COMMITTEE OF PUBLIC ACCOUNTS debate -
Thursday, 10 Jun 2010

Death of Children in HSE Care: Discussion with HSE

Mr. John Buckley (An tArd Reachtaire Cúntas agus Ciste) called and examined.

Professor Brendan Drumm(Chief Executive Officer, Health Service Executive) called and examined.

Chairman

We have with us representatives of the Health Service Executive. The purpose of the meeting is to deal with the correction of evidence given to the committee at the meeting of 4 March 2010 on the death of children in the care of the Health Service Executive.

I advise witnesses that they are protected by absolute privilege in respect of the evidence they are to give to this committee. If witnesses are directed by the committee to cease giving evidence in relation to a particular matter and they continue to do so, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise nor make charges against a Member of either House, a person outside of the House, or an official by name or in such a way as to make him or her identifiable.

Members are also reminded of the provisions within Standing Order 158 that they shall also refrain from inquiring into the merits of a policy or policies of the Government or of a Minister, or the merits of the objectives of such policy or policies.

I welcome Professor Brendan Drumm of the Health Service Executive and ask him to introduce his officials.

Professor Brendan Drumm

I am accompanied by Ms Laverne McGuinness, national director, integrated services directorate, and Mr. Bernard Gloster, local health office manager and a specialist in the area of child care.

Chairman

An official of the Department of Finance is present.

Mr. Tom Heffernan

I am from the sectoral policy division of the Department.

Chairman

Before asking the HSE for a short statement on this issue, I point out that at a meeting of this committee on 4 March 2010, the issue of the number of children who had died while in the care of the HSE was raised. It has since emerged that the information given to the committee was incorrect. Today's session provides an opportunity for the HSE to correct the record on this matter. This is the only topic the committee will deal with today. I ask Ms Laverne McGuinness, national director, integrated services, to make the opening statement.

Ms Laverne McGuinness

Chairman and members of the committee, a public statement was issued on 3 June which stated that I personally had provided "wrong, untrue and inaccurate information" to the committee. I believe that this statement was unfair as I did not knowingly or intentionally provide inaccurate information to the committee. I am pleased to attend today to clarify to the committee why the information I provided at its meeting on 4 March was different from the information provided on Friday, 28 May and Friday, 4 June to the Minister of State with responsibility for children and youth affairs, Deputy Barry Andrews, and the independent review group established by the Minister of State.

First, I would like to emphasise that behind the numbers I will refer to today are children, families, friends and carers and again place on the record our very sincere sympathy to these families and friends of the young people who died.

Since 2008 we have been working on a strategy to fundamentally modernise child care and family services in Ireland within the resources available and the industrial relations environment we operate in. I am confident that if we stick with this strategy, it will provide safe and highly professional services in the years ahead. In the interim, we are very focused on managing the risks which are inherent in this area of social care.

The figure of 20 children who died while in care notified to the committee on 4 March originates from a response to a request from HIQA, the Health Information and Quality Authority, in February 2009 which we responded to the following month. In March 2009 we advised HIQA that 21 children had died in the care of the former health boards and HSE since 2000. This figure was later revised to 20 when it was established that one of the cases identified referred to a young adult. This was the most up-to-date and accurate information available at the time of the committee's meeting on 4 March 2010.

Six days after the committee meeting, on 10 March 2010, HIQA published, "Guidance for the HSE for the Review of Serious Incidents including Deaths of Children in Care". On the same day, 10 March, the Minister of State, Deputy Andrews, requested that we provide information on children who died in care, young adults up to 21 years who had died and had previously been in care and children who died who were known to the child protection services.

Taking account of the clarity in the guidance from HIQA, the request from the Minister of State, Deputy Andrews, and discussions with the independent review group last month, we went back out to our social services around the country with far more precise definitions of the information which was required. We applied these new definitions to records going back over ten years from 1 January 2000 to 30 April 2010. During this period, there would have been more than 200,000 referrals to child protection-social services and child protection concerns in relation to more than 20,000 of these children. The compilation of this new information was a manual process as the records do not exist in one central location or database. Notwithstanding this, the exercise was not completed as quickly as we would have wished and this delay has reflected badly on our child and family services.

On Friday, 28 May we provided the first set of information requested to the Minister of State with responsibility for children and youth affairs and the independent review group. This related to children up to 18 years who died of natural and unnatural causes while in care. For children in care, the former health boards and subsequently the HSE act inloco parentis in accordance with the provision of the Child Care Act 1991 by court order or voluntary consent. Within this group, 18 children died of unnatural causes while in care during the ten year period and a further 19 children died from natural causes and health related conditions during the ten year period — a total of 37 children. The difference between the figure of 20 provided to the committee on 4 March and this figure of 37 is because: there have unfortunately been additional deaths between the time of the initial request, which was sent out to our social services in early 2009, and the extended review period which is April 2010; all children who died from natural causes, in accordance with the HIQA guidance have now been included whereas before only some were included; and two accidental deaths and one drug-related death have been identified following further validation of files and the new more precise definitions.

On Friday, 4 June we provided the information with respect to the two additional groups sought by the independent review group. The first group consisted of young adults between 18 and 21 years who had previously been in care but who were no longer in care when they died. If any such young person was no longer engaging with after care services or had moved to another jurisdiction the HSE may not have had the details of his or her death. From the information available 27 young adults within this group died during this ten-year period, four of natural causes and 23 of unnatural causes. The second group consisted of children who would have had ongoing contact with child protection services at the time of their death and children who died up to two years after their case had been closed. This review involved a very wide analysis of our records which identified that 124 children who were known to social services died during the ten-year period, 63 of natural causes and 61 of unnatural causes.

There has been public commentary saying that the HSE has been refusing to provide information to the independent review group. I clarify again that we are very willing to provide the independent review group with as much information as we are lawfully permitted to provide. What we have refused to do is provide information that would cause us to break the law. It would be helpful if this could be acknowledged. We continue to work with the independent review group and explore ways by which information can be provided to it and await further developments regarding the legislative amendment which may facilitate the provision of information.

We have established a HSE child deaths and serious incidents review group chaired by Dr. Helen Buckley of TCD which will monitor and oversee the review of all future child deaths in accordance with the HIQA guidance. We are maintaining an open register for the period, 1 January 2000 to 30 April 2010. In the event that further deaths are identified over the next three months, they will be added to the list and notified to the independent review group and the Minister of State with responsibility for children and youth affairs.

I hope that this information will be of assistance to the committee.

Chairman

Thank you, Ms McGuinness. Can we publish the statement?

Ms Laverne McGuinness

Yes.

Chairman

Before I ask Deputy Fleming to speak, I seek clarification on one point Ms McGuinness made regarding providing information to the investigation. She said the HSE is prevented from doing so under law. I ask her to specify under which laws it is prevented. If the HSE is prevented by law has it specified precisely to the commission what laws need to be changed to make the information available?

Ms Laverne McGuinness

On the information required by the independent review group, it is looking for the specific files on the children who died in our care or who were known to the child protection services. Within child care there is specific legislation referred to as the in camera rule under the Child Care Act and legislation. Legally we are prohibited from sharing that information for privacy reasons, for data protection reasons and to comply with the in camera rule. It has been accepted that there is a legal impediment to handing over those files.

Chairman

Has the HSE made a submission regarding this information barrier?

Ms Laverne McGuinness

The independent review group is aware of the barrier with regard to handing over the files. We have had a number of discussions with the Department of Health and Children and with the independent review group in that regard. They are currently looking at ways——

Chairman

Can we see the document related to the HSE's submission to the group regarding this?

Professor Brendan Drumm

I wish to comment on that. We now have in-house legal expertise, which met the Attorney General. How much was written down and how much of it was verbal I will need to check for the Chairman. There has been a great deal of discussion with the Attorney General. We were accused yesterday of being the most secret organisation in the world or something like that. I do not think any organisation puts up more data on the web. We have been called before the courts on dealings with the Ombudsman in the past. We have been called before the courts and have been asked to issue apologies in terms of releasing files on kids under the in camera rules. It is not only our opinion, it is obviously the Attorney General’s opinion that there is a need for a change here and he is now reviewing it. A remarkable discussion is going on out there where I hear people saying that we are overly legalistic and we should be more flexible with the law.

