First, I will outline the broad area within which we operate. The HSE has a statutory duty under the Child Care Act 1991 for the care and protection of children and their families. In line with the agenda for children's services the HSE is committed to the principle that supporting families is the basis for enhancing children's health and welfare. Under the Child Care Act the promotion, welfare and protection of children at risk are the responsibility of the HSE.
The general context is that the HSE provides services to children within a child population of more than 1 million children, according to the census of 2006. The latest statistic relating to children in care, who are some of the most vulnerable children in the State, was 5,631, as at the end of September of this year. Again, in general context, prior to the establishment of the Health Service Executive in 2005 there were 10 health boards with 32 community care areas. In the past 12 months that has changed to four regions, with 32 local health office areas remaining.
In late 2009 to oversee the management of those four regions four regional directors of operations were appointed and four assistant national directors were appointed to oversee the four care groups of children and families, disabilities, older persons, and mental health. In addition, in enhancing child care services within the HSE in June this year, the Minister of State with responsibility for children and youth affairs, Deputy Barry Andrews, announced the forthcoming appointment of a national director for child care services.
The next area I wish to highlight is that of general child protection awareness in the State. As we are very aware in recent years, in particular, during the past two years because of the Ryan and Murphy reports, the level of awareness of child protection issues and of concerns about child abuse has increased significantly. There has been much rigorous attention by the media on every voluntary organisation and on the HSE in regard to cases that will be forthcoming in the system. In the paper I state there is emerging scrutiny and an awareness on the part of the entire country, in the sense that further reports have been published which highlight what is working well, and, more significantly, what needs to be improved. This year the HSE published two reports in regard to the young persons, A and B, and last month it published the Roscommon report inquiry. It is the intention of the HSE to continue this openness and forward movement in presenting the learning and the areas that need to be developed.
Common themes have emerged from this scrutiny and the State inquiries. Generally, across the board, there is much good practice. Of the numbers of children in care, 90% are in foster care. The overwhelming majority of children who receive the care of the State get good services. However, the reports which have been published raise issues about inconsistencies in practice, lack of standardisation, poor and inconsistent supervision and the need for greater quality assurance mechanisms. However, the reports published have raises issues about inconsistency in practice, a lack of standardisation, poor and inconsistent supervision and the need for greater quality assurance mechanisms. The question to which I wish to give an answer today is that we realise where we are now but how do we move forward? In 2009, the HSE established a working group called the task force. It identified a wide ranging mechanism of areas which needed to be developed. One such mechanism included the restructuring required in terms of delivering better and more effective outcomes for children. The PA Consulting report and the strategic review of management services in child care services identified that there must be one clear accountable person in each local health area to ensure better outcomes for children.
The HSE is moving forward on this. The establishment of a national office, of which I am the assistant national director, has been one significant component. We have been working with key stakeholders throughout the country with regard to how we put together a better mechanism based on the PA Consulting report. We have held several workshops with key practitioners at local level. We have identified four areas which we intend to roll out in the coming months and the roll-out will be extended to the remainder of the country based on the experience of the initial phase. We must implement change but we cannot do so quickly without a clear understanding of the implications and changes necessary to ensure better child care practice. On the basis of the PA Consulting report we are moving forward throughout the country.
The second key change relates to changes in practice. The fundamental building block we must reinforce is the implementation of Children First. A revised version of the Children First guidelines report is shortly to be published by the Office of the Minister for Children and Youth Affairs. The history of Children First has been recorded in an excellent report by the Ombudsman for Children. It identified that while many good practices were undertaken, the implementation of the Children First guidelines was inconsistent with regard to oversight. How to do we move this forward? The HSE is working closely with the Office of the Minister for Children and Youth Affairs. We have also carried out negotiations and arrangements with the Garda Síochána. We intend to ensure there will be one national implementation framework for quality assurance.
I draw attention to one area of our work in this regard during the past year. It involves reinforcing everyone's role and responsibility in terms of the implementation of the protection of welfare of children. A document was circulated internally within the HSE with regard to roles and responsibilities. The document is perfectly clear on the matter. HSE staff have a specific responsibility regarding the protection of children. Irrespective of the position held, if I am an employee of the HSE, I have a share in this responsibility. This is the message going to every member of staff in the HSE.
