Category: Health and Children

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Statements on Homelessness Wednesday 3 December 2014

PLEASE CHECK AGAINST DELIVERY

According to the Dublin Simon Community, the official count for rough sleepers last month was 168. This represents a 30% increase in numbers since Spring 2014 and double the number since November 2012.

This is a time of many sickening firsts and all-time highs:

  • Emergency accommodation now has over 1600 adults plus 680 children. That’s never happened before!
  • Of the 1600 adults in emergency accommodation, 39% are women. That’s never happened before!
  • Emergency accommodation is turning into long term accommodation with no viable options to transition onto. That’s never happened before.
  • Many have given up looking for emergency accommodation.
  • Others believe themselves to be safer on the streets than in emergency accommodation.
  • Individuals and families are being are evicted from private rental properties every day of the week, unable to meet rent increases in an unfettered market.

We have an Emergency on our hands and it is winter. A very cold winter.

The numbers are steadily increasing and we need to act. Really act. Not a knee-jerk panicky reaction following the tragic death of Jonathan Corry. A dedicated and sustained response that looks at the crisis holistically.

For it is not just a homelessness crisis. This is a housing crisis.

A housing crisis characterized by a shortage in the social housing sector and a serious lack of affordability in the private rental sector, exacerbated by an absence in rent regulation, a rent supplement scheme completely out of sync with actual rental prices and the absence of measures to prohibit landlords discriminating against tenants on rent supplement.

The unprecedented crisis in the social housing and private rental sectors is pushing non-typical candidates into risk of homelessness and homelessness itself, for example, there are as many as 150 families in emergency hotel accommodation, the majority of whom have been pushed out of the private rental sector by spiralling rents.

Aside from the massive cost to the State, this hotel  and B&B accommodation is completely inappropriate, hugely disruptive for families and children, who may have to move schools as a result, and potentially unsafe.

I call on Government to immediately family proof all forms of emergency accommodation and to coordinate with the Child and Family Agency and emergency accommodation staff concerning child protection.

The crisis is in turn putting unprecedented pressure on frontline services and pushing those more “typically” vulnerable to homelessness (those with addiction issues and mental health difficulties and in complex situations such as young people aging out of State care, victims of domestic violence leaving the home) it pushes them  further and further to the margins only to resurface to public and political attention when they die in their sleeping bag, sleeping rough on the door step of the National Parliament.

The recently published Private Residential Tenancy Board Consultant’s Report found that rent control would make the housing market worse.

Focus Ireland rejected this finding. It maintains that rent regulation is a crucial part of a suite of measures, including an increase in rent supplement to reflect the actual cost of rent and tax breaks for landlords to encourage them to rent their properties.

I would also subscribe to a measure of rent regulation against an index as in many European countries or in line with inflation.

There are many initiatives to be commended, however there are “buts” attached to nearly all of them. For example:

  • Housing 2020 and the recently announced Social Housing Strategy but realistically we are 1.5/2 years away from meaningful delivery.
  • The new rent increase protocol agreed with the Department of Social Protection for families at imminent risk of homelessness but it is only available in Dublin and what we really need is a level of flexibility throughout the system and at an earlier juncture.
  • The Housing Assistance Payment, which is receiving a positive response from Landlords in terms of there being a guarantee around rental payment but doesn’t actually prohibit landlords from refusing to accept tenants in receipt of financial support. Also, how are people to find suitable accommodation within the maximum rent limits?

Excellent recommendations have been made in these regards and more by Focus Ireland, Threshold,  Dublin Simon Community and Peter McVerry Trust. The solutions are there. They just need to be implemented.

In closing, I would like to briefly discuss something a number of colleagues in this House said yesterday concerning Jonathan Corry and the fact that he had been offered assistance and accommodation over the 30 years he had been homeless, which de declined to take up.

I sympathise deeply with Jonathan Corry’s family and friends following his death. I didn’t know him or anything about his mental health status but I think these examples of people failing to take up an intervention and seemly choosing to remain homeless needs to be viewed in light of the Dublin Simon’s recent statistics on mental health difficulties among their service users, whereby 71% were identified as having a mental health difficulty.

Of those identified with a mental health difficulty:

  • 63% of individuals have been diagnosed with depression.
  • 46% have been diagnosed with anxiety.
  • 11% have been diagnosed with schizophrenia.
  • 11% have been diagnosed with psychosis.

A very high proportion of people who are homeless have addiction issues.  Furthermore, a very high proportion of people who have a mental health difficulty also have an addiction issue.

I call on the Government to urgently implement the key recommendations from Mental Health Reform:

  • Fully staff homeless outreach mental health teams.
  • Ring fence local authority housing for people being discharged from psychiatric hospitals.
  • On-tap, in-house mental health expertise within homeless services. E.g. Merchants Quay Ireland has an in-house mental health nurse full time, to provide support to clients that other staff members have concerns about. There are anecdotal reports that this has reduced the number of people having to access mental health supports through A&E when in a crisis.
  • Establish a dual diagnosis services for people with a mental health and addiction/alcohol misuse problems.

We have the reports. We have the plans. We have the expertise, particularly in the NGO sector. What we need now is action. Sustained and dedicated.

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Protecting Childhood: Motion on the Marriage Age

Wednesday, 25th June 2014

“That Seanad Éireann:

– notes the need to ensure adequate protection of children and of children’s rights in our laws, and in particular to ensure that children are not coerced or forced into ‘arranged’ marriages;
– notes that sections 31 and 33 of the Family Law Act 1995 allow exemptions from the normal rule that parties to a legal marriage must be over 18; and that the possibility of seeking this exemption by way of court order was retained in section 2(2) of the Civil Registration Act 2004;
– notes further that this exemption was criticised by the High Court in a judgment in June 2013 in a case concerning an ‘arranged’ marriage; and
– proposes that the Government would consider whether to remove or amend the statutory provision allowing minors to marry on the basis of a court exemption.”

Senator Jillian van Turnhout:

I welcome the Minister of State to the House. I would like to thank Senator Bacik, who like me has worked on this issue, for initiating the motion before us. I am very happy to second the motion and thank her for her co-operation.

I raised this issue back in May during the Seanad debate on the abducted schoolgirls in Nigeria that Boko Haram had threatened to sell into forced marriage. Like many people, I felt helpless looking on at the situation and it made me wonder if there was anything we could do. For me, this is one area that we can do something about. We can send the clear message that the age for marriage is 18. That is something that we must take responsibility for doing. During the debate I made the worrying correlation between Nigeria and Ireland because, in certain court ordered special circumstances, exemptions to the ordinary legal age for marriage of 18 years can be made. That means Ireland does not currently prohibit all child marriages.

It is important to note that Ireland is bound by a number of international human rights laws and standards, the provisions of which are profoundly incompatible with child marriage, for example, the International Bill of Human Rights, the UN Convention on the Rights of the Child, CEDAW, the Supplementary Convention on the Abolition of Slavery, the slave trade, and institutions and practices similar to slavery.

In September 2013, Ireland, with its fellow EU member states, supported the United Nations Human Rights Council resolution, Strengthening Efforts to Prevent and Eliminate Child, Early and Forced Marriage: challenges, achievements, best practice, and implementation gaps. The European Union as a negotiating block at the international fora condemns the prevalence of child marriages yet makes provision for it in a number of its own jurisdictions, for example, in Germany and Italy. In Germany, if one of the parties to be wed is at least 16 years old, but not yet 18 years old, the German age of emancipation, that party needs to seek approval from the family court in order to be wed. Consent of the concerned party’s parents is not sufficient. In Italy, a sworn statement of consent to the marriage is required by the parents or legal guardian if the child is under the age of 18.

Exploitation of young girls through violence and abuse, including forced and arranged marriages, is a global problem. According to Girls not Brides, every year, approximately 14 million girls are married before they turn 18 across countries, cultures and religions. They are robbed of their childhood and denied their rights to health, education and security. According to UNFPA, by 2030, the number of child brides marrying each year will have grown from 14.2 million in 2010 to 15.1 million, a 14% rise if the current trend continue.

In March 2014, the Iraqi Justice Minister tabled a Bill to allow girls as young as nine years old to marry. While reports have indicated that it is unlikely that the law will pass, it represents a worrying trend toward religious tendencies usurping girls’ human rights. In response to the Bill, prominent Iraqi human rights activist Hana Adwar said: “The law represents a crime against humanity and childhood. Married underage girls are subjected to physical and psychological suffering.” This contention is known to be true. The more than 60 million girls married under the age of 18 worldwide have a higher risk of death and injury during childbirth, fewer marketable skills, lower lifetime income, a higher rate of HIV, exposure to domestic violence, and illness for themselves and their families than their unwed peers.

