An Update on Youth Justice Policy

28 January 2014


I have a good deal to say but I will try to contain myself.
I welcome the Minister, who has laid down a comprehensive statement on youth policy, which she had hoped to do in December. It is great that this is all together and that the Minister used the House to do this. The Minister mentioned that we are improving our data, but I remain concerned at the lack of data in the area, a point to which I will return. This particularly applies to juvenile offenders and children coming into contact with the criminal justice system. Through an analysis of various reports compiled by the Association for Criminal Justice Research and Development and a number of significant academic studies by the likes of Sinead McPhillips, Dr. Ursula Kilkelly and Dr. Jennifer Hayes, three key risk factors associated with children who became involved in criminal behaviour have been identified. As the Minister knows, these are family background, educational disadvantage characterised by poor literacy skills and low levels of academic achievement, and personal and familial factors such as alcohol and drug misuse, intergenerational crime and mental health problems. The studies have categorised the factors for us but it is not the understanding of the majority of the public, who are confronted daily with media reports and headlines about violent youth offenders and delinquent youths who are out of control. In the absence of political and media discourse to the contrary, it is understandable that they want to see zero tolerance and tough-on-crime type approaches. That is why the Minister’s intervention is important. I support her understanding and her moves to promote prevention and early intervention.

I commend the work of so many of the agencies involved in the delivery of juvenile justice policy in Ireland, such as An Garda Síochána, particularly its Garda youth diversion projects, the dedicated young persons’ probation division of the Probation Service, the Courts Service, and the Irish Prison Service, as long as it still has 17-year-old children detained in St. Patrick’s Institution. I would like to make special mention of the Irish Youth Justice Service, IYJS, which has been leading and driving reform in the area of youth justice since its creation in 2005. It has made important strides and shows the importance of Departments working together, as the Minister outlined.
It is a real missed opportunity that a centralised data and research department has not been established in the IYJS. We need to co-ordinate inter-agency research between the agencies involved in the delivery of juvenile justice and map the trajectory of the child through the criminal justice system. Every child has an individual story but we mostly get to read these in child death reports and other significant reports. We need to collect the data earlier. We also need to identify divergences between the policy and legal framework of youth justice and its implementation, administration and practice.

I would like to personally congratulate the Minister on a number of successes and advances in youth justice policy under her stewardship. In particular, I welcome the decision on St. Patrick’s Institution and today’s update on bringing the detention centres together. It has been long promised, but the Minister has done it and I thank her for it. We need a unified approach and I am happy to hear that a new head of the campus has been appointed. I look forward to the opportunity to support the legislation brought to the House. There are significant challenges in respect of the campus but I will support the Minister. In the interim, since December 2013, 17 year olds are being remanded to Wheatfield Prison. I note specific concerns raised by the Irish Penal Reform Trust in respect of 18 to 21 year olds, and obviously any 17 year olds detained there, that Wheatfield is often overcrowded and does not have adequate education and training capacity for its inmates. The focus for our young adult prison population must be on rehabilitation and not simply containment. I remain concerned about the interim period and how we are serving these young people.
I raise my concern over the lack of sufficient special care and protection places available to children with severe emotional and behavioural difficulties. I raised the point in November when we debated the Child and Family Agency Bill. From a juvenile justice policy perspective, my concern echoes that articulated by Judge Ann Ryan, who until recently presided over the Children’s Court in Smithfield. She has spoken of her frustration at the lack of HSE special care and protection places available to children, citing a correlation between the failure of the State to appropriately deal with these acutely vulnerable children and the likelihood that many will find themselves before the children’s courts facing criminal charges.

