Home > Joint Committee on Health and Children Debate. Report of Child Death Review Group: discussion.

[Oireachtas] Joint Committee on Health and Children Debate. Report of Child Death Review Group: discussion. (21 Jun 2012)

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Chairman:I welcome the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald; Mr. Jim Breslin, Secretary General of the Department of Children and Youth Affairs; Ms Michele Clarke and Mr. Alan Savage…… 

[For the full debate please click on the link above]
Deputy Frances Fitzgerald: I thank the members for their wide-ranging comments. To begin with, Deputy McConalogue referred to the independent child death review panel, which is a clear recommendation in the report, as Senator van Turnhout said. My plan is to move ahead and consult with various groups that were identified by the authors, who may or may not be part of an independent child death review mechanism. At this stage, I have not decided the exact format of the unit but it clearly needs to be independent. Critical incidents and deaths should be referred to it so that we can have the kinds of reports that Dr. Helen Buckley has been already producing very effectively. We have the reports for the past two years, which are excellent. They are essential and should have been happening over the years within the system. We now have that mechanism. Dr. Buckley has said the work needs to be reviewed and that the criteria for referral of cases to her is too wide. She has suggested certain changes which should be taken on board in any new mechanism that is established. I will move on that as quickly as possible. I hope to be able to come back to this committee in September to discuss the establishment of that independent child death review mechanism. That is obviously a priority arising from today’s meeting.
HIQA, the Health Information and Quality Authority, will have an oversight role on this matter. The draft standards have been published, but HIQA will launch the finished standards in a couple of weeks. HIQA has shown itself to be extremely effective in its work concerning hospitals and other areas. The authority will publish child protection standards, including its oversight of this sector. I will revert to the committee on that matter.
Deputy McConalogue also referred to resources. I would encourage him and others who are studying this report to examine the resources that are currently being made available and their best use. That is critical because what emerges from the report is that many different resources were made available to families and individuals. I have already said that up to 15 agencies were working with some families, and ten with others. I could pick out any one of the cases and reference a number of organisations, ranging from education, welfare, home tuition and public health nurses to voluntary organisations. The latter bodies are not named but it is indicated that they were working with the families. In addition, the groups involved included child protection staff, social workers and child psychiatrists. It is incumbent on us to examine how the resources are organised. There is a role for this committee to seriously consider how best to reorganise those resources. We must also ask how those resources meet our child protection priorities. Currently, there is a great deal of money going into this area. Of course, I am conscious of our economic situation and of the difficulties that some services are experiencing. I would urge the committee, as well as calling for more resources, to examine the resources already available and the organisation of the services because this is key. We must examine how, for example, the services can best be brought together to work to improve children’s lives so that when they give a service to a family, as Senator van Turnhout put effectively, there must be sharp intervention that is timely and clear and makes a difference. As well as calling for more resources, we need to examine the structural organisation of the services to see how they can more directly support families. That is incredibly important.
One of the places where we will be examining this is in the task force. The task force report will be published in July. That will examine the various services available. For example, let us look at psychologists in community care. How can the psychology service work effectively with the kind of families that are described in this report? If I look at the CAMS workers, how can we ensure integration because it seems there are barriers to getting effective work between the different professional groups in the interests of the child? The children and the families are those who are meant to be getting the service. What is it about the organisation of services outlined in this report that is not working for children and families?
On the particular resources, of course, social workers are important. However, there are care workers in this country and we have many working with voluntary organisations. There is significant investment by the Government - €30 million into three or four projects on family supports. We must learn the messages that come to us from the evaluation of those reports as well.
I understand that some disciplinary action has been taken. Clearly, there are ongoing reviews. There are industrial relations issues that arise in disciplinary action. I emphasise, as far as this report is concerned, it was a review of the files and any workers who were involved in these cases did not have an opportunity to come before the authors or to discuss their work generally.
