DUBLIN: BREAKING THE SILENCE: Significant Failings Uncovered In Care Units For Troubled Children: HIQA Report: UPDATED

5 Apr

BREAKING THE SILENCE:

SIGNIFICANT failings in the management and staffing of special care units are compromising the state’s capacity to meet the needs of the vulnerable children they house, a report has found.

Inspectors from the Health Information and Quality Authority (HIQA) described one of the units, Coovagh House in Limerick, as being “in crisis,” noting “grave concerns regarding safety of children and staff”.

Coovagh House was one of three special care units assessed as part of HIQA’s National Overview Report of Special Care Services provided by the HSE. The other two units are Ballydowd in HSE Dublin North East and Gleann Álainn in the HSE South.

 

All three house children detained on foot of court orders for their own safety or the safety of others. The report by the independent health watchdog found:

* 20 out of 109 staff in the units were unqualified.

* Staff levels were compromised by a high level of sick leave and a recruitment embargo.

* On occasions, permanent staff was outnumbered by agency staff, contributing, inspectors said, to “a lack of cohesive practices and consistency in the units”.

* There was little evidence of an effective ongoing staff development and training programme, as required by the National Standards for Special Care.

* Professional supervision for staff had lapsed significantly.

Inspectors warned that the “HSE strategy of using agency staff to provide appropriate levels of care staff in special care units must consider the impact and implications of ongoing changing personnel on this group of vulnerable children”.

In particular, inspectors found Coovagh House was in crisis. At no time since it opened in 2003 has it catered for its full complement of five children. At time of inspection, it housed just two boys.

HIQA found that there had been significant property damage to both Coovagh House and Ballydowd.

The HSE had given a commitment to close Ballydowd in November 2009 after HIQA declared it unfit for purpose, but it remains open. In its report HIQA said its inspectors were told there had been a 50%increase in the national demand for special care placements in 2010 and it was not possible to close Ballydowd, keeping it, and a second unit, the Solas Unit, open pending a new national model of special care and high-support provision.

However, the new national model has not yet materialised and while Coovagh House and Ballydowd are now managed nationally, Gleann Álainn in the HSE South is managed locally.

The HSE said it welcomed the HIQA reports pointing out that of the total of 56 recommendations only two had not yet been addressed, 29 were met in full and 25 were met in part.

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THE HSE’s new child services supremo has said the agency’s crisis intervention skills “lacked credibility” and also questioned whether current child death reviews were too broad.

Scotsman Gordon Jeyes, appointed in December as the HSE’s first national director of children and family services, also said the provision of aftercare should be obligatory, but also needed to be used where it was most required and where resources allowed.

Speaking about his new role, in which he will be a key player in the transfer of child protection from the HSE to a new agency as part of new Government plans, he said: “The buck stops with me.”

He said of the HSE, which has faced a series of problems regarding child protection in recent years: “The culture that I have seen was certainly one that was defensive.”

He said there was a need for greater accountability in child services, but maintained that while “processes and practices in Ireland are far too inconsistent” and some children had been failed, the vast majority did not struggle in the system.

The deaths of children known to care services are being examined retrospectively by the Child Death Group, and deaths that occur in the system now are being reviewed under HIQA guidelines.

Mr Jeyes said he understood why those guidelines were needed given the HSE’s lack of credibility on the issue, but said he questioned whether investigating deaths by natural causes or tragic accidents was necessary.

“The figures are not out of kilter with the countries in the United Kingdom,” he said, questioning why figures issued in the past by the HSE were published when they were obviously too low.

“The criteria set by HIQA is broader than in any other jurisdiction than I am aware of,” he said.

He also said he wanted to introduce a new category of “missing and in danger” children, while he also said he wanted to support but challenge social workers to achieve better results in a financial climate where “it is going to get worse before it gets better” and where “caseload is erratic and inconsistent”.

The Government plans to de-couple child protection from the HSE and place it with a new agency. Mr Jeyes said he expected clarity on the details of the changes “fairly rapidly”.

Mr Jeyes said he expected more stories to appear in future which indicated that the HSE had made mistakes in the past in some cases involving children, but that he expected every child to have a quality plan and a social worker or transition worker this year.

He added that changes were also needed to ensure that children who have committed a crime can be placed in special care.

NEWS UPDATE:

THE HSE director for children and family services has said the death in the last year of 27 children and young adults who were either in state care or known to child protection services was “not out of kilter” with figures elsewhere.

Seven of the deaths were due to suicide, three of which occurred this year, four were drug overdoses and two were homicides, the HSE said.

A further seven died of natural causes, such as diseases, four died in road traffic incidents and three in other accidents.

Gordon Jeyes, HSE national director for children and family services, said the death of any child is shocking, but added the figures for deaths of children in care, or known to care services in the Republic, were “not out of kilter” with the figures in Britain. The annual rate of death recorded was 160 per year; however, the Irish system investigates children who died of natural causes, which is broader than the categories of deaths recorded in Britain.

Mr Jeyes said he understood why those guidelines were needed given the HSE’s lack of credibility on the issue, but said he questioned whether investigating deaths by natural causes or tragic accidents was necessary.

“The figures are not out of kilter with the countries in the United Kingdom,” he said.

“The criteria set by HIQA is broader than in any other jurisdiction than I am aware of.”

The figures for Ireland come a year after the HSE admitted it did not know how many children in care had died in the previous decade.

Further public outrage ensued when the HSE said it could not release details files on children who had died in care to the Government who then had to enact emergency legislation to access them.

Since then the HSE has provided various figures ranging from 21 to 37 and 188 last year. In December it revised upwards its figure for deaths to 199 between January 1, 2000, and April 30, 2010.

Last year, on foot of this revelation, the Health Information and Quality Authority (HIQA) published recommended guidelines for reporting deaths in care and set upa panel independent experts in child care and support to review the HSE’s handling of child deaths and follow-up investigations.

Under this system the executive notifies the Health Information and Quality Authority of all deaths of children in care and children known to the child protection services. It also records the deaths of young adults between 18 and 21 years who were previously in state care or are in receipt of aftercare services.

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