Annual Report of Ombudsman for Children 2016: Discussion

I welcome to the meeting the members of the committee and, from the Ombudsman for Children's office, the ombudsman himself, Dr. Niall Muldoon; Dr. Karen McAuley, head of participation and education; Ms Nuala Ward, director of investigations; and Ms Ciara McKenna-Keane, investigator. They are all welcome and I thank them for their attendance, our previous meeting having been deferred in December.

Prior to commencing the discussion, I must read out the following note on privilege. In accordance with procedures, I am required to draw to the witnesses' attention the fact that by virtue of section 17(2)(l) of the Defamation Act 2009, they are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to do so, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable.

Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official either by name or in such a way as to make him or her identifiable.

I ask all members present, our witnesses and members of the public present to switch their mobile phones off or to flight mode because if they fail to do so, it will interfere with our recording systems and adversely affect the broadcast of the proceedings. Any submission or opening statement our witnesses have made to the committee will be published on the committee's website after this meeting.

I understand the witnesses wish to make an opening statement followed by questions from members of the committee. I now call on Dr. Muldoon to make his opening statement.

Dr. Niall Muldoon

I thank the Chairman, Deputy Farrell, and the Vice Chairman, Senator Freeman, for inviting me and my colleagues to appear before the Oireachtas Joint Committee on Children and Youth Affairs. I am looking to present the Ombudsman for Children's office annual report for 2016. We were due to present this information in December of last year but, due to timing issues, our appearance was postponed. Therefore, we are very pleased with the opportunity to appear today, and I thank the committee for its rapid rescheduling of same.

As the committee is aware, the Ombudsman for Children's office is an independent human rights institution established under the Ombudsman for Children Act 2002. My office has a unique combination of statutory functions. We examine and investigate complaints made by or on behalf of children and, under section 7 of the Act, we promote and monitor the rights and welfare of children and young people in Ireland.

Our annual report, which was published in May 2017, lays out the main work of the office during 2016. It shows another increase in the number of complaints received by the office and outlines the work we have done in raising awareness of children's rights through our rights education programme, the advice offered on upcoming legislation and other policy work. I know all members have had access to our annual report but I will briefly mention a few of the key statistics from it. In 2016 we received 1,682 new complaints, which is an increase of 3% on 2015 and a 47% jump since 2010. Of those who contacted us, 78% were parents and, as has been the case for many years, education was the most complained about issue, covering 46% of our complaints. Child protection and welfare accounted for 23% of the complaints, which represented a slight drop on the previous year. Health complaints were up to 17% from 14%, and another area where we noted an increase was in housing and planning complaints, where there was an increase from 3% in 2015 to 5% in 2016. The majority of people who contacted us came from the main urban centres of Dublin, Cork and Galway.

In 2016 we interacted with more than 4,000 children and young people, many of whom took part in rights education workshops in our office, while we met others at events and seminars all over the country. We advised on a range of legislation and policy in 2016, including the Education (Parent and Student Charter) Bill 2016, the Education (Admission to Schools) Bill 2016, the Criminal Law (Sexual Offences) Bill 2015, as well as the consultation on the age of digital consent. We also carried out a wide-ranging consultation with young people called Tune In, in which more than 2,000 young people responded to our questions about how they communicate and how they would like to receive information on their rights.

Having read our annual report, members will note that we have highlighted a number of key issues using case studies of complaints made to our office on behalf of children. In the case of Ciara, a young girl in need of a hip scan, we found that the process of faxing referrals was resulting in errors and subsequent delays in diagnosis.

We asked the HSE to analyse all similar cases, and in the 2,000 it analysed it found the same problem had affected 20 other infants. In this case, the HSE then put out a national order to stop faxing and introduced a new system. This is an excellent example of how making a single complaint can improve a system for other children and their families.

Other case studies outlined in the report highlight the continuing struggle faced by children with disabilities and their families. Children with disabilities continue to face barriers in trying to access services and live a normal life. Committee members may have noted that yesterday we published an investigation involving a young girl, whom we have called Molly. She is 14 and has Down's syndrome and severe autism. She was abandoned at birth and has been in foster care since she was four months old. We investigated the complaint made by Molly's foster mother about the level of support and services provided to Molly by the HSE and Tusla considering her disability. This case is important not only for Molly, but for the 471 other children with severe and moderate disabilities who are in State care and who need additional supports. This case, like those included in our annual report, highlights the need for increased and improved interagency co-operation to ensure the rights of children with disabilities are fully realised in Ireland. It is also important to mention the urgent need to ratify the UN Convention on the Rights of Persons with Disabilities to promote the rights of these young people.

Homelessness affecting all children is an issue that is not going away. More than 3,300 children and young people in Ireland are homeless, trying to live a normal life while eating their dinner on their knees, sharing a single room with their family and having no space of their own. I have been clear in outlining my concerns about the issue of homelessness and how it affects children and young people. I do not believe the measures in place to tackle homelessness have fully addressed the disproportionate and long-term impact homelessness has on children. I have met the Minister for Housing, Planning and Local Government, Deputy Murphy, but still remained concerned about how children and families will be helped out of this nightmare and how long it might take. I appreciate that family hubs are being rolled out to address the issue of appropriate emergency accommodation for families who are homeless and that they offer a better alternative to hotels and bed and breakfasts. However, a commitment on the length of time that children and families will be expected to spend in these family hubs before finding a permanent home is needed. There is also an urgent need to implement national quality standards for homeless services.