I remain concerned about this. For example, a HIQA report was published and the response was to close the centre, yet there are not enough places for the children who are vulnerable.
I refer to children who are remanded in custody. The most recent data available from the IYJS are from 2008 and show that of the 111 children detained on remand in children detention schools, only 44% went on to be sentenced to detention on conviction. That raises a twofold concern – first, that detention as a last resort requirement, the principle underlying the Children Act, was not being adequately embraced by judges at the pre-trial stage and, second, that there was an urgent need to introduce a formal system of bail support to help children to manage their bail conditions, thus helping to reduce the number being placed in detention on remand. Unfortunately, the pilot scheme mooted in 2008 in Young People on Remand: The National Children’s Research Strategy Series to offer bail support services for vulnerable children who ceme before the Children Court in Dublin and Limerick failed to materialise owing to insufficient resources. Will the Minister provide the House with the figures in this regard for the past few years? I would be interested in seeing and trying to understand them. I fear the position has not improved much from what I hear anecdotally. Will the Minister consider revisiting the bail support pilot scheme?

I refer to the issue of training. Staff and personnel engaged in the formulation and delivery of youth justice policy should be trained in the provisions of the Children Act. The Committee on the Rights of the Child made a recommendation to this effect in 2006. An advanced diploma in juvenile justice is being run by the King’s Inns. The course is attended by a great mix of professionals from a wide variety of disciplinary backgrounds, including legal professionals, juvenile liaison officers, prison officers, detention centre staff and the IYJS. Robust, specialist training such as this needs to be rolled out on a systematic basis and attendance supported by employers such as the State.
I also raise the issue of the age of criminal responsibility. The concluding observations of the UN Committee on the Rights of the Child expressed concern about the age of criminal responsibility being ten years under the Criminal Justice Act 2006. The Minister has submitted a consolidated report to the committee. Has she had a communication from the committee? Will Ireland consider this issue before it appears before the committee?

On Second Stage of the Courts and Civil Law (Miscellaneous Provisions) Bill in March last year I alerted the Minister for Justice and Equality to my concern about routine breaches of the Children Act in the Dublin Children Court. Examples include the court appointed registrar calling the name of the child in the public waiting room, the former practice of District Courts including YP, meaning “young person”, beside the child’s name on the court list and the presence of Gardaí and legal representatives unrelated to the specific case in the court which is mandated to sit in camera. The Minister said he would write to the Courts Service and I await a response. I raise the issue in this debate because we need to consider practical remedies to ensure the Children Act is implemented in the spirit intended by the then Minister and the Houses of the Oireachtas.

16 January 2014: Quarterly Meeting of the Joint Committee on Health and Children, the Minister for Health James Reilly TD and the HSE.

Question 9: Registered Nurse Prescribers
Question 10: Cardiac Rehabilitation Services
Question 11: Neuro-Rehabilitation Services 

Question 9: Registered Nurse Prescribers

To ask the Minister for Health the reason for the HSE policy that Registered Nurse Prescribers who work in private healthcare facilities including nursing homes are not issued with prescription pads; if he would agree that this discriminates against qualified registered nurse prescribers working in private facilities and may impact on patient care by preventing timely symptom relief for residents with medical cards living in private and voluntary nursing homes where access to a GP may not be immediately available; and if he has plans to ask the HSE to change this? 

Professional guidance is already in place with regard to scope of nursing and practice and specifically in relation to nurse/midwife medicinal product prescribing.  Nurse/midwife medicinal product prescribing has been in place in Ireland since 2007 underpinned by (a) legislation, and (b) the NMBI regulatory framework. There are currently 650 registered nurse prescribers.

The issue in question is the requirement for access for nurse prescribers in private nursing homes to primary care prescription pads for the purposes of GMS reimbursement for medical card holders. This is a matter primarily for the HSE to determine.
The Department supports, in principle, nurse prescribers in private nursing homes having access to primary care prescription pads, subject to robust governance and accountability structures being put in place. The provision of nurse prescribing services in nursing homes would greatly enhance continuity of care from the hospital sector through to the nursing home sector. Medicines legislation currently in place does not differentiate between prescribing by nurse prescribers in public or private setting. Nor does it deal with reimbursement under the Community Drugs Schemes of prescriptions by nurses.
The issue of reimbursement through the Primary Care Reimbursement Service (PCRS) is a matter that will be progressed through engagement with the HSE by the Primary Care Division in this Department.


