Frances Fitzgerald (Dublin Mid West, Fine Gael)

In January 2010, the Health Information and Quality Authority, HIQA, published Guidance for the HSE for the Review of Serious Incidents including Deaths of Children in Care.

In accordance with the HIQA guidance, last year, the Health Service Executive, HSE, established a national review panel to undertake these reviews. Dr. Helen Buckley, senior lecturer and research fellow at the school of social work and social policy in Trinity College Dublin, was appointed as chair. There are 20 ordinary members on the panel, 18 of whom are external to the HSE.

While the national review panel has been established under the auspices of the HSE, it remains, and this is important, functionally independent, making findings of fact and producing reports that are objective and independent of the HSE.

On 18 October, the HSE published the 2010 annual report and on the same day the HSE also published six individual panel reviews of deaths and serious incidents involving children. I thank Dr. Buckley and all who have been involved in these reports.

The annual report we are discussing covers March through December of last year, 2010. During the period from March to December 2010, 30 cases were referred to the panel by the HSE. These comprise 22 deaths and eight serious incidents. Of the 22 deaths, six of the people concerned died from natural causes; four died from drug overdose; four died as a result of suicide; four died in road traffic accidents; two died in homicides; and two died in accidents other than road traffic accidents.

The annual report notes that two of the 30 deaths related to children in care at the time of the incident. Cases known to the child protection service, but not involving care, accounted for a majority of notifications.

The annual report comments that the criteria set out by the HIQA are "broad by international standards". In England serious case reviews are undertaken in the form of local inquiries into the death or serious injury of a child where abuse or neglect is known or suspected to be a factor. In Northern Ireland cases are considered for review where abuse, including sexual abuse, or neglect is a factor. The report comments that, in Ireland, all accidental deaths and deaths by natural causes, as well as serious incidents, must be reviewed even where there is no suggestion of parental or professional wrong-doing.

In addition to the annual report, the HSE also published six individual review reports concerning four deaths and two serious incidents involving young people. Three deaths were by natural causes and one was following an accident. The two serious incidents also concerned accidents. None of the subjects of the reports was in care at the time of the incident, however, one of the accident victims, who was over 18 years of age, was still living with foster parents at the time. All were known to the HSE child protection services.

In summary, of the reviews presented, in no case was an action or inaction on the part of the HSE child and family services found to be directly linked to the incident or death of a child. In a number of cases, good practice, in sometimes difficult circumstances, is particularly remarked on.

The death of every child is a tragedy and I offer every sympathy to the families whose children were reported upon by this review panel. The publication of this review and the other review reports are difficult for the families involved, and we must continue to do our utmost to ensure that learning is applied while protecting the privacy of families.

A primary purpose of the review is to establish if any action or inaction by the State's children and family services contributed in any way to these events. The findings of the review process are designed to strengthen services for children and promote learning in the system in order to improve professional practice and protect children even more.

The individual reviews make recommendations with regard to the standardisation of assessment processes, the need for alternative methods for dealing with high reporting rates in some areas so as to ensure proper screen and diversion of referrals to the most appropriate "track" and the need for early, strategic and multidisciplinary intervention where domestic violence is a risk factor for children and families.

The review also makes a number of recommendations with respect to interdisciplinary and inter-agency action in meeting the needs of some children and their families, including on shared assessment between services and the need for a shared support between hospitals, GPs and community based services for young people, including maternity hospitals in the case of young and vulnerable mothers. Deputies will be familiar with that as we have discussed on a number of occasions in this House the need for inter-agency work, sharing of information and working together in the interests of families and children and vulnerable adults.

This is not the first report with such recommendations on improving our State's child protection and care services, and it will not be the last.

I will soon receive the report of the Independent Review Group on Child Deaths compiled by Norah Gibbons and Geoffrey Shannon. This report will, in effect, represent a retrospective examination of the cases of children and young people who died in the preceding decade, from January 2000 to April 2010, and I am sure there will be many lessons to be learned from that report also. These reports are important, in particular as they help to highlight the intense pressures under which Ireland's children and family services must operate.

There will likely be over 25,000 referrals to social work child protection teams across the State in 2011. As of August 2011 there were 6,215 children in the care of the State. This figure has increased steadily over the past number of years - up by 900 in just over three years.

We are lucky in Ireland that we have so many foster parents willing to look after many of our children. We have very high rates of care. The vast majority of children in our care are being cared for by foster parents.

The many challenges facing the child protection services are not helped by the very significant financial difficulties faced by the HSE child and family services this year and in the past number of years, not to mention significant staffing pressures, be it replacement of staff on maternity leave or the filling of vacancies, but it is not the social workers on the front line who bear the blame. We have services staffed with good people who are committed to delivering a different, better life for Irish children.

There are good news stories. For example, nearly 99% of all children in residential care now have an allocated social worker with 96% having a written care plan, but there are simply not enough good news stories, mainly because our care system traditionally has been under-funded, under-resourced and under-attended for more than a decade, to which many of the reports amply testify.

My Department has only been operating for a number of months but in that time my officials and I have made significant inroads into getting to the bottom of the suite of systemic problems and failings that beset our child protection and social work systems.