On written material, I will seek to see how much is written down in relation to those discussions.

Chairman

Before handing over to Deputy Fleming, I refer Professor Drumm to a letter written by one of his staff, whose name and address were supplied to the Irish Independent, stating that the HSE does not exist as a national entity and operates on a need-to-know basis and that there are power blocks in the organisation which are blocking information. It is something that needs to be considered very seriously.

Professor Brendan Drumm

Child protection is a particular area. We are bedevilled with people showing up anonymously and behind masks on television programmes and so on. The HSE has massive interests throughout it, which are not necessarily enthused by the transformation programme that is under way. We expect in an organisation of our size that there are some people who are happy and some people who are unhappy. There is absolutely no doubt; we accept we have challenges and there are areas where we continue to need to improve our processes. There is a major plan of change in child protection that has been under way for the past two years and which HIQA and everybody have accepted will take a further two years. We have found huge unevenness across the system, where we found social work workloads to be far higher in some areas than in other areas. We have put in a plan to actually use our social work resource evenly across the system and get performance that is even. That is a big challenge, but that is what is under way.

Chairman

Cynics would say that people are going behind masks and remaining anonymous because they are afraid to speak the truth publicly.

Professor Brendan Drumm

If the Chairman could find any example in any place of the HSE taking disciplinary action against somebody for speaking in public, I would certainly be very interested to see it. I suspect he would have to go a long way across the world to find an organisation that has been less active in taking disciplinary action. If that is the reason, it is difficult to judge its credibility.

Deputy Seán Fleming

I thank Ms McGuinness, Professor Drumm and other HSE staff for being present today. On 4 March Ms McGuinness told the committee:

Twenty children have died in the care of the health services over the past ten years. Some of them died from natural causes, as a result of congenital defects, or by misadventure.

On Friday, 28 May the HSE issued a statement that 37 children had died in care during the past ten years of natural and unnatural causes. If the latter statement is correct, the first statement was not correct. The Chairman has already indicated we believe that the original information was inaccurate, to use the Chairman's word this morning. I welcome Ms McGuinness's clarification in saying that the figures are different. I want to absolutely confirm this here this morning. Under no circumstances do I believe anyone ever suggested or thought even for a split second that she knowingly or intentionally provided any wrong information. That certainly was not anyone's view. However, the wrong information was put on the record. We are not saying there was any deliberate attempt to mislead the committee.

However, the Committee of Public Accounts is the main forum in which senior officials from the HSE, Departments and other public bodies are made answerable in public through the Oireachtas. Witnesses do not have the facility to speak in the Dáil Chamber — the Ministers handle it there. However, in a committee such as this, there is an opportunity for the senior executives. It is good in the interest of openness with which the witnesses are happy, that this be the forum. That is why Ms McGuinness has gone on the record. She has called it something different and has used the term "clarify". We will not argue over the word. We all know why we are here, which is because people were concerned that different figures were emerging for whatever reason. I am not getting into the difference of definition. It was probably the lack of proper child care facilities, programmes and networks within the HSE that lead it to think the figure was 20, but when examined differently we got the figure of 37. Our main concern is the service being provided to the children. I am pleased to hear the 200 extra social workers will be in place this year. While some people might think differently, the HSE is the forum through which family and child care services should be delivered. Behavioural difficulties in children are normally part of a wider problem within a family set up and involve wider issues that impinge on the HSE's daily services. Therefore, I do not agree child care services should be removed from the HSE. The system did not work well or was not well co-ordinated, controlled or managed, but it is still the place to deal with child care.

I have two main questions. Can the HSE representatives explain how and why the system led to giving us the figure of 20? Our instinct is that the HSE as a body has not given child care the attention it merited. The HSE has done much good work, particularly in the area of cancer services and various other areas, but child care did not get the same level of priority. That is why we are pursuing this here. Yesterday, the Minister with responsibility for children mentioned a new person at national management level would be appointed, similar to the cancer care programme. I would welcome that because it is important to send out a signal. Can the HSE delegates explain how the system operated up to now? Hopefully, it will improve in the future.

With regard to the in camera rule, I understand fully and appreciate that the HSE cannot hand out files that contain detailed sensitive information on family members and others connected to them. It would be unfair to release those files. However, can the HSE explain to whom it can release the files? I am aware it cannot release them outside the HSE. However, would it be possible to designate the independent review group as HSE for the purpose of its review? Surely that would be a simple way to deal with the issue and would not involve releasing the files to an external body. I understand from HIQA that the HSE is setting up its own review group to deal with the issues. Are all the members of that panel HSE staff? If not, how can the panel being set up under HIQA’s guidelines have access to the files? If the members are not all HSE staff, will the same problem arise as has arisen with regard to giving the same files to the independent review group?

There is a practical way to sort out this issue, without having to resort to legislation. Has the HSE explored the pragmatic way of dealing with the issue by designating the members of the review group as HSE staff for a period or as consultants to the HSE? While the Minister should nominate the members of the review group, it should not be necessary for legislation to be set up, because if it is, we will be constricted by it when the report is issued. It is not a question of being prurient with regard to family and personal details. We welcome the HSE here again, but we are also sending a signal to everybody who appears here that any information they provide should stand up. We are not just saying this to the HSE, but to all witnesses who appear before the Committee of Public Accounts.

Ms Laverne McGuinness

I thank Deputy Fleming for his clarification. With regard to how we arrived at a figure of 20, perhaps I could explain how our system works. We have social workers in every part of the country. We have 1,200 social workers and a further 200 on the way and each of these social workers will deal with child protection cases. Over the past ten years, a significant number of child protection concerns has been notified to the HSE, up to 200,000 at any given time. Those records are not held in a central repository and are manual records. Therefore, going back over the records over a period of ten years was a significant exercise to undertake and in some cases the information may not have been as well collated as originally.

The HIQA recognised there was no way of carrying out a national review of child deaths and asked us for information on this in February. We went to our social workers through our management systems and asked them to provide us with all the information they had on children who died in their care. We did not have a national definition at the time and in some cases social workers returned deaths by natural causes while others did not as they did not interpret such a death as an adverse incident which would need investigation or review. The death of any child is tragic, but unfortunately, the death of some children would have occurred whether the children were in the care of the HSE or not. This discrepancy probably adds to the complexity with regard to the figures.

In March 2010, we welcomed the guidance document issued by the HIQA, which set out how reviews of deaths of children should be conducted and provided guidance as to what should be included within the scope of a review. We went with the definition provided by the HIQA and based on it and on correspondence from the Minister of State, Deputy Barry Andrews, and the independent review group, the social workers revalidated the information they subsequently provided. Notwithstanding that, all the information that has come back to us is in manual form. It is being collated in a central repository. I am pleased to be able to say that we are moving to a computerised method of recording child deaths and we hope to have it operational in a month or so. This means we will have a central repository from which we can get more robust information. I hope this addresses that part of the Deputy's question.

On the wider agenda of child care services and where they sit in terms of the priority they are given within the HSE, my brief includes child care as well as community services, hospital services and primary care services. When child care became part of my brief in 2007, we set about drawing up a strategic road map to change how child care services would be delivered throughout the country because we recognised gaps and deficiencies had built up over the years. The first work we carried out was a review of all our social work services and their operation in every local health office. This work identified huge gaps in some parts of the country, but very good practice in others. We identified the deficiencies and inequities and then set about devising a tool kit to address the issues. We put in place a task force in 2009, made up of senior clinicians and dedicated managers, to decide on the best way to provide child care services and came up with a tool kit for social workers which includes, for example, standardised risk assessments. Previously, risk could be assessed differently in Donegal, for example, than in another part of the country. Therefore, we have now set up one way of carrying out risk assessments and this plan is ready to implement. Three national policies have already been set up and are being implemented and more will come on stream throughout the year. It is an ongoing programme of work.

