Dublin South-Central service area, Tusla has been unable to recruit a sufficient number of social workers with the right skill mix to carry out its work programme.

During the course of HIQA’s 2018 statutory investigation into Tusla’s management of child sexual abuse allegations against adults of concern, Tusla staff frequently expressed concern about staff recruitment and retention. Critical social work posts remained vacant across the country, which had an ongoing, negative impact on the consistent delivery of a high-quality and timely service. Staff believed this deficit was constantly causing delays in the system, for example, the timely allocation of a social worker to a child and the management of child protection and welfare referrals. The challenges in recruiting staff were persistently reported as an organisational risk at board, executive and operational levels across Tusla. Senior Tusla managers asserted that there was an insufficient number of social work graduates in Ireland to meet Tusla’s service needs. Furthermore, staff indicated that inefficient and overly bureaucratic systems, together with the burden of too much paperwork, were reducing the amount of time they had to spend on direct social work with children and families.

Tusla is indeed experiencing a shortage of qualified social workers. However, at the time of our investigation, no comprehensive, strategic approach to workforce planning was in place, which was informed by the reality of the current employment market. For example, there was little evidence that a review of current processes and requirements, or consideration of upskilling other social care disciplines, had happened or was formally under way. Without taking such a strategic approach, Tusla cannot rely on recurring staff shortages as the default reason for failing to deliver an efficient and safe service to children and their families. Nor can they use this as an excuse for not providing an environment where social workers and social care workers can enjoy doing the core job they are qualified to do. Tusla has to manage the same workforce challenges faced by other jurisdictions and, as a relatively young agency, must avoid an organisational mindset that sees such problems as insurmountable due to factors outside of its control.

One of the key recommendations emerging from our investigation was that Tusla and the Department of Children and Youth Affairs should, as a matter of urgency, seek the assistance of the higher education and training establishments to create formal career-path mechanisms for students and graduates. HIQA also recommended that the Department of Children and Youth Affairs, with the assistance of HIQA, should undertake an international review of best practice in the regulation of children’s social services in order to inform the development of a regulatory framework for these services in Ireland. This is with the view to providing independent assurance to the public that the State’s child protection and welfare services are safe and effective.

In the interim, HIQA recommended that Tusla should conduct an internal operational review to simplify and integrate procedures, and invest in more administrative support to free up social work practitioners’ time and expertise. This should include a review of the existing social worker, social care worker and support staff skill-mix, and the development of a workforce strategy.

Other jurisdictions have made best use of non-social work staff to carry out activities currently undertaken by social workers in Ireland. In the UK, for example, following screening of referrals and during the assessment process, social work assistants are used to provide practical support or to gather information to help inform social workers in their assessment.

In December of last year, the expert assurance group established to oversee and advise on the implementation of the recommendations of HIQA’s investigation published its first quarterly report. The chair of the group, Dr. Ryan, notes that "it is well documented that Tusla has not been able to recruit the number of social workers to meet its needs, and is unlikely to be able to do so in the immediate term." He stresses that "the need for an effective workforce strategy that meets the immediate, as well as long term goals for the organisation cannot be overstated." The report states that Tusla is preparing a multi-annual workforce plan to identify the organisation’s personnel requirements for the coming years. The expert assurance group expects that this plan will provide insight into how the organisation will adapt to labour-market conditions in order to deliver effective services to children. The report recommends that "significant engagement with discipline and service leads" is undertaken to identify the optimum service delivery model.

We welcome the development of a strategic workforce and look forward to reviewing the final document.

A shortage of qualified social work staff is undoubtedly contributing to delays in the appropriate management of referrals and the early assessment of children at risk. However, Tusla, in conjunction with the Department of Children and Youth Affairs, has to manage the same workforce challenges faced by other jurisdictions and avoid an organisational mindset that sees such problems as insurmountable due to factors outside its control.

Alan Farrell (Dublin Fingal, Fine Gael)
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I thank Ms Dunnion for her opening statement. What steps have been taken, to the best of her knowledge, to create, with educational institutions, a framework for a formal career path? Ms Dunnion mentioned that other jurisdictions use non-social work staff to carry out activities undertaken by social workers here. What progress is being made on that here? Is it having any beneficial impact on social workers in performing their duties and doing paperwork? Any social workers I have spoken to in recent years have told me that over 50% of their job has been dealing with paperwork which in their view is about 80% too much because it stops them getting out and being effective social care workers.