How do we ensure we know what we are doing and that we are moving forward? We must implement a better management information change system, that is, the national child care information system. To prepare for this, we are moving on a standardised framework of what we term "business processes", including the standard reporting forms, initial referral and assessment frameworks and care planning. All these will form one standardised framework system used in all 32 local health areas.
Up to 2005, the history involved the use of ten different mechanisms. The ICT system forms the second part of the change. Once the standardised processes are in place, the ICT systems will move in and ensure key management information is in place and accessible such that we can capture information about the number of children in care on waiting lists. Another aspect of information which we have developed is the North-South child protection hub. There is a good deal of detail available on this. The hub will mean every social welfare public health nurse, speech and language therapist and everyone else who works with children will have access to international understandings and research through the North-South hub. The hub was launched last week by the Minister of State with responsibility for children and his counterpart in Northern Ireland.
Another area in which we are moving forward is change management. One significant problem often raised by social workers relates to the amount of change that can be undertaken while we work with children directly at ground level. At the moment we are pulling together this information. This process involves in excess of 60 programmes or projects. One of these is the implementation of the Children First guidelines, another is the implementation of the PA Consulting report. This is being pulled together in such a way that it can be addressed in bite-size chunks and each can be progressed according to priority.
The national director for integrated services is part of a steering group made up of four regional directors, four regional senior managers and me. The group meets every second Thursday. The purpose is to ensure we are moving forward and making progress. Each region has a steering group to undertake the reform programme and to ensure progress is taking place.
The recruitment of social workers and additional staffing has been an issue. I wish to make clear that the HSE is actively recruiting these 200 social workers. As of 12 November, some 194 of the 200 social workers were in position and working with children. The next problem, which we are currently addressing, is how to ensure we maintain a figure of 200 social workers over and above the level in place as of December last year. The next census will come out next week but at present we have 222 social workers working directly in child protection over and above the numbers as of 31 December last year. This amounts to 1,011 social workers working directly in the child protection area. To ensure we maintain these numbers we are back filling positions which may have been temporary. Essentially, we are recruiting approximately 400 social workers to maintain the 200 positions over and above the increase.
Next, I refer to the area of quality assurance. We welcome HIQA's inspections of foster care and that as of next year HIQA will inspect child protection services. We have undertaken and conducted an audit of foster care services and we have put in place plans to address the issues it has identified. We are conducting three child protection audits in three regions. We are preparing to identify all the deficits in advance such that we can address all the issues arising with regard to the children and to ensure children get better services. Three audits are currently under way. They are test audits and will help to inform how we carry out a national, nationwide audit of all child protection services within the HSE. We expect the three audits to be completed in the coming months and, during 2011, we will carry out a rigorous audit to identify all the deficits we have found. With regard to how we can address all the recommendations of the reports, there is a directorate within the HSE called the quality and clinical care directorate. The directorate works with our office to ensure there is tracking on all recommendations of all major reports dating back 20 years to ensure these are fully implemented.
Another significant area which arose this year was the tragic deaths of children in care. This has been a very difficult environment for many people throughout the country. On foot of the Ryan report recommendations, there was a recommendation that HIQA would provide guidance to the HSE on serious incidents and deaths of children in care. On foot of that guidance the HSE has established a national review panel. All matters pertaining to the deaths of children in care and serious incidents are referred through that mechanism to HIQA. HIQA in turn reports regularly to the Minister's office and we report regularly to the Minister's office with updates on various matters. At present, we are working very closely with the national review panel concerning the undertaking of reviews at present. All future matters will be undertaken under that mechanism. In addition, in May 2010 the Minister of State with responsibility for children announced the establishment of the child death independent review group. All information requested has been forwarded to that group and we look forward to the lessons that will come from that report in due course.
The position is that the HSE is striving to effect significant change to ensure it meets its statutory obligations in respect of the protection and welfare of children. There have been reports that identified areas that need to be improved to make better outcomes for children. These areas are being addressed through a major reform programme which has commenced. It will deliver a significant structural practice and management information change and stronger quality assurance mechanisms.
With my colleagues I am happy to answer any further questions.