The third piece of work we carried out, which linked in with the other changes resulting from our review, related to child care structures and how they operated within our system. We worked on how social workers interconnected with our management structures and the positions of child care managers and principal social workers. We got some outside assistance to advise on how best to deal with this area and had a full strategic review carried out. That review would bring clarity, accountability and responsibility to areas where sometimes there were blurred lines of responsibility and accountability between child care managers and principal social workers. We are now developing an implementation plan to effect that change.

Unfortunately, change is never as quick to happen as we would like. Our change programme will probably take a period of two years, but we have already started on that change.

Deputy Seán Fleming

Did the legal advice suggest any practical way of dealing with the issues?

Ms Laverne McGuinness

A number of issues arise with regard to the legal advice. We are examining the position to discover how we can deal with it in practical terms. As the CEO stated, we previously handed over files and subsequently got into trouble with the courts. We were obliged to apologise. We are exploring the position in conjunction with the independent review group. We are taking perhaps one test case to discover whether we can return to the courts to seek permission to release the files.

On the other issue, I do not believe there is an intention to change the in camera rule. We are examining the position to see if there is a way to safely hand over the files to the independent review group. The Deputy also asked how, when we bring in independent people — which we have on our new panel — we can give them the files. This is because we will have commissioned them into our organisation so they will be within it. That is why when we ask such people to carry out a review, we can hand over the files to them.

The independent review group is different because it is a separate legal establishment. We are considering practical ways of proceeding. My colleague, Mr. Bernard, Gloster is involved in discussions with the independent review group to see if there are pragmatic ways of moving forward. We will still be obliged to go to the courts but a change in legislation may not be required. An amendment or enabling legislation would be required for us to hand over the files.

Deputy Seán Fleming

I am not a legal professional. However, Ms McGuinness will understand that people want this to be done quickly. They will become annoyed if haggling takes place in respect of legislation or if the matter is tested in the courts over a number of months. I accept that the HSE established its own panel. I previously suggested that the Minister of State should nominate the members of the independent review group and that the HSE could then supply a legal designation in respect of them. I accept that the group might not then be deemed independent. However, we should not become hung up with regard to this issue. If the Minister of State nominates people, then the HSE should be able to find a mechanism to take them on, within its own organisation, so that they can carry out the work. I would like a simple solution, such as that relating to the HSE's panel, to be arrived at. People want results, they are not interested in a legal debate.

Ms Laverne McGuinness

Yes, and we want to hand over the information.

Deputy Seán Fleming

That is just a suggestion I make. I would welcome if there were some way to give consideration to it.

Mr. Bernard Gloster

We are certainly open to the Deputy's suggestion. Like everyone else, we want the work to be completed in a relatively timely fashion. We attempted to make that point on several occasions in recent weeks. I suspect that the issue which might arise in respect of the members of the group being designated by the HSE to conduct the review would be that of independence. That was the intention of the Minister of State, I would imagine, from the way in which the group was established. It certainly is an option worth considering and we can engage further on it.

On the independence issue, the review group will be engaged in looking back whereas the panel considering the deaths is a live expert panel designated by us. That is the distinction the Deputy quite rightly made. As Ms McGuinness pointed out, parallel to any discussion on amending legislation we are considering every option to provide the maximum amount of information possible without compromising the issues associated with the law and with data protection.

My final point relates to a matter which is only relevant to one of the 37 cases but which may become an issue in respect of others. I have been contacted directly on behalf of one of the families of one of the 37 children who died and have been asked that the matter be allowed to stand and not be reviewed. So there are also sensitivities in that regard. I can categorically state — I hope that with the passage of time this will be reflected in other reports and comments — that we genuinely, sincerely and 110% want to provide as much information and informed learning as possible, in respect of the system relating to how the State cares for and responds to vulnerable children, to the independent review group.

Deputy Róisín Shortall

I am glad we have been given the opportunity to discuss this matter today and I thank Deputy Fleming for raising it. Like other public bodies which come under the remit of the Comptroller and Auditor General, the HSE is required to come before the committee, by law, and provide accurate information. Everyone accepts that mistakes can be made from time to time. There is an onus on the body involved to correct such mistakes as soon as possible. The HSE has been aware for some time that information previously provided to the committee was inaccurate. As far as I am aware, it did not attempt to communicate with the committee in respect of correcting the inaccurate information to which I refer.

Ms McGuinness began by denying that she knowingly or intentionally provided inaccurate information. Nobody suggested that she had done so. There is a large element of the straw man in such a statement being made because that was not what was being claimed by the committee. The excuse provided by Ms McGuinness is extremely convoluted. It is difficult to accept what the HSE is saying in respect of the reasons for it not having accurate information on the number of children in care who died during the past ten years. It beggars belief that the HSE was not in a position to provide figures for the committee and that it did not have in place a system for notification of the death of children in care.

References to the in camera rule and to the HSE being legally precluded from providing information are part of a smokescreen. The rule to which I refer does not stop the HSE from providing figures. Neither difficulties nor confidentiality issues arise in respect of the provision of figures. Legal issues arise with regard to the details of individual cases and in respect of the review in the context of confidentiality. As far as I can see, there should be no problem with regard to the HSE providing figures. The difficulty arose because it seems that the executive did not have a system in place for notification of the death of children in care.

As I understand it, the HSE has a system in place for notification of all cases of measles. If that is the position, why did it not have such a system in place in respect of the notification of the death of children in care? That is the issue about which I am concerned. The fact that a system such as that to which I refer was not in place, either in recent years or at any stage previously, indicates the low priority which attaches to the issue of child protection within the HSE.

I am becoming increasingly convinced that the HSE is incapable of providing child protection services. Ms McGuinness referred to drawing up a new strategy and stated that the HSE has been working on this for the past two years. Either the lives of children who find themselves in care are important or they are not. If they were important to the HSE, it would have put services in place to meet their needs. It would also have a system in place in respect of the notification of the death of children in care.

From first-hand experience of dealing with a number of constituents who, for one reason or another, required the care of the HSE, I am aware that the latter has been found wanting on many occasions. I attended the funeral of one of my constituents, Daniel McAnaspie, this week. As was stated at the funeral mass, we can only hope that his death will mean something in so far as the HSE will now begin to take this issue seriously. I do not have any confidence that the HSE will take it seriously. It should not take the death of children or a certain level of public attention to impress upon senior officials within the HSE that child protection is important.

The record will show that child protection has not been afforded any significant level of importance within the general scheme of things in the HSE. That is why one cannot but come to the conclusion that the latter is incapable of providing adequate services. It has had ample opportunity to provide such services but there has been a litany of failure in this regard. There is an onus on those in government and in politics generally to ask whether the HSE is capable of doing its job in respect of this matter. I am increasingly coming to the view that it is not.

There are 1,200 social workers in place at present and there is a promise to employ a further 200. What is the European standard with regard to the number of social workers required given the size of our population? What is the European norm and how do we compare with it? How do we compare with the norm in Northern Ireland, for example, which is our closest neighbour?

What precisely is the management structure dealing with child protection services, which is clearly inadequate? Who is the most senior person specifically in charge of child protection services and what is that person's grade? Will Professor Drumm clarify his earlier point in respect of social worker workloads being uneven?

Ms Laverne McGuinness

I am updating the record. The figures were updated on 28 May. Some 37 children died in our care.

Deputy Róisín Shortall

Ms McGuinness is updating the record from when?

Ms Laverne McGuinness

When I came before the committee, the information I had available and provided was the information on foot of the request from HIQA.

Deputy Róisín Shortall

I am not talking about what HIQA is looking for or definitions. I am asking the witness what system existed, if any, for the notification of deaths of children in care.

Ms Laverne McGuinness

There was not a central repository in place with regard to——

Deputy Róisín Shortall

So the HSE did not have a system of notification.