Committee members will see from our annual report that children with mental health issues still have to jump hurdles to access necessary supports. The services provided for children need to go to the children who need them when they are needed and in the way in which they are needed. This is not what is happening. At present, a child must take what the system can offer and make do with what is available. The child is doing all the adapting. Children should not have to wait until they reach breaking point before they get some type of help. I know committee members are aware of the various committees, reports and task forces dealing with mental health issues. I am sure they share my concerns that all of these mechanisms should not only work together, but lead to action for those children who are very much in need. In this regard, I commend the work of Senator Freeman and her committee last year.

The national youth mental health task force report published in December included some very positive recommendations. The recent establishment of a specific Oireachtas committee on the future of mental health is to be welcomed. Again, I implore all Members of the Houses to demand results and outcomes for our young people. Many young people have nobody to speak on their behalf or they do not feel able to speak out. Oireachtas Members are their voices in the highest place in the land. Please use that power effectively. My office is undertaking consultations directly with children and young people who rely on mental health services. There is no doubt whatsoever the service they receive and the supports they avail of now have a profound impact on their long-term outcomes.

Education remains a key issue for the office due to the number of complaints relating to education and due to the key legislation in train. It is not that surprising that many of our complaints relate to education considering the amount of time young people spend in school. It is also worth pointing out that many of the education complaints we receive overlap with health, disability or transport issues. Our recent School Transport In Focus report is testament to this crossover.

The education (parent and student charter) Bill, which, to our delight, has been renamed the education (student and parent charter) Bill and which puts children at the centre, has been broadly welcomed by the Office of the Ombudsman for Children. We believe promoting consistency in complaints handling, improving engagement and addressing issues as early as possible will minimise reliance on formal complaints procedures in the education system. If passed, this may, in time, reduce the number of education complaints we receive.

Child protection is always one of my key concerns, and while there was a slight drop in the number of complaints relating to it in 2016, 23% remains a large proportion.

I have been vocal previously in my criticism of Tusla's delay in dealing with complaints which come to my office. However, I am happy to acknowledge a marked improvement in this regard for 2016. The introduction of mandatory reporting may result in an increase in referrals to Tusla and, perhaps, a subsequent increase in complaints to my office and it is essential, therefore, that adequate resources are provided to deal with this. The reporting of any and all child protection concerns can, in my view, only be a good thing.

Another area I would like to mention briefly is health. In 2016, we saw an increase in the number of health complaints received by the office. The health system is still not operating to a satisfactory level and too many children are still getting caught up in administrative problems that are impacting their treatment. Never has this been clearer than in the case of children suffering from scoliosis. In 2016, we received a number of complaints about this issue and in March 2017 we published a report highlighting scoliosis as a children's rights issue. Many commitments have been made by the Government to meet the demand for scoliosis treatment but, unfortunately, there are still issues for children waiting for diagnosis or surgery. I am concerned that while the numbers on waiting lists are decreasing, children whose surgery has been outsourced to the UK, France or Germany, on arrival in those countries are being deemed unsuitable. Where do those children fit into the waiting lists on their return? We cannot allow waiting lists and administrative practices to worsen an already terrible condition.

The final area I would like to comment on is direct provision. Members will note that in our annual report for 2016 and in previous annual reports we have called for children in direct provision to have the same access to complaints procedures as other children living in Ireland. In April 2017, the necessary steps were taken to allow us to begin to accept these complaints. Since that time, myself and my team have travelled across the country and visited all of the centres, including the emergency reception orientation centres, EROCs, where children are living. By and large, we observed extremely passionate and hard working staff in direct provision centres and EROCs but we were shocked at the difference in standards between the centres. It seems to be pot luck whether a child ends up in a warm, pleasant, well-resourced centre or a centre where facilities are simply not to the same standard. There continues to be a reluctance among those living in direct provision and EROCs to come forward and make complaints, which is of concern to me. It is also clear that direct provision allowance is not adequate to support normal family living and that the provision to allow people in direct provision to work will not in and of itself solve that problem. These are only a few of the issues that have come to my attention since April 2017. We will continue to work in this area in 2018.

I thank members of the committee for taking the time to listen to my contribution, which I hope clearly sets out the work we are doing to promote children's rights and a child centred approach across the public service.

As we must vacate this room at 3.15 p.m. I propose to allocate five to six minutes speaking time to each member. Is that agreed? Agreed. Before I open the floor to Deputy Sherlock, perhaps Dr. Muldoon will outline the effects of mandatory reporting on services across the State since it came into effect, which was prior to publication of this report, and also what engagement he has had with State service providers in terms of mandatory reporting.

