Dáil Éireann debate -
Tuesday, 17 May 1994

Vol. 442 No. 8

Adjournment Debate. - Child Sexual Abuse.

An Ceann Comhairle

As the matters raised by Deputies Fitzgerald and O'Donnell are very similar, I suggest that each Deputy should first make her ten minute statement to be followed by the Minister for Health who could then reply to both Deputies. Is that agreed? Agreed.

Before calling on the Members concerned I remind the House that, although a conviction has been obtained in the case referred to, sentence has yet to be imposed and under the revised sub judice rule there is an onus on Members to avoid comment which might prejudice the outcome of proceedings. Accordingly, Members should exercise discretion in their contributions and, if it can be avoided, should also avoid referring to persons outside the House by name or so as to be identifiable.

Ms F. Fitzgerald

I thank the Chair for giving me the opportunity to raise this matter and the Minister for being in the House to answer.

Every day the Minister's delay in bringing the Child Care Act fully into operation puts further children at risk. It is now almost three years since this Bill went through the Dáil. The earlier Act dates from 1908 and it is critical that all sections of the recent Act be brought into force immediately. How many more sad and tragic cases must we hear about before the urgent need to do this is fully recognised? I have here the contributions the Minister himself made to the Committee Stage of that Bill in 1988 and 1989 and I know how important he believes this Child Care Act to be.

Within the last year we have spoken in this House about the Kilkenny case and others which have highlighted and dramatically illustrated the darker side of Irish family life. It is crucial that nothing said here this evening should add further to the trauma already suffered by the children and mother involved in the case in question. I raise this on the Adjournment because it raises a number of central issues which must be faced. Many women and men throughout the country have been horrified as details of child sexual abuse cases emerge. One of the most disturbing features of this and of the Kilkenny case is the feeling that somebody should have done something earlier.

As yet neither I nor anybody else in this House has detailed information on the management of this case which suggests that it is the same as the Kilkenny case and I do not for a moment want to suggest that it is. However, it is clear that this case and others raise questions and force us to ask some very uncomfortable questions about ourselves. We are indeed horrified as a society by the crime and yet there is deep ambivalence in Ireland regarding anything that is seen as an attempt to interfere with the family. We often see an idealisation of the family in Ireland. It is important that we get a balance between idealising the family and assuming that child sexual abuse is around every corner. Because we have in the past to some degree denied that such things can happen in families, we have not made adequate provision for them.

I have said again and again since I was elected to this House that we are not child centred enough in our public policy. How can a political system, emerging from a Constitution which articulates a particular concern expressed in the most human terms — cherishing all the children of the nation equally — end up with such an insensitive and incomplete response to the welfare of children? The problem is that until recently the political system in Ireland has never been more than reactive in this area and only the most outrageous and public emotive issues relating to children have received any kind of response. The approach in public policy to the welfare of children has been nothing short of a disgrace and the evidence is overwhelming. The Children Act, 1908 has been in operation until 1994; there has been no proper juvenile justice system since 1908. The Department of Health should be called the Department of Health and Social Services because there is no doubt that policy on the welfare of children has been a hit and miss affair which has been dramatically illustrated by recent cases.

We are aware, because that awareness has been forced on us, that there has been gross abuse of children in the sacrosanct shrine of the family. We are aware that the pattern of family life is changing utterly and that the implications for children are vast and threatening. We must, therefore, put together the scattered threads of our concern for children in a national policy of which we can be proud. There is no doubt that our collective assumptions about the roles, rights and welfare of children need to be challenged.

Once again, as shown by this case, it is vital that the issues raised, the shortfall in services, the gaps in the contacts between professionals are addressed. However, professionals working on the ground say it is extremely difficult to make the interventions which will end abuse. The question that must be asked in this case and others like it is whether the abuse would have continued if there had been in place ten years ago a nationwide support system of rape crisis support centres and refuges. It is only recently that women's voices have been heard and listened to in mass campaigns. We should, therefore, not be surprised that individual women are not heard and individual children are not heard or believed.