It is inappropriate and, frankly, contradictory that we in Ireland speak out against child marriage in countries such as India, Nigeria, Malawi, Iraq, Nepal, Ethiopia and Bangladesh while our Statute Book still allows for exemptions to the normal marriage age, and fails to specify a minimum age for such exemptions. As outlined by Senator Ivana Bacik in 2012, some 28 marriages were registered under the exemption. As stated by the Senator, the exemption threshold is very broad and it uses standard language giving the court wide discretion. This means that decisions pertaining to allowing children to marry are made behind closed doors, often subject to the in camera rule since the parties to the application are children. Yet, from the moment they are married, they become adults and are outside all the child protection laws. We never hear about those decisions and those vulnerable children. In this regard, the Family Law Reporting Project has come across many of these cases, and may be able to shine a light on the prevalence and general circumstances in which they occur.

There is no written judgment in the High Court case referenced in this motion. The case concerns the annulment of a 16 year old girl’s marriage to a 29 year old man on the basis of the girl’s lack of capacity to give true consent. How can a 16 year old girl give consent to a marriage to a 29 year old man? I am not speaking of a case in Iraq but in Ireland. This happened in Ireland. However, Mr. Justice MacMenamin felt the case raised concerns of such a magnitude that it warranted his making a general comment about the danger of the legal loophole to children. We are faced with a choice. As the Legislature, we must provide guidance for the courts to implement the statutory provisions as intended or, and this would be my preference, we can lead by example and remove or amend the statutory provision currently allowing minors to marry. I believe Ireland should send a clear signal to children here that we protect childhood and that the age for marriage is 18 years. We have had excellent debates here on protecting childhood. We are talking about consent, the age for which should be set at 18 years. That would mean that Ireland, as part of the European Union as a negotiating block, is not saying that it can understand cultural differences and our courts can adjudicate, but we do not trust the courts in other countries. We need to send out a message that we are setting the age at 18 years without exemption.

Link to full debate here.

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Mother and Baby Homes: Statements

Wednesday, 11th June 2014

I warmly welcome the Minister to the House. Everyone in the Chamber will agree that the recent revelations are yet another deplorable stain on our collective conscience. In preparing for my statement, my personal shame as a member of the collective that turned a blind eye to the abuse and suffering of women and children, out of fear and deference to the powerful, is as acute as ever before. It is the same shame I felt reading each of the reports – Ferns, Ryan, Murphy and Cloyne – into the systematic abuse and exploitation of vulnerable children in State and church institutions in Ireland. It is the same shame I felt reading the harrowing testimony from survivors of the Magdalen laundries and symphysiotomy procedures performed by medical professionals in Irish hospitals.

I share the overwhelming sense of shame and compunction over the unthinkable fate suffered by our sisters, cousins, friends and daughters labelled “fallen women” by church and community for becoming pregnant out of marriage and sent to these homes for their sins and rehabilitation. The isolation, hardship and suffering to which these young women were subjected in the name of honour and respectability is almost unthinkable in contemporary Ireland. How many of these young women fell pregnant against their will, by way of rape, incest and familial abuse, and found themselves arbitrarily and extra-judicially detained in these homes? It is the worst injustice imaginable when the victim is punished. It reminds me of punishment by stoning for adultery under Sharia law for women who have been raped.

Due to the time limit, I will limit my main observations to the issue of adoption, including the legality of adoptions prior to the Adoption Act 1952. Although the national adoption contact preference register contains data on only a small number of adoptions, the 2011 Adoption Authority of Ireland audit of the records found 50 cases of illegal adoptions. Given that the vast majority of adoption records are held by the Health Service Executive, HSE, and Child and Family Agency, CFA, we have seen only the tip of the iceberg of illegal adoptions. The area of adoption legality is extremely complex and technical and the commission will need an expert on adoption law to deal with what is likely to be a huge body of work. The Mahon tribunal had two to three experts working together.

So many of the issues thrown up by the mother and baby homes are not just legacies of the past but prevailing issues today, from which an examination of the past can yield lessons for legislation and policy today. Earlier today, I met several survivor groups, and we must ensure any inquiry, and the process to establish it, will hear their voices and involve them. The latest revelations have once again brought to the fore the trauma and suffering of many of the survivors. We must ensure we care for the living. I welcome, so early in the Minister’s new term of office, his speedy and committed response to establish a statutory commission of investigation. We are all waiting to find out the scope of the inquiry and which homes and what period will be included. Will the State take responsibility for collating all the records or will it do the same as in the report into the Magdalen laundries, namely, receive the records and then return them to the church-run institutions?

The inquiry must deal with many inter-related matters. The prevailing issues are adoption, the right to identity, lone parents, the role of women, poverty, social strata, and the rights of unmarried fathers, whose names are still not necessarily recorded on birth certificates. Will the investigation have the resources it needs and the appropriate expertise to deal with the myriad issues I have outlined? We must find a way to prioritise the truths from which there can be learning. We have recently seen the role social historians and archivists have played and can continue to play in investigative teams. Can we learn from the Murphy report experience? Should the inquiry find a way to do its work by sampling to find the appropriate balance between truth, expediency, bearing witness, and establishing and identifying causal and contributing factors, thereby maximising the scope to learn lessons?

Lest we forget, each and every one of these children had a name, and to ensure they get the memorial they deserve, their names must be listed in their honour. They are the children we promised, at the formation of the State, to cherish equally.

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

Questions submitted in advance by Senator Jillian van Turnhout and response received:

Question 9: Work undertaken by the HSE’s National Oversight group

Question 10: Allowing Pronouncement of death by advance Paramedics

Question 11: Poor performance in Children’s rights alliance report card 2014

 

Question 9: Work undertaken by the HSE’s National Oversight group

To ask the Minister to outline the work undertaken thus far by the HSE’s National Oversight Group that was set up to coordinate a response to requests for day service or rehabilitative training places for young adults with a disability, and to detail particularly the work undertaken in engaging with young people who require these services and their family members.

Revised Process to support School Leavers and those exiting Rehabilitative Training 2014

In line with the Social Care Division Operational Plan 2014, a revised process is being implemented this year to ensure a more streamlined approach to the assignment of places to School Leavers and those exiting RT places. A summary of key elements of the process is outlined below:

 

  • Providing for the emerging needs of the estimated 1,200 additional young people leaving school and rehabilitative training programmes using a newly developed streamlined approach (€7m and 35 WTE) and for emergency cases (€3m and 15 WTE).

Implement a standardised process to:

  • Identify, in conjunction with the Dept of Education and service providers the young people who will be leaving school or exiting a RT Programme who have a requirement for ongoing HSE-funded supports by 1st February, 2014.
  • In respect of those identified as having a requirement for ongoing support, identify and agree the supports required, with a specific focus on responses to those who have complex service needs.
  • Identify the service providers with capacity to respond to the individuals who require support by 1st April, 2014 and agree the allocation of additional resources in respect of individual placements as required.
  • Advise the school leaver and their families of the placement location and service they will be receiving in September, 2014.  Notification of placement will commence in May and all families will be advised no later than the 30th of June.
  • Implement a communications process with all stakeholders.
  • Building on the learning from 2014 review and refine the process for engagement and implementation in 2015.

 

An important aspect of the new process has been the establishment of a National Oversight Group, consisting of representatives of umbrella organisations, representing the Disability Service Providers, service user representation and senior staff from the health service. In addition, the health service has assigned a full-time Project Lead to work to co-ordinate the implementation of the Project in 2014.

Work has been ongoing on the 2014 process since October/November 2013. The Oversight group met and agreed the timelines. A template was agreed for collection of information regarding each individual seeking to access health funded services. A letter was circulated by the National Council for Special Education to all mainstream schools to ensure that individuals with disabilities and their families would be aware of the revised process. The Health Service Guidance officers engaged with the special schools directly. The National Disability Governance Group, which includes Lead Area managers and disability specialists meets monthly and receives updates on progress.

Following the meetings of the Oversight group the Regional Disability Specialists/Disability Managers engaged with local service providers to ensure a complete profile of each individual seeking to access service was submitted.

Each application is being reviewed to establish if the applicant is appropriate to specialist disability services, has the capacity to attend rehabilitative training programme or attend day services.

In relation to engagement with service users and their families the position is that in Dublin for example Individual meetings have occurred with the following:

a) School Leavers

b) Parents/Guardians

c) Teachers/Principals

d) Clinicians/Health Care Professionals (as appropriate)

 

Continuous communication with school leavers and parents/guardians on any issues or concerns arising regarding transition from school are ongoing with the Guidance service.

I am pleased to report that the deadlines set in the Operational Plan have been met in that in excess of 1400 applicants were received by February 1st 2014. The next milestone is 31st March and Disability Services are online to meet that target date where a review of service users’ needs and current service provision will be completed.

