asked the Minister for Health the number of lists of suspected and actual cases of non-accidental injury to children maintained by the health boards in each of their areas in accordance with his Department's guidelines which were published in 1980.
Ceisteanna—Questions. Oral Answers. - Children Injury Cases.
5.
The number of lists is as follows: Eastern Health Board, 10; Midland Health Board, 2; Mid-Western Health Board, 3; North-Eastern Health Board, 3; North-Western Health Board, 2; South-Eastern Health Board, 4; Southern Health Board, 5; Western Health Board, 3.
Arising out of——
This is a statistical question and does not allow for elaboration by supplementary questions.
With respect, arising out of the Minister's reply, I have a question directly related to the statistics which the Minister has provided and I should be given an opportunity to ask that question.
Your last questions were not relevant. The Deputy may now ask his question and I will tell him if it is relevant.
In relation to the number of lists to which the Minister referred as being maintained, could he indicate if there is a central list maintained to coordinate all the information that is available? If a child is named as being at risk in an Eastern Health Board area and if the parents move into another health board area is there some central registry incorporating all the information contained on those lists?
That is a separate question.
It is a separate question and it arises under one of the other questions also.
If the Minister is prepared to answer the question surely he can do so.
It will arise under one of the other questions.
6.
asked the Minister for Health the number of children named as being suspected or as actual cases of non-accidental injury on the lists of children at risk of such injury maintained in each of the health board areas.
The numbers currently on the lists maintained in each health board area are as follows: Eastern Health Board, 143; Midland Health Board, 58; Mid-Western Health Board, 40; North-Eastern Health Board, 24; North-Western Health Board, 11; South-Eastern Health Board, 112; Southern Health Board, 82; Western Health Board, 89.
Is the Minister satisfied that all children at risk are being registered? I draw the Minister's attention to a recent "Today Tonight" programme on RTE on which it was clearly indicated by some social workers that all children at risk from non-accidental injury were not being registered.
That is a separate question.
The cases are referred to the director of community care by hospitals, general practitioners, social workers, public health nurses, teachers, gardaí, community welfare officers, the psychiatric service, neighbours and others. The lists are also reviewed regularly and where the initial suspicion has proved to be unfounded the details are removed from the lists.
Is the Minister satisfied that all the personnel working in the community care area have the necessary training to determine if names should be included on those lists?
The director of community care is responsible for the maintenance of the lists in a community care area. The people who refer the cases to the director come, as I stated, from a wide range of backgrounds because of their involvement throughout the community.
Would the Minister confirm that the directors of community care, who have ultimate responsibility in this area, have no specialist training to make those decisions? Could I draw the Minister's attention to his own guidelines which require health boards to provide specialist training and ask him if any action has been taken to ensure that those guidelines are being properly followed by health boards?
The guidelines are disseminated, reviewed from time to time and brought to the attention of members of community care teams.
Is the Minister's Department aware of any health board who have provided any specialist training of any kind for any members of the community care teams including the directors of community care?
That does not arise on this question. This is a statistical question. It asks the number of children named as being suspected or as actual cases of non-accidental injury on lists of children at risk of such injury.
It arises out of the Minister's reply.
It relates to a different matter. The Deputy raised that matter on a previous question. It does not arise on this question.
The Minister referred to the dissemination of information. What efforts are made to ensure that the list is up to date by ensuring adequate dissemination of the guidelines? The Minister mentioned teachers. At what point do teachers come across this? Does the Minister feel there is need for public involvement, the involvement of non-specialised personnel, who may be able to refer cases and who might then be included on this list? Is there sufficient public knowledge that the director of community care is the person who should be notified of a suspected case of non-accidental injury?
I am not sure that members of the public and of the community generally could be further advised. I will certainly pursue that matter further following the points made by the Deputies.
Is it the Minister's intention to provide a telephone number in the different areas where a member of the public could contact a source to have such a matter attended to? The situation at the moment is that if a member of the public reports a case to a social worker there is no guarantee that that social worker will follow it up and a member of the public has no guarantee that that case will be properly handled. Will the Minister say if he will provide a well publicised telephone number?