In many cases of family violence it is asked why the mother did not intervene. The Kilkenny case addressed this question very well. We must remember that the power of the abuser over women and children is huge and, within the family, there is the added layer of complex relationships. I hope we can learn from the UK where inquiries over many years have had a negative effect on professional morale and created a climate in which defensive practices have become the norm rather than protecting the interest of children and parents. This is not about indentifying one bad apple in a system that otherwise works well. The whole system and approach needs to be analysed.

I have a number of questions for the Minister. Why have the guidelines on the management of abuse, physical and sexual, first issued in 1987 not been monitored? Is it the intention to monitor how these guidelines have worked in the past and to update them? Have guidelines been given out to health boards on the investigation and management of child sexual abuse? Are they working? Have guidelines been issued for all the professional groups involved in managing child sexual abuse? What does the Minister intend to do to ensure that at local level a wideranging programme of community education on child sexual abuse is put in place? This is the only way individuals will find out about the avenues of help available to them, and it is the only way that neighbours and concerned citizens — and there are many — will be able to take action.

We are now at a point where people may believe that there is sexual abuse but are not quite sure whom to approach or how to deal with their worries or the information they have. If we are to intervene effectively and appropriately in families, it is necessary that there be sensitive, well-trained, multi-professional teams working together locally.

Another question is the training being put in place for teachers, gardaí and others involved in this work. It is essential to have appropriate training courses. It is essential also to have effective intervention in families. There must be good contact between the different professional groups — general practitioners, gardaí, social workers, teachers, to name but a few. It is crucial that these groups should move beyond deeply ingrained professional approaches and work effectively with one another. I ask the Minister to consider regional guidelines for proper interdisciplinary work throughout the country.

I understand also that a number of cases of child sexual abuse in residential homes are under investigation. The Minister must ensure that there are proper standards and regulations governing practice in residential homes for children. Many cases like those coming to the attention of professionals in the community might previously have been happening in residential homes, or children might have been helped in residential care. Only 10 per cent of cases of confirmed sexual abuse end in prosecution, mostly because no one in the family is prepared to make a complaint. This is why the range of services I have outlined is so necessary.

There is a serious shortage of appropriate accommodation for teenagers in need of residential care, for young people at risk, young people who have overdosed or who need psychological help. As the Child Care Act has not been brought into force, young people of 16 or 17 years of age who are abused in the home receive no assistance, neither is there provision for supervision orders. It may well have been that in the case in question a supervision order would have provided an opportunity for a professional to get to know the family. Third party barring orders, mandatory reporting and the nationwide provision of refuge places must also be examined.

When in Opposition the Minister called for the Child Care Act to be fully implemented as soon as possible. He urged the then Minister to state when the Act would be brought into operation. It is outrageous that critical sections of it are unimplemented and will remain so for the coming years. The Minister should outline the information available on the case in question and state when he expects the report from the health board.

Ms O'Donnell

In many ways, one has a feeling of deja vu in this Adjournment debate. Almost a year ago to the day, I stood facing the Minister Deputy Howlin, as we debated, by way of a motion, the report of the Kilkenny incest case. That report was a comprehensive review of how the South Eastern Health Board had dealt with the abuse referred to in the case heard in the Central Criminal Court on 1 March 1993. The nation had been sickened by the revelations of a litany of physical and sexual abuse of a woman over a period of 16 years. Evidence had been revealed in the case that the victim had more than a hundred separate contacts with the health services and had disclosed to various health care professionals details of the abuse suffered by her.

The brief of the report was to establish why there had not been earlier action and intervention by the health board. This was not a statutory inquiry but an informal one and the team was asked to make recommendations for the future investigation and management by the health services of cases of suspected child abuse. The report, which was a damning indictment of inaction and incompetence, of mismanagement, a failure to keep records and a total lack of integration between the Garda and the health board, was launched with indecent pomp — I criticised it at the time — by the Minister in a Dublin hotel. The Minister heralded the report as a milestone in child care policy. This report was to end all reports on this matter. Millions of pounds were promised to improve and enhance resources in child care protection, particularly where sexual abuse was involved.