Tbe process commenced on October / November 2013

  • We achieved an agreed approach across the disability sector.
  • We will identify and implement a prioritisation process by the end of April 2014
  • We will consider appropriate placement options by end of May 2014
  • We will advise Individuals/Parents/Guardians of placement no later than 30th June 2014

A summary of the current position is that:

A total of 1407 number has been identified, 905 school leavers, 427 RT exits work is continuing on a further 75 who have been classified as other or no category.

Throughout the engagement a range of challenges continue to arise as the process is streamlined. The process is flexible enough to address many of these however a consistent theme that is emerging relates to some locations where the physical infrastructure is at maximum capacity and alternative accommodation will need to be identified. The health service is committed to appropriately supporting this group of young people to ensure that optimum outcomes are achieved

 

Question 10: Allowing Pronouncement of death by advance Paramedics

To ask the Minister for Health/HSE to give an update on progress regarding allowing pronouncement of death by advanced paramedics (as is allowed in other jurisdictions but currently not in Ireland) as recommended by the Pre-Hospital Emergency Care Council, and on allowing pronouncement of death by senior nurses. 

 The Pre-Hospital Emergency Care Council (PHECC) is responsible for clinical practice in pre-hospital care. PHECC approves clinical practice guidelines (CPGs) for all aspects of the clinical work of registered paramedic practitioners in Ireland.

There are two key PHECC CPGs in relation to the death of a patient – for recognition of death and for cessation of resuscitation. The procedures set out in these guidelines allow practitioners to cease treatment and resuscitation where a patient cannot be revived.

Currently, Irish paramedics, unlike paramedics in other jurisdictions, do not pronounce death. After a paramedic makes a clinical decision to cease treatment, a medical practitioner is required for pronouncement of death.  I am advised that PHECC is examining this issue through the Forum on End of Life in Ireland, with a view to engaging in broader consultation on this matter and developing appropriate and recognised clinical and legal procedures to resolve it.
The Nursing and Midwifery Board of Ireland (NMBI) is responsible for specifying standards of practice for registered nurses and midwives. NMBI has developed a Scope of Practice framework to enable decision making and development of practice for all aspects of a nurses’ clinical practice in Ireland. In addition NMBI provides guidance to nurses and midwives on their scope of practice and has published professional guidance to nurses regarding their scope of practice for pronouncement, verification or certification of death. The guidance outlined the processes required to develop an organisational policy to include the appropriate clinical governance supports and the professional responsibilities and authority for nurses to be involved with the pronouncement of death in a care setting. The HSE is consulting with the Directors of Nursing Reference Group on this matter.

 

Question 11: Poor performance in Children’s rights alliance report card 2014

To ask the Minister to give an update on the worrying E Grade his Department received for Mental Health in the Children’s Rights Alliance Report Card 2014, with emphasis on a number of key areas including the need to ensure all children under 18 receive age-appropriate and timely mental health services and treatment and can the Minister advise when the Child and Adolescent Community Mental Health teams will have the appropriate provision of in-patient beds and the 150 staffing posts filled to achieve this end. 

 

The Government has prioritised reform of all aspects of mental health services in line with A Vision for Change, including additional and improved quality care for children in both residential and community based settings. Total HSE Mental Health funding in 2014 is significant at around €766m. In this context, additional funding of €90 million, and around 1,100 new posts, has been provided over the last three Budgets. This has been primarily directed to strengthen Community Mental Health Teams for adults and children; specialist community mental health services for older people with a mental illness, improving services for those with an intellectual disability and mental illness, and enhancing Forensic Mental Health services.

Key to developing Child and Adolescent Mental Health Services (CAMHS), as per A Vision for Change, is the establishment of 99 multi-disciplinary CAMHS Teams providing acute secondary mental health care in the community, including hospital liaison and Day Hospital services. In 2008, there were 54 CAMHS Teams. There are now 66 Teams in place – 60 Community, 3 Adolescent, and 3 hospital liaison mental health teams.

The additional €90m provided for mental health over 2012–14 is being used, in part, to expand and enhance the skill mix of CAMHS Teams.  Around 230 new posts were allocated to CAMHS Teams over 2012-13, and recruitment of these is well advanced.  Of the 150 posts approved in 2012, 136 or 91% are complete with 8 further posts at an advanced stage in the recruitment process.  Of the 80 posts approved in 2013, 35 or 43% are complete, with a further 18.5 or 23% at an advanced stage of the recruitment process.  In summary, of the 230 new posts approved to CAMHS in 2012 and 2013, 197 or about 85% have been filled or are well advanced in the recruitment process.  Outstanding CAMHS posts will be filled as quickly as possible.

There are a number of posts for which there are difficulties in identifying suitable candidates due to various factors including availability of qualified candidates and geographic location. Alternative approaches being considered for posts not fillable in the normal way.

Just over 14,000 referrals were received by the Child & Adolescent Mental Health Teams in 2013.  This represents nearly 1,000, or 8% more, than projected in the HSE National Service Plan 2013, while the target of 70% of referrals being seen within 3 months was maintained.

A Vision for Change recommends the provision of 80 Child and Adolescent psychiatric in-patient beds nationally.  In 2008, there were 16 such beds and at present there are 51 beds operational country-wide, with more planned.   Capacity will be enhanced also, with the completion of the CAMHS Forensic Unit as part of capital developments now underway for the National Forensic Mental Health Service, and the National Children’s Hospital. In addition, improved community based services, coupled with increasing bed capacity, are all aimed at discontinuing the practice of placing children and adolescents in adult acute in-patient units, except in exceptional circumstances.  Admissions of children to adult units have decreased by almost 60% from 2008, when there were 247 reported, to a provisional figure of 106 in 2012.

The review of the Mental Health Act 2001, already well progressed, is a key step in providing a revised and more modern mental health legislation in this country. The Programme for Government contains a commitment to review the Act, informed by human rights standards and consultation with service users, carers and other stakeholders.

The review has been delayed due to a number of factors, including the wishes of members of the Expert Group to first see details of the Assisted Decision Making (Capacity) legislation, which was published in June 2013. Due to the high level of inter-connectivity between both sets of legislation, members of the Expert Group reviewing the Mental Health Act felt it would be necessary that the Capacity Bill should be finalised before they completed their own review.

Work is continuing on the completion of the report of the Expert Group, and members are carefully deliberating, re-examining and refining their recommendations on key central issues such as consent to treatment, capacity, criteria for detention, and treatment of children under the Act. It is expected that the final report will be completed in the near future, after which its recommendations will be considered at Ministerial level.

While noting the contents of the recent report by the Children’s Rights Alliance on Mental Health services, real and significant improvements have taken place on implementing A Vision for Change and modernising mental health services across the country over the last three years.  Nonetheless, historic deficiencies remain to be addressed.  The aim is to strive for equity in providing high quality services, while balancing residential and community-based provision.  This approach has already been proven in many areas at local level. The Government will retain its commitment to mental health, and focus on up-grading all aspects of mental health care, in line with evolving service demands and resources available overall for the Health sector, for 2014 and beyond.

to move to the following access targets:

–          6 month target inpatient / day care

–          9 month target for outpatient

–          again with hospitals effecting full compliance with performance targets in the first half of the year and subsequent maintenance for the remainder of the year

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27 March 2014: Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, Frances Fitzgerald TD

Questions submitted in advance by Senator Jillian van Turnhout and response received:

Question 9: Figures in relation to Special Care Placement.

Question 10: EU Commission Recommendation ‘Investing in Children: Breaking the cycle of disadvantage’.

Question 11: Amendment to Childcare Act 1991.

 

Question 9: Figures in relation to Special Care Placement

To ask the Minister for Children and Youth Affairs to provide the most up-to date figures on the following, in relation to Special Care Placements:

a)   What is the current waiting list for Special Care Placement?

As of 11th March 2014, there was one young person waiting for a special care placement. There have been ten admissions to Special Care since 1st January of this year.

 

b)   How many applications have been made to date since the beginning of 2013?

From 1st January 2013 to 5th March 2014 there were 116 special care applications – 22 of these applications were re-referrals.

 

c)    How many of these applications were successful?

Forty applications were successful, 27 were withdrawn or removed by the relevant Social Work Department, 46 were not approved and there were three in 2014 where further information had been sought and a decision has not yet been made. A Social Worker making an application for a Special Care place will also work to put in place other supportive mechanisms for the child while they await the outcome of the application. Where it is found that the alternative supports are meeting the needs of the child without the necessity of detaining the child for his/her own safety, the preference is to continue with the alternative programme. Where a child has been sentenced to detention in a Detention School, the child’s application for Special Care is withdrawn.

There is an appeals process available to Social Workers if they disagree with the decision where a child’s application to Special Care was unsuccessful. The Social Worker will also consider the Care Plan for the child and make other arrangements to find the most appropriate placement for that child. An unsuccessful application does not preclude the Social Work Department from applying at any other stage, especially in light of a child’s needs changing.

