I welcome this opportunity to provide further information and to answer questions in respect of the south-east foster home matter. As members are well aware, this involves allegations of abuse and neglect of the most egregious nature. The committee has asked the HSE to provide clarity on two particular matters of concern, which have emerged over the past week, and I am conscious that recent media coverage may have raised other issues that it may also wish me to address.
In addressing the committee today, we will be mindful of the fact that this matter remains subject to a live investigation by An Garda Síochána and we will be careful not to prejudice or impede that process.
The committee asked the Health Service Executive, HSE, to address specifically a number of key issues which I will deal with in turn. Before addressing those issues I wish to place on the record that I met the Minister for Health, Deputy Varadkar, and Minister of State, Deputy Kathleen Lynch, yesterday during which meeting we discussed the recommendation to Government for the establishment of a commission of investigation into this matter. I welcome such a commission as it would provide a statutory mechanism to conclude this drawn-out process and allow the 47 users, their families and other interested parties to get answers to the questions they have been asking for many years now on this deeply concerning and dreadful case and to achieve some level of closure for all concerned.
Turning now to the issues and regarding the apology, the intention in early December 2015 was for the HSE to provide an update and an official apology to the 47 users, including Grace, who had contact over the years with the foster home at the centre of the abuse allegations. Letters, which included official apologies, issued by registered post to 43 families. Three service users were untraceable by the HSE or by An Garda Síochána. On 9 December, a verbal briefing, to include an official apology, was to be given to Grace and her mother the next day, 10 December. While the 43 letters issued as planned, the HSE mishandled issuing the important apology to Grace and her mother. In considering how to communicate to Grace in the most appropriate way, the view was taken that this should be undertaken in person in the first instance rather than by letter. With this change in the mode of communication in the case of Grace, it is now evident that the official HSE apology that was intended to be issued to Grace and to her mother was not made at that time. Unfortunately, the desire to offer a formal HSE apology was lost in the communication to the staff members who were to conduct the meeting in person with Grace. Having personally reviewed the situation with those staff involved, I am satisfied that it was the intention to offer a full and frank apology to Grace. I confirm that the HSE has since apologised officially to Grace and to her mother. This official apology has been made by the chief officer both in person and in writing with the assistance of the professionals now caring for Grace. There is correspondence in this regard appended to the opening statement.
As the director general of the HSE I wrote yesterday to the 44 families to let them know that I am unhappy with the way the HSE mishandled the apology and I also apologised to them for the further distress this mishandling may have caused them or their family member. That letter is also appended in sample form. Furthermore, it is clear from both of the unpublished reports that there were significant failings in the care provided by that foster family and significant failures by the former health board, and subsequently the HSE, to make the situation safe. For this, I offer them and their family member a full, sincere and heartfelt apology.
With regard to the communications to the Committee of Public Accounts, the HSE became aware of concerns being raised in the public domain on 20 January following a report in a national newspaper. The HSE sought reassurance at local level that the apology had in fact been given. As a result of this, a report was provided confirming that an apology had been offered. The report formed the basis of the submission to the committee by the HSE on the morning of 21 January. However, it is the case that the assurance given to the chief officer, which she in turn passed upwards, referred to an individual expression of regret of the senior staff members to Grace and her mother. This expression of regret was then mistakenly taken as confirmation of an official apology on behalf of the HSE. I wish to take this opportunity to offer, in person, an unreserved apology to the Committee of Public Accounts and its members for submitting a document that contained erroneous information at that time. I assure the committee that having met the principals involved, I am satisfied there was no intention to mislead the committee.
Regarding the question of other placements after 2009 when Grace was removed, it is important at this point to assure the committee that based on all the information available to the HSE and having regard to the two investigation reports, the best information currently available is that no new placement was made by the South Eastern Health Board after the primary decision of 1995;
Grace was the only health board placed person to remain with the foster family after 1995; and the South Eastern Health Board, now the HSE, is aware of one other person having contact by living arrangement with the family after 1995. I confirm today that she - Ann, as I will call her - remains in full-time, seven-day residential care with a voluntary provider and takes regular visits home to her mother. I also note for clarity that a different name has been used by Fergus Finlay in the Irish Examiner today. I believe Fiona is the name he has assigned to her. I want to be clear that we are talking about the same person, but this document was written before we knew that Mr. Finlay was using that name, so I have referred to her as Ann.
In April 2015, following a national broadcast, the provider, as full-time carer, contacted the HSE, having reflected on their involvement in recent years, and indicated concerns regarding historical unexplained bruising. Two professionals independent of the case were commissioned by the HSE to examine this matter. The investigation report was provided to the HSE yesterday, and nothing untoward is evident in the findings. The provider has also provided information to HIQA and Tusla, and the HSE remains in contact with those organisations. Within the limited powers it has, the HSE is pursuing references to alleged non-residential contact between Ann and her former foster carers. I can confirm she is in a residential placement and this is her primary source of protection.