Dr. Niall Muldoon

As mandatory reporting only came into effect on 11 December it is too early yet to know what the impact of it has been. I understand that preparations for it had been thorough in most regards. I have engaged with the Irish Primary Principals Network, IPPN, and the National Association of Principals and Deputy Principals, NAPD, and they appear to be still rolling out a lot of the training in that regard. There will likely be a slow change.

Mandatory reporting has been well flagged but the specific implications for individuals is still coming to the fore as schools re-open and the measure comes into effect. It is vital that this is adequately resourced from a Tusla point of view and that everybody is aware of the implications of being a mandatory reporter. We also need to review this measure on an annual basis to determine the impact of it. It is often lost in the argument about resources that the rationale for this is because we have failed our children so often before.

Aside from mandatory reporting, there are other good elements in the Bill which allow Tusla and other people to analyse the safety statements and work of organisations, including religious orders, sporting organisations and so on. These are extra safeguards that will come to the fore over time.

It is an active and important aspect of the Bill. I welcome its introduction. I look forward to seeing the impact and if it does need to be further resourced, that must be followed through on by the Minister for Children and Youth Affairs. From my point of view, I look forward to it making a positive impact because its essence is there still are children who have not been able to come forward. That is the key thing. If a teacher has a good relationship with a child, he or she is more than likely to be the person. If it is a sports coach or the parent in a crèche, wherever it might be, that person now has the opportunity to be the voice for that child. That can only be a good thing.

I thank Dr. Muldoon. I will call, in the following order, Deputies Sherlock and Rabbitte and Senators Devine and Freeman. If other members wish to indicate, please do so.

I thank the delegates for their attendance. Dr. Muldoon's report presents some sober reading for members. With a certain degree of collective responsibility in mind, it is perhaps an indictment of how the political system engages vis-à-vis protecting the rights of children in this State. My head is slightly hung down on this one because there is a certain sense of embarrassment or shame that the political system has not prioritised the care of our children within the State to the extent that it should. As a Member of the Dáil for ten years at this stage, I also consider myself partly responsible for that to a certain extent. As an individual and a new member to this committee, care of children has not been in the top echelons of political priorities. I say that in a honest and open fashion.

In the short time available to me, I wish to speak to Molly's case. I am startled that there are 471 children with severe disabilities who are in foster care, in de facto State care, who need additional supports but who are fighting for those additional supports. I am aware of one case in my own area. Did Molly have a care plan? My understanding is that every child should now have a care plan and that care plan should be followed up upon. If Molly did have a care plan, why was that not acted upon? Whose responsibility was that?

Dr. Niall Muldoon

I will hand Deputy Sherlock's question over to Ms McKenna-Keane, because she was the investigator on this and will have more detail in that regard.

Ms Ciara McKenna-Keane

I was the lead investigator in the Molly case. In respect of the care plan, Molly did have one. She always had an allocated social worker. In these cases, the family also has a link social worker for them. Molly, as a child in care, would have her own social worker. However, as the committee will see from the statement we published yesterday, the social workers found that their hands were tied. The case spans 14 years. It was initially the responsibility of the HSE's child and family services, which then moved to Tusla at the beginning of 2014. As we said in the report, during that time the social workers did engage in exhaustive advocacy. However, they felt that they could not do anything at that level and in fact they were the ones who came forward. It was the family's link social worker who came forward and said the family should report it to the Ombudsman for Children's office because the social workers could not do anything at their level.

The irony of this is that the person representing the agency that was supposed to provide and enact the care plan was so frustrated that she gave advice to Molly's foster mother. I am delighted that Ms McKenna-Keane is using the term "foster mother" because she was caring for her since the age of four months.

I am making a kind of aside here but we do not see them as integral to the care of the child in question. They are always living in the fear that the child could be taken from them at any point.

Ms Ciara McKenna-Keane

Exactly. That is a fear.

The key point here is there was a care plan in place but the resources did not follow the care plan. It is the key point in Molly's case.

Ms Ciara McKenna-Keane

With respect to the care workers, they are not qualified to support the foster family in this case. The foster family were approved for Molly's age group but not for her disability or level of disability. They relied on their link social worker to help them to access supports and services. That social worker then had to advocate to the HSE disability service, which became Tusla, in order to get those services for Molly. They were not forthcoming. I suppose they were as frustrated as the foster family in that regard.

There are 471 children. In the short time I have, I am trying to drill down into whether the 471 children spoken of in the report are now in the same position as Molly, with the same risk profile pertaining to those children.

Dr. Niall Muldoon

The key unique factor is we have managed to get the HSE and Tusla to agree to look at these 470 young people. Even up to two months ago, the HSE did not know the names of those individuals. They had not linked the idea they were in care. They knew them as disabled children but they did not know whether they were in care. Over the next 12 months they will look to see if we can predict these needs. With somebody like Molly, we can predict what she will need over the next ten or 12 years and there is very little change in that regard. We should be able to get a better set of action plans and follow-through resources in that regard.

I would like some forbearance. There was no guardian ad litem in this instance. Is it not the case that there is a serious flaw in the system, where children with severe disabilities not the subject of court cases and availing of the guardian ad litem scenario are already at a disadvantage relative to other children in foster care who are the subject of court cases? The case must now be made that every child with a disability - whether it is a severe, moderate or intellectual disability - in foster care should have a guardian ad litem to advocate independently and ensure those agencies, including Tusla and the HSE, will deliver on those rights.

