Before dealing with the four Private Notice Questions addressed to the Minister for Health which have been allowed by the Ceann Comhairle, I should like to make a brief comment. As this is the first time the Dáil is operating under the revised procedures on the sub judice rule approved on 7 April last, which is relevant to certain aspects of the questions, I ask Deputies to exercise the utmost restraint in relation to reference to persons outside the House and, when asking supplementary questions, to avoid making references which might prejudice the right of any individual to a fair trial. I understand that the Minister proposes to reply to the questions together. I now call on Deputies Flanagan, Jim Higgins, McManus and O'Donnell to put their questions to the Minister for Health.
Private Notice Questions. - Child Abuse.
asked the Minister for Health if, in view of the increasing number of reported crises in childcare, the action, if any, he proposes to take in this regard and, in particular, if he will commit himself to a specific timeframe for the implementation of all the provisions of the Child Care Act, 1991.
asked the Minister for Health, in light of the death of a 15 year old girl, details supplied, the specific steps taken by the Western Health Board to ensure that the girl's safety and well being were secured; and if he will make a statement on the matter.
asked the Minister for Health to state what investigation he is holding into the death of 15 year-old Kelly Fitzgerald who died in London shortly after returning from spending six months at her parents' home in County Mayo; if, in view of the lessons of this case, he will take any steps to speed up the introduction of the outstanding sections of the Child Care Act to increase the protection available to children who may be at risk, and if he will make a statement on the matter.
asked the Minister for Health if, in light of the public concern following the death of Kelly Fitzgerald, who had been brought to the attention of the Western Health Board by the British authorities as being at risk, he will indicate to the House the immediate steps he intends to take to ensure that the caring services provided by the health boards are more responsive to the needs of children; and if he will make a statement on the matter.
In common with all Members of the House, I was shocked to learn of the tragic circumstances in which the child, Kelly Fitzgerald, died in London early last February. I have received a preliminary report from the Western Health Board outlining its involvement with the family since they returned to live in Ireland in December 1990. A number of central issues are still being examined by different authorities, and these are as follows: first, the inquest in London has been adjourned for the time being; second, I understand that the Garda investigations are continuing; third, four children of the family are currently in the care of the Western Health Board on a temporary basis, pursuant to a place of safety order and fourth, an application to the District Court for a fit persons order, committing the children to the care of the board until they attain 16 years of age, has been adjourned by the District Court to the first week in May.
In these circumstances, I hope the House will understand that it would be wholly inappropriate at this stage for me to go into any detail about specific aspects of this case. I am sure Deputies will accept that it is vitally important to refrain from making any comment which might in any way prejudice the various matters currently before the different authorities. Bearing in mind what I have said about this tragic case — in particular, that it is far too early to draw any definitive conclusions in relation to it — I should like to make a number of general points in response to the various concerns which have been expressed about child abuse.
Since the mid-eighties the number of suspected cases of child abuse and, in particular, child sexual abuse, reported to the health boards has increased dramatically. The number of confirmed cases of child abuse known to the health boards increased from 184 in 1984 to more than 1,400 cases in 1991. In response to this frightening problem much work has been done in recent years. Guidelines for the identification, investigation and management of child abuse cases were revised in 1987 to include for the first time specific reference to child sexual abuse. Appropriate services for the investigation and management of alleged child abuse have been established in each health board area. Some services are based in a particular hospital in the region while others are provided on a community basis. My Department, in consultation with the Garda Síochána, is currently preparing new guidelines for health boards and gardaí on a co-ordinated approach to the investigation of suspected cases of child abuse. For its part, the Department of Education has circulated guidelines to schools setting out procedures for dealing with suspected cases of child abuse which come to light within the school setting.
The foregoing measures are designed to facilitate the investigation and management of suspected child abuse. It is of the utmost importance to develop strategies aimed at preventing all forms of child abuse. In this context my Department and the Department of Education, together with the health boards, have actively promoted the Stay Safe Child Abuse Prevention Programme. The aim of this programme is to prevent child abuse by equipping parents and teachers with the knowledge and skills necessary to protect the children in their care. Children are taught safety skills in the classroom and these skills are reinforced through discussions with their parents. The response of parents, teachers and children to the Stay Safe programme has been very positive and resources have been made available to ensure its full implementation in all primary schools.
