Jan O'Sullivan (Limerick East, Labour)

I welcome the fact that the report has been published. I note the words of Norah Gibbons on the children and the importance of protecting their interests in so far as we can. They have been hurt beyond belief by their parents and the failure of the State to act over a long number of years, going back to 1989 until they were finally taken into care in October 2004. This is a 15-year period during which they were neglected by the State. We have to bear in mind the words of Norah Gibbons, namely, that we do not add to their pain any further in terms of how we comment on the case.

I read the report and found it horrific but I intend to focus my contribution on what we should be doing in response to it. It is important that we use this debate to make changes, to reflect and to decide that we will not merely move on to next business as if this is something that we can deal with this week and we move on to something else next week. If we do the latter, we will be failing the children as well.

Previous speakers referred to previous reports and previous cases, and there was a raft of them - the Kilkenny incest case, the Kelly Fitzgerald case, the Monageer case, the west of Ireland farmer case, the Ryan report. The first one that really affected me was that outlined in Ms Sofia McColgan's book, which I read and by which I was profoundly affected. I was profoundly affected by the courage of Ms McColgan to write the book but also by the sense of helplessness that the children in the McColgan family felt when they tried to bring their plight to the attention of those in authority in hospitals and in schools. They simply were not heard. Unfortunately, the experience of these children has been the same and that is the overriding conclusion in the report.

The report refers to the fact that, "an ill-defined family support approach was preferred over a child protection approach, even when there was a well established pattern of parental non-compliance and recidivism". It relates back to that issue of balance between the rights of parents and the rights of children. It is clear in this report that the voices of the children were not sought on their own without parental intervention, and they certainly were not listened to. Exactly the same points are made in the Kelly Fitzgerald report.

In the appendices to this report there is reference to the Kelly Fitzgerald report and also to the west of Ireland farmer case report. The west of Ireland farmer report states that there was a stronger emphasis on the parental and familial aspects of the case presentation as compared with the protection needs of the children. Repeatedly, it is the same point, that the balance of the family's rights superseded the rights of the children.

The book Keeping Children Safe was published in 2001 by the then Mid-Western Health Board of which I was a member. The back of the book states it offers a major critique of Irish and international child protection research, policy and practice and draws conclusions which set a new agenda for designing child care systems which can balance family support and child protection, and keep children safe. Repeatedly, the same point is made, that the children simply were not heard in the situation.

We must pay careful attention to what is being said. It is clear from the report that attention was not paid, because there was no intervention but because, the report suggests, there might have been too much intervention that diverted attention from the main point, which was the abuse of the children. The inquiry report outlines the range of services involved with the family and states that:

[T]he wide range of services and their deployment, rather than a lack of them, [which] contributed to an overall failure ... to recognize the full extent of the children's suffering. The number of services going into the home may have led to a false perception that everything possible was being done while in reality the children needed to come into the care of the State to protect them from their parent's actions.

The lessons here are complex. It is not simply that somebody must go into the home. It is about what they do when they go into the home and about learning from case conferences. For example, there were a number of case conferences on this family but there was no progression. There were small insignificant improvements such as painting the house and keeping it a little cleaner, but there was no evidence that the care of the children had improved from case conference to case conference.

There is very strong criticism in this report of the kind of management, governance, supervision, learning, education and upskilling of the social workers' knowledge of the legislation, which was already in place and which could have been used, and that they were not able to stand up to either the court or the parents when it came to putting the children first in all of this. Children First is the title of the child protection guidelines and, unfortunately, the children were not put first in this case.

My main point is that we could simply state that these recommendations must be implemented, but many of them are a repetition of recommendations made in the past. If those had been implemented this case would not have happened and these children would not have suffered.

There are a number of areas where action needs to be taken. The first is to do with legislation. There is a specific recommendation in Ms Norah Gibbons's introduction. She states:

Indeed there is no reference to emotional welfare in the definition of welfare in Section 2 of the Guardianship of Infants Act 1964. An amendment such as this would help to strengthen the recognition of the importance of a positive emotional environment for the healthy development of children and strengthen the ability of the statutory services to seek the protection of the Courts for children suffering emotional abuse, which is always present where children are neglected or abused.

