Tuesday, 28 May 2019

Questions (3)

Anne Rabbitte


3. Deputy Anne Rabbitte asked the Minister for Children and Youth Affairs the steps she has taken to address the concerns raised in relation to staffing and other standards at private residential care homes used by Tusla. [22404/19]

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Oral answers (6 contributions) (Question to Children)

Recent inspections have shown that serious concerns arise about the quality of private residential care homes, which care for 239 children. Has the Department taken steps to address the concerns that were raised about staffing and other standards in private residential care homes run by Tusla?

Caring for adolescents, many of whom have traumatic histories, complex behaviour and an ambivalence about their placement is a challenge. When this care takes place in a residential setting it requires high levels of experienced staff to support these children. As is the case in other jurisdictions, maintaining high standards in residential care is an ongoing challenge. At the end of April, as the Deputy indicated, there were 376 children in residential care, and 238 of these children are cared for in privately managed centres commissioned by Tusla. To put that in context,  6% of children in care are in residential care.

It is concerning that in some residential centres there is a high turnover of staff. There is also a dependency on agency staff. Staff have sustained injuries in the course of their work. That inevitably has an impact on stability in the centres, which has an impact on children, as well as an impact on staff.

One action that Tusla is working on with my Department is increasing the levels of assessment, therapeutic input, counselling and support to the centres. Tusla assessment, consultation and therapy service teams, known as ACTS, who provide the services, have developed significant expertise in terms of working with troubled young people. The process of helping these young people is slow and the support offered to them has varying results. That is the nature of this type of work. In practical terms, the ACTS team can assist in the development of a behaviour management and emotional support plan as part of the overall care plan for the young person on discharge from special care. That type of support can assist staff in residential centres to more appropriately manage and respond to challenging behaviour by traumatised young people. The staff that work with these children are carrying out the most difficult of tasks. Our efforts to improve standards is about making their workplace and their work life better, as well as supporting the children with the best service possible.

The Minister correctly highlighted some of the serious issues I wish to discuss such as staff turnover, lack of experience of staff and the dependency on agency workers. They have an impact on the mood of the entire centre. The children in Coovagh House in Limerick said they felt like they were living in a youth prison.

I understand that the person in charge has only visited the centre four times. A number of other issues have been highlighted. HIQA has responsibility for inspecting centres and following through on inspections but it does not have enforcement powers when it has identified issues. Could the Minister give it those enforcement powers, as was previously highlighted by my colleague, Deputy Rabbitte, in order that it can follow through, once it has identified an issue, to have it corrected?

I thank Deputy Aindrias Moynihan for raising the particular issue, which I will examine personally. As the Deputy said, HIQA has the responsibility to do the inspection and as part of that it works with the providers of residential care to ensure that a plan is put together in order to meet standards and then come up with a report. Oversight and ensuring standards are raised remains with Tusla and my Department. That is where the responsibility lies in that regard. They are supported and complemented by HIQA continuing with its investigations over a period. That is the process that is currently in place. What I have also tried to describe in terms of the wider breadth of the residential centres is that Tusla is also developing more efforts in terms of its ACTS team to support what goes on within the centres in order to ensure those standards are raised.

The issues were highlighted more than a year ago and there was a follow-up inspection last August. It does not make sense that when issues are identified they are not followed up. Why does HIQA not have the authority or the teeth to follow through and to enforce its own recommendations?

The situation in Coovagh House was identified more than a year ago. I understand that my colleague, Deputy Rabbitte, proposed that HIQA would be given the necessary powers. Could the Minister ensure that HIQA has the power to follow through and enforce its recommendations?

Deputy Aindrias Moynihan raises the question of enforcement as a tool of ensuring things happen, usually with force or by imposition. HIQA has certain responsibilities. It identifies where there are deficits and where the standards need to be raised. In the context of this exceedingly difficult work with very troubled young people, sometimes it takes a long time to resolve the challenges. That is the nature of the work. What we have done to ensure there is enforcement, to use Deputy Aindrias Moynihan's word, change or the raising of the standards is by means of the Tusla team coming in to support what goes on in that context. That is ultimately what will provide the sustainable change we are seeking and enable ultimately, if it is possible, the healing of the young people.