Dr. Niall Muldoon

I would not be sure that is necessarily the answer. In many states there is a statutory compulsion for agencies to work together. We should not have to make that happen but we should do it if necessary. The interaction is crucial, particularly if the parties must fight for the same resources from two different agencies. The argument I always make is that the funding still comes from the same taxpayers.

Is this down to a turf war between two agencies?

Dr. Niall Muldoon

It often is. It comes down to resources.

It is a turf war and the kids get caught in the middle. That is the bottom line.

Dr. Niall Muldoon

That is part of it. The forward planning is only on a 12-month basis. Molly was born and had severe disabilities. She is non-verbal and is not able to toilet herself or maintain hygiene. She has certain needs, including nappies, for all her life. One can prepare and budget for that over the long term, as opposed to fighting every year and saying we will not pay for the nappies now but they might come in January because the budget will be different. That is not child-centred. A child-centred approach means that when somebody asks for resources and once it is a legitimate claim, it should be easy to get.

I thank the ombudsman as he has done us a great service with this report. The Molly case has really opened the eyes of many of us with respect to fostering services and the deficits that exist.

There are many children not in care in need of disability services and a path has also been opened for them to access the ombudsman. This is important. Many of my constituents have contacted me as they have children with disabilities and find themselves being given a horrific run-around. They feel as the child approaches 16, they are being left hanging on until he or she enters adulthood and somebody else can make the decision. That is an addendum to what I was going to say.

Ms Ciara McKenna-Keane

May I say something related to that?

We state in the report that all children in the community who have a disability should be supported to reach their full potential. The reason we specifically mentioned this cohort of children is due to complaints from the foster care sector. Otherwise children like Molly would not have the chance to grow up in a family environment at all-----

Ms Ciara McKenna-Keane

-----if it is made difficult for them to be fostered out because the supports and services are not available. They are doubly vulnerable.

Ms Ciara McKenna-Keane

We have an action plan in place where we address respite care for all children with disability in the community but there is a severe shortage.

Ms Ciara McKenna-Keane

We have made a recommendation in respect of that shortage.

I do not want to dampen the good work that the office has done to highlight the matter by asking about respite care for children with disabilities. Such families need support because they are at breaking point and I see that on a daily basis. Next year the number of complaints made to the Office of the Ombudsman for Children about education might slip downwards but complaints about health care provision might increase.

In the short time available to me I shall focus on areas that I have noted. The witnesses have spoken about direct provision. I am also interested in what happens to undocumented individuals. Yet again I shall talk in local terms and refer to the undocumented Brazilian children who live in Galway and Gort. How can their voices be accessed? They are petrified about communicating with services due to being undocumented. They believe they could end up in a worse scenario than children in direct provision and be deported. These undocumented children have become an integral part of the community and are in education. When one considers their undocumented status one must talk about the visa details that have been stamped on the passports. As a result they can complete their leaving certificate course but they cannot access third level education. This year nine such children in Gort sat their leaving certificate examination. Unfortunately, none of them could get into third level education because of the passport stamp on the passports of their parents.

I want to discuss Oberstown. When I think of Oberstown I recall the fire in 2016, prisoners on its roof and all of the various riots that took place there. Is the Ombudsman satisfied that the management and board of Oberstown have adequately addressed the issues?

I have read the Ombudsman's annual report. I noted that the vast majority of complaints about child protection and welfare related to Tusla. Can the Ombudsman provide the committee with general details about the serious issues raised in this regard? Has there been good dialogue and follow-up?

Dr. Niall Muldoon

I am not sure whether the committee wants me to discuss direct provision further. From our point of view, we are delighted to be in the system of direct provision at long last. We have found it to be a huge positive. Next April will mark the first anniversary of the scheme and we have worked extremely hard. We have sent ten people around the country to try to ensure that we visit every single centre at least once and we have visited some of them a second time. We have organised and completed nine workshops on children's rights with the children in some of those centres. We are slowly building up a relationship around the country in that regard. I hope we have made it easier for parents to approach us. From that point of view, we have had a very positive engagement. We have seen things that we will follow up on, and I shall not go into the details at the moment, but that is the benefit of being in the system and having access.

I am sorry to interrupt the Ombudsman. Please forgive me. Can his office access the linguistic and translation services in such cases?

Dr. Niall Muldoon

We hire them ourselves and make sure that is part of our workload. Before we travel to a centre we check who we need to bring with us.

I was thinking in terms of the dissemination of information.

Dr. Niall Muldoon

Yes.

It might be alien to some individuals to report such matters to the likes of the Office of the Ombudsman for Children.

Dr. Niall Muldoon

Our material is published in at least five different languages, depending on which centre we decide to visit.

I thank the Ombudsman.