 

d)   How many State provided places are there in mainstream residential care and

e) How many are provided by Private Providers?

All Special Care placements in Ireland are operated by the Child and Family Agency and placements are under the direction of the High Court. There are no private providers of Special Care Services in Ireland, however some children with complex needs are placed out of State.

More generally, in December 2013 there were 142 Children’s Residential Centres in operation throughout the country; 47 of which were Agency-managed; 28 were run by the voluntary Sector; and 67 were operated by private providers.  These centres are typically found in domestic homes in housing estates, on the outskirts of towns and villages. The centres typically have between three and six children. These children are usually in their teens.  There is always some flux in placements available as services adapt to meet the needs of the resident children.

In December 2013, there were 356 children in care placed across the different types of residential care. Of these there were 143 children placed in the 67 privately run centres.

 

f)    What is the allocated budget for private provision?

The cost of the provision of mainstream residential placements in the privately-owned children’s residential centres for 2013 was approximately €50m. To date private placements have been commissioned on the basis of a child’s needs which will influence staffing ratio, the need for live-staff at night and additional supports to the child in the placement. There has been a consistent and predictable spend in respect of this type of residential provision, which reflects demand.

Significant work is under way within the Agency to secure the most appropriate and cost-effective care for children in the different settings in which they are accommodated. In early 2012 the HSE’s Children and Family Services undertook a tendering campaign to secure 80 places at a cost of €18.7 m per annum or €4,500 per place purchased for a two year period (extendible for a further two years if required). This arrangement will be for children whose needs can be met in a centre caring for 3 or 4 children. The process is now complete and contracts are currently being awarded in respect of 2014. It is estimated that the procurement arrangements utilised will reduce the spend in this area by €3.9m in 2014.

Any additional places that will be required will be purchased on an individual basis and in some cases may be more expensive where bespoke placements are commissioned for young people with particularly challenging needs.

The Agency has been working to increase value for money in this area by, as outlined above, seeking to promote cost effectiveness within the different options available and also moving to fostering where appropriate.

The Agency intends to undertake a centre activity audit of all aspects of residential care in 2014, and this will allow for a level of comparison of cost of placement across private and public group children’s centres and individual placement arrangements.

 

Question 10: EU Commission Recommendation ‘investing in children: breaking the cycle of disadvantage’.

To ask the Minister what action the Government is taking to implement the EU Commission Recommendation (20 February 2013) Investing in children: breaking the cycle of disadvantage, concerning child poverty and well-being and, having acknowledged that tackling poverty requires a whole-of-Government approach, will DCYA carry out a social impact assessment on any fiscal adjustments in Budget 2015 and onwards?

Ireland, led by the Department of Children & Youth Affairs (the first such Department in any EU member state), is committed to improving the lives and experiences of Ireland’s children and young people.

Many of the actions being implemented by this Government are in line with the EU Commission recommendation on ‘Investing in Children’ which was adopted by the Council of Ministers in 2013. These actions include:

·     Protecting and enhancing children’s rights on foot of the decision of the people in the Children’s Referendum 2012;

·     Improving child protection, welfare and family support services through the newly established Child & Family Agency;

·     Implementation of the recently-reviewed Youth Homelessness Strategy;

·     Continuing to be a world leader in both the areas of children’s participation (through the national Dáil na nÓg and local Comhairle na NÓg model); and childhood research (through the ‘Growing Up in Ireland’ longitudinal study and ‘State of the Nation’s Children’ reports).

Tackling Child Poverty

The EU recommendation on ‘Investing in Children’ includes a significant focus on tackling child poverty, referencing the ‘setting of national targets for reducing child poverty’ and access to quality services.

The draft National Policy Framework for Children & Young People, which is being prepared by my Department and which is due to be considered by Government shortly, currently includes a commitment to address child poverty.

With respect to services, my Department is responding through initiatives such as establishment of the Child & Family Agency (with an enhanced focus on prevention, early intervention and family support) and the roll-out of the €30m Area Based Childhood (ABC) Programme.

 

Early Years/Childcare

The EU recommendation on ‘Investing in Children’ recognises the importance of early childhood education and care. The EU Commission has set a target of member states having at least 95% of four year olds in pre-school. Ireland is in compliance with this target through provision of the free pre-school year.

The EU recommendation on ‘Investing in Children’ also recognises the importance of access to affordable childcare. In this context I announced a review of existing targeted childcare schemes to consider how best to structure future childcare support, to both support working families and to incentivise labour market activation, which could be expanded to more families as resources allow.

Delivering improvements in quality standards and staff qualifications is a critical precursor to any future expansion of universal childcare provision and/or Government supports. I have prioritised implementation of an eight-point Quality Agenda, and there has been significant and unprecedented progress in the implementation of this agenda over the past eight months. This will continue in 2014 with establishment of landmark new National Quality Support Service, which is being seen a significant development in the context of developing EU policy.

 

Social impact assessment

In February 2012, the Government decided to develop an integrated social impact assessment to strengthen implementation of the new national social target for poverty reduction and to facilitate greater policy coordination in the social sphere.

Work in the area of social impact assessment is being led by the Department of Social Protection. A social impact assessment of Budget 2014 was published in February 2014 by that Department.  My own Department liaises regularly with the Department of Social Protection to ensure a child-centred approach informs such assessments and consequently provides learning to use in the development of our policy and service responses for children.

 

Question 11: Amendment to Childcare Act 1991.

 

Can the Minister provide a timeline for the delivery of the legislation to amend the Child Care Act, 1991, to provide a statutory right to the preparation of an aftercare plan for eligible young people leaving care and will the Minister consider extending this statutory support to young people leaving detention, as they often present with very similar needs?

The amendment to the Child Care Act 1991 to strengthen the aftercare provisions for children in care was approved by Government on 25 February 2014 for publication, and has been submitted to this Committee for its consideration.

I understand that the Committee plans to consider the matter during the month of April. Following the Committee’s deliberations the text of the amendment may need to be refined in conjunction with the Office of the Parliamentary Counsel, after which a timeframe for the progression of the legislation will be discussed and agreed with the Houses of the Oireachtas. I am very appreciative of the work of the Joint Committee and the contribution of the members.

Regarding children leaving detention, on average approximately one third of such children normally would have care orders and so would, in the main, be required to have an aftercare plan prepared by the Child and Family Agency.

At present, the mechanism for supervision of a child post-release from a sentence of detention (other than those who were in the care of the Child and Family Agency) is by the Probation Service if the courts impose a “detention and supervision” (i.e. in the community) order at conviction stage. Extending the right to an aftercare plan to all children completing a sentence of detention would require significant and detailed examination by officials in the relevant units of my Department, and the relevant other Departments and agencies involved, before any recommendations in relation to the matter might be formulated.

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25 July 2013: Quarterly Meeting of the Joint Committee on Health and Children and the Minister for Children and Youth Affairs, Frances Fitzgerald TD.

Question 3: Childhood Obesity

Question 4: National Consent Policy

Question 5: Counseling service for mothers

Question 3: Childhood Obesity

In light of the growing childhood obesity epidemic in Ireland and Government policy as set out in Healthy Ireland-A Framework For Improved Health and Wellbeing 2013-2025, to ask the Minister for Health why under the new Framework for Junior Cycle the status of physical education and SPHE (amongst others) has changed from a subject to a short course, thereby reducing recommended teaching time, and what will now be done under Healthy Ireland to ensure physical education and social, personal and health education in schools gets the priority they need?

I am aware that on 4 October 2012, the Minister for Education and Skills, Ruairí Quinn, TD, published A Framework for Junior Cycle which outlines his plan to reform the junior cycle in post-primary schools. I understand and am supportive of the overall vision being pursued with the framework and my Department will assist the Department of Education and Skills in achieving this vision. We believe that if the reforms are implemented as envisaged, they may increase student engagement with school due to the decreased emphasis on rote-learning and the broadening out of areas in which students can achieve recognition for their achievements. This will have a positive impact on health and wellbeing. I am aware that the Department of Education and Skills is supportive of health and wellbeing and I welcome the inclusion of wellbeing as one of the eight principles underpinning the Framework for Junior Cycle.
A position paper on Social Personal and Health Education and Physical Education has also recently been developed by a working group of relevant experts in the HSE which has been shared with the Department of Education and Skills. It is worth acknowledging that several health indicators in Ireland demonstrate positive trends in the health and wellbeing of adolescents in the last 10 years. Trends in the Health Behaviour of School-Aged Children Reports (ESPAD), for example, record declines in cigarette use, alcohol use, binge drinking and illicit drug use.

Research evidence from an international perspective points to the need to have comprehensive all-encompassing strategies for health behaviours which involve multiple settings, including the school setting, if progress is to made in improving health and wellbeing. Improvements in the trends on health behaviours are most marked since 2002/2003, the years that the SPHE programme was required in junior cycle. It is likely that the roll-out of the SPHE programme has had a positive influence on the health behaviour of young people.