The House will be aware that following the shocking revelations of physical and sexual abuse of a young woman in the Kilkenny incest case I established an inquiry to examine not only the role of the health services in that case but also to make recommendations for the future investigation and management by the health services of suspected cases of child abuse. The investigation team headed by Catherine McGuinness, senior counsel, is now in the process of completing the report and I understand it will be submitted to me on 14 May. I intend to take the recommendations of the McGuinness report to the Government and to discuss with my colleagues the provision of the necessary resources to allow for the full and effective implementation of the Child Care Act at the earliest possible date.
The House will be aware that 17 sections of that Act have been brought into operation to date, including a number of important service delivery and preventative provisions. The next phase of implementation will involve the commencements of Parts III, IV, V and VI which deal with the taking of children into care, court proceedings and the powers and duties of health boards in relation to children in their care. The important new provisions contained in these parts will greatly strengthen the powers of the health boards and the Garda to intervene effectively in cases of child abuse. However, at the same time it must be recognised that these are the more complex provisions in the Act and the most significant in terms of resource implications. The successful implementation of these provisions will require a massive investment of additional resources for improvements in the social work and child psychiatric services, additional residential places and foster homes for children who cannot live at home, special therapeutic services for disturbed adolescents and improved funding to voluntary bodies providing family support services.
I wish to assure the House that it is my intention that these key parts of the legislation will be brought into question as soon as the necessary staff, services and facilities which are required to underpin it have been put in place. The substantial additional funding needed for this specific purpose is one of the matters I will be discussing with the Government when I receive the report of the McGuinness inquiry. Full implementation of the Child Care Act is only one part of the strategy to address the horrendous problem of child abuse. Society in general, and not just professionals such as doctors, teachers and social workers, must be sensitive to the rights and needs of children. While these professionals can make a significant contribution, they can only do so much. All of us as a society must clearly acknowledge that children have certain basic rights and that we have a collective obligation to vindicate those rights.
In response to this rather lengthy reply, I put it to the Minister that he is totally unaware of the extent of this problem throughout society when he says that considerable progress has been made in this area in recent years. This problem will, regrettably, continue to increase until such time as the Minister implements the provisions of the Child Care Act which was passed in this House more than two years ago. I remind the Minister that the Child Care Act was formerly known as the Child Care Bill, 1986, and was then known as the Child Care Bill, 1988. Although the Minister says that 17 sections of that legislation have come into force, he should not feel any sense of achievement or pride in that because included in those 17 sections is the short title and the interpretation. Out of a total of 79 sections, a mere 17 sections have been given the force of law. Until such time as the powers of the Garda Síochána in this matter are strengthened and until the concept of a supervision order and an emergency care order is introduced and given the force of law in order to allow the Garda Síochána and health board personnel to enter houses in circumstances where there are fears that the welfare of children is a risk, the problem will occur and will increase substantially. On the matter of costing, the Minister has accepted that the cost of full implementation of the Child Care Act——
Ask questions please, Deputy.
In response to questions asked at the weekend, the Minister has said that £44 million is required. If that sum is an accurate account of the amount needed to provide a level of acceptable care for the children of this community, that is an extraordinary shame that successive Ministers for Health have to bear. Is the sum of £44 million a true figure? Does the Minister accept that he is justified as Minister for Health in saying that because he does not have £44 million he cannot do anything? I put it to the Minister that there are important and worthy provisions of that Act that could be given the force of law without an expense of anything like £44 million.
A number of issues has been raised by the series of statements made by the Deputy.
He asked questions.
I accept that it is very important to implement in full the Child Care Act and it is my intention to do so as soon as resources allow. I have no intention of bringing into force provisions of legislation that cannot be implemented. A complex system of resources needs to be put into place, including the making of regulations and the training and staffing of personnel. I want to put all of that into place and I intend to do so. It would be a mistake to think that the House could pass a law that would simply abolish child abuse. Full implementation of the Child Care Act will not solve all the problems. There needs to be a programme of sensitisation for the whole community, so that everybody is aware of the increase in a phenomenon that is abhorrent to us all. I have outlined a number of strategies, including the "Stay Safe" programme, which is an integral part of that plan. I regret that the Deputy opposite cannot find it within himself to accept that significant progress has been made in realising the extent of the problems in society and in putting in place a series of strategies to address those problems.
I understand that the Western Health Board has supplied the Minister with a detailed file, on which staff members worked over the weekend, in relation to the particular case concerned. I see that the Minister nods in agreement. In the public interest, I ask the Minister the number of visits made by Western Health Board social workers to the home of the deceased teenager from the time that a file was referred by Lambeth Social Service Council to the Western Health Board, the time that the deceased came within the jurisdiction of the health board? Did the social workers in question see Kelly Fitzgerald, did they meet Kelly Fitzgerald, did they talk to Kelly Fitzgerald and did they assess the situation of Kelly Fitzgerald?
