Dáil Éireann - Volume 525 - 07 November, 2000

Adjournment Debate. - Child Care Services.

Mr. Neville: I thank you, a Cheann Comhairle, for selecting this matter and I thank the Minister of State at the Department of Health and Children. I refer to the report of the findings relating to the inspection of children's residential centres, which was completed by the social services inspectorate. A total of 12 centres which provided places for 61 children were inspected. Their ages ranged from four to 17 years. Many of the children have experienced profound loss and many have also suffered abuse and neglect.

It is important that the highest standards are maintained in these institutions. The work is difficult and personally demanding. I compliment the management and staff for their contribution. However, resources must be made available to ensure the optimum service for these children. Staff expertise and experience in their role is vital to the quality of service. There is concern at the recruitment, retention and training of staff, care planning and review, management and monitoring of residential care services and the support arrangements for children in residential care. This goes to the core of the service. I ask the Minister of State to address his fundamental issue in her reply.

There is urgent need for improvement in child care training. When will the expert group on various health professionals' recommendation that child care should be accorded a formal professional status and, as a consequence, the recruitment of non-qualified personnel to cease be implemented? The Minister of State must accept there is a need for the introduction of a nationally recognised professional qualification and the provision of in-service training for child care workers.

It is not acceptable that some centres are being run by staff with limited experience of residential child care. There must a clear career path for child care workers. Employing staff in such a delicate area on a temporary basis is not good enough. One cannot expect staff who are temporary to be as committed to the provision of dedicated care as those who occupy permanent care posts. There is a number of areas where concentrated action by the Minister is necessary if progress is to be achieved in raising the standards of residential child care services.

The Minister must, as a matter for urgency, establish a set of national standards for residen[336] tial child care which would cover both voluntary and statutory sector centres. These standards must also apply to other institutions where children are cared for in out of home residential settings. Will the Minister address the failure of health boards to implement in full the statutory regulations that require a board to prepare a plan for the care of the child, before placing a child in a residential centre or as soon as practicable thereafter? It is not acceptable that inspections to date have shown that care planning is weak and sometimes ignored. This is a most unsatisfactory situation. As the report has pointed out, it can lead to children being allowed to drift in care, when good planning would have identified the matters requiring to be addressed and directed services towards those matters, thus enabling more children to be able to return to their homes or move on with confidence to living independently. Will the Minister accept that without proper care plans which set out the aims and objectives of the residential placement and the support to be provided the child, reviews of the cases of children in care are meaningless? I call on the Minister to guarantee that health boards will address planning and review procedures more seriously in future.

A further matter of concern is the lack of attention given by the boards to monitoring placements. The responsibility for monitoring of standards is clearly placed upon the health boards by article 17 of the Child Care Regulations, 1995. Various records are required to be maintained to facilitate this activity, but in many cases inspectors discovered that no authorised person had been appointed by the board to undertake the monitoring function. Consequently, managers relied on the accounts of residential managers regarding the standards of care being provided in centres. Normally, the line manager for the centre would be best placed to carry out this function, but it can be delegated to someone else who can, in turn, report the findings of monitoring exercises to the line manager. In some cases, line managers were surprised to learn of the findings of the inspectors. Had they carried out their role regularly they would have had a better idea about how the services were being provided. The board is left in a vulnerable position if it does not ensure regular monitoring of standards. While inspection will provide relevant information for those with responsibility for monitoring, it can only take place periodically. The views of children and their parents are very low in the system's list of priorities.

Minister of State at the Department of Health and Children (Ms Hanafin): I thank Deputy Neville for his interest in this matter and for highlighting all the main issues in the report of the social services inspectorate on children's residential centres. The social services inspectorate was established by the Government in April 1999. Its main function is to support the child care services [337] by promoting and ensuring the development of quality standards.

On its establishment, the inspectorate was asked to concentrate initially on residential care, given the concerns which we all share in relation to what happened to children in residential care in the past. A number of structures were developed to assist the inspectorate. First, a steering group representing the Department of Health and Children, nominees of the chief executive officers of the health boards, and the acting director of the social services inspectorate, oversees the operation of the inspectorate.

A sub-committee was established to develop the draft standards against which children's residential homes are inspected and a second sub-committee was established to develop the inspection process and methodology. With the current staffing of the inspectorate and given the number of health board run residential homes, it was clear that the full programme of inspection would take more than two years. Accordingly, it was decided that at least one formal inspection should take place in each health board area so that lessons learned from the initial inspection could be applied by the health boards to other homes for which they are responsible. This was to focus attention on the issue of good practice, which is a vitally important message to get across.

The steering group also decided that the most appropriate way of disseminating information as broadly as possible was to compile an overall theme-based report once the initial round of inspections had taken place. This report was formally presented to me on 1 October last. The report is an important and useful document. Its purpose is to highlight areas where quality care is delivered. Like Deputy Neville, I also wish to commend all those people working in residential care who are very committed to their work.

The report also highlights where improvements can be made in residential care to ensure that children in residential care, who are often vulnerable, are provided with the best care possible. I am pleased to note the report points out that, overall, senior managers and local centre managers welcomed the inspection process. If our system was perfect there would not be any need for an inspectorate. However, like any other system, it is not perfect, and implementing the recommendations of the inspectorate is an important step in the right direction.

Eight key themes are identified in the report. These are care planning; monitoring of standards and placements; recruitment and retention of staff, including staff support and supervision; the development of statements of purpose and function; mechanisms for obtaining the views of children and parents; leaving care policies; complaints procedures; and the establishment of a set of national standards to cover both the voluntary and statutory sector centres.

Each health board is now required to follow up on action points identified or shortcomings in [338] their services, and the social services inspectorate will review progress in this regard.

A one day conference is planned for all health boards early in the new year to identify and draw together best practice in these areas. This will be an important and timely response to the inspectorate's report.

I am very concerned at the numbers of unqualified staff working in residential care and I have asked the steering group to work with the health boards to seek to address this issue as a matter of urgency. There are other significant staffing issues. The changes proposed by the expert group report on various health professions relating to child care workers are being addressed and the Department of Health and Children is involved in ongoing discussions with all health boards in an attempt to regularise the problem of temporary posts in the child care and training areas.

I have already referred to the development of standards which were agreed with the health boards, the social services inspectorate, the Department of Health and Children, and other relevant parties last year. Having road tested the draft national standards during the initial inspection programme, there are now some minor refinements to be made. When this has been done, the draft standards should be reviewed and formally adopted as the standards to apply uniformly to all children's residential homes – both health board and voluntarily run. This will ensure that both sectors of residential care provide a uniform, high quality service.

An issue which is of great concern and which is highlighted in the report is care planning. A key issue when a child is taken into care, whether this be residential care or foster care, is the process by which they will leave care, hopefully to be reunited with their families. If there are poor care plans, or no care plans, one can end up with a child drifting within the system. This is not acceptable.

We all recognise that for a child's needs to be met, a care plan is essential. It is particularly important that health boards adhere fully to their statutory responsibilities in this area. There are positive developments in regard to care planning. I understand the inspection and registration service of the Eastern Regional Health Authority recently organised a seminar on care planning and a template for care planning has been agreed.

The sum of £1 million is being given to the mid-west area to develop programmes for after care, which is also essential. I welcome the inspectorate's report which I regard as a valuable resource to ensure that only the highest quality standards will be given to our children in residential care.