Ms Mary Dunnion:

The recommendations that we made on linking with third level institutions and formal career pathways were a result of the statutory investigation. At that time the Minister for Children and Youth Affairs set up an expert assurance group whose role is to oversee the implementation of those recommendations. The most up-to-date information we have is what was published in December 2018. Beyond that we do not have any other detail of what is happening in that regard. We certainly see in Tusla's action plan that it has identified specific streams of work including these, but I do not know the timelines associated with those or what stage they are at.

Alan Farrell (Dublin Fingal, Fine Gael)
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Is there a formal communication channel between HIQA and that implementation group such that there would be regular conversations?

Ms Mary Dunnion:

We met the implementation group at the beginning of its work in late 2018 and we would expect that we will meet it during 2019, but it is not a formal scheduled structure. It is part of the recommendation from the statutory investigation that the implementation status would be published so that the public would know the direction of travel.

In answer to the second question, we have 14 inspectors, which is quite a tight team in Tusla, we cover all the services from Donegal to Cork, and we only get sight of the inspection areas we are looking at. We have seen the emergence of an increased number of administrative staff supporting social workers and social care workers in their role, which is a very welcome finding in our inspection process.

Tom Neville (Limerick County, Fine Gael)
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What is the career path for a social worker within Tusla once they are hired? What is the ratio of management to social workers within Tusla? If Ms Dunnion does not have those figures, we will have to try to get them. Have any studies been done on people who have gone through the interview process or how long does it take? Ms Dunnion mentioned the bureaucracy. Is there a flowchart available that shows the end-to-end recruitment process and where candidates fall out if they leave the process? Is the recruitment process driven locally or is it a panel format, similar to that in the HSE?

Ms Mary Dunnion:

In essence I am not able to answer any of Deputy Neville's questions in any true detail. Tusla would be best placed to answer them. One of the key findings in the statutory investigation and, as a consequence, the recommendation, is that what an organisation as large as Tusla requires is a comprehensive workforce strategy which would include all the points the Deputy is making. Unfortunately, that was not evident during our statutory investigation and that is why we made the recommendation we did. We believe the workforce strategy will be available at the end of quarter one of 2019 and we welcome that.

Tom Neville (Limerick County, Fine Gael)
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Is there any rationale for why a workforce strategy was not put in place?

Ms Mary Dunnion:

Our investigation found that there was a gap between what was happening at the executive and on the ground. It was very important that the gap should be narrowed. There were pieces of work on workforce planning. It was not comprehensive work that would cover the totality of the organisation for its current and future needs, and that would be the really important part. There was no reason it had not happened. There was an acknowledgement that it needed to happen, and that was reinforced by the recommendation that we made.

Tom Neville (Limerick County, Fine Gael)
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In reference to the recruitment process Ms Dunnion mentioned the heavy workload or administrative load of social workers. Is there anything in the studies about the information technology systems? The major criticism of Tusla in our previous meeting was of its electronic communication. That I assume has a knock-on effect on paperwork.

Ms Mary Dunnion:

I will answer the first part before handing over to my colleague who will be able to explain what is happening on the ground. One of the key findings in our investigation was that there was an overly bureaucratic process in place, that much of it was paper-driven and, as a result, in the context of quality and safety for children, there was not a good exchange of information because the systems were not in place. From a staff recruitment and retention point of view, we recommended very importantly that Tusla consider the way it works and make sure that the most efficient things were in place so that it was not a bureaucratic system. The second part of that was that it needed information systems. At the end of our investigation it was introducing these information systems. My colleague would have seen them in operation on inspection.

Ms Bronagh Gibson:

Tusla has developed an integrated information system. It is an electronic system that is accessible throughout the country. If a child who may be known to the child protection service in Donegal moves to Cork, his or her information will be accessed by the local service area. That is in place in all 17 Tusla service areas throughout the country. It is in the early stages of implementation in some of those areas and has some of the teething problems that one would imagine. However, it does have good systems in respect of who can access it, depending on the grade of information it holds. In a recent inspection we found that the kind of teething problems it was experiencing are around the kind of information, and sections of the system, that can be accessed, and that there are some similar issues, whether the system is paper or IT. Social workers need to update the system, keep it updated and have the time to do that. They do have administrative support now in many service areas to do that.

There have been many positive changes in that regard.

Tom Neville (Limerick County, Fine Gael)
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Obviously, the positive changes are on the back of the increased usage of electronic communication. I welcome that that system is being implemented. The system is being newly implemented on the back of issues previously raised at the committee and I understand that there can be teething problems with IT systems. We should give credit where credit is due for the system being implemented.

