Áine Brady (Kildare North, Fianna Fail)

The culture of the health service under which Mr. Shine worked has changed greatly to enhance transparency and to strive to ensure dignity and respect is an integral part of the ethos of health care agencies.

An independent review group, chaired by Dr. Miriam Hederman O'Brien, was established in 1995 with the co-operation and support of the Department of Health and Children. As part of its terms of reference, this review group was instructed to furnish a copy of its report to the then Minister. The review group recommended common written protocols for dealing with allegations of sexual abuse by members of staff be introduced and applied in all health care institutions.

The trust in care guidelines on preventing patient-client abuse and managing allegations against staff members were produced by the Health Service Employers Agency in 2005, at the request of the Department of Health and Children. These guidelines are for health services employers to protect the dignity and welfare of patients and clients and to provide a caring environment in which abuse does not occur and patients-clients are treated with dignity and respect at all times. The guidelines also set out the reporting procedures to be followed in the event of abuse being suspected or alleged. They contain a robust procedure for managing allegations of abuse against staff.

In line with the review group's recommendations, a chaperone system and an intimate examination protocol and procedure was put in place in the hospital concerned. The review group emphasised the importance of having in place a complaints system to deal with allegations of sexual abuse. A regional complaints policy and procedure is in place for the former North Eastern Health Board. Statutory delegated complaints officers are also in place in the hospital in question. In addition, a staff support service is available to all staff in the hospital on a confidential basis.

The Hederman O'Brien review has helped inform the development and updating of policy in this area. This learning has been given practical effect through, for example, the publication of the Children First guidelines, the establishment of the Office of the Ombudsman for Children, the Office of the Minister for Children and Youth Affairs and the implementation of the Children Act 2001.

Significant changes have taken place in child welfare and protection in recent years. The Government's policy emphasises the importance of the family and of the family setting for the overall well-being of children. Children First, the national Guidelines for the protection and welfare of children published in 1999, are the national over-arching guidelines that apply to all individuals and agencies that are dealing with children. They are intended to support and guide health professionals, teachers, and members of the Garda Síochána and the many people in sporting, cultural, community and voluntary organisations who come into regular contact with children. The key message of the guidelines is that responsibility for protecting children must be shared by all adults. Anyone who works with, has responsibility for, or comes into contact with, children should be aware of the signs of abuse, be alert to the possibility of abuse, and be familiar with the basic procedures to report their concerns.

The Government has taken a range of measures through legislation to deal with child abuse, including the Child Care Act 1991, the Protections for Persons Reporting Child Abuse Act 1998 and the Sex Offenders Act 2001. In its conclusions and recommendations, the Ferns inquiry stated that consideration should be given to the introduction of a new criminal offence which would apply to situations where any person "wantonly or recklessly engages in conduct that creates a substantial risk of bodily injury or sexual abuse to a child or wantonly or recklessly fails to take reasonable steps to alleviate such risk where there is a duty to act".

Section 176 of the Criminal Justice Act 2006 created such an offence of reckless endangerment of children. It is an offence for a person, having authority or control over a child or abuser, to cause or permit any child to be in a situation creating a substantial risk to the child of being a victim of serious harm or sexual abuse or to fail to take reasonable steps too protect a child from such a risk. The offence is punishable by a fine or up to ten years imprisonment or both.

It is important to ensure appropriate counselling is available to all those who have been in contact with the HSE and the hospital in question following the 2008 Medical Council inquiry. The Minister for Health and Children and the HSE are anxious that all former patients of the consultant in question are made aware of the free counselling support available. The HSE has made arrangements for counselling support, using the National Counselling Service, which provides, individual, couple, family, group and psychosexual counselling. Persons affected by these issues, but who may not wish to avail of counselling, can also speak with a psychologist or counsellor in confidence. More than 100 people have made contact with this service and it will continue to be made available as required. The need for additional support will be continuously monitored by the HSE.

The HSE has assigned co-ordinating responsibility for these matters to the area manager for consumer affairs in the north east who will continue to liaise as required with former patients and support groups.

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