Healthy Ireland which was launched in March contains a commitment to fully implement SPHE and PE and this was agreed with the Department of Education and Skills. As the Senator will be aware, Healthy Ireland contains a vision of an Ireland where everyone can enjoy physical and mental health and wellbeing to their full potential, where wellbeing is valued and supported at every level of society and is everyone’s responsibility.

Clearly, the creation of healthy generations of children, who can enjoy their lives to the full and reach their full potential as they develop into adults, is critical to the country’s future. Responsibility for prevention programmes cannot rest solely with my Department, the HSE or, indeed, the Department of Education and Skills but must be shared across Government Departments and all of society.

Officials in my Department will continue to meet with officials in the Department of Education and Skills to address issues of concern including these matters.

Question 4: National Consent Policy

What implementation plans are in place for the new National Consent Policy (May, 2013) for use in health and social care, particularly the education and training of staff who are expected to implement and deliver the policy

The HSE Consent Policy was developed by an advisory group and a wider stakeholder group. These groups included representatives of the staff who will use the policy on a day to day basis and the document reflects the needs of practitioners. The principle of consent and the knowledge of the importance of obtaining consent are expected of all staff employed or contracted by the HSE. Knowledge of the importance of consent is, and has long been, a professional requirement for health and social care professionals. Therefore the main focus of support for the policy is providing guidance rather than training and education of staff. At a local level there is a training requirement for new staff on local protocols and documents/forms used for consent, and this will continue.

The definitive document (HSE National Consent Policy) is in itself a guidance document and has been supplemented by the publication of a brief summary entitled ‘Seeking Consent: A Brief Guide for Health and Social Care Workers’. This provides practitioners’ guidance on how to use the policy in service settings.

To support staff in the hospital services the HSE will review the consent forms that currently exist for common procedures with the view to development of nationally agreed forms/templates. This will reduce variation in information provided and improve the quality of the consent process; and reduce training requirements as staff move around the system.

Children and Family services provide particular challenges in the area of consent. The Children and Families Services are developing an implementation plan to address particular requirements that arise in the delivery of services. The plan is being prepared at the moment.

Two service user guides have also been developed and published to help patients and service users understand the consent process and what they can expect from their healthcare provider and professional.

A log is maintained of all queries raised with the Quality and Patient Safety Directorate in regards to the use of the policy and these will inform the updating of the policy and other guidance as required.

Question 5: Counseling service for mothers.

Given that an estimated 28,500 women in Ireland are diagnosed with perinatal depression, post-natal depression and pregnancy or childbirth related post-traumatic stress disorder each year, to ask the Minister for Health what efforts are being made to tackle delays of 9 months and more for mothers to be seen by a professional counsellor in the public health care system?

Pregnant women access a range of services including primary care, obstetrics and ante-natal and post-natal services. If the individual herself, or any of the healthcare professionals caring for her during her confinement have a concern, they should first access their GP or Primary Care team in the normal way. Where an individual is assessed as requiring referral for specialist mental health services, their GP would refer to their local General Adult mental health service.

For women with a recognised mental health need, they may discuss the management of their pregnancy with their consultant psychiatrist as it may be necessary to alter their treatment programmes as some medications as contraindicated in pregnancy.

All community mental health teams would have experience of such presentations and collaborate with the obstetric services to ensure a safe delivery and appropriate aftercare.

For women with a previous history of post-natal distress or depression, there is an elevated risk of recurrence and this would be actively managed through high frequency review by the GP who assess when it would be necessary to engage with the specialist mental health services if at all.

Access to counselling for all medical card holders, including pregnant women, is now available through the Counselling in Primary Care Service. The detail of this new service and pathway of referral is attached in Appendix 1.

If an individual is being treated within the specialist secondary care mental health services and counselling is indicated clinically then the appropriate intervention by a trained health professional would be made available.

There are 123 General Adult Community Mental Health Teams nationally. The HSE, in its 2012 Service Plan, prioritised €35m and 414 WTEs for reinvestment in mental health to progress the objectives in the Programme for Government. One of these objectives was to enhance General Adult and Child and Adolescent Community Mental Health Teams.

The HSE, in its 2013 service plan intends to build on this investment with a further €35m to strengthen General Adult and Child and Adolescent Community Mental Health Teams.

In addition, there are three peri-natal Psychiatrists based at The National Maternity Hospital Holles St, The Coombe and Rotunda Maternity Hospitals reflecting the number of births at these centres each year.

Of the 414 posts allocated in 2012, 389 posts have either been filled, or under offer or awaiting clearance. These posts include multidisciplinary team members across all the health professions.

Of the 477 posts approved in 2013, 133 posts have been accepted by candidates. A further 16 offers have been made from existing panels. The HSE is establishing new panels and other arrangements to fill the remaining posts.

Currently, our mental health data system is a manual system and the information in respect of service users who may be pregnant is not captured nationally.

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23 May 2013: Quarterly Meeting of the Joint Committee on Health and Children, the Minister for Health, James Reilly TD, and the HSE.

Question 32: Provision of Neuro- Rehabilitation Services

Question 33: Neurologist waiting lists

Question 34: Children’s palliative care programme

Question 32: Provision of Neuro- Rehabilitation Services

Following the publication of the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015 (December 2011), an undertaking was given to publish an implementation plan “forthwith”. Why has this implementation plan not been published to date? When will it be published? And, will it meet its 3-year implementation schedule by December 2014?

The Department of Health and the Health Service Executive (HSE) have developed and published the “National Policy and Strategy for the provision of Neuro-Rehabilitation Services in Ireland 2011 – 2015”. In addition, the HSE is developing its Rehabilitation Medicine Programme within the Clinical Strategy and Programmes Directorate. The Report is the overarching policy on neuro-rehabilitation services and includes proposals for a framework for the future of neuro-rehabilitation services in Ireland, including key elements such as:
• guiding principles;
• implementation structure;
• methodology for implementation; and
• information and communication.

The Report recognises that given the current economic climate, the focus in the short to medium term has to be on re-configuration of services, structures and resources and the enhancement of the skills and competencies required to meet the changing context.

The key priority areas, as identified in the HSE’s National Operational Plan for 2013 are to:
• Map and develop Integrated Service Area level rehabilitation networks;
• Implement the model of care for rehabilitation services within the networks with a focus on community rehabilitation.

An implementation plan beyond the overall operational plan commitments would not be beneficial, as the work involved to progress networks and teams will require to be flexible and responsive to the areas identified and to their specific service profiles.

The Rehabilitation Medicine Programme has been working in collaboration with the National Disability Unit as part of an expert Working Group planning for the implementation of the Report. The Rehabilitation Medicine Programme has incorporated key elements of the Report into its own Model of Care and adopted the Strategy’s recommendation of “hub and spoke” model for specialist rehabilitation services and is keen to progress with a comprehensive model for the continuation of such service into the community. This co-operation will continue in 2013.

Question 33: Neurologist waiting lists.

What plans are in place to tackle waiting lists to see a neurologist in public hospital out-patients clinics, which are over 4 years for more than 1,000 patients? And, what will be done to cut the waiting time for neurosurgery, which is currently over 6 months for 37% of patients requiring this treatment?

Outpatient Services
An Outpatient Services Performance Improvement Protocol has been developed to improve the provision of outpatient services in all publically funded healthcare facilities providing outpatient services which will include neurology referrals. A minimum standard has been established of no patient waiting greater than 12 months by 30th November 2013. A primary target list has been developed for each hospital identifying all patients that will breach the target if not seen by 30th November 2013. Capacity analysis is currently being undertaken in all hospitals with regard to meeting this target. All hospitals are developing plans by specialty including neurology at present to address long waiting lists. Solutions being considered to tackle waiting lists to see a neurologist in public hospital out-patients clinics include data validation, patient level validation, additional clinic slots, additional clinics and capacity within the region.

Inpatient Services
In relation to inpatient neurosurgery services there are currently 452 patients awaiting inpatient/day case neurosurgery. Of this total 288 are waiting 0-6 months and 164 are waiting > 6 months.

The maximum wait time guarantee for all adults awaiting any type of inpatient or day case surgery is 8 months in 2013. The aim is for all hospitals to systematically reduce this maximum wait time each year by matching capacity with demand, eliminating inefficiencies in the patient pathway, ensuring the strict chronological management of patients of equal clinical priority and implementing the recommendations of the Surgery Clinical Programme

Question 34: Children’s palliative care programme

To ask the Minister for an update on the children’s palliative care programme currently funded by Irish Hospice Foundation (IHF) and HSE. In particular: an assurance that all 8 children’s outreach nurses (5 IHF funded/3HSE funded) are now in post and if not, why and when will they be in post?; to outline the plans the Department of Health and HSE have to identify sources of sustainable funding for the Children’s palliative medicine consultant post (IHF funded) and the 8 outreach nurses when the IHF funding ends in 2016; and to confirm that children with terminal illness are entitled to the medical card without means test in the same way as adults.