Is there mobile integration with the system or do users have to return to the office to input data? Is the system integrated with that of the Garda? Can electronic communication take place between the system and the Garda?

Ms Bronagh Gibson:

I do not know if the system allows communication with the Garda. In regard to mobile integration, the system is accessible on a server which users can access off-site using a laptop, for example.

Tom Neville (Limerick County, Fine Gael)
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Can the system be accessed by phone?

Ms Bronagh Gibson:

I do not know.

Ms Mary Dunnion:

At the time of the 2018 investigation, laptops were being issued to staff. That was the beginning of the process, but it was laptop driven. At that time, there was no network into the Garda Síochána system. Work was being carried out in that regard, but we have not yet received an update on it.

Tom Neville (Limerick County, Fine Gael)
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Does all communication between staff now take place via email or is a paper system still in being?

Ms Bronagh Gibson:

There remains a dual recording system in Tusla. Some records are maintained on paper while others are electronic.

Tom Neville (Limerick County, Fine Gael)
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In light of a new system having been put in place and staff having access to email, is there any rationale for maintaining paper communication?

Ms Bronagh Gibson:

Not as far as I am aware.

Seán Sherlock (Cork East, Labour)
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I thank the representatives for their attendance. The motivation for asking them to appear was to gain an understanding of the dynamics within and between HIQA and Tusla. I am trying to understand the dynamic that exists in terms of the regulation of social workers. CORU is the regulatory body for registration and so on. However, I do not have an understanding of the dynamic that exists between HIQA and, for example, the social care or social work framework. HIQA may have, for example, 14 inspectors operating across the country. Its opening statement states:

Tusla cannot rely on recurring staff shortages as the default reason for failing to deliver an efficient and safe service to children and their families. Nor can they use this as an excuse for not providing an environment where social workers and social care workers can enjoy doing the core job they are qualified to do.

Is that statement based on a determination or examination of the dynamic that exists as between the client or service user and the social worker? Does that mean that HIQA's 14 inspectors speak to each social worker throughout the country in order to allow that adjudication to be made? How does HIQA determine the level or quality of contact time? How does it determine the level of bureaucracy and paperwork? Can it manage that time? Can it measure the time social workers spend in contact with their clients and the time they spend on paperwork? Does HIQA go down to that level of granularity?

Ms Mary Dunnion:

Our opening statement pertains particularly to the statutory investigation. We had a presence in most Tusla service areas in the context of that investigation. It took more than a year to carry out. We met staff individually and in groups, along with focus groups and meeting the executive and board members. It was a comprehensive review of all processes. Of critical importance in the statutory investigation is the fact that although the Minister, Deputy Zappone, identified a potential or actual risk in the management of a specific lens of children, the same pathway pertained for all child protection referrals. In assessing the efficacy of that pathway, we used Tusla's standard operating procedures. To reinforce and validate our process, our investigation team included members from other jurisdictions who had executive roles in child protection and welfare. It was a very robust process which considered a large number of case files. It benchmarked its findings against the business rules that Tusla set for itself, which meant that the conclusions were evidence-based and it was obvious how they were reached. I hope that reassures the Deputy in the context of how we are comfortable making the------

Seán Sherlock (Cork East, Labour)
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I wish to be sure that I understand correctly. The statutory investigation shone a light on the processes. The standard operating procedures and protocols were offered up to HIQA and it could determine from that how the overall organisation was operating.

Ms Mary Dunnion:

Yes. There were many factors. One must consider whether the staff are familiar with and confident in the processes that are in place. That is true for any organisation, including HIQA. If there is confidence in the system, is it being adhered to? If it is not - we are all human - is that non-adherence detected and managed and the learning shared? We found significant opportunities for improvement in Tusla in that regard.

Seán Sherlock (Cork East, Labour)
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Is adherence a systematic issue within Tusla?

Ms Mary Dunnion:

It was at the time of the investigation. The inspections we have conducted since then have revealed improvements in some areas, while other areas require improvement. One of the recommendations of the investigation was that Tusla implement a plan to address the findings of the investigation. The expert assurance group set up by the Minister has oversight of that.

Seán Sherlock (Cork East, Labour)
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HIQA interacts with the Department on that group. What is the current rate of progress on those issues?

Ms Mary Dunnion:

Ms Gibson, who was part of the most recent inspections, will address that question.

Ms Bronagh Gibson:

Our most recent inspection in Dublin south central indicates slow progress implementing some standard business processes and adhering to timeframes. For example, we found that the required timeframes regarding the assessment of referrals in order to have enough information to make a call about the level of risk to a child or the level of need were not being followed.