The information that will be uncovered by my Department is likely to be unsettling. I am seeing again and again hard-working, dedicated front line professionals stymied by a broken system which has not put Children First.

Having worked in this area as a social worker, both in the United Kingdom and in Ireland, I know there is nothing more frustrating for a social worker than to call upon the system to help a child or a family only to discover the system is incapable or unwilling to answer the call.

We will not immediately fix this problem. The deficit I have inherited is too great to instantly repair. I have said many times inside and outside this House that while I am very proud to be the State's first senior Minister for Children my one regret is that the Ministry was not created ten years earlier because ten years ago we had the resources to solve these problems quickly and definitively. The money spent on one vanity project could have changed the lives of many children and families. These resources are no longer available but the problems to be solved remain and have grown. Where previous Administrations could buy solutions, this Government will have to build them. This will require us to create savings and efficiencies, redeploy resources, find new ways of doing things and examine with intense focus everything we do. While this will take time, it must be done and we have started the process.

In July, I launched the new Children First national guidance for the protection and welfare of children. In addition, I have received Government approval to bring forward legislation to put Children First on a statutory basis to ensure, as far as possible, compliance by all organisations working with children, including statutory, private, community and voluntary bodies. This is highly relevant to the reviews under discussion. Work is proceeding on this complex legislation and I hope shortly to be in a position to publish the heads of the Bill. The introduction of legislation has been discussed for years and was a key recommendation of the Ryan report implementation plan. Whereas the previous Government failed to act on this matter, it is being acted upon under my Ministry.

I have also initiated an interdepartmental framework to oversee the consistent nationwide implementation of the Children First guidelines. My Department recently launched the new child protection and welfare practice handbook and held four regional meetings with front-line staff offering a cascading programme of training for Health Service Executive professionals at all levels. The programme is being rolled out with joint training with gardaí.

Many of the recommendations of the individual reviews issued last month, in particular those with respect to co-ordination and sharing of information, will be addressed through the consistent implementation of the Children First guidelines. I discussed previously the recruitment of additional social workers as part of the Ryan report implementation plan. While the number of staff is important, unless the system is fit for purpose and service delivery models work properly, we will continue to fail our nation's children.

I am committed to building a new architecture for child welfare and protection and integrated family support services. Certain key principles must underpin this new architecture and were highlighted in the recommendations of the national review panel. As the reviews repeatedly illustrate, consistency of practice is required in child protection and welfare services, as is better local management and prioritisation of casework. We also need a greater focus on prevention and early intervention to support families in crisis and prevent manageable welfare cases from becoming more serious protection cases. Much better financial discipline is required in the management of our services as this has not been provided by the HSE in recent years. We also need reliable and real time data on our social work and care services to inform proper evidence based planning and resource allocation. I have expressed previously in the House how shocked I was at the lack of national data pertaining to many of the issues raised by Deputies with regard to child care protection services, adoption and fostering. Much greater inter-agency collaboration is required, in particular between care services and youth justice.

Central to this new architecture will be the delivery of the new child and family support agency, as committed to in the programme for Government. In September, I established a transition task force to advise on and oversee the establishment of the new agency. In the interim, it is my intention, working with my colleague, the Minister for Health, to establish a shadow child and family programme in the HSE in 2012. This will provide for a dedicated management structure and budget for children and family services. Management of these services will be led by Mr. Gordon Jeyes, the national director, who has a close working relationship with me and my Department.

As indicated, the national review panel's annual report highlighted that the criteria for the cases to be reviewed are broad by international standards. This is an important point to note.

According to the report, "the NRP is concerned that the HIQA guidance places virtually impossible obligations on it. The combination of timelines, detail required and unanticipated volume of notifications presents difficulties for the NRP that were never intended." The report suggests ways in which the process of reviewing serious incidents and child deaths could be improved. Given that this is a new process, it is not surprising that the review panel remarked on the nature of the process and challenges in putting into operation the HIQA guidance. I am concerned about the capacity issues identified by the panel. I recently met with HIQA and asked that it review the content of the report and its recommendations. HIQA has agreed to review the guidance and is engaging actively with the national review panel and HSE children and family services in this regard. These are matters which will be considered by HIQA in the first instance and by my officials in the context of related policy and legislative developments which are in train.

The independent chairperson, Dr. Helen Buckley, notes in her introduction to the annual report that "as knowledge about child harm and the means of addressing it have expanded, so also have expectations about the capacity of the services to keep children safe". We must never assume that the existence of a child protection service is a panacea which absolves society of its responsibility to be vigilant. Reading the report and reviews, it is clear that responsibility for child protection extends to everyone. As we have repeatedly highlighted, while professionals working on the front line have an additional obligation in respect of what action and intervention they take in response to issues that are brought to their attention, everyone in society has a role to play in child protection. As a society, we must continue to recognise and be on the lookout for the many untoward influences and dangers waiting to insinuate themselves into children's lives. The Government must also continue to strive to enhance all services that have child protection and welfare as their ultimate aim. The work of the national review panel and HSE, the change management programme under way and the HIQA review of the panel and the report I will receive shortly into deaths of children in care over a ten year period will help to achieve this objective.

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