Ms Laverne McGuinness

There is a notification system. If a child dies in care, that notification takes place within the local health office in the social worker's area of work. That is a child death notification. What we have been looking to have notified in the past are serious adverse incidents. We have set up within the HSE a system where serious incidents of children in our care dying because of adverse conditions are immediately notified to us as part of our overall quality and risk process. That is in place now but it was not always in place. It was not in place with the health boards either.

Deputy Róisín Shortall

There was no central notification system for the deaths of children in care.

Ms Laverne McGuinness

There was no central repository of information regarding notifications. It did not exist in the previous health board system either.

Deputy Róisín Shortall

That is not a justification for the HSE not having any system in place.

Ms Laverne McGuinness

I am not justifying it on that basis.

Deputy Róisín Shortall

It speaks volumes that there was no system in place.

Ms Laverne McGuinness

There were local notifications but no central repository. We are moving to a process where adverse incidents, as well as child deaths in care, will be computerised. The modifications are being done and we hope to have that operational within a period of months.

Deputy Róisín Shortall

Was that not considered a significant issue? I presume the deaths of children in care were regarded as a significant issue that needed to be recorded.

Professor Brendan Drumm

To clarify, the Deputy is correct in that such incidents should have been recorded. Many of these kids, for example, died from chronic diseases and some had diseases from the day they were born. They may have been in care because of issues relating to the disease as much as anything else. Such examples were not traditionally recorded. Since the HSE initiated its serious adverse incidents unit, unnatural deaths would have been reported as they were considered adverse incidents. Even within this, the deaths of children in play, for example, were not reported. If a child drowned on holiday, for example, that was not reported. No natural deaths were reported and prior to that there was no national reporting. We are dealing with the period 2000 to 2005.

There is no doubt that the Deputy is correct on the recording of every death in care, including natural deaths, and there was no central repository in place. There was a repository created by the HSE for adverse incidents. We accept the Deputy's comments that every death should be electronically recorded. These are the reasons.

Deputy Róisín Shortall

That would indicate the low priority attached to the child protection area.

Professor Brendan Drumm

To be fair, HIQA put out the guidelines. It was widely accepted that children who died of natural causes were not reported. We can argue whether that is right or wrong. Children who died of leukaemia or under other circumstances——

Deputy Róisín Shortall

There was also an acceptance on the part of the HSE that it was sufficient to offer homeless children an opportunity to call into a Garda station to find out if there was a bed for them at night. It was also considered appropriate that children would stay in hostels without supervision. That is part of the culture within the HSE that did not regard child protection services as an important area.

Professor Brendan Drumm

There are people in social services everywhere in the HSE who commit massively to the care of children. Children who end up in care are a very challenging group and are in care because of the challenges they face. They deserve every support they can be given but I do not believe the suggestion that the people out there in the HSE are not prioritising them. Some of the challenges with regard to hostels are very difficult.

Deputy Róisín Shortall

I beg to differ with Professor Drumm. The fact that the HSE had nothing better to offer many very vulnerable children than a hostel or to call into a Garda station to see if there was a bed available indicates the kind of culture in the HSE regarding this as a low priority.

Mr. Bernard Gloster

To be fair and put this in context, the Deputy is quite right in that there is a significant difficulty in responding to youth homelessness, which is a phenomenon in some of the larger citizens. When section 5 of the Child Care Act 1991 was implemented in the mid 1990s, it concerned the inclusion of that group which was not in part of the State care services and was, by virtue of circumstances, difficult to engage.

Deputy Róisín Shortall

I am talking about children in the care of the HSE when the executive has nothing more to offer them than a hostel bed at best. I am not talking about the problem of homeless children.

Ms Laverne McGuinness

There are two issues. There was a practice involving bed and breakfast arrangements but it has stopped in parts of Dublin. Some children placed in foster or residential care — primarily in foster care — may see placements break down. They may have had five, six or seven different foster care placements. The children may be dealing with social issues which they came to the service with. These children are not locked up and there is balance between liberty and the child's rights. The children do not wish to avail of services provided to them. On that basis, we provide outreach services. We have social workers out every night of the week in Dublin providing services on an outreach basis to teenagers and young adults who do not want to engage with the mainstream parts of our services.

With regard to out-of-hours services, in Dublin there is a 24-hour service in place; although it is not in place in the rest of the country we have emergency places of safety and if a child finds himself or herself in a particular circumstance at any time during the night, we have immediate arrangements in place whereby the person can be provided with accommodation contracted as part of foster care until such a time we can get him or her to our services the following morning. These are new improvements put in place over the course of the past 12 months.

Deputy Róisín Shortall

It is as if the executive has just come to the issue.

Ms Laverne McGuinness

The issues presented——

Deputy Róisín Shortall

It is always what the executive will do in the future.

Ms Laverne McGuinness

That has been done. It was contracted last year. We recognise that not everything is perfect in our child care services; there are gaps and deficiencies. We are addressing them as best we can within the resources we have available and on a priority basis. We need additional social workers, although we are delighted that 200 additional workers will be with us this year. The recruitment process is under way and interviews will be held next week. We hope to have a significant number of job offers made next month. That is part of the Ryan recommendations.

Deputy Róisín Shortall

What is the European norm on the number of social workers and how many do we require to reach that number?

Ms Laverne McGuinness

We tried to carry out comparison studies between Ireland and Northern Ireland. The range of services provided did not seem completely comparable. Based on the numbers we have of children in our care — we provide more services than this — the number is one in five. There are 1,200 social workers specifically working in child protection services and we will have 1,400 when the extra 200 workers are in place. I mentioned the social work survey because some social workers do not carry the same caseload as other social workers, so there is a productivity issue and we have addressed it in other parts of our services. For example, we could have a social worker with a caseload of ten, while in other parts of the country a social worker might have a caseload of four or five. We need to maximise our resource to ensure that they are carrying a systematic caseload. We have a target set for a minimum caseload of 15 and we are working towards that. We have done that in line with international practice.

When we have the additional 200 workers, it will be a significant improvement and it will help us carry on with our strategic change of programme and agenda, as well as the revised targets which we set out in our service plan this year.

Professor Brendan Drumm

There was a question about Northern Ireland. I do not have the figures here, but the number in Northern Ireland is significantly higher.

Deputy Róisín Shortall

Is there a European norm?

Professor Brendan Drumm

The number in England is significantly lower again than in Northern Ireland. We can give the Deputy the English number and the Northern Irish number. This question is very important because an issue arises in respect of fulfilling the regulations. We are in trouble at the moment in respect of children in care with a relative and whether they have an approved foster carer. Depending on the numbers, that can have a big impact on front line services. Dealing with that situation means pulling out social workers. For example, in Mulhuddart I have a good letter from some of the good GPs from a primary care team. They lost a social worker temporarily, although we managed to get it back, because that person had to be pulled centrally to fulfil the regulations in terms of visits——

Deputy Róisín Shortall

How many social workers does the HSE need to do the job properly?

Professor Brendan Drumm

When compared with England, they are 450 above where we are at the moment. We are getting 200 of those, but Northern Ireland is probably higher than that. There is no doubt about our statutory duties under the regulations. There is an endless amount of social care. There is very good data from across North America and Europe which show that only 10% of serious child sex abuse or physical abuse cases are reported. This has been shown through audits done on people when they are 30 or 40. That is frightening, but it occurs everywhere and is higher in eastern Europe. When we see some of the awful incest cases, it looks like 10% is being reported, so there is a huge challenge.

Deputy Róisín Shortall

But the HSE is not even able to deal with that 10% challenge.

Professor Brendan Drumm

That is the point. We are struggling to deal adequately with that 10%. If that 10% begins to rise, there will be a bigger demand on child care. We all know from scanning newspapers that this is a massive international problem, and the numbers required are huge.

Deputy Róisín Shortall

It has been known for a long time that it is a massive problem in this country. Why is it that nobody has been shouting in the HSE about additional resources being required?

Professor Brendan Drumm

We live within our budget, and every part of the HSE in the last three years has suffered significant reductions in the number of people across the system.

Deputy Róisín Shortall

At the height of the boom, the HSE was not even getting close to dealing with the problem. It did not seem to rate within the organisation's priorities.