That is a specific legislative recommendation and I hope the Minister of State will move to amend the Guardianship of Infants Act 1964 on this point.

I also support Deputy Charles Flanagan's call for the Children First guidelines to be put on a statutory footing. That is another legislative measure that can be taken.

The third one, and on which most of the response has focused, is that we have not yet got a date for the referendum on the rights of children. Such a referendum is a critical element. The holding of a referendum would not have protected the children. However, according to the quotations to which I referred on the balance of parental rights and children rights, the balance in all of these cases fell clearly on the side of the parental rather than the children's rights. If the children's rights were enshrined in the Constitution it would be much more difficult for statutory bodies and courts to make the kind of decisions that were made in this case. Although it probably would not have prevented what happened in this case it is important for the future that we get the rights of children enshrined in the Constitution as quickly as possible.

Those are three legislative and constitutional areas where there is definite need for action but there is also need for other action. Other Deputies referred to the HSE taking specific action on where the fault lies. Having read the report, I still do not know where it fault lies. My inclination would be that it should not be so much about individual social workers as about the organisation of the system - the supervision and practises that do not seem to move a process forward from one element to the next. Indeed, the word "episodic" is used in this report and it is also used in one of the other reports - I believe it is the west of Ireland farmer case - where each episode that went wrong in the family was treated as an individual episode rather than a process of progression and learning which would have rescued those children much earlier.

Somebody needs to gather all of these reports together and all of the recommendations. Perhaps some kind of seminar should be held but anybody who is involved in child protection needs to be educated on what is to be learnt from these reports. There is evidence of a lack of training or professional development, and even knowledge of the law was not evident among some of those involved in the case.

There is a need for a learning process for everybody who is involved in child protection. We cannot assume that someone, because he or she went to college and became a social worker, knows ten years later what he or she should be doing as a social worker. There has been much development, in terms of the law but also in terms of what we are supposed to have learnt from these reports. People working at the coalface need to be knowledgeable and have an understanding of this. The term "insight" was used by Norah Gibbons. She is a very understanding person; I think we have all met her in various situations. Insight is not something one can define very easily or test in somebody's college exams. However, people need to understand the complex dynamics of a family situation where parents can manipulate their children and where the children sometimes cry out for help. There needs to be expertise among the people intervening to recognise that the children are crying out for help and to take the action that is required.

Norah Gibbons stated:

The six children at the centre of this case were denied their voice on many occasions. Their voice was not heard in the High Court in Autumn 2000 when the parents were successful in preventing a shared parenting arrangement with their relatives from going ahead. No application to protect them as set out under the Child Care Act 1991 (as amended) was heard in the District Court until 2004. Case Conferences and other meetings that should have had the interests of these children as their central focus were often diverted into dealing with other issues. Finally in 2004 these children in effect rescued themselves when they could no longer be silenced.

It was the cry for help of one of the children while in care which was the catalyst that made things happen.

This case goes back to 1989, when the attention of the health board was first brought to alcohol abuse and inadequate care in the family. It was in October 2004, 15 years later, when it came to a conclusion and all of the children were taken into care. The first child had been taken into care a little earlier because the child requested it and then spoke about what had happened in the family.

What I want to get across most strongly in my contribution is that we owe it to this family and other families who may be in similar situations - I know an audit of neglect cases in particular will be carried out - to look at this as deeply as we can. I use the word "deeply" because it is not a matter of listing off a number of recommendations at the end of the report and stating we will implement them and everything will be fine. We know it will not be fine because we know we have had such recommendations previously and they have not resulted in a change of practice.

I welcome the fact that extra social workers will be employed but what we really need to do is ensure they, and those such as public health nurses and others who intervened and were involved in this case, have a cohesive and educated understanding of the complexities of such cases.

My most important final plea is that the voices of children are heard always and that there is a definite mechanism for doing so. If this is left woolly and parents answer the door and are present when children are being interviewed it will not work. There has to be a way in which the children can speak individually to somebody who has the power to rescue them from situations such as this.

See this speech in context