The HSE and the Irish Hospice Foundation work in very close collaboration in relation to children’s palliative care services and the National Development Committee for children’s palliative care is jointly chaired by both organisations.

This Committee;
• Provides national strategic guidance in relation to children’s palliative care needs
• Makes recommendations in relation to the resourcing of children’s palliative care services.
• Oversees the preparation of development plans for each HSE Region

In support of this work and to ensure streamlined services across the country, a network of Outreach Nurses, Consultant ‘champions’ and Directors of Nursing has been established.

Four Palliative Care Outreach Nurses are already in post and the process of recruiting the remaining 4 is at a very advanced stage, with candidates selected for the 4 posts.

The HSE continues to work with the Irish Hospice Foundation to develop a sustainable model of funding post 2016.

Other priorities for the Committee are
• Developing an appropriate monitoring and evaluation process for the Children’s Outreach programme
• Identifying the respite and home care needs of children with life limiting conditions including the development of a ‘Hospice-at-Home’ service model
• Improving clinical Governance, education and development
• Developing minimum information data sets

Children with terminal illness are entitled to a medical card without means test in the same way as adults. No means test applies to an application by a terminally ill patient and all terminally ill patients will be provided with a medical card number for a period of six months once their medical condition is verified by a GP or a consultant.

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19 April 2013: Questions to the Department of Children and Youth Affairs, for answer before the meeting of the Committee on Health and Children.

Question 17: Child and Family Support Agency

Question 16 (Senator Jillian Van Turnhout)

Question 18 (Senator Jillian Van Turnhout)

Question 17: Child and Family Support Agency.

To ask the Minister to share with the Joint Committee on Health and Children the Implementation Plan for the new Child and Family Support Agency; including details of the transfer arrangements from the NEWB, Family Resource Centres and HSE; and the referral pathways for children and families to the new agency.

Vision for Child and Family Agency
The Programme for Government commits to “fundamentally reform the delivery of child protection services by removing child welfare and protection from the HSE and creating a dedicated Child Welfare and Protection Agency, reforming the model of service delivery and improving accountability to the Dáil.”

I established a Task Force to advise on the establishment of this new Agency. I requested the Task Force to base its work on “best practice in child welfare, family support and the delivery of public services, and according to principles that:

• The welfare of the child is paramount;
• Children and families should be supported in their local communities to the greatest extent possible;
• The welfare of children is founded upon strong and loving families and supported by the purposeful and shared responsibility of the state and society to always protect and promote their welfare;
• The Agency will operate to the highest standards of performance and value for money;
• Children will receive the best parenting when received into the care of the state.”

The final report of the Task Force was published in July last year and made recommendations on a number of key issues. The Task Force provided a specific chapter on the vision for the Agency, amongst which included the following:

“The Child and Family Support Agency, working in collaboration with the Department, provides leadership to relevant statutory and non-statutory agencies, ensuring that the conditions needed to achieve children’s wellbeing and development are fulfilled.

The Agency is responsible for the wellbeing of children and families who require targeted supports due to family and social circumstances. These range from support to families in the community to highly specialist interventions where children are at risk of being unsafe. Such children and families are not an isolated grouping nor are they a static grouping as children and families can move in and out of needing support as their life circumstances change.

In fulfilling its statutory role, the Agency ensures that:
• The needs of such children and families are identified at the earliest sign of their emerging need;
• A coordinated set of supports that addresses all the facets of a child’s wellbeing is put in place which incorporates and utilises well-developed interagency working mechanisms;
• The effectiveness of the supports is monitored;
• For the services provided directly or funded by the Agency, service delivery systems and practice are continuously reviewed to ensure they respond successfully to changing needs, and unmet need is clearly identified as a part of ongoing planning and reporting processes to the Department and the Minister;
• It provides mechanisms to engage with children, families and communities regarding the design and quality of service provision.”

I share the view of the Task Force that in order to achieve genuine improvements for children and families, the Agency must have a broader focus than child protection. Prevention, early intervention, family support and therapeutic & care interventions are all key to the provision of integrated multi-disciplinary services for children and families based on identified need.

It is my intention that the new Agency will address the persistent and difficult issues which have been found regarding the standardisation of services, communication, professional collaboration and coordination, and sharing of risk assessment, management and treatment for many children and families with the most complex needs. At the same time, the Agency will have a role in supporting families more universally – providing less complex, less intrusive, less expensive responses which have a preventive function.

The new Child and Family Agency and the wider transformation of children’s services represent one of the largest, and most ambitious, areas of public sector reform embarked upon by this Government. The reforms are much deeper than structural or organisational change as they embrace operational, cultural and inter agency improvement. As such, they will not be delivered overnight and the organisational arrangements are intended as an enabler of the improvement in outcomes which will be the real service goal in the years to come.

Progress on Planning and Implementation
On 13th July 2012, Government approved the drafting of Heads of a Bill to provide for the establishment of the Agency. The detailed policy decisions to inform the drafting of legislation were set out in these Heads of Bill and approved by Government in November last. Such policy includes:

• The functions and legal remit of the Agency;
• The constituent services that are to make up the new Agency;
• The governance arrangements between the Minister and the Agency and between the Board and the Executive;
• The funding relationship between the Minister and the Agency;
• The arrangements for the Agency to contract others to provide services on its behalf;
• The arrangements for dissolving the Family Support Agency and the National Educational Welfare Board; and
• Provisions for the transfer of staff, assets, liabilities and contracts.

The Government decided that the constituent elements of the Child and Family Agency on establishment day will be made up of:

● Child welfare and protection services currently operated by the HSE including family support and alternative care services.
● Other child and family related services for which the HSE currently has responsibility including pre-school inspections and domestic, sexual and gender-based violence services.
● Psychologists working in the community setting in relation to children and families
● The Family Support Agency.
● The National Educational Welfare Board.

The scope of these services is sufficiently broad to capture an enhanced range of both universal and targeted services operating to a unified management structure. These will constitute the immediate service responsibilities of the new Agency. Further consideration will be given to the subsequent transfer of additional services to the new Agency after the initial set-up phase and following further consideration of relevant recommendations of the Task Force in consultation with relevant departments.

The Agency will function as a separate statutory body with strong governance and a framework of public accountability underpinning its operations. The Agency will have a board appointed by the Minister based upon expertise and competency. Therefore, accountability and transparency will be a key feature of the governance and performance management frameworks to be introduced in the legislation.

The legislation must provide for the reassigning, under law, of the sensitive and complex legal responsibilities which arise in relation to the care and protection of children and the promotion of their welfare. Particular care is also being taken in respect of the disaggregation of the functions from the HSE to ensure that there are no unintended consequences (for either the Agency or the services remaining within the HSE) in the separation of functions, either in legal terms or in terms of the practical operation of day-do-day services for children and their families or other HSE clients.

Work on the drafting of the legislation has been progressing in conjunction with the Office of Parliamentary Counsel. The legislation is at an advanced stage and once it is finalised it will be brought to Government for the purposes of approving its introduction to the Oireachtas. The legislation is on the A list of the Government’s legislative programme and I intend to bring it before the House in this current term.

While the legislative process is under way, all necessary organisational preparations are continuing in parallel. These preparations are being led by the Programme Director/CEO Designate of the Child and Family Agency, Mr Gordon Jeyes. The preparations are being supported by an oversight group chaired by the Secretary General of the Department of Children and Youth Affairs. In addition to the CEO Designate, its membership includes officials of the departments of Children and Youth Affairs, Health and Public Expenditure and Reform; HSE Children and Families and a representative of the CEO of the HSE.