I have taken advice in relation to the specifics of this case and I am strongly advised that I should not go into the specifics in any detail. Reluctantly, I do not wish to give the kind of detail sought by the Deputy. I say that because there are care proceedings in relation to members of the family before the courts. The district justice at Charlestown District Court on 23 April said that all parties with a knowledge of the case should refrain from making any comment in relation thereto until the case is finally determined. The district justice specified that breach of that order would be deemed a contempt of court.
(Limerick East): We did not ask for comment, we asked for fact.
I do not wish in any way to be drawn into answering questions on the interaction between the health board professionals and the family concerned until the court proceedings which relate to other members of the family are finalised. I omitted to answer one aspect of the questions asked by Deputy Flanagan. Any estimate of costings now — and I did not give any figure myself — would be largely a guesstimate because we do not know the scale of requirement that will be needed once the law is enacted. However, I am determined that there will be sufficient resources in place once the provisions are enacted to ensure that it is not simply a matter of passing legislation in the House, then giving the book to the health boards and saying "Get on with it". The resources have to be found. I do not have a figure for the exact cost. My departmental staff are working on that, in consultation with the health boards and professionals.
On a point of order, a Leas-Cheann Comhairle, in relation to the care proceedings I wish to put it to the Minister that the proceedings relate to the custody of the other four children who are in care at present. They have nothing whatever to do with the case of the late Kelly Fitzgerald. There is nothing to stop the Minister from answering the specific questions I put to him in relation to the care or otherwise of the Western Health Board. Is that true, Minister?
I would like to answer the Deputy's questions most fully and I should like to give the Dáil as much information as I can.
(Limerick East): The Minister should answer the questions then.
I am strongly advised not to give information publicly in relation to the interaction of the health board and health care workers with the family concerned until all proceedings relevant to the family, including other members of the family, are determined by the courts.
We might have to wait years.
That is reasonable advice and it is advice that I must pay attention to.
There is a great sense of shock among the public about this most recent tragedy. The big question people want answered in the House today — and the answer is not forthcoming — is how many more such tragedies will have to occur before real and effective action to deal with the problem is taken by the Government. It is known that there has been a large increase in the number of reported cases and it is known——
This should be a supplementary question please, Deputy.
I ask the Minister to deal with the matter of children who are at serious risk of the moment and for whom the services cannot provide full protection because the regulations under the Child Care Act are not in place to provide that protection. Does the Minister know exactly how much under resourced and over loaded the service is? If so, why does Cabinet not now bring in a supplementary estimate to deal with the crisis? It is incredible to any member of the public who considers the tragedies that have occurred and the brutality that has been inflicted on young children that there is no action, especially in view of the fact that in the not too distant past an estimate for £50 million was brought in to provide the Market Development Fund. Why is it that the Minister cannot bring the same sense of urgency to the protection of our children from torture and brutality?
After the incident that came to light in Kilkenny I established a committee of inquiry. That committee had a double brief. Not only was the committee to examine the specifics of that case, more particularly it was to examine the service and management of child services. I have asked the committee, chaired by Catherine McGuinness, to report as expeditiously as possible. The earliest date on which that committee of inquiry could come back to me is 14 May. The least we can do is await the report of that committee to ascertain what recommendations or changes are put forward. Perhaps further legislation and-or additional resources will be required. We must ascertain what, in specific terms, is required.
I have also said I will do two things: I will publish the McGuinness report and bring the findings of that report to Cabinet for action. That plan is not in any sense a knee-jerk reaction to a particular tragedy but is doing the right thing, that is drawing up an analysis, with the professionals involved, of the position, ascertaining what is needed, so that the best possible provision can be made for care. That is my objective and that of the Government.
The Child Care Act, 1991, is in place. Why are the relevant regulations not in place? What is the point in introducing more laws if we cannot comply fully with those already enacted? That question needs to be answered here today.
I could implement the law by ministerial order tomorrow but that would not improve matters one whit. What are required are the resources to train personnel——
——to put structures in place and prepare the ground work. I am determined to do that, this Government is determined to do that, and do it we will——
Give the professionals the legal power; that is all we are seeking.
——not in any way to focus on one incident, no matter how unfortunate or awful, but to learn from each incident, to provide the best possible child care in consultation with the professionals, this country can provide. That is my determination and that of this Government.
