Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 13 May 2008

Vol. 654 No. 1

Leaders’ Questions.

Last night's "Prime Time Investigates" programme showed up another appalling scandal in Irish society similar to the Leas Cross programme. This time it dealt with our young rather than the elderly. The programme clearly showed that services for children at serious risk are hopelessly inadequate and they are not being delivered. It also showed clearly that some children will die and others will suffer long-term damage unless decisive and effective action is taken. I accuse the Minister for Health and Children, the HSE and the Department of Health and Children of hiding behind the mantra, the construction of words, "services are being delivered to children who are at immediate and serious risk". The phrase "immediate and serious risk" is repeated over and over again as an incidence of competence when clearly the issue is that children at risk are not receiving any services. Given that 258 people are lying on trolleys around the country, 3,598 children are waiting for psychological assessments and 40,000 people are waiting for operations, how many children at risk are on waiting lists where no intervention has taken place and where clearly the consequences pointed out in last night's programme beckon for their future?

I did not have the opportunity to view the programme last night but I understand its contents. The newly appointed Minister for State with responsibility for children and youth affairs, Deputy Barry Andrews, will take this matter up with the HSE tomorrow to see where the situation is from his point of view. It is an issue to which he attaches a high priority.

A great deal of progress has been made in this area. As I understand it, where a report of a child at risk is made, it is assessed by the general pool of social workers within the health service and a person is allocated to the case if the risk is such that that is what is deemed to be required. A spectrum must be addressed. Increased resources are going into this area. The HSE is in the process of seeking to employ a further 50 staff in this area. Staff turnover has been high but the right way to proceed is through the Office of the Minister for Children to pull together all the issues and policy areas in the one office. This is regarded by many as succeeding and progressing well. In the past, the problem was services were provided in isolation from families and family supports. The emphasis has been placed not only on the interaction between the social worker and the child but also on working with extended family members to ensure children at risk are not dealt with in isolation from the environment in which they were reared. That community-based activity is regarded as a more progressive and effective way of dealing with this issue than was the case in the past. I understand the Ombudsman for Children was interviewed for the programme but I do not know whether that formed part of it. My understanding is that this was a reference to a progression being made in this area. Not all problems are solved. Progress is being made and the Minister of State is taking this matter up with the HSE as his first priority on taking office.

The Taoiseach has come in here with an extraordinarily high reputation for straight talk and delivery. He mentioned outcomes and delivery as being fundamental to what he must do. On 29 April 2008, Deputy Shatter asked the Minister of State with responsibility for children how many at risk children were on waiting lists where no intervention has taken place. The Minister of State at the time was unable to answer that question. He has now been promoted for his lack of knowledge about a fundamental issue with which he was dealing. He did not know the answer to the question.

The reason he did not know the answer is because the HSE or the Minister for Health and Children are also unable to answer the question for the simple reason that they are dealing with 2006 figures. Deputy Shatter pointed that out on 29 April and there was no answer. Since then, we have had a consistent hiding behind the words "serious and immediate risk" when we know that there are hundreds of children who are at risk but who do not receive services simply because they do not fall into the category where one can tick the two boxes of "immediate" and "serious".

The Taoiseach has, quite rightly, spoken very strongly about those marginalised at the edge of society, bringing the vulnerable to the centre of State services and lifting people up. I agree with those sentiments but is he not ashamed of a situation where, as the paymaster for the past number of years, he now assumes the reins of responsibility in the full knowledge that the Minister who took over from him does not know the number of children at risk on waiting lists where no intervention has taken place? It is a fact that the Government is now colluding with the HSE in the endangerment of the children of the nation and playing games with words.

The Taoiseach mentioned that he understood what was in the programme. I know he does. I will give three examples. There was a referral from a teacher in 2006 regarding an eight year old girl who disclosed that her uncle kept trying to kiss her on the lips and that her stepfather kept showing her pictures of naked women. To date, she has never been met by social workers and her file remains open. What about the child aged four whose mother had seriously self-harmed by ingesting glass and cutting herself? The mother had disclosed that she was suicidal and that her boyfriend was very violent. She failed to show up for an appointment and no further contact could be made with this family. The case was closed last December. What about the 12 year old boy who was displaying extremely sexually abusive behaviour towards other children? He was referred in early 2006 and it was almost two years before his parents were met by social workers. However, they could offer him no response and no service.