At the time, the Minister and the report exonerated everybody and urged us not to seek scapegoats or accountability but to look forward. There was no admission of blame, wrongdoing or bad professional practice. There was an indecent haste to move on and learn lessons. The Minister did not take responsibility. Nobody did.

On 27 April last, I tabled a parliamentary question to ask the Minister for Health the changes which had been made to the reporting of children at risk and specifically, what measures had been put in place in the respective health boards following the recommendations of the Kilkenny report. I requested a progress report and I expected it to be substantial. What I got was a two page fudge.

The Minister spoke of a draft new procedure for the notification of suspected cases of child abuse between the health boards and the Garda. This, the Minister claimed, is being operated on a pilot basis in a number of unspecified selected areas, with a vague intention of national application before the end of the year. There is no indication in this reply of any sense of ugency by the Minister to deal with one of the central recommendations of the Kilkenny report.

Another key recommendation of the report was the mandatory reporting of all forms of child abuse to the health boards. In his reply, the Minister refers to his Department being in the process of preparing a discussion document.

The final paragraph of his reply to the specific question of measures in each health board area to improve arrangements for the notification, investigation and management of child abuse is a masterpiece of ministerial distraction. The Minister said: "this information is at present being collated and will be forwarded to the Deputy as soon as possible". Three weeks later I am still awaiting a reply.

Mr. Howlin

The Deputy did not look in her pigeonhole this afternoon.

Ms O'Donnell

I was too busy worrying about this incident, but I am sure the Minister hastily prepared the information. Little or nothing has been done at the front line which radically ensures that the administrative slippage, so evident in the investigation in Kilkenny, is not still happening. The Minister may have a child care policy unit in his Department, but the front line, where the caring services interface with victims and dysfunctional families, remains inadequately resourced. I am not talking only about money. The Minister was allocated £5 million after the Kilkenny report, but no amount of money can make up for the keeping of proper records, accountable management structures, inter-agency cooperation and liaison with the Garda. These were some of the specific recommendations of the Kilkenny report. When I asked my question I expected, and I have a right to receive in the public interest, an honest audit of the status of those recommendations. I am asking again for them now. I hope the schedule will outline the recommendations and a progess report on each.

One recommendation states: "We recommend that linkages be established for all hospital attendances, they should be kept in summary form and should preferably be computerised". Will the Minister say whether professionals in all hospitals keep a record of examinations for sexual abuse and what arrangements are in place for a report of a finding of sexual abuse on medical grounds to the Garda or health board?

The report also recommended that guidelines be prepared regarding the retention by general practitioners of written records. Is this being done? I understand that the Medical Council has reviewed its own guidelines as to medical confidentiality in child abuse cases. The new code of ethics allows the doctor to breach confidentiality to safeguard the welfare of the child. What makes more sense when very often the doctor has first hand evidence of alleged sexual abuse?

For too long teachers, priests, TDs, local councillors, solicitors, family friends and neighbours have been silenced by a disproportionate respect for the privacy of the family. Violence against women and children, which may or may not include sexual abuse, is a crime and not a private family matter. A family based on marriage, which is held in such high esteem by our Consititution, our courts and the Church, can be a place of torture, horrific violence and misery. We must replace a culture of non-intervention with one of intervention and protection.

With the Stay Safe Programme in our national schools, we are facilitating the disclosure by children of such violence. What procedures exist for confidential reports to be compiled and acted upon? Can teachers be assured they are not leaving themselves open to isolation and legal action? The rights of children must take precedence over the rights of the token family.