The Minister will agree that there has been a very slow gestation of public policy in regard to child welfare since the foundation of the State and a rather shameful lethargy in the implementation of the provisions of the Child Care Act, 1991. I will adhere to administrative matters and not refer to a specific case. In his contact with the Western Health Board, has the Minister ascertained whether sections 7 and 8 of that Act — which I understand have been implemented — have been adhered to by the Western Health Board? For example, has it established child care advisory committees to review individual responsibilities and performance of functions specified in that Act? As the Minister will be aware, under the provisions of section 8 of that Act, there is a responsibility on the relevant health board to undertake an evaluation of the adequacy of child care and family support services in their part. Will the Minister say whether those two sections have been adhered to by the Western Health Board? Will he agree that such adherence would go a long way to reassure people nationwide that there is at least some compliance with existing legislation? The Minister would appear to be full of good will in this respect but he needs the support of this House in giving impetus to implementation of the remaining provisions and finding the necessary resources. That is a matter of choice we will all have to support. Therefore, I urge the Minister to impress on his Cabinet colleagues the urgency and importance of implementing in full the remainder of this very positive legislation. Will the Minister agree that this is positive legislation, that it is about supporting families, rather than supplanting them, and that in a very small minority of cases — perhaps recent ones which have been highlighted — the strong arm of the law will have to intervene in the family? Will he agree that, essentially, legislation is about supporting families in a very positive manner which constitutes the way forward in these matters?
I thank the Deputy for her support, which is the approach which should be adopted. I think we are all equally horrified at incidents of child abuse, particularly at some of the cases that have arisen recently. We must address them in a collective manner. They are difficult for us as a society, in more ways than simply finding resources. A number of difficult circumstances have presented themselves which must be addressed by us as a society.
The Western Health Board acted very responsibily in regard to this case and I know that the uncle of the deceased has been very positive in his comments in relation to the child care services in the Western Health Board area. Under the provisions of section 7 of the Child Care Act, 1991, the board has established a child care advisory committee and is reviewing the procedures even in relation to the treatment of this case. No doubt I will be able to make a fuller statement when all the various inquiries and court cases have been finalised. I am committed to the Act and some Members who have been here for a while will realise that I participated in the deliberations of the Special Committee on the Child Care Bill, 1991, the best legislative committee on which I ever served. Most of us who worked on that committee recognised the effort and determination on the part of all participants to draft the best possible legislation, supportive of the family unit, in relation to the betterment of children. I am determined that the next step in bringing that legislative process to completion, that is the full enactment of the Act, will be done as soon as I can possibly manage to do so.
(Limerick East): A Cheann Comhairle, just one supplementary——
I am sorry, questioning has continued sufficiently long. There is no room for debate on this subject now. I will allow a very brief question from the Deputies who tabled questions in relation to the matter.
Will the Minister concede that, in spite of the lengthy nature of his varying replies to the questions the Child Care Act, 1991, as at present constitued — laudable and all as it may be as legislation — is meaningless until such time as the requisite resources are provided to allow its provisions be fully implemented?
May I put it to the Minister finally——
I did ask for brevity.
On the question of costs, will the Minister agree that £44 million in many respects is a red herring when one bears in mind the amount of costs involved and that the change in age from 16 to 18 is the problem?
It is important to deal with this in the House in as sensitive and united a manner as possible. I did not give a costing. I informed the House and the Deputy opposite that I did not set a figure. I told the Deputy it would be virtually impossible to be accurate in relation to a figure for the full implementation of the provisions of that Act.
Surely the Minister knows how much he is seeking?
My departmental officials are consulting the relevant health board. Obviously I will be bringing the determination and report of the McGuinness Inquiry to Cabinet at an early stage. I reject the assertion that the 17 sections of the Act, currently the law of the land and being implemented, are a waste of time. That is an insult to the professionals involved in developing those services. I might add that it constitutes one arm only of all the legislation, action and guidelines I have already outlined to the House being put in place. I do not think legislation, or the health services alone, have the solution to problems such as these. Rather it is a societal problem that goes well beyond the health services. The application of this Act is very important but is not an end in itself.
I must dissuade Members from the notion that they may debate this matter now.
When the Minister sat on these benches he was one of the strongest advocates of this.
When the Minister was in Opposition the Government had to do everything.
After all that jargon is the Minister aware that we are talking about a child who need not have died?
Deputies
Disgraceful.