Seán Sherlock (Cork East, Labour)
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The natural instinct of committee members is to empathise with social care workers and social workers. Our limited interaction with them through our constituency offices indicates that caseload is a significant factor for them. If there is a finite number of social workers and social care workers and the rate of attrition is high, one can reasonably extrapolate that the number of cases each worker must manage is increasing. I would contend that there are not enough hours in the day for them to deal with every case from a time management point of view. There must be some sympathy for the position in which they find themselves, notwithstanding the immediacy of the need of the child or family. Are social care workers and social workers now being put through the ringer? The statutory investigation was very challenging in terms of its conclusions and was instigated in the wider context of a tribunal. Are Tusla staff now subject to a higher level of bureaucracy that is challenging their ability to deliver for the people they serve and putting them under even more pressure?

Ms Mary Dunnion:

I understand the Deputy's question and from where he is coming.

Seán Sherlock (Cork East, Labour)
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To give some of the context, we all understand very well how HIQA operates. We know, for instance, what it does in tertiary hospitals in measuring bed spaces and processes within acute hospital settings. However, should it be so strident within social care settings in human contact between a social worker and the client and his or her family? As stated, I know that it is not possible to compromise in dealing with risk, but we need to give them a bit of a break and recognise that they find themselves under massive pressure. I do not think it is fair to state "nor can [Tusla] use this as an excuse for not providing an environment where social workers and social care workers can enjoy doing the core job they are qualified to do." Ms Dunnion can correct me if I am wrong, but social workers and social care workers might not be able to do the job they are qualified to do because they do not have the toolkit to do it and their caseload is getting heavier. Therefore, the risks also increase, which is not necessarily always the fault of the social worker. I am fearful that we could be putting the blame on the head of the social worker or the social care worker. That is my key point. I ask Ms Dunnion to dissuade me in holding that view.

Ms Mary Dunnion:

The first important premise is that Tusla has statutory responsibility for the safety of children. When we are making our assessments, they are made on the capacity and capability of Tusla to sustain delivery. None of our inspection reports ever cites an individual social worker or the profession of social workers or social care workers. A critically important point is that Tusla holds statutory responsibility and the public should be assured that it is being upheld to the optimum.

Seán Sherlock (Cork East, Labour)
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I appreciate that.

Ms Mary Dunnion:

Throughout all of our reports we acknowledge the shortage of social workers and social care workers, but that does not negate the statutory responsibility for maintaining the quality of services and the safety of children. What becomes critical is what Tusla is doing to manage the shortage. There have to be many strategies in place and the first thing to do is to recognise the reality. It is then necessary to acknowledge that there is an ongoing problem that will not be solved in the next five years. The first question is whether there is a strategy in place to deal with it. The finding was that there was not. The next question was whether it had been ensured the environment of social workers, social care workers and administrative staff was the optimum it could be, by which I mean had it been ensured people were not bogged down in paper and that the process had been streamlined as properly as it could be. Following on from that question, it is necessary to ask whether Tusla has reviewed the matter critically. The answer at the time of the statutory investigation was "No". Our next issue was the need for social workers to be confident that the processes optimised what they were doing. The question then was if the training provided was really robust. Is there a training programme in place to make sure they know what they are doing, how to do it and that there is support for social workers and social care workers in doing so. Gaps were also found in that regard.

The most critical aspect - for me anyway - is our role when a new social worker comes to work in Tulsa. It is a frightening environment in which to work and in which very important decisions are being made. The main question is whether the person feels safe and the junior social worker is subject to really good supervision. We found that it was not in place. It is not a critique that is unfair on individuals. We are looking at the arrangements in place to make sure the individuals about whom Deputy Sherlock rightly spoke are supported properly. We found that that was not the case and that there were major opportunities to make improvements. Throughout our inspection processes to date, we have seen where the position has begun to improve. That is good, but there is a way to go.

Seán Sherlock (Cork East, Labour)
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I thank Ms Dunnion for that answer. I have one final question. I want to understand the dynamic in the relationship between HIQA and the institutes of higher education. HIQA has made specific recommendations on the need for more graduates, etc. Does it have a statutory role in determining that dynamic? Does it have influence in leaning on Tusla and the Department to be able to suggest that if certain courses of action are taken, certain programmes are created or there is engagement with a particular institution, more places could be created to meet the shortages? I understand HIQA can make recommendations, but is that all it can do? Does it have any power to follow through on them?

Ms Mary Dunnion:

We have absolutely no powers.