Who made these decisions? If we are serious about protecting the children of the nation, not playing games with words and hiding behind the Minister for Health and Children's mantra of serious and immediate risk, surely we should be in a position to provide a service at weekends and out of hours. Most of these incidents take place out of hours and at weekends when social workers cannot be contacted and when there are no services.

I do not want to hear the Taoiseach respond to this in words that amount to another covert cutback in health services here. Does he know how many children are on waiting lists where no intervention has taken place? Will he give a guarantee that the State and the Government under his direction will see to it and give a guarantee that there will be an out of hours and weekend service for those who are most vulnerable and at risk and who, as "Prime Time Investigates" pointed out, will die in some cases and suffer long-term damage in others? This is the Taoiseach's responsibility now. He has talked it up on one side; I would like to see delivery on the other.

There are 20,000 referrals per year, 5,800 of which are deemed serious and seen immediately. If anyone is in danger, their case is referred to the gardaí and is taken into care. I understand that 5,367 children are in the care of the HSE under the Child Care Act 1991.

Those are 2006 figures.

A Deputy

Deputy Shatter is not the leader.

I am giving the figures and an indication to the House and the wider public as to the scale of the issues. Approximately——

The wider public wants to know how many children are currently at risk.

When the Deputy is Taoiseach, he can ask the questions. A total of 4,710 children are in foster care placements. We have seen a significant expansion of foster care placements in recent years.

Clearly, it is not simply a question of every case being referred to an individual social worker. One needs community-based family support services as a more effective means of dealing with these issues because these children are in this situation on an ongoing basis. An extra 333 social workers have been appointed since 2003, while 718 social workers are specifically working in this area for the 20,000 referrals coming through. These are the issues and this is the rate of resource being applied. A total of €1 million per day is applied to this area, quite apart from the salary costs of those excellent people who provide that service, so it is not a question of the Government being indifferent to the situation.

The Government has been pulling together all the service provision so that we get a more effective and efficient way of dealing with this problem. That is the issue. A significant amount of resources is being applied. I understand that the Ombudsman for Children has indicated that progress is being made in these areas. There are still specific problems which the Minister of State is taking up with the HSE as a matter of priority. He is taking up the issue of the out of hours service with the HSE tomorrow.

The Taoiseach does not know how many children are currently at risk.

The programme last night was shocking. One of the most shocking things about it was that it was not the first time we have heard about this problem. A review of the HSE's child services published in the newspapers on 21 April 2008 reported exactly the same thing. It told us that there was a waiting list of 374 social work cases in the north Dublin area that had not been properly assessed. It said that in central Dublin, some children are waiting up to a year to be allocated a social worker. It said that at risk children were waiting for three and a half years in County Kerry for services such as psychiatric support. It went on to give the litany of the degree to which this service is not functioning.

The Taoiseach says that progress is being made. It is very difficult to square that with what people on the ground are saying. A couple of weeks ago, the Garda Representative Association told us that it is virtually impossible to get a social worker out of hours. The same can be said by doctors, teachers and people who are at the frontline coming into contact with and identifying these problems for referral in the first place.

We need to hear what is to be done about the problems highlighted in the programme last night and that have already been reported by the HSE. First, what will be done to provide an adequate out of hours service? Social work is not a Monday to Friday, nine to five service. In particular, it needs to be available out of hours when many of the problems arise in the first place. What will be done to provide an out of hours service?

Second, as I understand it, the embargo on the recruitment of staff, which is at the heart of much of this problem, is operating on a region to region basis. The HSE is supposed to be a national organisation but, in practice, the same embargo operates in a region with almost a full complement of social workers as in a region which has only half a complement. What will be done to deal with that aspect?

The Taoiseach identified that there are referrals and urgent referrals. The content of the television programme was that the top priority cases are not being seen. They are still in the filing cabinet drawers because the staff or resources are not available to see them.

The Taoiseach made an oblique reference to the possibility of other types of interventions or supports being provided to children at risk but what does he say to a teacher, doctor or member of the Garda Síochána who comes across a case about which he or she is concerned but who knows now that if it is referred on to the social services, through the HSE, the case might be waiting for a very long time before anybody takes a look at it?

I agree that we must deal with this important issue. There are 718 social workers dedicated to this area and 20,000 referrals per year, which amounts to 30 referrals per case worker, on average. I know that the same case levels do not apply everywhere but the figures give an indication that the level of resources are such that we should not be ending up with the types of cases the Deputy raised.