The oversight group is supported by a joint Department of Children and Youth Affairs and Child and Family Agency project team (led by the CEO Designate) which is driving day to day delivery of the overall project. Its responsibilities include the full range of activities required to bring the project to completion. Representatives of the Family Support Agency and the National Educational Welfare Board are also members of the team and are actively involved in leading the requisite change management programmes within those agencies. The project team undertakes integrated project planning, risk management and reporting. It reports to the Oversight Group and relevant matters are escalated to the Oversight Group if necessary.
Progress achieved to date in preparation for the Agency includes:
• the separation of children and family services within the HSE from other health and personal social services, with discrete management responsibilities and budgets;
• recruitment of a senior management team to lead the agency. All positions with the exception of the Chief Operations Officer and Head of Education Welfare are currently filled. These two positions are currently being re-advertised/advertised;
• the establishment of a dedicated sub-head for children and family services within the HSE Vote to bring transparency to the current budget of HSE children and family services;
• the undertaking of an external due diligence process, under the auspices of the two Departments, to inform the reassignment of budgets from the HSE to the Child and Family Agency;
• the establishment of an industrial relations process to communicate with staff representatives and resolve issues to facilitate the transition to the new Agency;
• the issuing in January 2013 of personal letters to almost 4,000 staff across the HSE, NEWB and FSA informing them of the plans to establish the new Agency and that it is intended that upon establishment their employment will transfer;
• commencement of external inspection by HIQA of the child welfare and protection services, in line with the goal of promoting enhanced transparency;
• the continued implementation of a comprehensive national change programme for the operational improvement of children and family services. This includes detailed design of referral pathways and assessment frameworks in order to ensure national consistency;
• continued implementation of the integration of education services within the NEWB and the development of the Family Resource Centre network in advance of the relocation of responsibilities to the new Agency;
• the appointment from January 2013 of Mr Gordon Jeyes as fulltime Programme Director for the establishment of the Child and Family Agency; and
• the recent approval of the Government that name of the new Agency will be the ‘Child & Family Agency’.

In line with the public service reform programme the replication and duplication of transactional or support functions such as payroll, financial transactions and property management will be avoided. These can be more effectively provided on a shared service basis in order to ensure that costs associated with disaggregation are entirely minimised. Accordingly, preparations are in place for the HSE to provide significant levels of such shared services to the new Agency. This will involve process and technical development within the HSE. HSE has recently received approval to contract for IT system enhancements necessary to facilitate this service which will be implemented this year.

In addition to these organisational preparations the decision has been taken to commence governance preparations on a shadow basis pending the enactment of legislation including its provisions for a Board. The Government has approved the appointment of Ms. Norah Gibbons as first Chairperson of the board of the new Child & Family Agency. Ms Gibbon’s expertise and experience in the area speaks for itself. It is intended that Ms. Gibbons will initially be appointed as Chairperson of the existing Family Support Agency which is one of the agencies being incorporated into the new Child & Family Agency. The appointment process will include appearance before the Oireachtas Health & Children Committee in line with procedures for the appointment of the chairpersons of state bodies. My Department will also be seeking expressions of interest for other board members by means of advertisement on the publicjobs and Department websites.
These appointments will reflect the intention, pending the legal establishment of the Child and Family Agency, to have the FSA Board prepare in advance for the governance task associated with the new Agency and provide oversight and direction to the preparations at an organisational level which are underway for the new Agency. The newly appointed board of the Family Support Agency will play this role on an administrative basis in addition to its existing statutory functions. Day to day statutory responsibility for child welfare and protection services and education welfare services will remain with the HSE and the NEWB respectively until these are transferred on the enactment of the necessary legislation. This approach reflects the overall strategy to undertake as much preparation as possible in advance of legislative enactment and the consequential transfer of onerous operational responsibilities.

It is important not to underestimate the scale of change involved and the absolute necessity for a carefully planned approach to be adopted while embarking upon such large-scale change within this crucial area of the public service. The approach to the project is informed by learning from the establishment of other major agencies, particularly where preparatory time was inadequate. Such preparations include allowance for sufficient consultation and consideration of the legislation by the Oireachtas and stakeholders in the period immediately ahead. A precise date for the establishment of the Agency will be set when consideration of the legislation by the Oireachtas has advanced.

Conclusion
In conclusion, it is considered that the intensive preparations underway and summarised here will provide for the effective establishment of the Child and Family Agency and will bring a dedicated focus to child protection, family support and other key children’s services for the first time in the history of the State, contributing in time to the transformation of what are essential services for families and communities.

Question 16 (Senator Jillian Van Turnhout)

To ask the Minister for Children and Youth Affairs to set out and provide details on the process for the selection of the sites; programmes; interventions; and supports to be provided under the new Area Based Approach to Child Poverty Initiative in 2013.

Written Response
The Area-Based Approach to Child Poverty Initiative was allocated €2.5m in Budget 2013. The amount allocated will rise to €4.75 in 2015. It is hoped that this Initiative will be co-funded by Atlantic Philanthropies and discussions are ongoing to this end. This Initiative will build on and continue the work of the Prevention and Early Intervention Programme (PEIP) which supported projects in Tallaght, Ballymun and Darndale/Belcamp/Moatview.

The new Initiative reflects the Programme for Government commitment to adopt an area-based approach to child poverty in co-operation with philanthropic partners, drawing upon best international practice and existing services, to break the cycle of child poverty where it is most deeply entrenched.

I can confirm that the focus will be, very firmly, on outcomes, rather than inputs and outputs, and these will be referenced in (a) the selection of areas where children are most disadvantaged, and (b) in measurement of the success of interventions.

It has been proposed that the Initiative will consist of the following components:

• Continuation of interventions, where appropriate, in the 3 existing PEIP sites, subject to those programmes being supported by positive evaluations and evidence regarding impact and cost effectiveness
• Selection of 6 sites (including as appropriate proven programmes in existing PEIP sites), where multi-faceted approaches to addressing Child Outcomes via evidence based programmes will be implemented. The impact of these interventions will be monitored in a cost-effective manner, to ensure they have the intended outcomes on child well-being
• In time, the mainstreaming of proven, cost-effective evidence-based programmes into service delivery in a wider context than the areas specifically participating in the Area-Based initiative.

The Initiative is being overseen by a Project Team, chaired by the Department of Children and Youth Affairs with participation of the Departments of An Taoiseach, An Tánaiste, Public Expenditure & Reform, Environment Community & Local Government, Education & Science, Health, Social Protection, HSE, and including Atlantic Philanthropies. The Project Team is supported by the Centre for Effective Services (CES) and Pobal, which has been asked to act as the fiscal agent for the Initiative.

A Working Group to Support the Project Team has been established. At present it consists of DCYA, CES, Pobal and Atlantic Philanthropy.

My Department published details on its website on 12th April last outlining the overall selection process. Details of a seminar arranged for 25th April where the Initiative will be explained to potential applicants have also been published. It is intended that Applications will close by the end of May, and Stage 1 of the selection process is expected to be completed at the end of June. It is inspected that the finalisation of proposals may be effected more quickly in the case of some successful applicants than with others, depending on their readiness. Shortly and in advance of the seminar my Department will publish detailed guidance for applicants and an application form. The Department of Children and Youth Affairs will be happy to supply the committee with copies of these documents as soon as they are published.

The criteria for selection of proposals to attract support under the programme are as follows:

• Evidence of need – The level of poor outcomes for children in the target area
• The quality of the proposal
• Additionality & Sustainability – The degree to which the proposal leverages other resources
• Understanding & ability of the applicants to capture outcomes

The Working Group and Project Team will conduct assessments of the proposals and recommend projects for selection.

Who should apply?
Applications are invited from area-based groups of not-for-profit organisations, with a proven track record of working with statutory and non-statutory service providers and local community groups with a capacity to form consortia. These consortia must be in a position to propose and deliver an area based initiative that delivers on the programme’s objectives of:
Breaking the cycle of child poverty within areas where it is most deeply entrenched and where children are most disadvantaged, through integrated and effective services and interventions that address:
1. Child development, and/or
2. Child wellbeing and parenting, and/or
3. Educational disadvantage,
From pre-natal to 18 years of age.

Proposals are invited across all elements but particular consideration will be given to proposals that focus on the quality and effectiveness of services and interventions from birth to 6 years of age.

What will the programme provide?
Successful applicants will receive funding to implement proven and cost-effective early intervention and/or prevention programmes and practices. The level of funding which will be available to individual projects for the duration of the programme will vary depending on the scale and impact of each initiative and the level of existing resources allocated to the area concerned. It will be a requirement of funding that the programmes and practices are implemented collaboratively by all relevant service providers in the area, both statutory and non-statutory, using existing resources. Applicants should have regard to the fact that, while the initiative is expected to provide additional levels of funding until 2016, the objective is to work towards withdrawal or reduction of additional funding from then on.

Research and evaluation
Research and evaluation were key elements of the PEIP and will continue to be important components of the new initiative to ensure that the outcomes from the interventions are evaluated and measured. Given that the new initiative will build on trialled and proven leaning from the PEIP, and other prevention and early intervention projects funded by the State and/or Atlantic Philanthropies, the research and evaluation component is expected to be less onerous and will be centrally directed.

Successful applicants will be subject to on-going research and evaluation requirements, overseen at central level by an Expert Advisory Committee. This process will be assisted by the Centre for Effective Services, acting on behalf of the Department.

Mentoring
With the exception of applicants who demonstrate an acceptable record in the delivery of prevention and early intervention programmes (e.g. the existing PEIP sites), successful applicants will be expected to avail of mentoring assistance over the course of the new initiative.

Systemic Change
It is anticipated that the initiative will expand over time, both in terms of the number and type of area based interventions and the degree of systemic change and mainstreaming of evidence based programmes and practices which is taking place. In tandem with this, it is anticipated that the range of area based projects which will be included in the initiative, will broaden.