Dr. Niall Muldoon

In terms of the undocumented, I could not agree more with Deputy Rabbitte. I have met a number of very articulate and intelligent young people who are as Irish as can be yet their fear of being deported to a place they have never even seen just because their parents originally came from there is palpable. I contend that members of the Oireachtas must find a way to legislate for such instances. Politicians have spent a lot of energy trying to legislate for the undocumented Irish in America. Can an amnesty or legislative option be provided that will give undocumented children here the opportunity to come clean and emerge out of the shadows? It behoves us to do so. There are 5,000 children in this situation, which is more than are in direct provision and lots of other areas. Such children have a huge contribution to make to this State.

However, after they finish the leaving certificate there is no personal public service, PPS, number or opportunity to be in third level education where they can thrive. We are losing a great deal of opportunity in that way as well. I do not have an answer, but I wonder if a conversation should be conducted in the Houses of the Oireachtas to try to do something about that.

Regarding Oberstown, 2016 was certainly a tumultuous year. I am aware that both the director and representatives of the management appeared before the committee in the recent past. Again, we engage actively with Oberstown. We have an in-reach there on a monthly basis and we engage with the young people directly across the different units. I have regular meetings and ongoing contact with both the chairman and the director. From our point of view, there are always things that could be improved. We are awaiting the publication of the judgment from the High Court. What has been reported in the newspapers highlighted concerns around the quality of reports, policies, administration and the like. The Health Information and Quality Authority, HIQA, was also very critical of some areas. We are very much aware of that and we look into it any time we engage with Oberstown. However, we put an emphasis on trying to meet and be a resource to the young people as quickly as possible when we are out there, to let them know we are available. It is same as we are doing with direct provision - creating a relationship with unit managers and ensuring that if people wish to make complaints they can come to us.

The overall concept of Oberstown is moving in the right direction but there is a great deal of work to be done in that regard. Deputy Sherlock talked about the non-publication of the report by Professor Barry Goldson and Professor Nicholas Hardwick. That is unfortunate. When one seeks transparency from that organisation, it is crucial to call in such experts. It is a shame that the publication has not happened, whatever the legal advice. I am aware that the authors were happy to work with Oberstown to try to find a way to publish a report of some type, so it is unfortunate that we have a set of recommendations with no context. I am concerned about that.

With regard to Tusla, my colleague, Nuala Ward, the director of investigations, knows the details.

Ms Nuala Ward

We have a positive engagement with Tusla. In the annual report for 2015, the Ombudsman for Children highlighted concerns relating to the delays we experienced with Tusla responding to us for some information. As can be seen in this annual report, that has improved, which is excellent. In terms of the complaints we receive from Tusla, it is noteworthy that a number of them are directly from children who are in care because they are supported by various advocacy groups to come to us. That is very helpful for us. The complaints can relate to how complaints were managed, communication or their placements. Tusla has launched its "Tell Us" complaints procedure, which is a positive initiative. We are hoping that will improve into the future.

I call Senator Freeman.

I thank Senator Devine for swapping with me. I have a meeting at 3 p.m. so I will have to leave after this. It is good to see Dr. Muldoon again. I admire the work he and his team do. It is a very difficult area. It is difficult to listen to the sadness that exists.

I have a three-part question regarding Dr. Muldoon's capacity to handle these complaints. First, is 1,600 a large number? Given that there are over 1 million children in this country, that does not appear to be a massive figure. It is a terrible amount but I am surprised. One of the groups of people I deal with - I call them the warriors - are parents who have children in the child and adolescent mental health services, CAMHS, system and in the disability services. There are 12,000 of them, so is 1,600 a big figure? Second, how does the Ombudsman for Children promote itself? Several people have contacted me in the past couple of months about certain difficulties. I am sorry that I keep forgetting to refer them to the Ombudsman for Children. Dr. Muldoon says that children know about him, but we need to get his name out to the parents to let them know he will handle these matters.

My final question relates to where there is a complaint about, for example, access to disability services. I am aware of a child who is waiting six years to be assessed. We believe he is on the autistic spectrum. If that complaint went to Dr. Muldoon's office, how quickly would it be resolved? Is it resolved more quickly because he is addressing it with the HSE or a disability service?

Dr. Niall Muldoon

One of the difficulties with any complaints service is that it is hard to know how many complaints we should be getting. Certainly, it has been a priority of mine to increase awareness of the office. In that regard we are, thankfully, bringing in two new team members in our education and participation office which will increase our opportunities to do outreach work in different parts of the country over the next year. They will come into the office in February. We also mentioned the "tune in" consultation which allows us to try to meet young people where they are. We went around the country and asked where they wanted to hear about this. Surprisingly, the majority agreed that they wanted to hear about it from teachers at both secondary and national school level. That was followed very closely by those wishing to hear from parents. As such, we have to target those people. We will target them through YouTube clips and we have hired a new social media officer and created Snapchat and Instagram accounts, albeit I am not 100% au fait with those. Those are the places they want to hear from us. We asked them where they would look for the things they needed and those are the places. We are trying to create social media activity on Facebook, Instagram and Snapchat so that young people who need to know about us and their rights will find it on their platforms.