One of the problems is the need to reach agreement with the professional care services to put an out-of-hours service in place. That is part of the ongoing problem here. I am not in any way seeking to hide behind statistics. I am simply making the point that if we have 718 social workers dedicated in this area, with 20,000 referrals per year, one would not expect to see the delays the Deputy is suggesting exist in respect of serious cases. Deputy Gilmore has acknowledged that there is a general pool assessment which must take place first, which dictates what cases need immediate care and attention because they are serious and the persons involved are at risk.

There are other risk issues which are not quite so serious that must be dealt with in the context of the extended family environment in which the child lives. In the past, that was not the case. It has been suggested that best practice is to continue along the current path of delivering a community-based service, through family support mechanisms rather than just dealing with the individual child in respect of the particular issue that arose. That is deemed to be the best way of not only dealing with the specific problem but also of meeting the needs of the child on an ongoing basis. That is what the Office of the Minister for Children is doing. There is a general recognition that the Office of the Minister for Children has been one of the cross-cutting areas that has worked better than most in terms of how the Government is addressing this issue now. In the past it was dealt with disparately by the Departments of Health and Children, Justice, Equality and Law Reform and Education and Science.

While I do not deny that the problems outlined exist, I am simply making the point that it is not a question of old ways being tried here which are failing. There are new, progressive, best practice methods being implemented, through the joined-up process to which I referred. I have spoken about the extra staff who have been put in place in recent years. I have also spoken about the case load, which would suggest to me that we should not be experiencing the level of problems highlighted.

The Minister of State with responsibility for children, Deputy Barry Andrews, is taking up this matter tomorrow. He will determine why some situations are arising, like those referred to by Deputy Gilmore, in view of the level resources being applied and the number of personnel available to deal with the issue.

Many people listening to Deputy Barry Andrews this morning would have had a lot of sympathy for the position in which he found himself, as a new Minister of State, having to trot out the same old excuses. The issue which must be addressed is why he was in that situation and why the same old excuses had to be trotted out.

Let us have some plain speaking on this matter. When the Taoiseach says that there are 20,000 referrals a year and more than 700 social workers, is he telling this House that the social workers are swinging the lead? Is that what he is saying? What does he mean?

We now have a number of reports which tell us that there are serious delays in cases being dealt with and children are being put at risk. Not so long ago, there was a case involving a mother and her two children who died in County Wexford and one of the stories attached to that tragedy was that an out-of-hours service was not available. The people who are working on the front line, including gardaí, teachers, and doctors, and coming across at-risk children and difficulties in families need to know what to do. Following last night's television programme and the reports we have seen, we now have a picture of a service that is not delivering. A referral can be made and even if it is a priority referral, it still may not be dealt with. The Taoiseach is implying that the problem is the social workers. He should clarify his comments and tell us what steps will be taken by the Office of the Minister for Children, the Minister of State, Deputy Barry Andrews and the Government to ensure that an adequate service is made available so that we are not back here, at some stage, discussing a catastrophe involving a child or group of children.

I am not suggesting anything but simply stating the facts regarding the level of activity and resources being applied. We would all expect that such resources would not lead to the difficulties referred to today. The Minister of State will be investigating the matter in detail with the staff.

I am not passing judgment on anybody. I am simply saying that if the level of resources referred to were not available and people were expected to take on caseloads ten times the current average size, then I would understand the delays and accept that the service is under-resourced. With regard to the flexibility required for an out-of-hours service, the Government would welcome an agreement on that issue. The problem is that we have not reached agreement yet.

The Government should make more resources available.

If we put in more resources, based on the existing arrangements, then we will still have the nine to five service about which Deputies are complaining, and no out-of-hours service. We must reach agreement in order to make such a flexible service available.

In addition to the existing resource allocation, a further 50 social workers are being recruited at present, which will bring the numbers employed up to 768. We obviously need to agree arrangements to make an out-of-hours service available and do so within the current resource allocation. That should be possible.

I am simply making the point that the levels of activity suggest to me that a greater degree of flexibility and availability might be possible, in view of the resources available. We are investing €365 million per year, which equates to €1 million a day. That is not insignificant. That is quite apart from, quite rightly, paying the salaries of the people who are working in the area, who number 718.

We must allow the Minister of State to engage on that issue and come up with solutions to the types of situations raised by the Deputy. I do not see why that should be the case, given the level of resources being applied.