Another recommendation from the Kilkenny report is that "Health Boards should provide, directly or in association with voluntary agencies, a minimum number of refuge places within their geographical area for victims of domestic violence". It is sad that there are only nine refuges in the State. There are more in the province of Northern Ireland than in the whole of Ireland. There is no refuge in Monaghan or Donegal. I would like to see a list of the refuges around the country. We can be sure that vast areas of rural Ireland are unresourced in terms of refuges.

Many incestuous families and families where there is violence against women and children share one characteristic, isolation. Incestuous families, at the behest of the perpetrator, are frequently very isolated. Family members keep to themselves and, consequently, neighbours keep their distance. Usually the mother, to whom children may first disclose information, will be so browbeaten and terrified, her self-confidence and self-esteem so diminished by years of living with a violent and dominant male, that she is incapable of taking action to protect her children. I quote from the Kilkenny report: "it is perhaps one of the most uncomfortable features of incestuous families that, other than the perpetrator, the adult closest to the child will not take action to stop the abuse". That is all the more reason for intervention by an outside person who must be courageous and sensitive.

The laws are in place for us to counsel the dysfunctional family in situ rather than immediately go in like paratroopers on a raid. The Child Care Act, 1991, provided a new statutory framework for the functioning of the health services in this area. The Minister promised to implement the remaining sections of that Act. He promised that the deficiencies in the powers of the health boards, as revealed in the Kilkenny case, would be addressed.

Section 19, which deals with supervision orders, gives the health boards power to enter a child's home for regular visits where a supervision order is in force. The wide provisions of the 1991 Act did not come into operation automatically in 1991; they awaited ministerial order. At the time of the Kilkenny report, the major sections dealing with children at risk, under Parts III, IV, V and VI, were not in force. Are they in force now and, if so, why were they not used by the North-Eastern Health Board? There are many questions to be answered, not only by the Minister but by health boards. If the Minister chooses to delegate to the health boards his statutory functions, such enormous powers and responsibilities, he must be responsible for that delegation.

This time last year I criticised the report, not for its recommendations which were excellent, but for its abject failure to admit mistakes at all levels. In July of 1993, before the Dáil adjourned for the summer recess, I criticised the Minister for the delay in responding to the report's recommendations. He criticised me in return for being impatient and unrealistic. He bleated and protested saying that he had set up a child care policy unit in his Department. The time for policy units is well past. A group of people looking earnestly around a table is not an adequate response to a child who is being raped or buggered.

The Minister recently launched yet another expensively produced document, Shaping a Healthier Future. He has paid off the debts of the health boards and plans a reorganisation of them. While he is doing that, would the Minister consider also their competence and accountability. The Minister is aware of the reply I am seeking — and I believe a reply was placed in the pigeonhole for me today, which I am sure was hastily produced. I do not want a reply by way of another expensively produced document——

Mr. Howlin

The Deputy judges everything without seeing it, unfortunately.

Ms O'Donnell

——to be launched in the Shelbourne Hotel. I do not want to be invited to the Shelbourne Hotel to discuss the Monaghan case.

Sufficient analysis was included in the Kilkenny report. Action and accountability is needed now. The Government is being paralysed by analysis. Every day reports issue from Government Departments analysing all aspects of their responsibility. We have had enough reports on this matter. I want answers and action from the Minister.

Minister for Health (Mr. Howlin)

I would like to preface my remarks by pointing out that the case referred to by the Deputies has not yet been fully disposed of by the courts and that I am anxious to adhere to the request of the Ceann Comhairle and avoid making any comment that could in any way prejudice the final outcome of the case.

I share the widespread horror and shock that has been expressed by Deputies and my people around the country about the sexual abuse suffered by the two young children in the tragic case referred to by the Deputies. The extremely distressing revelations of the dreadful abuse perpetrated against the two victims has touched a chord in all of us. We all share a sense of outrage and shame that guideless, vulnerable children of such tender years have had their childhood innocence destroyed in this most heinous manner. Our earnest wish and hope for the children is that they will be able to put this dreadful experience behind them and look forward to a happier future.