We are trying to raise awareness all the time and we are engaging with adults at all levels. I have a very close relationship with teachers' associations, including those for principals and the INTO. We engage with them so that they are aware we are available. We also engage with parents' groups and advocacy groups like the Warriors and associations for the parents of children with special needs. I engage with them all the time and attend the annual general meetings of their organisations. We all try to raise awareness as often as we can. It is difficult to know when we will have reached the right level of awareness. In fact, I do not think we ever will. The whole essence of what we do should also mean we are increasing our complaints because we should always become aware and the more we are aware, the more new people will know about us. The essence of this work is that we are only sought when someone needs us. What we have to do, however, is plant enough seeds so that people know about us now even if they do not need us until ten years later. I am spending a lot of time trying to meet young people in secondary schools. I tell them that they will be the parents in ten years time. If they know about us and children's rights, they will be the ones who can fight for their children's rights in a different way.

What about the speed of complaints?

Dr. Niall Muldoon

We have a target of 12 to 14 months for a full investigation where everything works smoothly and all the organisations work with us. However, our average timeline is quite quick.

Ms Nuala Ward

It can be quite quick. Sometimes there can be delays where we seek information from a public body. If it is a particularly complex case, we may ourselves seek legal advice which can also delay things. As much as possible, we have tried to introduce an early resolution model. One of the cases here relates to Tom, a young person with intellectual disabilities in hospital. We were very concerned at the distress he was experiencing because he did not have a residential placement. We move very quickly to resolve complaints like that as quickly as possible in the best interests of the child. We are aware that time moves differently for children and that adverse effects can be severe, which is why we do our very best to resolve matters as quickly as we can. Not every case is as straightforward as we would wish it to be, however.

Dr. Niall Muldoon

We finish a lot of cases within six weeks. Once we contact an organisation, it tends to look after a case better because it knows we are on the pitch. The Molly case is a good example. It took a number of years but we were breaking new ground and each organisation had to be persuaded to move in that direction. That is an unusual one. We knew that by taking that one case, we would change a whole system. In individual cases, we can try to move as quickly as possible for the child involved. Our raison d'être is to get in and out as quickly as possible so that a child gets what he or she needs.

That is very interesting. Snapchat and Instagram are going to be invited to the committee and we will, hopefully, get to put a lot of questions to them. On awareness, I regularly point out that school journals are under-used to provide children with an idea of their rights. One does not want them all marching up and down on strike over everything that might be listed in the journal, but it would certainly raise awareness of rights. It would be a simple tool to use if schools got on board.

I am delighted that we have had an Ombudsman for Children in this country for 14 years now. We are eventually catching up with what children are privileged to have in other countries. It is not a privilege, it is just a default position for them.

I wanted to ask about the mental health of our children in care and about the nature of the mental health complaints. Senator Joan Freeman and myself were on the Seanad Public Consultation Committee. Are the complaints similar to what we heard there about access, continuity of care and time? Are the complaints similar to that or is there anything unique in what children are putting forward to the ombudsman? Is the number of complaints rising? I would imagine it is because of the demand on services. Does Dr. Muldoon agree that any such rise is because of demand on services or is it just because of particular people falling through the cracks?

My other question was on disability. Some 8% of children in care have a severe or moderate disability. Does Dr. Muldoon have an idea of the timeline for the review which the HSE and Tusla have agreed to so we can all have a look at it? I am delighted that Dr. Muldoon raised the issue of direct provision. It has been referred to in the past. It was established 20 years ago. Children have been born and raised in that system. It has been described as State-sanctioned child poverty and exclusion. Those in the system now have the same access to the Ombudsman for Children for complaints. On his visits and his travels throughout the country, did he speak to children directly? The children who are probably most at risk are the children who are here alone and have no family around them. Would he have had contact with them as well?

Dr. Niall Muldoon

I love the idea of the school journal. I will certainly steal that and see if we can get engaged with it in some way or other. The mental health complaints are, as the Senator mentioned, on access to services, continuity of services when moving from child to adult services, and continuity when being transferred from one area to another. Timelines are also a huge issue. I will ask Ms Ward to come in if there are more issues on top of that.

On the overall mental health system, the work that Senators Devine and Freeman did is huge. They identified that we do not have enough staff. We do not have the staffing in the right place. We do not have it in primary care where we need to prevent mental health issues. There are difficulties with diagnosis and with consistency between child and adolescent mental health services teams. One might diagnose a child as being ready to go in for an overnight bed and another might say that diagnosis does not fit, so the child does not get the bed. Those issues are coming up continuously.

When I met with the Minister of State, Deputy Helen McEntee, who had responsibility for mental health at that time, she talked about at least five or six unfillable posts for psychiatrists. These are posts which have not been filled for more than five years. No organisation or business in the world would leave its offices open for five years without having found another way to fill the gap. It is doing a huge disservice to our children in that area. Up to now the clinical lead has always had to be a psychiatrist. As I have suggested before, I wonder if there are other professionals who could take that lead for certain stages and at certain times. If we look to other countries some have used psychologists to offer medication. Certain nursing professionals have been allowed to dispense medication. It may not just be about medication. There may be other issues.

