Frances Fitzgerald (Dublin Mid West, Fine Gael)

I am pleased to contribute to the debate on the HSE national service plan for 2012. It must be said that the overall financial and service challenges facing the HSE this year are very significant. This is probably the most challenging period ever faced by our health service. We will not be able to deliver the kinds of services we want to deliver for our citizens without serious reform. This is the case across all care groups, including the child and family services.

When we focus on a report like this, there is a tendency to focus on cuts and what people are afraid will not be delivered but it is equally important to focus on what is being delivered and committed. In the case of the HSE, €13.3 billion of spending is committed to in 2012. We must ensure that spending is used in a way that is effective, efficient and delivers the services we want for our citizens. I commend my colleague, the Minister for Health, Deputy James Reilly, and his colleagues, Ministers of State, Deputies Kathleen Lynch and Róisín Shortall, on their commitment to reform and on the amount of work they are doing to ensure services are delivered and that the reform agenda is progressed in all areas.

The service plan this year is rooted in reforms aimed at ensuring the reductions in funding, which are real, will not mean an equivalent drop in the level of service, in particular through fast-tracking new, innovative and more efficient ways to deliver services supported, for example, by the work of the special delivery unit. I take the points made by Deputy Michael Moynihan on the delivery of medical cards. The Minister for Health has taken action in this regard. It is unacceptable that forms get lost and that the service is not delivered efficiently to people who badly need those medical cards. It is not good enough. We must provide a service to citizens at the core and ensure that the kinds of services we want to deliver are delivered in a speedy and efficient way.

The same applies to the points Deputy Michael Moynihan made about the elderly. While I will focus on my areas of child and family services, I would say in regard to the elderly that it is unacceptable that so many elderly have not been offered the kind of community care packages which would keep them in their communities and at home. That is something we need to consider It is an area which is being focused on more in terms of the delivery of the fair deal scheme. We need to ensure people are offered the range of community services which will ensure they are not forced into residential care but can remain in their communities.

As Minister for Children and Youth Affairs, reform is very much part of my agenda and it is central to the work of the HSE child and family services, led by the national director, Gordon Jeyes. As everybody in this House knows, there have been too many reports which have highlighted problem areas in child protection services. We have had at least 16 reports on child protection services and we have also had the very serious reports on clerical abuse. We have had the Monageer inquiry report, the Ryan report, the Roscommon child care inquiry report and, more recently, the HSE national review panel reports on serious incidents, including the death of children in care, and the HIQA inspection reports on foster care and special care services.

Analysis has not been lacking - and it is quite disturbing in many cases - about the kind of care we have provided to children. Some common themes have emerged from those reports, in particular the need for greater clarity and consistency in practice, enhanced inter-agency working, more consistent assessment, and more equitable distribution of HSE resources based on assessed need. It is no longer good enough to have the same number of people in every area, we need to match personnel to the demands of particular areas. The demands concerning child protection are very different in different counties.

We need to develop more targeted family support services, better training for our managers and staff, more staff supervision, and more reliable data collection. As Minister, I have been very disappointed by the quality of data I have been able to access concerning child protection services. I got one audit and the figures were simply not comparable across areas because people were not comparing like with like. That is not good enough. If we want to plan services we must have adequate comparable data, which must be relevant, immediate and consistent.

I expect the upcoming report of the independent review group on child deaths to provide further stark evidence of past failings over the decade 2000 to 2010. That report is currently with the Attorney General and as soon as there is legal clearance I will publish it.

This year marks the 20th anniversary of Ireland's ratification of the UN Convention on the Rights of the Child. We can mark this anniversary and make it a national cause to ensure that these problems are of the past and not of the future.

I would like to say a few words about the change agenda within child and family services. It is aimed at strengthening the organisational capacity, business processes and systems required to deliver safe and reliable child protection services. We must be able to do so. That change agenda is necessary in order to utilise resources to the full, promote better outcomes for children and achieve Government objectives for the improvement of the child protection system. In time, this will constitute an important and demonstrable example of the benefits of the Government's approach to public sector and public service reform.

The change agenda, which I am leading in the Department, will result next year in the establishment of a new and dedicated child and family support agency, as committed to in the programme for Government. This year's health service plan paves the way for that transition. We now have for the first time a dedicated subhead for child and family services within the HSE vote. In the programme for Government, we said we would separate out child protection systems from the HSE's other work, because it has not worked as part of the larger HSE service. This significant change will bring about greater transparency and budgetary control. We have a separate budget now, which is an important first step in beginning this transition.

The 2012 provision for child and family services is €568 million, which represents an increase of 4% compared to the 2011 budget. However, there will still be a requirement to control excess spending which caused severe budgetary difficulties in 2011. Accordingly, an average reduction in expenditure of 7% will be required to bring spending back from the 2011 outturn levels to the budget provision in 2012. Notwithstanding the financial constraints applying, I welcome the decision to provide an additional budget of €40 million to support child welfare and protection services this year, and to deal with the kind of budgetary problems that have arisen in the area in recent years. This reflects the priority the Government attaches to child and family services, and is an acknowledgement of the very real financial pressures experienced within this area in recent years.

I would like to give the House some idea of the areas where these pressures are being created. We have an increasing number of children coming into care of about 5%. We also have an increase in families seeking housing and support to cope with children. An increasing number of families are seeking help from our social services, including child care. There is an increase in such cases being referred to the courts, in addition to the increased costs of detention and special care. We also have increased costs arising from guardian ad litem cases. It is important that children should have somebody to represent them in court in certain cases, but this comes at a cost. We need to improve the way we manage this so a management system is required. This service was set up without any management structure.

Other key areas for the Department include the progress of a children first national guidance, which will be put on a statutory basis. I have established an interdepartmental committee to ensure that work is done in and across all Departments so that every Department is conscious of the need to implement child protection policies. This work is under way.

We also have a lot of work to do in developing and establishing a national child protection register, as well as developing consistent risk assessment, which applies across the whole health sector, and measurement tools. A greater focus on quality assurance and auditing of workloads is also required. We must also prepare and implement a workforce development plan for child and family services. We intend to develop the important implementation of national standards for preschool services. An out-of-work social service is a key priority for this year.

I look forward to working closely with Mr. Gordon Jeyes, the HSE's national director of child and family services, to deliver on the areas I have referred to. It is an ambitious programme of work and will significantly strengthen policy, legislative and practice frameworks in delivering the range of services I have outlined. It is not good enough to continue services as was done in the past. The various reports I mentioned have illustrated the failings involved and, thus, the need for change. I acknowledge the work that is being done around the country by the dedication of the many staff involved in this area. It is a demanding area in which to work, involving huge demands and increased financial pressures. In that context, staff have to deliver a quality service to children and families who come to them for help. It is challenging and demanding but the Government has the will to meet that challenge. I have the support of my Government colleagues to deliver the programme as outlined for the House.

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