If I am not mistaken I believe there is a question on the Order Paper of a 24-hour call service which I will deal with when the question arises.
7.
asked the Minister for Health the number of children who have been taken into care by each of the health boards in each of the last five years; and the number of fit person orders that have been obtained by each of the health boards in those years.
8.
asked the Minister for Health the number of children who have been taken into care by each of the health boards in each of the last five years as a result of suspected or actual non-accidental injuries inflicted by parents.
I propose, with the permission of the Ceann Comhairle, to take Questions Nos. 7 and 8 together and since the replies are of a statistical nature to circulate them with the Official Report. Following are the statistics:
|
Total number of children taken into care 1977-1981 |
||||||
|
Health Board |
1977 |
1978 |
1979 |
1980 |
1981 |
No. of Fit Person Orders that have been obtained |
|
Eastern |
349 |
433 |
455 |
462 |
583 |
296 |
|
Midland |
29 |
37 |
46 |
50 |
56 |
16 |
|
Mid-Western |
51 |
65 |
87 |
113 |
120 |
31 |
|
North-Eastern |
31 |
41 |
49 |
62 |
63 |
20 |
|
North-Western |
24 |
59 |
65 |
73 |
100 |
23 |
|
South-Eastern |
69 |
71 |
116 |
84 |
116 |
30 |
|
Southern |
91 |
105 |
132 |
106 |
124 |
90 |
|
Western |
110 |
130 |
119 |
140 |
155 |
70 |
|
No. of children taken into care as a result of suspected or actual non-accidental injury inflicted by parents. |
|||||
|
Health Board |
|||||
|
1977 |
1978 |
1979 |
1980 |
1981 |
|
|
Eastern |
6 |
9 |
9 |
10 |
28 |
|
Midland |
4 |
12 |
10 |
12 |
15 |
|
Mid-Western |
0 |
0 |
1 |
3 |
5 |
|
North-Eastern |
2 |
3 |
3 |
33 |
3 |
|
South-Eastern |
4 |
4 |
14 |
7 |
9 |
|
Southern |
6 |
8 |
10 |
4 |
10 |
|
Western |
3 |
6 |
6 |
9 |
6 |
|
North-Western |
0 |
0 |
2 |
1 |
2 |
Arising out of the non-reply of the Minister could he indicate——
The Deputy can only ask a supplementary question arising out of the reply.
I cannot ask supplementaries on statistics which the Minister has not given me.
Normally no supplementary questions are permitted on statistical questions. They are often submitted in tabular form and the Deputy has to wait until he sees the reply and can ask a supplementary question in relation to them on another question.
The supplementary question I wish to ask will arise under the next question so I will not make life any more difficult for the Chair than it is.
There are 48 figures in each of the two tables circulated.
9.
asked the Minister for Health the number of children at present regarded by each of the health boards as being at risk from non-accidental injury inflicted by parents; and the criteria health boards use for determining whether they should have such children taken into care.
In general, health boards do not keep lists of children termed as "children at risk". However, lists are maintained of children suspected of having had non-accidental injury inflicted on them by parents and as such they are children who are, of course, subject to the risk of further injury.
The number of such children for each health board is: Eastern Health Board 105; Midland Health Board, 47; Mid-Western Health Board, 32; North-Eastern Health Board, 20; North-Western Health Board, 8; South-Eastern Health Board, 88; Southern Health Board, 40; Western Health Board, 71.
In determining whether a child at risk of non-accidental injury should be taken into care health boards act on the recommendations of the professional workers involved in the particular case. In such cases, child and family are kept under constant observation by members of the community care team and receive appropriate help and advice. The decision to take the child into care is generally taken when the board, on the recommendation of the professional workers involved, consider that the child cannot, with safety, be maintained at home.
The Minister I am sure will correct me if I am wrong but did he make the extraordinary statement that children who are simply at risk are not maintained on such a register unless they have already been battered on at least one occasion? Could the Minister clarify the first part of his reply if that is what he meant?
