Child Protection, April 2010


Deputy Dan Neville

I welcome the opportunity to contribute to this important debate. I would like to take up where Deputy Shatter left off regarding the report he has laid before the House, Inspiring Confidence in Children and Family Services, a strategic view of the delivery and management of children and family services prepared for the HSE by PA Consulting. Some of its findings are of great concern. The attempt to suppress the report is also of concern. Having received it last October, one would have expected the Minister to have laid it before the Houses, thus allowing a debate to ensue.

Let me consider some of the key findings of the report. It is a valuable report but it is shocking in what it exposes regarding management and the Children First guidelines. One of the key findings is that there is an urgent requirement to set out and communicate direction for the services. It found there is no shared view about what the service model should look like within the HSE. The report states, “The HSE needs an overall strategy and service model that will provide guidance to local managers and practitioners on how they should be delivering services for children”. Surely this is an essential requirement in the management of child protection in the HSE but it is not present according to the report.

The report also states, “This lack of overall direction has a profound effect on the outcomes children can expect in different parts of the country”. It states that there are significant and in many cases unnecessary variations across the local health offices in how Children First is being managed and delivered. These variations can be traced to the different priorities and practices of the former health boards which have endured with the establishment of the HSE in 2005. This means that depending on where children at risk live in Ireland, they can expect to receive different services from their local health boards. In some local health offices children and their families can expect to receive practical support to help them achieve “upward spirals” in managing the challenges in their lives.

The PA consultants report states that more visible leadership was required across the levels of service as well as tighter management. Implementation of the recommendations of the Ryan Commission implementation plan and the report of the HSE taskforce will not happen, it stated, without visible leadership at all levels in the organisation. Surely these reports are a key to the future efficiency of the Executive. The implication is that there is no visible leadership at all levels.

To inspire confidence within the HSE and externally, the report states that tighter management is required as regards resources, quality of practice and outcomes for children, surely a key issue in relation to child protection. The present outcomes for children are criticised. The current management style, according to PA, tends to be reactive, crisis driven and focused on individual cases. There is a great deal of management traffic around individual cases, but much of this is not purposeful in the sense of building better delivery methods to secure better outcomes. Therefore, we have a lot of management activity, but it is not aimed at the outcomes for children, which should be the key objective rather than the system itself. At a fundamental level, as the report states, there is no clear understanding of the respective roles of professionals working with children and HSE managers. This contributes to a disconnect between service delivery at national, regional and local levels. Structures for delivering the service need to be simplified and clearer. There is a distance between frontline staff and the top of the organisation, which is unhelpful in terms of service delivery.

The report also states that it is unclear where responsibility, accountability and authority lie for children and family services, particularly at local level. At a fundamental level, this means people within the HSE and outside do not know who is responsible for child protection. At the levels of the delivery system, people can have responsibility without corresponding authority. Some inherent tensions were detected between two critical local roles, the principal social worker and the child care manager. In that regard the report states, “These can work well, but they depend on the quality of relationships.” Roles have been also tailored over the years to manage specific issues, adding to the complexity of delivery. Roles and responsibilities, therefore, need to be simplified and clarified.

Within the HSE, the report states, that working and referring cases across the service is still complicated. There are issues around how professional and service boundaries constrain referrals between services. A more profound issue relates to identified service gaps, for example, access to psychological services for children who clearly have behavioural issues but are not diagnosed as psychotic. This can often leave social workers managing very complex cases without appropriate service supports. Supports for social workers and their managers are underdeveloped. Social work professionals work in one of the most challenging areas in the HSE. The human scale of what they have to do is of enormous significance.

The reports states that there is inconsistent application of practice in implementing child protection and support. There are significant and unhelpful variations, in practice, across the local health offices, for example, in relation to how patients are referred and how risk is assessed and the thresholds between the different levels of service required. The service is not being managed based on current intelligence.

The HSE, states PA, currently produces a wealth of data on how children and family services are being delivered. That is positive, but it goes on to state, however, that this is not being routinely used by managers across the service to provide intelligence on how it is being delivered, resources allocated and what outcomes the service is delivering for children. The current data are not perfect, but nonetheless represent a sound starting point from which to deliver intelligence-led delivery of service. It shows that the intelligence and information exists within the HSE, but it is being ignored. That is the only interpretation one can put on that.

Based on the findings of the report, it was recommended that the HSE should take the following actions. It should agree and communicate a clear service model for the future that focuses on outcomes for children. This should guide both managers and all practitioners on their priorities for engaging with children at risk. The executive, it recommends, should be consistent in how it delivers services, strengthens collaboration and provides supports for people working with children and their families. An intelligence system should be developed that uses currently available data to improve the service and to simplify and make clearer key roles and responsibilities across the delivery system.

The report’s focus has been to propose changes that are absolutely necessary, according to PA, to bring clarity to key roles both internally and externally, ensuring that the structure reflects and drives key functions. I congratulate Deputy Shatter for laying this before the House. Surely, the only interpretation that may be put on this report is that we have a dysfunctional child protection service.