Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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To ask the Minister for Children and Youth Affairs the number of children currently receiving special care in overseas facilities; the facilities in which they are placed; the cost of providing treatment in each of these facilities; her plans to ensure that children with special care needs receive this care within this State. [41029/12]

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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Under the Child Care Act 1991, the Health Service Executive has a duty to promote the welfare of children who are not receiving adequate care or protection. The policy of the HSE is to place children in care settings, preferably in foster care, as close as possible to their home and community. A total of 6,259 children were in the care of the state in July 2012, the vast majority of whom were in foster care.

A very small minority of young people under 18 years of age have highly specialised needs arising from severe behavioural difficulties, due to their childhood experiences or in some cases as a result of injury, accident or disability. The care needs of those young people are generally met by directly provided residential services or services commissioned by the HSE within this country. For this small number of young people, the HSE is on occasion and in exceptional cases required to make arrangements for their placement in care and treatment facilities outside of the State, primarily in the UK, to allow for access to an individually tailored mix of care and highly specialised therapeutic services and psychiatric treatment not available in this country. This is done on as infrequent a basis as possible and only where such placement is considered to be in the best interest of the child. The HSE has a national protocol in place for such children.

The HSE has advised me that as of 21 September 2012, eight young people were detained in out-of-State secure placements. Four young people are in St. Andrews, Northampton at a cost of €12,582 per week, per child; two young people are placed in Kibble, a specialist facility in Scotland, at a cost of €6,685 per week, per child; and two young people are placed in Boystown Nebraska at a cost of €2,017 per week, per child.

Additional information not given on the floor of the House.

The HSE ensures that these placements are suitable. The units in which the children are placed are inspected and monitored by their national authorities and the HSE is attentive to the standards of care delivered in the specialised units. The level of requirement for these services is closely monitored by the HSE's national director for children and family services and my officials.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Minister for her reply. One of the elements in my question was to inquire about her plans to ensure that children with special care needs receive care within the State. On the previous occasion we addressed the issue the Minister said on the record - she laid emphasis on it - "that the referral of persons abroad for specialised therapeutic interventions is an established feature within our health and social care system." I am concerned that such referral has become an established feature of the system. This is an important issue. The Minister indicated that a small number of children are affected but the cost factor week-on-week is substantial. Do the figures the Minister cited take into account the cost of facilitating family visits and social worker visits from this jurisdiction to each of the placed children?

Does that happen? How long have the small number of young people been in this care and what is the long-term plan for them? These are young people but what about their further care in life as they grow older? Has the Minister examined the cost of providing treatment here for that particular cohort of young people? Has there been any exploration in conjunction with authorities north of the Border to examine the greater viability of providing these specialist care supports to children on a North-South basis on the island of Ireland, thereby eliminating the expensive costs of flights and all the other ancillary costs that must accrue as a result of their being placed on the neighbouring island of Britain, or as in two of the cases cited by the Minister, in the United States?

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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We accept that on occasion we must send children abroad for highly specialised care in medically complex cases, for example to Great Ormond Street Hospital, because it and others are global centres of excellence. Other countries also send children there. We must accept that for children with highly complex and challenging behavioural difficulties sometimes their best possible care can be provided in overseas specialist centres. That is why we are using these services - we do not have them in this country at present. We will certainly have looked to see if such services were available any place on the island; that would have been taken into account. These services would have been chosen very carefully for the children involved. Given there is such a small number of children involved, I do not wish to say anything that would identify them but suffice it to say that there are very complex care and behavioural needs involved, including emotional and sexual difficulties, and these children need very specialised care.

That said, I have indicated previously in the House that I believe our special care facilities, high support units and detention services in this country represent an area that needs attention. We need more clarity in regard to how this care should develop in the future. I have met with the relevant people and have an examination under way at present of how we are organising those services because I am not satisfied with the organisation or national planning in their regard. I believe the people on the front line are doing a very good job, as well as they can do it, but in terms of policy direction and future development of those services the work has simply not been done and it needs to be done. We have to see the referral of those children in that context. We do not have the services for them in this country. Perhaps for some of them we will be able to provide those services in the future.

I assure the Deputy the costs are per week in the unit so this does not include the various observations he made in regard to other costs. I assure him also that the social workers are in contact with those children and the services are in constant contact with the providers. We have experience of children doing extremely well in these units, and returning back to Ireland and doing well, either independently or with their families.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I absolutely concur with the Minister's reference to Great Ormond Street as being a centre of excellence on a global stage but this is not what we are talking about here. Rather we are talking about particular care settings in regard to very complex cases. It is not just about specific procedures. The instances the Minister cited are placements for care needs and supports that are not currently within our system. Has any serious assessment has been given, even a rough, off the top of the head kind, of the total costs, apart from those of family visits? The Minister has not clarified whether social workers from this jurisdiction visit these children in their overseas placements. One is talking about in the order of in excess of €400,000 per annum for some of those individual children, which is substantial money. Will she clarify whether an assessment has been done as to the potential of providing that care support on the island of Ireland? We might not be talking about eight cases but a smaller number, and perhaps collectively we might be able to ensure those facilities here, which would be more easily accessible to families and all others who have a role to play.

Frances Fitzgerald (Dublin Mid West, Fine Gael)
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I refer to the Deputy's point on care. What these young people are receiving is not simply residential care. The reason I compared it to Great Ormond Street is that they are getting the kind of treatments and care and psychological interventions that are simply not available to them here. I assure the Deputy the social workers are in contact with the children and do visit them. The reason these services are being used is that, having assessed what is available in Ireland, the kind of specialist help these young people need, in the residential care settings such as they are being sent to, is just not available here. I assure the Deputy that as part of my work in regard to high support and special care, the question of whatever specialist services we can provide in Ireland will clearly form part of that. Right now, however, we do not have these services in the country.