Perhaps I should read again what I said so that the Deputy can absorb very carefully what I said and be clear about what my reply was. I did not say what the Deputy suggested and neither did anybody else suggest that. The problem about keeping a total list of children at risk is knowing which children will be at risk. Obviously, the health boards will have suspicion of cases where non-accidental injury has been inflicted. Obviously other children in families associated with an incident like that or where there are other incidents of violence will be included on this list. It is really a question of how to determine when a child is at risk.
The Minister is saying that it is not necessary for a child to be battered and beaten on at least one occasion before the child appears on the list. I would not want any confusion to arise out of that. Is that what the Minister is saying?
Yes, of course. I went on to elaborate that where cases occur of children having received non-accidental injuries, other children in the families concerned would come on to the list then.
The Minister referred to constant supervision — I presume that by that he means constant social worker supervision — being made available in relation to children at risk. Might I draw the Minister's attention to the fact that there is considerable public disquiet regarding the level of supervision and could the Minister indicate what constant supervision means? On how many occasions, for instance, would a family in which there were children at risk be visited by a social worker?
That would be a matter for the judgment of the professional staff involved. The social workers and other community care workers operate as a team in that respect.
I would remind the Minister that in 1981 three children died as a result of non-accidental injuries. There were two court cases in 1981 arising out of the deaths of young children in which parents were convicted of criminal offences. There is one case pending this year. I suggest it is a public scandal that three children are dead as a consequence of non-accidental injuries, of injuries that were inflicted by their parents. Is the Minister concerned about this? Does such a situation not indicate that either the level of supervision is insufficient or that the criteria applied in determining whether children are at risk is inadequate and should be investigated.
The Deputy asks that question specifically in the next question so perhaps he will wait until I have given the reply to that other question.
The Minister has said that children at risk are provided with supervision but he has not clarified the extent of such supervision.
The word he used was "observed".
To what extent, then, are children at risk observed?
This operates on the competence of the community care team and not only on their supervision and observation but also on the information that comes to them from other workers within the community. I am familiar with cases where, for instance, the supervisor of home helps often brings to light cases of children who are at risk. Therefore, there is co-ordination and co-operation between members of the community care teams and other workers in the community in keeping an eye on such cases.
Can the Minister confirm that, if a member of the public reports an instance in which he thinks a child is at risk, that child's name automatically is put on the at-risk list? I am aware of cases in which such situations arise at weekends when members of the professional staffs are not available with the result that by the time the child is examined there is no evidence of non-accidental injury.
As I indicated in reply to an earlier question, as soon as a member of the public brings any such case to the attention of a member of the community care team, the matter is then considered. Obviously, the case should be followed up at that stage, but if the Deputy knows of instances in which there is not follow up I should like to have the specific details concerned.
10.
asked the Minister for Health if he will amend his Department's guidelines on non-accidental injury to children and include in the section entitled "The Legal Position" a statement that a health board may apply to the High Court to have children at risk made wards of court and taken into care in circumstances in which it is not possible to seek a care order pursuant to the provisions of the Children Act, 1908.
11.
asked the Minister for Health whether he will undertake a major re-examination of the services available to protect children from non-accidental injury; and whether he will as a matter of urgency require all social work personnel attached to each of the health boards to undertake an immediate review of the action that should be taken in respect of all cases of non-accidental injury to children or suspected non-accidental injury that have come to their notice over the past five years.
With the permission of the Ceann Comhairle, I propose to take Questions Nos. 10 and 11 together.
My Department have already initiated an examination of the operation of the guidelines on non-accidental injury to children. Directors of community care have responsibility for monitoring and co-ordinating the management of non-accidental injury cases in their area. They have been asked to consult with relevant members of their team as well as local hospital staff and to report on the adequacy and effectiveness of the procedures outlined in the guidelines in the light of experience to date. This consultation process will of course include social work personnel.
The Deputy's proposed amendment to the section of the guidelines dealing with the legal position will be considered in the context of this review. I might mention however that I shall be introducing a new, comprehensive Children's Bill in this House later in the year and it is likely that the new provisions will obviate the need for the type of proceedings which the Deputy has in mind.
