James Reilly (Dublin North, Fine Gael)
Link to this: Individually | In context

Question 86: To ask the Minister for Health and Children her views on the recommendations of the recent report on the Monageer case (details supplied); if she will supply details of the implementation plan which has been put in place; the Department that has responsibility for ensuring that each of the recommendations are implemented; and if she will make a statement on the matter. [21890/09]

Barry Andrews (Dún Laoghaire, Fianna Fail)
Link to this: Individually | In context

I welcome the publication of the redacted report of the Monageer Inquiry. I believe that publication of the redacted report will facilitate greater awareness of the needs of families and will improve the response of service providers, and that there is great value in this.

The provision of appropriate, robust and responsive child welfare and protection services is a key priority for both me, as Minister of State with responsibility for Children and Youth Affairs, and the Government. The report of the Monageer Inquiry has identified a number of issues in relation to services for children and families, and my Office, the HSE and An Garda Síochána are taking actions on addressing the report's recommendations.

Some of the issues raised in the inquiry report relate to coordination and integration of HSE delivered services from hospitals, general practitioners, public health nurses, early intervention teams and other social work services, and the identification of a family with particular needs and the response to those needs.

I am pleased to acknowledge the new proposals unveiled in recent weeks by the HSE to support a more integrated health and social care system. The plan is to put in place a post under a National Director for Service Integration to address the service needs of children and families across the HSE. This is the first time that such an appointment has been made in respect of health and social services for children. Coordinating these services in order to provide an integrated multidisciplinary solution with good communication and clarity of roles and responsibilities goes to the heart of the recommendations of the Monageer Inquiry Report.

Another major development, and one which addresses some of the major communications issues identified by the Inquiry team, is the establishment by the HSE in February, 2009 of a Task Force to standardise policies and procedures for Child Protection and Welfare Services across the country, to be completed by the end of this month and implemented in June. This Task Force has involved detailed, in-depth consultation with social work staff and management in the HSE around the country and will set national standards across the HSE. It has examined issues around the reform of social work services, analysis of key management information flows and the definition and implementation of standardised business processes. The work of the Task Force will be significantly enabled through initiatives taken in the context of Information and Communication Technology (ICT) and my offices Knowledge Management Strategy.

Whilst I acknowledge the need to provide out of hours services across the country, a key finding of the Inquiry reads: "that even if the Gardai or Social Services had called to the Dunne family home during the course of the weekend, it is likely that the tragedy would not have been averted".

From June 2009, the HSE will operate a place of safety service for children, to enable gardai to place children in a safe environment when they have to remove children from a situation of extreme risk. The HSE is also putting in place a more integrated multi-disciplinary approach to out of hours services, building on existing GP, acute hospital and mental health services, to ensure that people seeking services outside normal working hours can be provided with appropriate advice, information and support and in emergency situations access to specialist staff such as professionals working in the areas of mental health and suicide prevention; Other recent initiatives include: The HSE is commencing a comprehensive review of nursing services in the community, which will cover public health nursing services as part of the HSE Transformation Programme and development of Primary Care Teams. This review will have regard to the role, function and reporting relationships of public health nurses and community registered general nurses, and will take specific account of the public health nursing service for children under five years of age by reviewing systems currently in place; In March 2009, the HSE initiated a process, led by a small group with experience in EIT services, to prepare a framework for the delivery of Early Intervention Services, covering both statutory and non statutory providers, to ensure a standard and consistent approach to the delivery of such services. The policy of the HSE is to refer children with disabilities to Early Intervention Teams as early as possible. The group has carried out an extensive survey to establish the stage of development of Early Intervention services in each region. Work will shortly be completed on the linkages and respective roles between Primary Care Teams and Early Intervention Services (including the role of the public health nurse). This will assist in early intervention identification and appropriate referral by GP's, public health nurses and others; The development and implementation of Standardised Business Processes for social work related services for children across the country, is a prerequisite to the implementation of the computerised single National Child Care Information System (NCCIS). The HSE has allocated additional resources to this work over the past 12 months and it is at an advanced stage.

The Child Welfare and Protection (CWP) processes being standardised include: Referral; Assessment; Child Protection; Family Support; Family Welfare Conferences; Children in Care; After Care Services; Fostering; Youth Homelessness; Separated Children Seeking Asylum; and Adoption.

The NCCIS is aimed at supporting front-line staff in their day-to-day operations; improving the quality and consistency of CWP services provided; and enabling collaboration between these services and Community and Voluntary services. The existing collection of legacy computer systems which are at the end of their lifespan cannot provide the type of management information on children at risk that is required at local and national level.

To date the HSE and the OMCYA have expended a considerable amount of time preparing the groundwork for the NCCIS which is urgently required to support Case Management. The NCCIS will facilitate the recording of the case history of every child referred, from initial contact with the HSE through to final outcome. The HSE has developed a Business Case to advance the implementation of this system which is under the Department of Finance for approval via a review process. The Monageer Report identified a significant number of issues in respect of Public Health Nursing, Early Intervention Teams and Child Care Services. A pilot project is currently underway in Wexford and will be fully rolled out from July 2009, taking account of the Report's recommendations. The learning achieved will inform the HSE National Transformation Programme (2007-2010).

The pilot project includes:

Mental Health Service - Suicide Crisis Assessment Nurse (SCAN) -

The SCAN Service provides a speedy response to the GPs or Primary Care Teams' request for those in suicide/self harm crisis. This service started in April 2008 in the Wexford and New Ross areas with 24 participating GP practices and will be expanded across Wexford county to all GPs and Primary Care Teams and will include Out of Hours provision;

Early Intervention Services -

A Project Worker will be appointed to undertake a system review of the Early Intervention Service in accordance with national standards and criteria and will improve co-ordination between the Early Intervention Service, Primary Care Teams, Specialist Services and the Acute Hospital and;

Enhanced Communication -

The use of Information Communication Technology to support the transfer of information between various health professionals.

I also wish to note the ongoing work to develop a greater understanding of the phenomenon of familicide. To further our understanding of the complexities of this occurrence, the HSE established a group headed by Geoff Day, Director of the National Office of Suicide Prevention in 2008. The work of the group is focusing on identifying risk and protective factors and the measures that can be taken to minimise such risks. The above initiatives demonstrate that the Government and the HSE have been quick to respond to the findings, conclusions, and recommendations of the report. The learning from this Inquiry is already being put to good use and my determination to improve services as a result of this learning is bearing fruit. This is what we should be concentrating on because we must look forward, learn and thus improve our responses in a coordinated and focused way in the best interests of children.