I have asked the North Eastern Health Board to submit an urgent report to me setting out its involvement with the family concerned and its contacts with the other key agencies concerned with the case. While I do not wish in any way to pre-empt my consideration of this fully report, I would like the House to know that preliminary information received by my Department from the health board indicates the following. Concern about the children was first expressed to the North Eastern Health Board in 1986. However, it was the considered view of the board that there was insufficient evidence to institute child care proceedings to seek the removal of the children from the home. They had been examined at both the Temple Street and Rotunda sexual assault units arising out of the health board's close monitoring of the case, a number of health and social problems were identified within the family. The board arranged for the provision of a range of appropriate support services to assist the family. The health board informed the Garda Síochána about the case immediately it became aware of it in 1986; however, it was not until 1992 that the authorities had enough evidence to initiate legal proceedings in the case.

As I have indicated, I have asked the North Eastern Health Board for an urgent report on all aspects of the case. I hope the House will appreciate that until such time as I have received the report and have had an opportunity to study it, I am not in a position to determine what, if any, further action needs to be taken in relation to this case.

I am already on record as saying that the single biggest contribution that can be made towards promoting the welfare of children and protecting those who are at risk is the full and proper implementation of the Child Care Act. This tragic case has again reinforced me in my resolve to bring the remaining provisions of the Act into operation within the time frame agreed by the Government.

I assure the Deputies that I am determined that the legislation in its entirety will be implemented before the end of 1996. Having regard to the enormous amount of preparatory work required both within my Department and in the health services generally, I want to emphasise that this is the shortest possible time frame for full implementation of the Act.

It is all very well for Deputies opposite to demand the immediate implementation of the Act. In fact, the Act could be implemented tomorrow if I were to bring a statutory order before this House. I have said repeatedly that I am not prepared to take action that has no effect on the ground. I want proper child care provision. I worked on the Child Care Act through its passage here and in special committee and I also drafted a Bill which I brought before the House as a precursor of the current Act. An enormous amount of work must be done before we have the proper infrastructure and regulations in place to protect children to the best of our abilities. My Department and the health boards are working towards that at maximum speed. I asked my Department for the optimum fastest time frame for implementation of the Act. That is what was approved by Government.

The Government has embarked on a sustained programme for investment in the child care services in order to ensure that a comprehensive and integrated range of services and facilities is put in place to underpin the legislation and to enable the health boards to carry out their statutory responsibilities under the Act. In 1993 the Government made available an additional £5 million for new services in the child care area. The important new initiatives funded from this allocation include over 100 new posts of social worker and child care worker; three new consultant staffed child and adolescent psychiatric services; 20 new posts in child psychology; the expansion of the home maker and home help services to assist families in difficulty; the establishment of community mothers programmes in a number of health board areas; increased financial support for pre-school services in disadvantaged areas, and 30 additional hostel places for homeless children. Details of the full extent of the individual initiatives amounting to eight pages of documentation, put in place since the Kilkenny report, have been forwarded to Deputy O'Donnell today.

This year, an additional £15 million is available for child care. This will meet the full year costs of the initiatives begun last year and will enable a further round of new service developments to be launched this year. The child care policy unit of my Department is currently finalising proposals for a package of major developments in each health board area.

These allocations represent the largest ever investment of resources in the child care area and demonstrates my determination to ensure that the Act is not simply implemented on paper but that there is real and tangible improvement in the level and quality of services and supports to assist families and children in need.

In a structured programme for the implementation of the legislation, priority is being accorded to the commencement of those provisions which will greatly strengthen the powers of the courts, the health boards and the Garda to intervene effectively in cases of child abuse. The need for the early implementation of these key provisions was underlined in the report of the Kilkenny incest investigation. When this has been achieved, arrangements will then be made for the commencement of the other outstanding provisions, including regulations for pre-schools, etc.