In light of Irish Heart Foundation and Irish Association for Cardiac Rehabilitation survey showing serious staffing deficits in cardiac rehabilitation services in all hospitals providing this service nationally, is the Minister concerned that these services cannot therefore maximise their life-saving and quality of life-saving capability 

Rehabilitation is the phase following acute medical intervention, during which structured approaches to halt or slow progression of the underlying health condition are undertaken and where the patient is enabled to return to an optimal level of physical, psychological and social well-being. Rehabilitation goals focus on recovering lost function and reconditioning, reducing the risk of a recurrent event (secondary prevention) and optimising quality of life. To be effective, rehabilitation must start as soon as the patient is stabilised in the acute medical setting. Rehabilitative care should be integrated across acute, out-patient and community services, to include access to both intensive acute rehabilitation and long-term follow-up.

The development of cardiac rehabilitation services were accelerated under the National Cardiovascular Strategy and the Building Healthier Hearts (BHH) initiative from 2000 onwards. The BHH identified ten recommendations and three implementation measures for cardiac rehabilitation. These recommendations identified the need for a cardiac rehabilitation service in all hospitals that treat patients with heart disease, which would be multi-disciplinary, exercise based and involve family members. During the years 2000 to 2005, €72 million was invested for the development of cardiovascular services in line with the recommendations of Building Healthier Hearts.
The HSE is aware of the findings of the study by the Irish Heart Foundation and the Irish Association for Cardiac Rehabilitation. Cardiac rehabilitation is an important and significant part of the recovery process for patients who have experienced an ischemic event. As the report acknowledges, the number of patients attending cardiac rehabilitation services has significantly increased whilst demand for services has also continued to increase.

The report confirmed that following the expansion of cardiac rehabilitation services under the cardiovascular strategy, most services have many members of the clinical team in place. The report states:

· all services have a medical director in place
· all but two services have a designated rehab co-ordinator with 30 of the 34 services having a full time co-ordinator in place
· the majority of services have access to nursing and dietician services.
· requirement for further focus on integrating psychology services given the important and specialised role such professionals play in the rehabilitation process
· significant gaps in dedicated access to social work and occupational therapy services

It should be noted that where dedicated social work and occupational therapy services are not available to the cardiac rehab team, medical staff within hospitals have the ability to refer patients to the general social work and OT services of the hospital.
Although the report identifies staff cut backs as a significant service issue, the largest category of staff vacancies related to maternity and sick leave. In such cases, staffing returning from maternity or sick leave will resume providing services as part of the cardiac rehabilitation unit and therefore should not be considered a staff cutback. Similarly, the previously invested budget in cardiac rehabilitation services continues as part of the overall hospital budget. There have been no targeted reductions in cardiac rehabilitation budgets and hospitals will continue to manage this and all hospital services in line with their overall budget for 2014.

However, the report does highlight the need for further actions to ensure continuity of cardiac rehabilitation services where important clinical support services are not available for the reasons identified in the report (i.e. maternity leaves, retirements, transfer of staff, etc). Similarly, it is anticipated that demand for cardiac rehabilitation services will continue to grow requiring all units to be able to respond to increased levels of referrals in the future. The National Director of Acute Hospitals will further progress this area over 2014 utilising the findings from the report particularly focusing on required improvements in waiting lists, access to allied health professionals and levels of patient enrolment in programmes. The integration of pathways between cardiology services and referral to cardiac rehabilitation services is also another area which the HSE will focus on to ensure greater levels of access for patients requiring such service. As part of the reorganisation of services in the future, there will be opportunities to develop single site services into larger multi-site services which can share development opportunities and achieve greater economies of scale to the benefit of patients. As an example, the University of Limerick has its Clinical Operations Group currently working to develop a single clinically governed cardiac rehabilitation service that will be available and operate across the acute hospitals in its region.