We have to look at the system as needing an overall change. In that particular Seanad committee the Senator brought in some great witnesses. They were fantastic. There were a lot of good ideas which could be used. Up until now we have been continuously trying to fix a broken system as opposed to seeing how we could look at the issue differently. Primary care is a crucial part of that. Tusla has talked about establishing what it calls therapy teams, which would include a range of therapists such as play therapists, drama therapists, art therapists and family therapists. There would be a range of people who could intervene in a different way at a much earlier stage. Such teams would not cost the earth. That would make a huge difference at the primary care level. Within CAMHS, there is never going to be enough psychiatrists. From the people I have met, it sounds like 80% of all psychiatrists who train in Ireland go abroad.

One will never fill the vacant places if that continues to be the situation. We must, therefore, acknowledge that and consider putting somebody else in place or allowing another professional to lead the team. We have received complaints concerning children who have been left for possibly four or five days in a bed, waiting for a consultant to assess the child after he or she has come into an emergency department and said he or she is suicidal. That is not appropriate and is very far from the right way to be child-centred. Such a child is in the worst case in his or her life and the worst situation he or she can think of. He or she feels ready to take his or her own life but we are doing them a huge disservice because we do not have enough consultants and only consultants are allowed to assess such children. We are traumatising such children again and are, essentially, locking them up in a bed when they should be supported in some other way. It is a result of our system and the way the legislation is set up that we are tied into that but that legislation could be changed within a year or two if we needed to and there was a will to do so. I am not saying what professional should be given the responsibility of treating such children but if one profession is not creating enough new staff to fill that space, we have to widen it for the sake of the children, even if only temporarily. Senator Devine has got her finger exactly on the button in regard to the complaints we receive. It is a crisis that is long overdue fixing.

I have also called for a version of A Vision for Change solely dealing with children to be generated. That would change the focus because one would then assess, evaluate, fund and resource it in a different way because they will be treated as children and as rights holders in their own right. Ms Ward may wish to comment further regarding complaints.

Ms Nuala Ward

Dr. Muldoon is entirely correct that the difficulty in terms of equity of access for children around the country to services is very real.

Dr. Niall Muldoon

In certain cases, it is a geographical lottery.

It is to be hoped that the continuity of care for children would also include their seeing the same person but that is not happening. That was also a major cause of complaint .

Dr. Niall Muldoon

It is rare for a child to have that continuity of care.

I thank Dr. Muldoon. There are 15 minutes remaining and three speakers, so I will have to be very strict on time. Deputy Neville has five minutes.

I thank the witnesses and welcome them to the committee. I also sit on the Joint Committee on the Future of Mental Health Care and, therefore, very much welcome the witnesses' comments and insight. In view of the limited time available, I will not repeat any questions already asked. Did Dr. Muldoon mention that he wants A Vision for Change to be solely child-centred?

Dr. Niall Muldoon

There should be a version of A Vision of Change for children, along with an adult version. Of the original A Vision for Change, only chapter 10 addressed children, which is very symbolic of how we think of our children because nobody ever gets to chapter 10. We should take it out and create a version of A Vision for Change solely for children.

Dr. Muldoon also mentioned that flexibility within practices is a problem.

Dr. Niall Muldoon

Yes.

That has also been found by the Joint Committee on the Future of Mental Health Care. I constantly try to educate myself on that issue in terms of whether legislation, work practices or systems is to blame because the evidence given to the committee indicates that the way the system has been built is responsible.

Dr. Niall Muldoon

That is correct.

However, within that management system IT systems seem to be restrictive because that committee is constantly seeking for reports to be generated and given to the members but we are yet to receive financial figures we are looking for in that regard, although we have a meeting next Thursday. That might give the witnesses some insight into the frustrations the committee has experienced with the system.

Dr. Niall Muldoon

That is the essence of it. The system is ruling the child and that is where we are at fault and why we must look at it differently. If one starts by recreating A Vision for Change from 2006, one will recreate the same problems, whereas if one takes children out and asks what they need, a more favourable result may be obtained. The Joint Committee on the Future of Mental Health Care chaired by Senator Freeman would, again, have many answers and suggestions in that regard. We are trying to work with the system without breaking it but sometimes one must make a radical change in order to change the whole system. Although I am not sure which element requires the radical change, people must be open to that. It is difficult for people who are now in the system to see the light and committees such as this must be brave and radical in thinking there is an opportunity here to do something different. It might take four or five years but that would be fine. One may hear of people waiting five years for suitable treatment. At least if they knew in the fifth year there would be something new, they would have some hope. When I asked the Minister of State, Deputy Jim Daly, about the possibility of changing the legislation regarding clinical leads and who the clinical lead could be, he said it could take two or three years. I replied that I would be quite happy with that. It has not been possible to fill some posts for the past five years. People are worried that we will not be able do it quickly.

Nothing is being done quickly here. If one could create a plan that said it was going to take three years, I believe that would be viable. At the moment we are trying to find what can be fixed with €1 million here and €2 million there. Instead, we need to ask how can we do it better and what would work for the children.