Deputy Ó Caoláin rightly asks about an implementation plan. I regard it as crucial. I have already said that I believe there should be a Gibbons-Shannon implementation plan on this report and that it should be integrated with the reform agenda. As I stated, this morning I spoke to the Taoiseach who has asked me to ensure that such implementation plan is presented on a quarterly basis to the Cabinet sub-committee on social policy - obviously, I am happy to present to this committee as well. That would be important in ensuring full delivery and securing full support across all areas of Government.
It is clear from this report there is work for different Ministers in terms of implementing what is here. There is clearly work for the Minister for Education and Skills. In terms of the alcohol and drugs issue, the Minister of State, Deputy Shortall’s, reform programme on alcohol needs to be supported. It is clear from this report, as a number of members stated, that this is a key issue for so many of the families……..
Deputy Frances Fitzgerald: Senator Henry made a point on the drugs, addiction and mental health difficulties which young people and their families had which are outlined in the report. It is very important to examine the services we provide at present with regard to drugs and alcohol addiction. Where adults receive services it is quite clear the needs of the children are not being taken into account enough. This is very clear. We need to ensure that if people are treating adults with addictions that the experience of the children in the family crosses the radar. I have attended a number of conferences in the course of the year where for the first time some of the agencies which work with children and those who work in addiction services with adults began to come together. We must ensure this happens. The experience of the young person was absent and this has led to the lives of the children being completely disrupted. It is very clear in case example after case example. I take the point made on this.
I challenge the committee to think about the reorganisation of services. Deputy Catherine Byrne spoke about first-hand experience of seeing a number of agencies working with a family. How do we ensure they work with families and are organised in a way that the right person works with the family, the proper interventions are made and some type of long-term plan is made for the children? This jumps out from the report. The services need to be reorganised in the interests of children and families. Public health nurses, CAMHS and domestic violence services are not integrated enough and this is very clear. We must find a way to integrate them so we do not have the type of duplication on which Deputy Byrne and others commented.
Nobody could but be moved by Deputy Conway’s description of her experiences as a front line social worker, the challenges in this work and the personal commitment she made. The report describes one young man who took a drug overdose. According to the report:
The overdose had caused serious damage to his lungs but he refused to follow up on this. At this time, his Social Worker secured a place for him in a drug and alcohol treatment centre but he was discharged within a week. The Social Worker found a place for him in a second treatment centre but again he was discharged, with the Centre stating that his needs were more complex than they could provide for. [If the centre could not provide for him where could?] A place was then found for him in a hostel and he stayed there and was drug-free. It was required that he leave the hostel during the day so his Social Worker collected him each morning and brought him back each evening. After three months of being free of alcohol and drugs, he began abusing these substances again and was discharged from the hostel. He began attending a psychiatric hospital and moved into a hostel linked with the hospital as part of its out-patient treatment programme. He responded well to this programme and attended the psychiatrist regularly. Just prior to his death he had asked his Social Worker to get him a pair of black jeans and she had agreed. They were to meet to organise the purchase. However the hostel phoned her to tell her that he had been found dead in his room.
This is the type of case we read about again and again. We can see the work done by the social worker and the failure of some services to really hold on to the young person and work through the difficulties. It is extraordinarily challenging.
Deputy Conway spoke about the management system, and this was also raised by Deputy Catherine Byrne. We have changed the management. Deputy Conway described a situation which was dysfunctional. This is why we are reforming the HSE and taking child protection into a new agency where there will be more accountability and more direct lines of accountability. Deputy Conway described better then anyone could what the situation was, which is why we are committed to reforming it.
Deputy Byrne also raised the issue of youth suicide. Unfortunately Ireland has the fourth highest rate of youth suicide in the EU. What is reflected here is that the children and young adults in care are a particularly vulnerable group. It is part of a wider societal problem, as is the drugs and alcohol issue. I want to repeat this is not simply about social work services. What has happened for too long is that these cases have been put directly to child protection services, and we have a culture in Ireland of referring on so something is no longer the responsibility of the person who is referring it on. Agencies must stay working with children and must work with schools and other people working directly with families. Deputy Byrne mentioned the school attendance issue. It is not about referring on a case to the child protection social worker. It is about all of the agencies deciding how best to intervene and work effectively……..
Report of Child Death Review Group: discussion
Joint Committee on Health and Children Debate
Thursday, 21 June 2012

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