In parallel, the HSE will also be expanding the range of services available to patients who experience ischemic events through initiatives implemented via the clinical programmes. For example, the National Clinical Programme for Heart Failure aims to reorganise the way heart failure (HF) patients are managed across the health service rolling out a co-ordinated, multi-disciplinary and patient focused disease management programme. The initial focus of this work has been on the creation of dedicated hospital centres where care and expertise in HF is concentrated. The programme also aims to develop appropriate support services for patients to be managed in the community and is currently working on a number of initiatives to advance this. To date structured heart failure services have been implemented in 11 sites under the HSE’s National Clinical Programme for Heart Failure.

Question 11: Neuro-Rehabilitation Services 

What progress has been made on the development of the promised implementation plan in relation to the National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland 2011 – 2015

The National Neuro-Rehabilitation Strategy made a number of recommendations for services for people with rehabilitation needs that covered a range of types of provision including: clinical, therapeutic, social , vocational and community supports.

Following development of the report, the HSE as part of it’s commitment to ensure the optimal care pathway for different Clinical needs, established the Rehabilitation Medicine Programme. The scope of the programme covers the whole of the patient journey from self management and prevention through to primary, secondary and tertiary care. These programmes provide a national, strategic, and coordinated approach to a wide range of clinical services and include the standardization of access to and delivery of, high quality, safe and efficient hospital services nationally as well as better linkages with primary care services. The RMP has almost completed the Model of Care for the provision of specialist rehabilitation services in Ireland which will be the basis for the delivery of services.
Outside of the Clinical Programme, the HSE Disability Services Division has a role in certain key aspects of Neuro-Rehabilitation Services, primarily the provision of community based therapy services, and personal social services, often funded through partner service providing agencies in the non statutory sector. The Disability Services Division is obliged to implement the recommendations of the Value for Money and Policy Review of Disability Services, and will use the recommendations of the VFM report, to focus on Disability funded rehabilitation services and enable reconfiguration of existing provision through the establishment of demonstration sites. Close links will be maintained with the Rehabilitation Medicine Clinical Programme to ensure that there is no duplication of effort and that all initiatives receive optimal support.

Demonstration sites have been identified by Disability Services and mapping has commenced.

The Rehabilitation Medicine Clinical Programme and the HSE Disability Services Division will jointly agree an implementation plan for the Neuro-rehabilitation Strategy, the first draft of which has been completed and is undergoing a process of refinement before finalisation.


I, too, wish everyone a happy new year. 
I warmly welcome the establishment of the Child and Family Agency and was surprised to learn this morning that it was to be branded with the new name Tusla, which apparently is a completely new word reflecting a shared desire for a new beginning and forging a new identity.  I wonder why we cannot call things what they are.  Why must we make up a word in order to brand the agency? 
On the Child and Family Agency, the good news is that at the Joint Committee on Health and Children I established with the Minister for Health that no historic deficit will be transferred to the new agency.  However, that is where the good news ends.  The agency has a budget of €545 million.  We established yesterday that the budget does not meet the anticipated costs for 2014 and we are not giving the agency a fighting chance.  It has not even got off the starting line.  There is an agency that is to herald a new start with a €545 million budget and we are not giving it a fighting chance.  In parallel, there is Irish Water where several Ministers and officials have defended, and even supported, the establishment costs which, according to the briefing document of September 2012, are €180 million.  Establishment costs are important.  The Child and Family Agency got zero for establishment costs.  It has no start-up budget.  Its funding is not sufficient.  No doubt it will have a deficit this year.  Are we throwing out the baby with the bath water?  I would ask that the Minister for Children and Youth Affairs clarify what is the budget, where are our priorities and will we wait until January next year when we will have a furore over what happened in the Child and Family Agency.