From the summary review of the information based on files reviewed by Resilience Ireland, I can now summarise the position in respect of Ann. I am conscious that this will be the subject of further detailed consideration and therefore I emphasise that this is a high-level overview. Ann was born in 1980. She is now aged 35 years and has had a severe intellectual disability since birth. Her contact with the foster family, with whom she lived on a part-time basis, commenced when she was 12 years old. All her arrangements were conducted privately by her family. During June 2011, having been contacted by the Garda Síochána, the HSE team at local level engaged with the family again to confirm that there was a Garda investigation, to advise them of concerns and to invite them to make direct contact with the Garda if they wished. In October 2011, Ann, then 31 years of age, was residing in a five-day week residential placement with a voluntary provider. A seven-day week service was offered with the same provider, but her family confirmed they had no concerns regarding the foster family and wished to continue their part-time contact with the foster mother and had confirmed this to An Garda Síochána. The seven-day week placement was not taken up at that time.
In early 2012, a local HSE team sought legal advice on the case of Ann, which informed them that they could take no further action regarding her placement at that point. From 2011 to 2013, there were various engagements with Ann's family, essentially to persuade them to cease contact with the former foster family. In October 2013, the HSE formally demanded that the foster family cease all care activity which was either current, as in Ann's case, or which they might be minded to engage in towards the future. Later that month, Ann's family was formally written to requesting that they cease the placement, and it ceased shortly thereafter.
Regarding the care needs of those who had any contact with the foster home in question, I confirm to the committee that the service user, who was removed from the foster home in mid-2009, has been fully cared for in full-time residential care by a voluntary service provider since mid-2009. The HSE chief officer and her team in the south east will continue to work collaboratively with the service provider, the service user and advocates to ensure the highest quality of service and support continues to be provided to the service user involved.
An important aspect of the Resilience Ireland report commissioned by the HSE was to look back at all service users who had any contact with the foster home in the south east and to have their care needs reviewed to ensure the necessary supports and services were in place. In the main, the service users were either in residential placement or living at home and availing of day services.
As a result of the review, increased respite was provided where needed to those living at home, and specially tailored supports were provided in some other cases.
Other matters were raised by voluntary providers in correspondence. In relation to equity of funding for providers in the south east, outlined in my handout is the funding relevant to the provider in question, from 2009 to 2015. We have full detail in two categories, totalled, with an indication of the percentage changes from year to year. This includes additional funding in 2015 for a new service regarding named individuals, sleepover costs, school leavers and changing needs.
Between 2008 and 2014, the five largest funded organisations in the State providing intellectual disability services received an average reduction in funding of 12%. Since 2009, the disability sector has been generally protected from any decreases in allocation, except for those due to Government reductions such as pay reductions, the Haddington Road agreement and the Financial Emergency Measures in the Public Interest Act. Based on the percentage increases or decreases of the three main providers in the area from 2009 to 2014, the voluntary provider in question had a 4.9% reduction in funding, while the average nationally was 12%, and in the local area the average reduction was 9% for the major providers. The increases in 2015 reflect the intention to support the provider, particularly in the context of the needs of individuals highlighted in the Resilience review.
It is important to assure committee members, those concerned and the wider public that the HSE did not wait for the publication of reports to take actions to improve the service and management failings identified in child care and disability services and to act on the recommendations of the reports. A comprehensive action plan is in place to address the combined recommendations of the reports. A number of the key recommendations implemented include those related to child care and fostering services in Waterford, for which a full review was undertaken. Recommendations were implemented between 2010 and 2012, with investment in staff and improvements in practice and supervision. Intervention with vulnerable adults is limited in the legislative and policy framework. A key recommendation of the Conal Devine report was the implementation of a HSE safeguarding policy for vulnerable adults. This policy was published in December 2014, with an immediate implementation plan which has progressed through 2015. This included the establishment of professional, resourced safeguarding teams in the nine community health care organisations.
The HSE is establishing a national independent review panel with an independent chair and review team for disability services. Establishment of the panel has been included as a priority in the HSE's national service plan for 2016. It is intended, in the first instance, that the review panel will focus on serious incidents that occur in disability services across the HSE and HSE-funded services. The review panel will be modelled on the Tusla review panel, which reviews cases in which children die or experience serious harm while in the care of the State. In December 2014, I appointed Ms Leigh Gath as an independent confidential recipient to examine concerns and provide help and advice to vulnerable adults, or anyone concerned about a vulnerable adult in a HSE or HSE-funded service.
The HSE received confirmation in writing from An Garda on Friday, 29 January 2016, that its investigation remains ongoing and that clearance is not provided for either of the reports to be published.