In relation to Question No. 10, I would draw the Minister's attention to social workers in the employment of health boards being frequently advised in cases in which children are at risk that under the existing legal position a health board cannot have a child taken into care? Would the Minister consider as a matter of urgency circulating all social workers, health boards and solicitors acting for them, that children who are in need of care can be made wards of court and taken into care by way of that procedure?
I would have no objection to doing that but I am advised that it would be a particularly cumbersome way of dealing with the situation. I have no objection to advising people of the availability of the remedy referred to by the Deputy.
I am not suggesting that that remedy should always be used. Where the Children Act of 1908 applies, it can be used. I am asking the Minister to circulate the relevant personnel concerned regarding the availability of the wards of court procedure. I am being contacted constantly by social workers from all parts of the country who are being given incorrect legal advice and because of that children are at risk. In these circumstances I am asking the Minister, rather than wait for a review to be concluded, to take immediate action, action of a fire brigade nature, to ensure that all persons dealing with children who are at risk, whether in terms of physical injury or otherwise, are aware of the legal procedures available to them to ensure that such children are properly protected.
I will be quite happy to do that.
Would the Minister accept that there is a grave urgency about all these matters and that the reference to the review in reply to so many of these questions today is to some extent unacceptable on this side of the House? Will the Minister confirm that the review he is talking of was initiated as early as January and that it was anticipated that there would be an early response on immediate action to be taken within the Department arising out of their examination of the more dramatic cases reported in the recent past? Is the Minister prepared at this stage at least to confirm that the child care Bill will not necessarily deal with the guidelines in this area but that any revision in that respect is something that could go ahead immediately?
I have not suggested that it is necessary to await the publication of that Bill. I merely pointed out that, in relation to the legal remedy suggested by Deputy Shatter, the Bill would cover that position more comprehensively. That was only by way of a point of information. So far as the review is concerned, it arose out of the most unfortunate and tragic incidents of the deaths of three children due to physical abuse. I hope to have that review completed as quickly as possible.
Is it not a matter of grave public concern that three children died last year as a result of non-accidental injuries and can he indicate how soon the review will be completed? Can he indicate also whether it is now the intention to set up a central register in relation to the list of non-accidental injuries to children and, if so, whether that forms part and parcel of his review?
I will be very concerned to ensure that the review is completed as quickly as possible. So far as the question of communication between health boards regarding the names included in the lists of the individual health boards is concerned, I will ensure that that matter is considered in the context of the review.
Will the Minister indicate the position in relation to co-ordination within health board areas of existing lists? If the Minister is considering the establishment of a central register containing the names of all children at risk in the country will he indicate whether such a register exists within each health board area at present in the context of all the lists maintained by the Eastern Health Board or other boards?
I did not say that I would undertake to set up a central register. I want to be clear about that because this is a matter of considerable importance to individual families and their children. Health boards are careful about the lists and names which are included. The establishment of a central register is a matter which should be considered seriously. We should consider whether it is valuable or necessary and that is why I indicated that the best approach may be to ensure that if a person whose name is on a list in one health board area moves to another area that the other health board is informed. I will ensure that the matter raised by the Deputy is considered in the context of the review.
I should like to know why the review of these cases took place after the court hearings rather than following the incidents. Does that procedure not raise serious questions about the review procedure within health boards?
Initially an investigation was undertaken into the position following the deaths. After that the matter was sub judice for some time and subsequently a full report was available from the court. As the Deputy has stated this was initiated in January and it is something she would have been close to at that time. On the basis of the findings a more comprehensive review was set up.
The Minister indicated that within each health board area there is more than one list—I believe there are at least ten lists of children at risk maintained by the Eastern Health Board— and I should like to know the extent of co-operation or co-ordination that exists within the health boards in relation to those lists. In other words, if a family moves from one part of Dublin to another part of the county how is that noted? Is there a central register within health boards? If that register does not exist does the Minister agree that the maintenance of lists is grossly defective and does not provide adequate information to protect children?
Consultation takes place between the director of community care in relation to the lists they have. I will inquire into the method of that consultation.