Is the Minister aware that a social worker called to the girl's home on 20 January 1993, two weeks before her death, that that social worker was refused access and that all the appropriate steps to obtain the necessary order to gain access to the girl were not taken; that, as a result of the failure on the part of the Minister to enact this legislation, this tragedy happened?
Deputies
That is outrageous.
I find that personally insulting and unworthy of Deputy Jim Higgins. It should be withdrawn because it is a slur, not only on the office I hold, but on a family engulfed by tragedy.
It is a fact.
We should learn from tragedies——
Cheap politics.
——and try to put a framework in place to ensure that tragedies such as this do not occcur.
The Minister should answer the question.
I am trying to answer it. That is what the Government and I will do.
Could it have been avoided?
The Child Care Act, which I intend to bring into force very quickly, will present us with an opportunity to identify children at risk to ensure that in the future we will not see colour pictures of children who have been identified in court cases. That is also unacceptable.
Dead or alive? Why is the child dead?
The Minister should answer the question.
Deputies should allow the Minister to answer the question in his own way——
He said nothing.
——without interruption.
It is an outrageous assault and an unacceptable slur. I have no intention of coming into the House to put any health care worker on trial for anybody's benefit with inadequate information. Until I have all the facts and all the available information is forthcoming I have no intention of ascribing blame to anybody or trying to score cheap shots. We have a great corps of caring people working in the Western Health Board and across the health service. I have no intention of allowing any of them to be questioned in this House.
The Minister has not answered the question.
Why is the child dead?
If order is not restored I will bring the matter to a conclusion straightaway. I call Deputy Fitzgerald for a brief, relevant and succinct question.
I can see that the Minister is disturbed by the details of this case. There are many disturbing cases like this where intervention has not proved possible. I take the Minister's point that a number of sections of the Child Care Act have been implemented but I am sure he will agree that the essential sections which would allow intervention, where necessary, have not been implemented. With the question of resources, that is the key question. What steps does the Minister intend to take to ensure that people who are concerned about the physical and sexual abuse of children are clear on the question of making referrals, the consequences and, in particular, the legal consequences for people when they take action? The cause of inaction is lack of clarity.
I am afraid the Deputy has gone on for too long.
As I said in my initial reply, I recognise that the most complex and significant sections of the Act have yet to be implemented. I intend to bring them into force as soon as possible, not in a meaningless way but in such a way that they will have an impact. In relation to the procedures to be followed, I have established a committee of inquiry to look into this matter. Catherine McGuinness is chairing this committee which is comprised of a team of professional care workers. Its report, which will be published after I receive it, will be made available to me on 14 May. I hope it will provide a framework for changes or initiatives which need to be taken. I ask the House for its support on all these matters.
A brief question from Deputy O'Donnell. I will then call Deputy McManus.
In relation to this remark about the non-legislative measures he has taken — for example, the Stay Safe Programme — is the Minister aware that although this programme has proved very successful in primary schools where it is being implemented on a pilot basis there is opposition to the programme from an organisation Families against Stay Safe? Will the Minister comment on this matter as it is worrying that people are fearful of a positive measure?
As I have already said, I support the Stay Safe Programme. The Minister for Education has also indicated her support for it. Indeed, we held consultation on the question of expanding the programme to include secondary schools. We live in a democracy and everybody is entitled to hold a point of view on any issue.
In relation to his comments on the role of the community at large, will the Minister ensure that the essential importance of the professional care worker is given top priority? Having regard to the statements he has made so far he has, in a sense, shifted responsibility. There is much support for the idea that we should mind our children and look after them but when people need assistance the services are not in a position to provide protection.
Questions, not statements.
The essential question is whether the professionals have both the resources and the power to deal with this matter.
I have said ad nauseam I am determined to ensure that resources will be provided. I want a proper analysis of the resources provided to be carried out and I have taken steps to find out the answer to that question. I have no intention of shifting responsibiltiy but it would be a mistake to think that all society's problems in relation to matters such as this can be resolved by an arm of the State, the health services, acting unilaterally.
So much for socialism.
We have a collective responsibility——
Disavowing fascism, Deputy; I will explain it some day.
When the Minister was in Opposition he wanted the Government to do everything; now when he is in Government he wants to slide out of everything.
It is a disavowal for fascism; "I want the right to kick in somebody's door".
I am determined to build a community that cares with properly resourced statutory agencies without relying exclusively on the statutory sector. I believe that is the way the caring services have always operated and will continue to operate.
That disposes of questions for today.