I will be brief. When a person raises an issue or a complaint with the Ombudsman for Children, which finds in that person's favour, but he or she still has a difficulty with the service - we are talking about the HSE in this regard - what does the person do? Does he or she come back to the ombudsman time and again? What is the best advice the ombudsman can give? I agree with Dr. Muldoon's comments on direct provision. I believe they are modern day Magdalen laundries, but in a different context. Given this State's history with children it is not good enough for us all to be shocked in ten or 15 years time when stories emerge. We know what is going on and it is up to us in the Oireachtas to change that. I am really interested in what someone does when they have a consistent difficulty. Even when the ombudsman is on their side it still does not seem to matter.

Dr. Niall Muldoon

From our point of view, if a complaint is upheld and we make a recommendation to a public body, whether it is to the HSE or any of the other public bodies, generally we follow this up within a six month period, but we keep engaged with the parent or the complainant to make sure they are getting what it is we had recommended. We keep on the case. We have had two cases that we have kept on for three, four and five years to make sure that the recommendation happens. Most organisations tend to follow through quickly. If it is not happening then we certainly do re-engage with the fullest possible power behind us.

I thank Dr. Muldoon for the presentation and for the hard work done by the Office of the Ombudsman for Children. I wish to raise some issues today, the first being housing and children who are homeless. It is a shameful fact that there are more than 3,100 children homeless in this State. Here we are talking about mental health and other issues. The children are living in conditions, and they and their families are facing difficulties, that no one here can comprehend or get our heads around. Dr. Muldoon spoke about the national quality standards. Will he tell the committee how he envisages the implementation of these standards?

I believe all members here have battled with the idea of family hubs but we know it is a better option than hotel accommodation. We need to know the timeframe, however, because we cannot place families into hubs for 18 months when they have already come from spending 18 months in hotel accommodation. What is Dr. Muldoon's opinion on the maximum time to live in a family hub?

Dr. Niall Muldoon

I will address the issue of the family hubs first. I am certainly clear, and we agree, it is a step up from the original emergency accommodation options of bed and breakfast accommodation or hotels. We are also clear, however, that nobody should be there for more than six months at the most. Within that timeframe family hubs should comply with the standards. We also feel that the family hubs options are poised to be very similar to direct provision; we created a very good system for what we thought was going to be the very small number of people who were to come in to direct provision. It could be very difficult to move on from the family hubs option. We have specifically asked the Minister to tell us how long people are in family hubs. The statistics will often look at those who are in hotels and about the success of moving people in to family hubs, but not for how long. We now need to know the numbers of every family that has been in a family hub. Anyone who has been there for longer than six months should be a priority to move on again. As the family hub option is a better service it could easily become institutionalised. For a lot of people a family hub could be a good place to stay, so we need to be careful of this also. It is our view that it should only be a stop-gap that leads to a more permanent solution. The effort around the creation of social housing and the move to Government-funded housing, as opposed to private sector housing, is the way forward and needs to be prioritised so we can move these people, under our own steam, to social housing as quickly as possible.

I will ask my colleague Ms Ward to speak about the national quality standards.

Ms Nuala Ward

As members may be aware, the Ombudsman for Children's Office published an investigation statement last year on the quality of accommodation experienced by a woman and her children as they were homeless for nearly 20 months.

They were staying in hotel accommodation and described stained mattresses, cramped overcrowded rooms and how they had to move on multiple occasions. We consider this a very serious matter and recommended that the quality assurance standards would be implemented as soon as possible. We also wrote to the Minister recently seeking an update on the matter.

Standards are only good enough if they are implemented, so we believe that there should be a compliance mechanism and sanctions for non-implementation of these standards. They should also be embedded. As the committee knows, a number of NGOs and private providers are providing emergency accommodation. It is, therefore, important in any service level agreement that these standards are met. It is taxpayers' money that is providing this accommodation for very vulnerable families and, at the very least, we should be assured that they are experiencing good quality accommodation.

Basically, we would be looking for the local authorities to go in and inspect, that is, to carry out spot checks. I have another quick question on local authorities. The report refers to Simon, a lad with disabilities, and his experience of local authority housing. Is that something the office is coming up against regularly with local authorities? These are people with specific needs.

Ms Nuala Ward

We have found that children who are experiencing homelessness are a priority for housing. Of those who present as homeless, they go to the top of the list. However, people who are homeless are not a homogenous group. There are particularly vulnerable people within the homeless population and we are concerned in particular about how prioritisation is given to children who are homeless and who have disabilities. We actively pursued Simon's case because there were administrative issues, in that the authority did not have full regard to his medical needs, which would have given him medical priority. However, he was not homeless. There were also language difficulties because English was not the family's first language and the local authority had not fully met their translation needs so that they fully understood. One can imagine how difficult it is to navigate our housing system when English is not one's first language. We have referenced throughout the report the need to recognise particularly vulnerable people within the homeless population.

I thank Deputy Mitchell. On behalf of the committee, I thank the witnesses for the presentation today and for dealing with members' questions in such a comprehensive manner, as well as for rescheduling with us and coming in at relatively short notice. It is very much appreciated.

The joint committee adjourned at 3.15 p.m. until 9.30 a.m. on Wednesday, 24 January 2018.