Professor Brendan Drumm

We have carried out major surveys of what we require and we tried to optimise what we have, which is what we have done in other parts of the service. The Deputy asked about uneven caseloads and we can provide that information. That information is management information to us, but there is no reason the Deputy cannot have it.

Deputy Róisín Shortall

Are the witnesses in a position to tell us what the waiting lists are for social work services?

Ms Laverne McGuinness

I do not have that data at the moment. We will provide as much information as we can to the committee, even though there is an industrial relations dispute and it is hard to collect that data. We will give the committee the information that is available to us.

Deputy Róisín Shortall

What is the grade of the most senior person dealing specifically with child protection?

Ms Laverne McGuinness

I will go through the structure on child protection in each local health office. There are social workers, team leaders and principal social workers. The principal social workers are responsible. There could be five team leaders in a local health office and a number of social workers will be working to them on particular caseloads. They then have a principal social worker who would oversee the practice, carry out the management reviews of some of the files and would mentor them on what is required and supervise the work that is being carried out.

There is also a child care manager in one of each of the former board areas. Their job is to co-ordinate reports up and down through the system in respect of child protection concerns and so on. That system did not apply in the same way across the country, and that is part of the strategic review that we carried out. This is where some of the blurred responsibilities were identified and it is now to be addressed.

Above these levels come general managers and local health managers. Under the new system, there is a regional director of operations. At a national level, there is an assistant national director who will drive national policy and implementation to change the strategic direction on child care.

In short, every principal social worker and local health manager is responsible for the child protection within his or her particular area and cohort.

Deputy Róisín Shortall

What is the grade of the most senior person at a national level who has specific responsibility for child protection?

Ms Laverne McGuinness

That is the assistant national director.

Deputy Róisín Shortall

Who is that?

Ms Laverne McGuinness

The assistant national director reporting to me specifically on child and family services is Mr. Phil Garland.

Deputy Róisín Shortall

What is the HSE's intention in respect of the management structure there?

Ms Laverne McGuinness

I know there has been some correspondence in the newspapers over the last few days, but there is no specific plan.

Professor Brendan Drumm

There is no specific plan at the moment. We were working with the Minister on the appointment of a lead in this area, but I cannot provide any specific details on that.

Deputy Thomas P. Broughan

Is there no competition for the position?

Professor Brendan Drumm

This is something that has been announced by the Minister. We would need further interaction on that.

Deputy Róisín Shortall

It is obviously the view of Professor Drumm that there has not been a need for such a senior person.

Professor Brendan Drumm

The approach at the moment has been to appoint somebody for 12 to 18 months. The need of the organisation is to make the best use of any resources it has. If anybody can bring more to that, we should welcome it.

Deputy Róisín Shortall

Does it make sense to have a new child care tsar, as we read in the newspapers? Is there a need to put a focus on this area in the HSE and ensure that it gets a look in?

Professor Brendan Drumm

The question was brought up as to whether somebody should be within the HSE or outside the HSE. I am a strict disciple of integrated care. Deputy Fleming stated earlier that if we do not provide integrated services on the front line, then they will not be well provided. It is a great place as a professional to work if someone is doing his or her own thing as part of the structures. I believe it needs to remain integrated, but if the decision was made to take it out of the HSE, then it could clearly be argued that any single agency dealing with something would have a 100% focus of everybody in that agency.

In an organisation of our size there will always be competing challenges, but I do not agree that child protection has not got a focus in the last two years. I would suggest that it has been one of the top three issues on our agenda. When I was asked by individuals who were looking at my position about the biggest issues facing the HSE, I put child care at number one and care of the elderly at number two.

Deputy Róisín Shortall

With all due respect, it is absurd to state there is a need for an additional 500 social workers when the HSE has not recruited any in the past three years.

Professor Brendan Drumm

No, we will operate totally within——

Deputy Róisín Shortall

How does that constitute giving it any kind of priority?

Chairman

The point has been made.

Professor Brendan Drumm

Were the Deputy to consider recruitment in any part of the system within the last three years, she would find that recruitment into the HSE has only been on the basis of programmes of work that came through in respect of demography from the Government. While we now are getting 200 posts based on that, it is not within the remit of the HSE to do this. We operate within strict employment control guidelines.

Chairman

Before asking Deputy Kenneally to come in, I wish to clarify one point. Is the number 38 or 37? Ms McGuinness mentioned a figure of 37 earlier.

Ms Laverne McGuinness

It is 37.

Chairman

I am uncertain how that tallies with Ms McGuinness's earlier statement that 61 died from unnatural causes.

Mr. Bernard Gloster

To assist, three categories of information were collected. On 28 May, the category referred specifically to children who were in the care of the HSE at the time of their death and that number was 37. Nineteen of those deaths were from natural causes and 18 from what we categorise as unnatural causes. The figure to which the Chairman is relating in respect of the numbers of 61 and 63——

Chairman

Mr. Gloster should stick to the number of 61.

Mr. Bernard Gloster

Sixty-one is the number of unnaturally-caused deaths in children who were known to the child protection services but who were not in the care of the HSE.

Chairman

Then it could be the 38 under 18 who died of unnatural causes.

Professor Brendan Drumm

While I am interrupting Mr. Gloster, those two figures do come together. We were asked for a third block of information that was separate from anything else we had been asked for previously. This was not an updated figure and so those two figures are united.

Chairman

But is the number 38 or 37?

Professor Brendan Drumm

It is 37.

Chairman

My arithmetic still does not——

Professor Brendan Drumm

Thirty-seven is a completely separate figure. I think The Irish Times may have put it up as an updated figure. It is not an updated figure, as the number of 37 is a completely separate figure. It refers to children who, as we said at the outset, were in loco parentis under our legal care. The other children were children who were in contact with the child protection services but who were not under our legal care. One can then divide them into natural and unnatural.

Chairman

Ms McGuinness referred to foster care earlier. What is the total number of children in foster care at present?

Ms Laverne McGuinness

We have 5,300 children in care, 92% of whom are in foster care. Obviously, this figure varies upwards and downwards from time to time. From month to month, one can have more or fewer children in foster care.

Chairman

What was the position on 31 May?

Ms Laverne McGuinness

Because of the industrial relations issues, the last confirmed data I have to hand go back to November, when the number of children in foster care was approximately 5,000.

Chairman

How many of those were with unapproved foster parents?

Ms Laverne McGuinness

I do not have that information. I must revert to the committee with it.

Chairman

But that is information members need today in their assessment of the situation. Surely the HSE should know how many children are placed with unapproved foster parents.

Deputy Thomas P. Broughan

Moreover, how many of them are with families?

Ms Laverne McGuinness

How many are with families?

Deputy Thomas P. Broughan

I mean with their own families.

Ms Laverne McGuinness

A total of 32% are with relative carers, that is, with their extended families.

Chairman

How many files of children who are missing are incomplete or incorrect? I refer to children who are deemed to be in foster care but who are missing.

Ms Laverne McGuinness

I do not have information on that today but I can get information on it for the Chairman.

Chairman

All right. I then will ask one or two other questions to get a full picture of the situation. Has the HSE a system in place to, for example, record how many children in the care of the State have had an illicit drug problem or dependency in the past ten years? How many children have been the victims of serious assaults in the past ten years? How many children have attempted suicide while in the care of the State in the past ten years? How many children have gone missing while in the care of the State over the past ten years?

Professor Brendan Drumm

We will have to get those figures, including those in respect of attempted suicide.

Ms Laverne McGuinness

Such figures would have to be collected.

Mr. Bernard Gloster

They would have to be collected in the same manner as the compilation of the deaths of the three groups of people, that is, back into a retrospective manually-based system.

Chairman

Despite all the controversy, has there been no attempt to collect such data?

Ms Laverne McGuinness

Funding has been provided to acquire a child care information system and it is going through peer review. It is well recognised that computerised information systems in respect of child care are non-existent. Funding has been provided to us this year to get in place a new information system that will take account of all issues with regard to child care and to have that information. Everything else throughout the 32 local health offices is manual.