Two working groups have been established under the aegis of the child care policy unit of my Department to prepare the initial draft of the new foster care and residential care regulations required to give full effect to certain provisions of the Act. These groups include representatives of the health boards, of relevant interest groups and representatives of my Department. Their work will help to expedite the finalisation of the preparatory work that must be undertaken before the next segment of the legislation can be brought into force.

While the central recommendation of the Kilkenny incest report was the early implementation of the Child Care Act, it also contained important recommendations for improving arrangements for the reporting, identification and management of suspected child abuse. These recommendations are being actively pursued at various levels.

My Department, in consultation with the Garda Síochána, has prepared a draft new procedure for the notification of suspected cases of child abuse between the health boards and the Garda. That was our first action which, happily, has now been achieved. This procedure, which revolves around a standardised form for the reporting of suspecting abuse, is aimed at ensuring closer co-ordination between key personnel from both agencies in order to facilitate the twin objectives of protecting the child and the full investigation of any crime. The procedure is currently being operated on a pilot basis in a number of selected areas and, subject to any refinement that might be needed, I expect it will be introduced nationally before the end of this year.

The implementation of this new procedure on a national basis will give effect to a major recommendation of the report of the Kilkenny investigation. This measure represents the first step in a comprehensive review of current arrangements for the reporting of suspected child abuse. At regional level, all health boards are taking specific measures to improve existing arrangements for the reporting and management of child abuse with particular importance being attached to cooperation and co-ordination between the hospital and community care programmes of the health services. I forwarded details of these measures to Deputy O'Donnell earlier today.

The Kilkenny investigation report also recommended the mandatory reporting of all forms of child abuse to the health boards. My Department is at present in the process of preparing a discussion paper on this question. Serious ethical questions arise for priests, religious, doctors and teachers in these matters. It is not as simple as one Deputy seemed to suggest.

The Medical Council, for its part, has reviewed its guidelines in relation to medical confidentiality as it relates to child abuse. The new code of ethics allows a doctor to breach confidentiality where necessary to safeguard the welfare of another individual or patient. This is in line with another recommendation contained in the Kilkenny incest report.

Apart from improving procedures for the identification, investigation and management of child abuse cases, it is also of the utmost importance to develop strategies aimed at preventing the incidence of all forms of child abuse. The child abuse programme known as "Stay Safe" has been of enormous practical value in teaching children coping skills in the classroom context and in increasing community awareness generally of the problem of child abuse. While there has been some opposition to "Stay Safe", both my colleague, the Minister for Education, and I are fully supportive of the programme, which is currently being implemented in national schools around the country. I take this opportunity to acknowledge the unequivocal support for the programme expressed by Deputies Fitzgerald and O'Donnell on various occasions in this House. A working group, representative of my Department, the Department of Education and the Eastern Health Board has put the process in train for the development of suitable materials for use in an appropriate abuse prevention programme for second level schools. It is expected that these materials will be ready for piloting later this year.

The training of front line staff in the health services likely to come across cases of abuse, whether of children or adults, is also being addressed in the context of the implementation of the Child Care Act. For example, my Department and the Eastern Health Board are supporting the Women's Aid organisation in the development of a training programme for hospital personnel dealing with women victims of domestic violence who are admitted to accident and emergency departments. This programme is being developed in response to a specific recommendation in the Kilkenny report.

From what I have said I hope Deputies will accept I have outlined a considerable progress report in building up child care and family support services and in strengthening the capacity of the health services to respond to the needs of deprived children, particularly those who are not receiving adequate care and protection. Much more remains to be done in this area and it is my firm intention that the momentum generated in the last 12 months will be sustained and that all necessary arrangements will be put in place.

No matter what system, law or resources are put in place we will never be in a position to give a categorical assurance that horrific tragedies such as we came across last year will not happen again. I am determined, as is the Government, that everything we can do to protect children from abuse will be implemented as speedily as possible.