Seán Sherlock (Cork East, Labour)
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That is fair enough.

Ms Mary Dunnion:

That is why one of the recommendations in the investigation is that the matter be examined in the context of a regulatory framework. That is why the bigger an organisation becomes and when it holds statutory responsibility for a service - I believe in regulation - it is very important that there be a framework to provide assurance for the public. We are very proud of the work we have done in older person and disability services. We are not the solution, but we do help in improving services. We do not have a legal remit, which is why we made that recommendation.

Seán Sherlock (Cork East, Labour)
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On the review of best practice, HIQA made a recommendation that an international review of best practice be undertaken. How stands that recommendation?

Ms Mary Dunnion:

It is with the Department of Children and Youth and Affairs. Work has begun and we are feeding into it. In tandem, we are undertaking a comprehensive piece of work, in which Tusla is also involved, in looking at best practice in the area of child protection and welfare.

Seán Sherlock (Cork East, Labour)
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I thank Ms Dunnion.

Alan Farrell (Dublin Fingal, Fine Gael)
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I have a few further questions. I should have asked this question at the outset, but is HIQA adequately resourced to fulfil its statutory responsibilities?

Ms Mary Dunnion:

No, it not.

Alan Farrell (Dublin Fingal, Fine Gael)
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How far short is it?

Ms Mary Dunnion:

Everybody states there is a shortage of resources, but we have identified specific requirements. For example, it is planned for HIQA to begin the regulation of residential centres for children. We submitted our workforce plan through the Department of Health and liaised with the Department of Children and Youth Affairs.

Alan Farrell (Dublin Fingal, Fine Gael)
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I turn to HIQA's interactions with the Garda in the production of various reports and recommendations that it is statutory obligated to produce. I was reminded that I had been a member of the Joint Committee on Justice and Equality for six years as I came in when I saw the white shirts of members of An Garda Síochána on the screen in one of the other committee rooms. Interactions between State agencies and the Garda are difficult at the best of times. They are fraught because of communications problems in the use of technology but also because of formality. What is HIQA's experience of its interactions with An Garda Síochána?

Ms Mary Dunnion:

We do not have formal interactions beyond statutory interactions which centre on Garda vetting. Using the investigation as an example, we networked with the An Garda Síochána and the dual relationship was very productive. We do not, however, have any reporting relationship with it, except if we come across something such as a major safeguarding issue or financial abuse. In such cases we make referrals to the Garda, but there is no formal process in place.

Alan Farrell (Dublin Fingal, Fine Gael)
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Is HIQA involved in statutory inquiries such as commissions of inquiry, etc.?

Ms Mary Dunnion:

We have a function under the Health Act to conduct statutory investigations at the request of the Minister or if our board requests an investigation where an incidence might be high risk.

Alan Farrell (Dublin Fingal, Fine Gael)
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This is a technical legal question, but is HIQA empowered to initiate inquires?

Ms Mary Dunnion:

Yes, we are through our board.

Alan Farrell (Dublin Fingal, Fine Gael)
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I turn to the recently published south Dublin report. I compliment Ms Dunnion on the speed at which HIQA communicates, particularly with my office. It is appreciated. The report made a number of alarming findings. Has there been a notable change in the manner in which the facility has been improved? Will Ms Dunnion comment on the issue?

Ms Mary Dunnion:

I might ask my colleague, Ms Gibson, to cover that question.

Ms Bronagh Gibson:

When we make recommendations, we must allow time for them to be implemented and bed down in services. Tusla is working on implementing the recommendations that we have made. According to a recent update, the actions required by some of the recommendations are slightly late. We intend to revisit that service area and assess how well Tusla is doing.

I might take this opportunity to address Deputy Sherlock's point on HIQA reports and their impact on the service. I have been working with HIQA for 11 years as an inspector and now as a manager. We have had a positive experience of inspections. Tusla's staff welcome inspections. They like to, and need to, showcase their positive practices and the progress that they have made. They are proud in that regard. Equally, they are happy to share with us the risks that cause anxiety within the service and the individual stresses that workers can hold. We hope that our reports reflect both of those aspects.

Alan Farrell (Dublin Fingal, Fine Gael)
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I thank Ms Gibson. If there are no further questions from members, does Ms Dunnion wish to make a final remark?

Ms Mary Dunnion:

No, thank you. Except "Goodbye".

Alan Farrell (Dublin Fingal, Fine Gael)
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On behalf of the committee, I thank the witnesses for their presentation and for dealing with members' questions in such a comprehensive manner.