Chairman

If such fundamental information is not available or if the HSE does not even collate it despite all the hype one has been hearing in recent times, the entire situation is in chaos.

Ms Laverne McGuinness

As for the information we have, we have specific information that is part of a performance monthly monitoring report. It is reported on a monthly basis to the Department of Health and Children. Unfortunately, due to the current IMPACT dispute, we do not have updated information in that respect. I have to hand the December figures with regard to the allocated social workers, the number of children in our care, the number of children——

Chairman

Yes, but what of the specific questions I asked?

Ms Laverne McGuinness

Such information is not collated on a monthly basis as part of the performance review.

Chairman

And never has been.

Ms Laverne McGuinness

No.

Chairman

Does Ms McGuinness think it should be?

Ms Laverne McGuinness

We have looked and actually have added new additional performance indicators this year to be part of our service plan. While the information of which the Chairman speaks is highly relevant, we do not have the systems to collect it at present.

Chairman

Is it a fair assumption for me to make that, as Professor Drumm has stated, while there are very dedicated people who are working with young people at risk on a daily basis, their entire effort is being swallowed up by bureaucracy or the lack of effort at central level to collate information?

Professor Brendan Drumm

Perhaps the problem is that we have not been taking back enough information. I believe the opposite has been the case. Some of the questions the Chairman asked, such as the number of attempted suicides and so on, are rational questions and perhaps we have not been bringing back——

Chairman

Or is it that the State might say that ignorance is bliss?

Professor Brendan Drumm

I do not think so. We now have been through peer review in respect of the electronic system and it then will be more easily collectable. However, one could argue that it could have been collected by paper means as well.

Chairman

It should be collected regardless of the method, should it not?

Ms Laverne McGuinness

There is an issue with regard to social workers. Obviously, their job pertains to front line services and interventions and we have had a number of engagements with them regarding the level of reporting. We have had discussions in which they have expressed the view that much of their time is consumed by the reporting of information. Perhaps it does not get the same level of priority as does intervention with the children they perceive to be at high risk. We do not have the systems, which is what the new child care information system is about. It is about specifying the information required and we hope to have it in place over the next two years. However, funding has been provided this year for it.

Chairman

I have two final questions before bringing in Deputy Kenneally. On the first page of her statement, Ms McGuinness stated "Since 2008 we have been working on a strategy to fundamentally modernise child care and family services ... [with] the resources available". That point has been dealt with by Deputies Shortall and Fleming. Ms McGuinness also made reference to "the industrial relations environment we operate in". What did she mean by that?

Ms Laverne McGuinness

Sometimes there are changes we wish to make but we cannot make them as quickly as we would wish because of the industrial relations machinery we must go through. I will take as an example compliance with Children First. We had a meeting a number of weeks ago with IMPACT in respect of compliance with Children First. It is part of the machinery that has been established that the industrial relations environment is there. Although we want to make the changes, it must be negotiated through as part of the industrial relations framework. Another example might be if we wanted to reassign specific social workers from one area to another. We cannot do that without going through an industrial relations framework or machinery.

Chairman

Did Ms McGuinness state this has been going on since 2008?

Ms Laverne McGuinness

The industrial relations framework always has been with us. It constitutes an extra challenge to get over in terms of the level of flexibility we have when we actually try to bring about change. I will take as an example the strategic review that we have carried out. It can clearly be seen that there is a child care manager role and a principal social worker role and what we have set out is the best way forward, based on the external expertise we have bought in and that has been considered. While everyone sees clearly that this is the way to go, we must negotiate our way through that with the unions. We cannot simply make the change as we do not have that level of flexibility. We must negotiate our way through with the unions to bring about those changes.

Chairman

Ms McGuinness is painting a very bleak picture. First, she is telling members that the HSE is unable to get information up the line in respect of the most basic questions I have put to her. Is Ms McGuinness saying that even if it does want to change it is bogged down by industrial problems?

Ms Laverne McGuinness

I am saying with regard to changing the structure we have industrial relations issues. Currently, we are in an industrial relations environment where we are not getting information up and down the line. That does not just apply to child care, it applies in the same way to disabilities and mental health.

Chairman

That is only for the past three months.

Ms Laverne McGuinness

That is since January. We have other information since December. We have not collated, on a national basis, some of the information the committee has spoken about. In regard to missing children in care, a joint protocol was signed by the chief executive and the Garda Commissioner last year. It is due for review and has been very effective in its operation.

Chairman

We cannot get information today about foster care.

Ms Laverne McGuinness

I have information about foster care but the Chairman is looking for specifics. I have a full foster care report which I can provide because a national audit of foster care was carried out. It shows the level of allocated and unallocated social workers, the number of assessments and the number of children who are currently awaiting assessments which have not been carried out. I have the figures which I can give to the Chairman.

Chairman

Would Ms McGuinness provide the other information I sought as quickly as possible?

Professor Brendan Drumm

On the other information, to be fair to people on the ground issues like attempted suicides or drug dependancy are not collated centrally. It is obviously on the files locally. People are dealing with these cases every day but it is not collated centrally. It will be when the new electronic system is introduced.

Chairman

My final question is for Professor Drumm. It is reported in the Irish Examiner that he feels this area should be outside the HSE. Has he been misquoted? Am I misinterpreting what was said? I have not read the article but I have heard reference to it.

Professor Brendan Drumm

I will respond the same way I responded to Deputy Shortall. As I said, I am a zealot on the issue of providing care through an integrated system. It is the only way one will get services provided to people. It is very difficult for everybody who works in the system to change in order to do that. There are huge challenges because we all like to work in silos, including myself — I loved working in one once upon a time. If this is seen as an area which people want to take off, the HSE has a huge remit. No other country's health service is that broad. I do not believe it is within our jurisdiction to make that decision. If one can deliver services in an integrated manner one is much better off. If we want to fix this problem tomorrow, the next day or in the next three months, we have a plan for the next two years in terms of trying to optimise child care services. If one wanted to fix this in the next three to six months then one might say we should put it out there and put another 400 or 450 social workers in place. If one had that resource to throw at it one would certainly resolve it quicker.

Chairman

Father McVerry, who is on the ground, said we need another 1,200.

Professor Brendan Drumm

As I said, I suspect that figure will grow and grow because more people will come forward. One good thing out of this exposure has been that it probably does raise people's capacity to look over the fence and say, "We should be worried about those kids". As we know, we only get 10%. I suspect that figure will rise. He may not be far wrong.

Ms Laverne McGuinness

I can give the Chairman the information he requested on foster carers. I will give a caveat. The information covers a point in time so it is not the most up-to-date information. The number of approved foster carer families at a point in time was 3,302. There were 799 outstanding incomplete assessments. Full assessments have not been carried out, 86% of which relate to relative carers. That figure will have improved since we carried out the national audit in October 2009. There are two specific local health offices, Dublin north-cental and Dublin north-west, and specific plans have been put in place to address that. Those figures will have changed since then. The information is at a point in time.

Professor Brendan Drumm

We will update those figures for the committee. I do not want to prejudge it but I hope to have figures in the relatively near future and we will update them for the committee immediately once we have them.

Deputy Thomas P. Broughan

If people foster children from their families, they have not been approved.

Ms Laverne McGuinness

They are incomplete assessments. They would not have the full assessments carried out.

Chairman

Surely that shows a very dysfunctional service.

Ms Laverne McGuinness

In regard to social workers carrying out priorities, it is statutory compliance regarding the assessment of relatives who are foster carers. The priority would have been in areas other than relatives. That is what the audit shows. Sometimes when one goes about reading these things out one identifies the problems in order to try to address them and put plans in place to do that.

Professor Brendan Drumm

I said earlier that problem can be addressed but at significant cost to front line services. There are local health managers who are balancing whether the primary care team should be trying to prevent these problems from arising and children from going into care or whether they should be assessing families who have had children.

Deputy Róisín Shortall

We should have family support services to deal with problems at an early stage.

Professor Brendan Drumm

Exactly. If one had enough people one could sort out a lot of this.

