Dáil Éireann debate -
Wednesday, 22 Jun 1994

Vol. 444 No. 2

Adjournment Debate. - Community Care Service.

Ms F. Fitzgerald

I thank the Chair for giving me the opportunity to raise this issue. I wish to raise the case of a 15 year old currently on remand to Mountjoy Prison. I understand that for the past three weeks this young boy has been looked after by two security staff and a psychiatric nurse at an address in my constituency. He has been in the care of the health board for some time. I am sure the Minister is familiar with the circumstances of the case.

The case represents a complete policy failure and the Minister must take responsibility for this. It is not good enough that all we have to offer our most vulnerable young people, particularly in our capital city, is a choice between bed and breakfast accommodation, the criminal justice system or the care which this boy has been receiving. This represents a primitive policy and the Minister should be ashamed to preside over such a system. This flies in the face of good practice.

I am concerned that some of these children are falling between the Department of Health, the Department of Justice and the Department of Education, that appropriate services are not being provided and money is not being given to the Minister's Department to develop the services that the children need. As a consequence, they are being dealt with under the criminal justice system.

We are not dealing with one case; this case highlights weaknesses in the system and forms part of a pattern of policy failures. I hope the Minister will not tell me that the circumstances of the case dictated the results. In reality we are failing vulnerable adolescent children. It is ironic that under the Child Care Act we have responsibility, in theory, for children up to 18 years of age but we have not developed the services that children between 12 and 18 years of age need or intervened in the cycles of disadvantage that they face.

An ostrich like approach to policy in this area has been adopted. I challenge the Minister to address this because this is a catch 22 for young people caught in this situation. Inappropriate placements lead to deteriorating behaviour. Appropriate placements would give these children an opportunity to force an alternative pattern.

I ask the Minister to take a deep interest in this matter which has been with us for some time. He should tackle it and prioritise the development of services for these young people. It is clear that with many residential units closing down we need a small number of specialist residential units for adolescents most at risk. The test of the service will be how it provides for the most needy children. How much of the £10 million which the Minister recently announced for the implementation of the Child Care Act is being spent on preventive services for adolescents? Where are these services being provided?

I ask the Minister — this is relevant — to produce a national strategy for the development of foster care. How many foster parents have been recruited in each health board area in the past five years? I think the Minister will be surprised by the answer. This area is not being given priority.

How much has it cost the health board to employ two security staff and one psychiatric nurse to look after this boy? Every civilised city has to cope with cases like this. We can do better. How many other children must come to our attention in this way before this serious gap in the services is dealt with?

Mr. Howlin

I am glad to have an opportunity to give the Deputy, and the House, the facts of this case; perhaps the Deputy will change some of her views when she hears them.

The person referred to by the Deputy is one of three young people on whose behalf proceedings have been initiated in the High Court claiming that they are not receiving proper care from the Eastern Health Board under the Child Care Act. The Deputy will appreciate that I am somewhat constrained in what I can say about his current care.

I understand that the community care services of the Eastern Health Board have had contact with this boy since 1979. He has been placed in a number of residential centres by the Eastern Health Board since then. I understand from the board that his conduct has been characterised by serious episodes of violence and damage to property, including setting fire to some of the residential places in which he has been residing.

In recent times his conduct deteriorated to the extent that none of the existing residential services available to the Eastern Health Board was able to cope with him. The Eastern Health Board decided that, as it could no longer contain him in any of the range of accommodation at present available, it had no option but to make special arrangements for him — and one other boy — in a house owned by the board in the Ranelagh area of Dublin. During the June bank holiday weekend, the board had the house, which had been idle for some time, cleaned and made arrangements to install a television, video, etc. The board provided four staff, having experience in the area of child psychiatry, to provide 24 hour care on a rota basis for the two boys. In view of their behavioural problems the board also found it necessary to provide for private security personnel to be present at the premises. I am advised that the two boys were provided with their meals, all necessary washing facilities, pocket money, leisure activities and asistance in relation to their general welfare. The board also made arrangements to have the boy in question admitted to a FÁS course.

I understand from the board that an episode followed which resulted in the breakage of all the windows and furniture in the premises and the smashing of the television. Subsequent to this, the board repaired the damage done and continued to try to provide care for the two boys.

I hope the Deputy will agree that the Eastern Health Board has gone to great lengths to try to provide for this boy. To talk in terms of primitive policy is inappropriate in the extreme in this case.

Ms F. Fitzgerald

The broader issue still applies.

Mr. Howlin

The point at issue is that raised by the Deputy. I am giving the facts of the case and a reasonable person could not say that the expenditure to support the efforts to help this boy could have been excelled. In fairness to the Eastern Health Board, it went to extraordinary lengths to care for this unfortunate boy.

Ms F. Fitzgerald

Of course it has, but there is a gap in the service.

An Ceann Comhairle

Let us hear the Minister's reply.

Mr. Howlin

Given the problems encountered by the board, it must be recognised that there are limits to what we can expect from our health services. Under the Child Care Act, 1991, health boards do not have power to detain individuals within institutions or to compel them to accept the care or accommodation on offer.

I recently unveiled the child care action plan for 1994 detailing further developments of child care services within each health board costing £10 million in a full year. Among the new services to be put in place are a range of developments relating to the care of young homeless which will cost almost £2 million in a full year.

The allocation which I approved for the Eastern Health Board includes provision for the development of the board's carers for young people scheme. This will involve the assessment and selection of an additional 50 families who will be trained to care for and manage difficult adolescents. The moneys provided will also help the development and expansion of foster care services, including the recruitment of an additional 30 foster places this year. This will facilitate the transfer to family settings of children currently in residential care. A total of 75 per cent of all children in care are in foster care, a growing part of the child care service. The moneys will also fund the development of a six to eight bed special unit which will cater for the particular needs for children with behavioural problems who require intensive care and the provision of additional residential places for homeless youngsters.

By any reasonable yardstick, this is a major programme of investment in residential child care and associated services. As I said, the full year cost of the developments I outlined is of the order of £2 million. With the expansion of our community care and family support services, they will go a long way towards filling the gaps that exist in our current service levels and will assist the health boards to respond more effectively to children in need.

Mr. Durkan

Not by a long shot.

Mr. Howlin

I am interested in the comments of the Deputies opposite. This is the largest investment ever in child care services and I hope that when we discuss expenditure on such services Deputies opposite, including their Finance spokesperson, will give a similar enthusiastic support to expenditure on health care——

Mr. Durkan

That is a cop-out, the Minister has the responsibility.

Mr. Howlin

——rather than face both ways at once. I am disappointed at the attitude adopted by certain persons outside the House who seem to be more interested in confrontation than in working with the health boards in trying to find solutions to the serious problems that confront us.

The circumstances of this case illustrate that the health boards have gone to extraordinary lengths to provide for very difficult and disturbed children, but there are limits to what can be done. Even if we had endless resources and goodwill we could not solve every problem. All problems thrown up by society cannot be resolved by the health boards and their agencies.

Ms F. Fitzgerald

I am disappointed that the Minister does not accept that there is a gap in the services available to these children.

The Dáil adjourned at 10.20 p.m. until 10.30 a.m. on Thursday, 23 June 1994.