Ombudsman damns neglect of child protection services

Emily Logan's investigation highlights State and HSE inefficiency in implementing Children First. By Sara Burke

On Tuesday last, the Ombudsman for Children, Emily Logan, published an investigation into the State’s implementation of Children First, the national guidelines on child protection. In the investigation, Logan reprimanded the State’s failure to adequately protect children.

This is the first totally independent report since the publication of Children First (CF) in 1999 – all previous reports have been commissioned or carried out by the HSE or other State institutions. It is also the first systemic report carried out by the Children’s Ombudsman, who up to now has published reports on specific cases but not on the overall system relating to children’s services.

Emily Logan is very critical of the failure of state agencies - the Department of Health, the Office of the Minister for Children and the HSE in particular - to fulfill some of their duties in relation to child protection. Since 2005, Logan states that many of the complaints coming into her office are related to the partial or non-implementation of Children First. In July 2008, the Minister for Children’s own report on Children First admitted that not all aspects of it were being successfully implemented and Logan felt that this warranted an investigation.

The main findings were:

• A huge variation in the type of services provided in different places.
• No internal or external scrutiny - it was found that the quality of care provided is not inspected.
• The failure of agencies to work together - for example the HSE with the Gardai and with internal HSE staff.

These kind of findings have been aired before, but what is significant is that they are coming from an independent source. Three points in particular add value to the previous findings:

• Logan details the failure of the health boards and the HSE to successfully implement CF, and based on that track record questions whether the HSE is the right organisation for implementing child welfare and protection services at all. In many other European countries social care services (including children) are run separately to health and acute services, often by local authorities. This means that they do not always lose out to budgets and priority to areas such as cancer care and emergency departments.
• Logan details the chronology of what has happened since CF was rolled out, and outlines 16 different initiatives, mechanisms and reviews that were undertaken in less than 11 years. These initiatives occurred across the board, including in the health board executive agency, the Department of Health, the Office of the Minister for Children, the HSE, the social services inspectorate, and a specific audit of Cork and Kerry, the conjoint programme for action on children, a high level inter-departmental group, reviews of adequacy of services, revised CF guidelines - the list goes on and on. This list is the clearest indictment of State failure to adequately protect children at risk.
• Logan concludes that there was ‘substantial effort’ to make CF happen, but to little real effect. As she puts it, ‘there is no shortage of analysis, but far less action’. According to the list of reviews and initiatives above, there was some considerable effort put into implementing CF after its initial publication in 1999 until about 2003. Between 2003 and 2008 very little happened. The latter period saw the reform of the old health boards and the formation of the HSE and a OMC review of CF, and for five years progress on implementing CF was stymied. Logan formally reprimands some of these agencies (an action that is within her legislative remit) and makes 11 findings of ‘unsound administration’ against the relevant public bodies – the HSE, the Department of Health and Office of the Minister for Children.

Another key area Logan highlighted in the review is the absence of both internal and external audits of child care cases. There have been multiple reviews, focus groups and expert groups, but a proper audit would actually open up the children’s file to see how cases have been managed, in what time frame, to what quality and what happened the children involved. The only audit to happen in the country since 2004 has been in Cork and Kerry and its findings were, according to Logan, ‘very worrying’.

Screening took an average of 21 days, meaning that urgent cases were not speedily identified. Initial assessments took over 95 days and 75% of these assessments have no record of outcome even though CF guidelines require a record of outcome.

The HSE response emphasised that improvements have been made since the investigation began. Since Phil Garland has been appointed assistant director with responsibility for child and family services, money to hire 200 additional social workers has been provided, standardised procedures are being put in place and as of September 2011 child care services will be open to external scrutiny from the Social Services Inspectorate based in HIQA.

Yet there is still no comprehensive out-of hours child protection service outside of Dublin., still fewer social workers per head than other European countries (even after the 200 extra mentioned above are added) and children's services are still not working together effectively. Ultimately child protection is treated as a marginalised service providing care for some of our most marginalised people.

While many children receiving care in Crumlin hospital have articulate, often high profile parents who can make noise and demand better quality services, children at risk come from some of the most needy circumstances and have no one to shout for them.

The Ombudsman has given the HSE 12 months to implement her recommendations and if there is a lack of progress she will refer the issue to the Oireachtas. The HSE say that their efforts will show benefits soon. It only remains to wait patiently and see if 11 years from now Children First, child welfare and protection services are given the priority and resources they require.