Deputy Róisín Shortall

The HSE does not put the resources into family support.

Professor Brendan Drumm

We do not put resources in place. We deal with the resources we are given and to be fair we have reduced our costs massively. We will put it anywhere we can.

Deputy Róisín Shortall

You are washing your hands of it.

Deputy Brendan Kenneally

I welcome the witnesses. I will be fairly brief. We have heard a lot today about resources. It is the one word which comes up when any witnesses come before us. A lot of the problem is the way the resources which are available are managed, rather than bringing other resources into a system which is not functioning properly. Ms McGuinness mentioned, in reply to a question, that there were industrial relations difficulties in changing the structure. I fully sympathise with that and it may be part of the problem.

She said that over the past ten years there were more than 200,000 child referrals to the HSE. She has told us more than once that 1,200 social workers are involved in child protection and social services. If one follows those figures through it means that each of the 1,200 social workers over the ten year period had 170 cases or 17 per annum, which is a new case every three weeks. If one breaks it down like that, it does not seem to be a very onerous workload. I accept some cases will take a short period of time to deal with and others will be ongoing and take up a lot of a person's time. She also said there were child protection concerns about only 20,000 of the 200,000 which seems to reduce the issue even further. If the 1,200 social workers were properly managed and dispersed we would have a good system in place.

Professor Drumm has said on numerous occasions before this committee that, in all the areas of the health services, the HSE is over-resourced in some parts of the country and under-resourced in others, and that he has been trying to address that. I assume he will address that with the 200 extra social workers he is recruiting. Is the problem with social workers at the current time productivity or that they are in the wrong places?

Professor Brendan Drumm

The Deputy is correct. We have mentioned resources today. It is the first time in my life I have mentioned resources; I have been accused of the opposite by people in the system. Child protection is an area where resources will constantly be a huge issue. We have very comprehensive information because we went out in 2008 as we had exactly the type of figures the Deputy raised and were trying to make sense of them. They raised serious concerns about how productivity varied across the system and have shown up significant issues which we are trying to resolve. The Deputy it correct, the extra 200 social workers are part of that. Resources are not the only requirement. We can certainly improve the use of resources. That is what our plan for the next two years is part of. If we want a quick fix, which we should go for if we have the money, resources could be used to resolve it more quickly. Does Mr. Gloster wish to comment on the workloads?

Mr. Bernard Gloster

I understand how the breakdown might look in terms of one every three weeks but it might be useful to explain more comprehensively the figures and the workload of a social worker.

On average, 20,000 reports are received annually, although that figure can be higher or lower in some years. These reports require attention in order to determine whether they should be subject to initial assessments. The work involved in reducing the 20,000 reports to 2,000 child protection cases is often complex because the social workers have to enter into contact with various professionals before a judgment can be made on the level of early risk.

In addition to these 20,000 annual reports, there are approximately 5,500 children in care in any one day. The regulatory requirements and work attaching to each of these children form part of a social worker's caseload. In regard to Deputy Shortall's question on children in care who present to the homeless services, responding to this sort of crisis also takes up a significant amount of the relevant social worker's time and resources. Social workers' caseloads therefore involve a significant element of reactive work alongside planned and regulatory requirement duties by virtue of the complexity of the issues which arise for the young people concerned.

We have developed a pretty good instrument for allocating social work resources in respect of the 200 new staff. Of course, we could do more if we had additional resources but I do not want to give the simple impression that more equals no problems or difficulties. Child protection and children and teenagers in care require work of a complex nature and it is the experience of most jurisdictions that significant challenges cannot be avoided and, unfortunately, tragedies will occur.

Professor Brendan Drumm

We are not arguing there is no need to even out productivity because gains can be made.

Deputy Brendan Kenneally

In the HSE's initial response, it stated that its examination of the area has thrown up significant issues. Can Professor Drumm outline some of these issues?

Professor Brendan Drumm

Does the Deputy refer to productivity?

Deputy Brendan Kenneally

Yes.

Ms Laverne McGuinness

We can provide the exercise to the committee. It involved a survey of the case files in every local health office conducted by one of our local health managers to determine types of cases and what was being counted.

Among the discrepancies discovered is that productivity does not always relate to the number of cases with which a social worker deals. Social workers might have a small number of cases in certain areas and a large number in others. Issues arose in regard to how we count the number of children on our registers. In some cases, two children from the same family were counted as one because the social worker was dealing with the family. Different policies and protocols for risk assessment were in operation.

Deputy Róisín Shortall

These are management issues.

Ms Laverne McGuinness

They are management issues but the social workers were operating separately and therefore they are also service delivery issues.

Deputy Róisín Shortall

Why did the HSE allow them to operate separately? The service needs to be managed properly.

Ms Laverne McGuinness

We inherited a system which needed a national focus. Different systems were in operation in Donegal, Roscommon and Kerry. We have sought to identify the inequalities and the best standard models and practice through the social worker survey and the task force report, which is in effect a user manual for social workers. Case conferences were previously conducted in different ways throughout the country but we now have a national system for them. A national duty system for social workers is being implemented. We have also applied a national standard for the duties and roles which are specific to social workers.

We needed a diagnostic tool to identify the problems so that we could introduce a standard way to deal with issues as they arose and to bring about change to child care services.

Deputy Brendan Kenneally

How much progress is being made on standardising procedures?

Ms Laverne McGuinness

The task force report on the full standardisation programme is due to be published on the Internet in the next few days. This is a technical document but it will reveal where inconsistencies in practice occurred. A considerable proportion of the at-risk assessments, care planning and transfer files and everything else that has a significant impact on children will have a standard formula.

Deputy Brendan Kenneally

How close is the HSE to this objective?

Ms Laverne McGuinness

The roll-out programme takes two years.

Deputy Brendan Kenneally

From now.

Ms Laverne McGuinness

We have already started on the journey. Three standards have been nationally applied and the next ones will be applied——

Professor Brendan Drumm

It will be nearly two years from now before it will be complete. The programme was examined by HIQA and everybody agrees it is a two-year programme. Although it is not an immediate fix, it will maximise the productivity we can get out of available resources. In the present environment, this is an issue with which we must contend notwithstanding the 200 new staff.

Deputy Brendan Kenneally

When does Professor Drumm expect the 200 new appointments to be made?

Professor Brendan Drumm

By the end of the year.

Ms Laverne McGuinness

We intend to have 200 in place by the end of the year. Interviews will be held next week and we hope to make job offers in July and the appointments will be made at the earliest opportunity thereafter, although much depends on the notice period which appointees must give to their current employers. We have compressed the period of time in which they will have to make their decisions. Almost 160 new professionals will also be graduating from college around this time.

Deputy Thomas P. Broughan

I welcome my HSE colleagues. Can we be given a geographical breakdown of the numbers in care?

Ms Laverne McGuinness

We can provide the breakdown of the number of children in care and foster care by region, with the caveat that the figures represent a point in time and can change. Between 90% and 92% of our children are in foster care and the figures are as follows: Dublin north-east, 1,237; Dublin mid-Leinster, 1,310; the south, 1,535; and the west, 1,048.

Deputy Thomas P. Broughan

More than half of children in care are in the aforementioned Dublin regions.

Ms Laverne McGuinness

That is correct.

Deputy Thomas P. Broughan

Did issues arise in respect of allocating staff resources to the regions in which the largest numbers of children were in care?

Ms Laverne McGuinness

In respect of the additional resources being invested this year, namely, the 200 social workers, a resource allocation model has been developed to take account of deprivation, population, number of children in care, etc. The 200 new staff will be allocated on the basis of need.

Deputy Thomas P. Broughan

Based on what Ms McGuinness has said it appears that urban areas were starved of resources in the past because whatever was available was spread throughout the system even though workloads were lower in some areas than others.

Ms Laverne McGuinness

Whether in child care, mental health or disability services, resource allocation was based on need. We did not have a specific model for allocation.

Deputy Thomas P. Broughan

Is McGuinness arguing that the dysfunctional management of child care is a legacy of the dysfunctional nature of health boards? Effectively that is what she is saying.

Ms Laverne McGuinness

Yes, the Deputy is correct. The number of social workers in each of those areas, be it Dublin north-east or Dublin mid-Leinster, was an inherited position.

Professor Brendan Drumm

The Deputy is correct that there is not a proper overlie of the workload in our data. It is difficult to sort that out from new posts.

Ms Laverne McGuinness

The social workers survey, which is the one carried out in 2008 and finished in early 2009, shows the number of social workers in each local health office, the number of children they have and levels of deprivation, based on the SAHRU index. It is a very comprehensive document. That is what we tried to do to see where were the equities and inequities.

Deputy Thomas P. Broughan

Of the 5,300 children in care, according to the HSE's most recent figures, how many are cared for to some extent or are dealt with by the Garda Síochána through the JLO system and youth probation service? Does Ms McGuinness have figures on that?

Ms Laverne McGuinness

I do not have those figures. There would be figures locally with regard to child care committees because there is an interaction with the youth justice services. It would be locally——

Deputy Thomas P. Broughan

If one goes back to the recent tragic deaths of Daniel McAnaspie and children like him, Ms McGuinness is saying that, in a sense, we do not really have an overview of the children who are most at risk and in the greatest danger.

Ms Laverne McGuinness

In relation to children at risk, all the children are risk assessed and have allocated social workers and specific interventions are put in place around them. We know specifically in respect of each individual case file whether there was interaction with the justice system. The social worker will have that information on the case file. It is not held centrally on a database. I do not have central figures.

Deputy Thomas P. Broughan

There is no overview of the liaison with the Garda. There are also children on the waiting list.

Ms Laverne McGuinness

Yes.

Deputy Thomas P. Broughan

That is the problem.

Ms Laverne McGuinness

I do not have information in relation to liaison with the Garda.

Deputy Róisín Shortall

That is not the question.

Ms Laverne McGuinness

I do not have information, in a central way, which shows the level of interaction with the justice services there may have been with some children or young adults.

Deputy Thomas P. Broughan

Ms McGuinness will accept that in the case of children whom the authorities clearly failed, there does not seem to have been a co-operative service in place. Such a service simply did not exist.

Ms Laverne McGuinness

There are local services which take place with youth justice services and the child care services where there is a collaboration and information and knowledge is shared. This is at a local level throughout the country.

Deputy Thomas P. Broughan

When help was needed in the case to which I referred and other cases it was not available.

On the incomplete assessment in respect of the 32% or nearly one third of children who are in the care of family members, Ms McGuinness is saying that in the vast bulk of these cases the children were not assessed. Was there any interaction between the HSE and the Garda Síochána and other similar bodies in that area?

Ms Laverne McGuinness

The figure of 86% refers to the group of 799 children, not the national figure. What would have happened — obviously we have gone back over a period of time to come up with some of the assessments — is that there could have been a child with a relative for the past 13 years. It could have been circumstances that might have happened in an emergency situation.

Deputy Thomas P. Broughan

What was very stark in all the cases in question was that no assessment was done if a sister, aunt or other family member took over the care of the child.

Ms Laverne McGuinness

Initial assessments may have been carried out. There would certainly have been interaction with the Garda Síochána services, at local level or whatever. There is a protocol that a full assessment has to be carried out. That entirety of the assessment was not carried out.

Deputy Thomas P. Broughan

What was the timeframe?

Ms Laverne McGuinness

Mr. Gloster may have to correct me but I believe there is a timeframe of six months in relation to carrying out the full assessment from the time initial assessments were carried out. It would not have been the case that automatically nothing was carried out. There would have been initial assessments and interactions locally with the Garda with regard to the foster care relatives. However, the specific formalities of foster care assessment, as it stands in the legislation, would not have been carried out fully in relation to that number of cases but that matter is being addressed as part of the implementation plan.

Professor Brendan Drumm

Deputy Broughan asked a question, which we did not answer, about the application for an increase in social workers in our estimate.

Ms Laverne McGuinness

As part of the estimates bid, we put in applications for various services. Social workers would have been included as part of the estimates.

Deputy Thomas P. Broughan

I will raise two related points to which we may have to return in future meetings. What is being done in respect of 24-7 services for the most vulnerable children and in the related area of young adults aged between 18 and 21 years?

Mr. Bernard Gloster

In relation to 24-7 services, essentially two services are available, one is the care service for the children already in care and the other is that the Garda has access, albeit limited, to dedicated places of safety. If gardaí encounter a child or young person whom they consider to be in need of care, they place the child in question, under the provisions of the Act, and the HSE picks it up on the next working day. That service is provided by a foster care agency using a dedicated number of families. It arose out of the issue and criticism, if one likes, of the inappropriateness of children who are encountered by the Garda needing care and protection sometimes having to spend time in Garda stations.

Deputy Thomas P. Broughan

That does not sound like 24-7 care. There does not appear to be any focal point so that a garda would know that if he or she rang a certain person the child in trouble would be safe. The HSE does not seem to have such a system.

Ms Laverne McGuinness

In relation to that particular protocol, it is an out-of-hours, foster care service. We have shared that information with the Garda. For each of the local offices where this system operates all the gardaí know about it and we consulted them at the time because obviously there may have been a preference to have social workers on call 24-7, as applies in Dublin. This was an arrangement put in place based on the resources that we had available to us. What we have is an out-of-hours place of safety for children. The Garda is familiar with and aware of the service and has been consulted on it. Gardaí are, therefore, aware of its operations and the service has been operating effectively. We have had it in place for almost one year throughout the country.

Deputy Róisín Shortall

Is it a hostel?

Ms Laverne McGuinness

No, it is not a hostel. It is an out-of-hours service. We have pre-approved foster carers and if a child presents during the night, he or she can be taken to a place of safety with a foster carer.

Deputy Róisín Shortall

Is the HSE meeting current demand?

Ms Laverne McGuinness

I can get some statistics for the Deputy.

Professor Brendan Drumm

We appreciate the opportunity to come before the committee. I hope we have brought some clarity. These are very difficult situations. The families in question are very challenged and it is a huge challenge to everybody who works with them. We accept that there are deficiencies that have to be worked on, many of which have been highlighted at this meeting.

On the Chairman's question about the Irish Examinerand Deputy Shortall’s question about where this should rest, the HSE, as an organisation, has been in the eye of many a storm. I will state here, because of the eminence of this forum, that the organisation is at the end of a five year period and there are no easy answers to the questions as to where things are best dealt with. There is no doubt that in an ideal world it would be best dealt with in an integrated system.

We do many reviews. Maybe what we need is a review that asks the following questions. What is the HSE structure? Has it delivered anything above and beyond what the older system delivered? Is it a better structure? Does it have faults? What can we fix? Where does child care fit into it? We have an awful lot of comment and our staff take an awful lot of negative comment at times. Surely there is an opportunity to ask whether the organisation has reached a point where some of those questions need to be answered in a wider vein. I put that on the committee's table.

Deputy Róisín Shortall

We could benefit from Professor Drumm's experience when he leaves the job.

Professor Brendan Drumm

It might be covered by secrecy. As the Deputy knows, we are supposed to be a highly secretive organisation.

Chairman

I thank Professor Drumm and his colleagues for coming in this morning. At no stage was there any suggestion that information was knowingly kept from us. However, there is a responsibility on organisations — not only the Health Service Executive. When information is given here which at the time is believed to be correct but needs to be corrected, we have a responsibility to ensure that the record is put right.

I have another point to make and do not allude to the HSE. When we seek information from public bodies we wait a long time to get that information. One example is the Department of Finance. We are still awaiting documentation relating to that famous night of 29 September 2008. We sought that information and still have not got it four or five weeks down the line. I believe we need to give out a signal that if we seek information that should be readily available, we should get it quickly and fully.

I thank the witnesses for coming along. The responses this morning were on the whole comprehensive and satisfactory. I know we will get further information from them.

The witnesses withdrew.

The committee adjourned at noon until 10 a.m. on Thursday, 17 June 2010.