Applications will also be required to demonstrate an approach which is based on additionality to existing levels of service provision and resources both statutory and non-statutory i.e. the proposal should demonstrate how existing services, practices and resources will be made more efficient and more effective as a result of the proposal. In effect, the initiative is expected to promote improved inter-agency collaboration at local level leading to systemic change which is capable of being replicated on a broader or national scale.

Question 18 (Senator Jillian Van Turnhout)

In light of the Fifth Report (July 2012) of the Government’s Special Rapporteur on Child Protection, Geoffrey Shannon, to ask the Minister to confirm the status of:
• The examination he called for to establish whether the system of Direct Provision itself is detrimental to the welfare and development of children and whether, if appropriate, an alternative form of support and accommodation could be adopted which is more suitable for families and particularly children.

• The establishment in the interim of an independent complaints mechanism and independent inspections of Direct Provision centres and the recommendation that consideration to these being undertaken through either HIQA (inspections) or the Ombudsman for Children (complaints).

Written Response

No answer provided.

Posted on

18 July 2013: Questions to the Department of Children and Youth Affairs, for answer before the meeting of the Committee on Health and Children.

Question 4: National Substance Misuse Strategy

Question 5: Implementation plan for the Child and Family Support Agency

Question 6: Oberstown campus development

Question 4: National Substance Misuse Strategy.

To ask Minister for Children and Youth Affairs to outline her position on the recommendations contained in the Steering Group Report on a National Substance Misuse Strategy on protecting children and young people from the impact of alcohol. Specifically, the recommendations relating to alcohol marketing and minimum pricing with a view to impacting on the age at which young people start drinking alcohol, as well as the consumption levels of under18s.

Children and Alcohol
Whilst there have been some indicators showing an improvement in the levels of alcohol consumption in children over the last decade, with the percentage of children aged 10-17 who report never having had an alcoholic drink increased from approximately 40% in 2002 to 54% in 2010, there are many more indicators that continue to give deep concern about the patterns of drinking that exist in children and young people.

Drunkenness amongst Irish Young people
There exists a consistent trend for drunkenness when drinking among Irish young people, a trend that sets them apart from the majority of their European counterparts.
In the latest report on drinking among 15 and 16-year-olds across Europe, Irish students reported drinking a third more on their latest drinking day than the European average. In addition, there also exists a trend whereby Irish girls drink as much as boys, and sometimes drink more. Irish students reported that, in the 30 days prior to the survey
• Half (48% boys and 52% girls) had drunk alcohol
• 40% had 5+ drinks on a single drinking occasion
• 23% had one or more episodes of drunkenness
• In 2010, 18.3% of children aged 10-17 reported that they had been drunk at least once in the last 30 days.
Unfortunately, the impact of the trend in drunkenness has already surfaced as chronic alcohol-related conditions among young people become increasingly common.
Between 2005 and 2008, 4,129 people aged under 30 were discharged from hospital with chronic diseases or conditions of the type normally seen in older people.There has also been a considerable increase in alcoholic liver disease (ALD) among younger age groups. Among 15 to 34-years-olds, the rate of ALD discharges increased by 275% between 1995 and 2009
The accompanying trend of increased ease of access to alcohol is also a source of concern. In 2011, 84% Irish 15 and 16-year-olds reported that alcohol was “very easy” or “fairly easy” to get compared to 75% in 2007. Just over a quarter (26%) said they had bought drink for their own consumption from the off-trade in the 30 days prior to the survey; 37% said they had bought their drink from an on-trade outlet.
This trend has been accompanied by an explosion in the number of outlets selling alcohol at ‘pocket money’ prices with a bottle of beer often cheaper than a bottle of water. Discounts on multiple packs of alcohol have created a culture where young people buy slabs of beer instead of six-packs.
Unsocial and Public Order Offences by Children and Young People‘Public Order and other Social Code Offences’ were the single highest cause of referrals to the Garda Juvenile Diversion Programme, representing 28.9% of all referrals. Many of these are associated with alcohol consumption and binge drinking amongst young people.
The effects of Alcohol Abuse by Adults on Children
There are serious consequences also to children living in families where one of the parents or carers has an alcohol misuse problem. Adult alcohol problems are directly responsible for a significant percentage of child abuse and neglect cases; was identified as a risk factor in three-quarters of Irish teenagers for whom social workers applied for special care; is associated with a range of disorders known as foetal alcohol spectrum disorders are caused by mothers drinking alcohol in pregnancy
In Conclusion

The Department of Children and Youth Affairs works closely with the Department of Health to identify and support actions supported by emerging international evidence on what is effective in helping reduce the current levels of alcohol misuse in Ireland. Actions on pricing, advertising, sponsorship, labelling and others will move us further down the road of achieving safer levels of alcohol consumption in adults and minimising or preventing consumption by children.

Question 5: Implementation plan for the Child and Family Support Agency

To ask the Minister for Children and Youth Affairs to share with the Joint Committee on Health and Children the Implementation Plan for the new Child and Family [Support] Agency including: the anticipated commencement date for the Agency; details of the exact number and disciplines of the staff who will be transferred from the NEWB, Family Resource Centres and HSE; and a clear explanation of the referral pathways for children and families to the new Agency.

As I stated in response to the Deputy’s questions on this subject in advance of the April meeting, the establishment of the Child and Family Agency is at the heart of the Government’s reform of child and family services.

Extensive work is ongoing in the Departments of Children and Youth Affairs and Health, and in the HSE to prepare for the establishment of the Child and Family Agency. The preparations are designed to allow for the Agency to assume full statutory responsibility for specific services for children and families upon establishment.

The Child and Family Agency Bill was published on 12th July last and it is the intention to introduce it to the Houses of the Oireachtas in the current session. A precise target date for establishment of the Agency will be set when consideration of the legislation is advanced.

The Bill focuses on the task of bringing together the functions of the three “source” agencies (the HSE, the Family Support Agency and the National Educational Welfare Board). Particular care is required in respect of the disaggregation of the functions from the HSE to ensure that there are no unintended consequences (for either the Agency or the Directorates remaining within the HSE framework) in the separation of functions, either in legal terms, or in terms of the practical operation of day-do-day services for children and their families or HSE clients across the life cycle.

A key task in drafting the legislation has been to ensure that the Agency operates within a strong framework of public accountability. Other important features of the legislation relate to the need to create the correct platform for interagency arrangements, shared service arrangements and a robust process for the commissioning of services from a range of providers.

In addition to creating a framework for the future, the Bill also has to take account of the transitional arrangements which inevitably have to be prescribed. These are potentially complex against the backdrop of changing governance and structural arrangements in the context of the wider Health Reform programme.

While the legislative process is under way, all necessary organisational preparations are continuing in parallel. It is important not to underestimate the scale of change involved and the absolute necessity for a carefully planned approach to be adopted while embarking upon such large-scale change within this crucial area of the public service.

The establishment of the Agency is being directed by a project team (led by the CEO Designate) which is driving the overall project plan. Its responsibilities include the full range of activities required to bring the project to completion – from the high level legislative programme elements through to the more practical day-to-day issues regarding the transfers of staff, systems and various undertakings relevant to the operation of the new Agency. Representatives of the Family Support Agency and the National Educational Welfare Board are also members of the team and are actively involved in leading the requisite change management programmes within those agencies.

The project team reports to an Oversight Group which is chaired by the Secretary General of the Department of Children and Youth Affairs and relevant matters are escalated to the Oversight Group if necessary. Its membership includes officials of the Departments of Children and Youth Affairs, Health and Public Expenditure and Reform; the HSE – both sides of the organisation; and the CEO Designate of the Child and Family Agency.

In order to prepare for the establishment of the new Agency, a due diligence exercise has been commissioned regarding the level of resources to transfer from the HSE to the CFA on establishment. The objective of the exercise is to establish that the level of resources to be divested from the HSE to the new Agency is fair and reasonable.

Following intensive work on the part of HSE and CFA-designated staff, individual letters of notification issued earlier this year to some 4000 staff that have been confirmed as transferring to the new Agency. This includes staff employed by the HSE (the majority currently working in Children and Family Services), the Family Support Agency (FSA) and the National Educational Welfare Board (NEWB). It should be noted that the staff of the Family Resource Centres are not employed by the Family Support Agency directly.

I am confident that the establishment of the Agency will bring a dedicated focus to child protection, family support and other key children’s services for the first time in the history of the State and will in time contribute to the transformation of what are essential services for families and communities. As can be seen from the above, following publication of the Report of the Task Force on the Child and Family Support Agency, intensive work has been underway to prepare for establishment of the Agency. There are strong project governance and project planning methodologies in place, with revisions on an ongoing basis as tasks are accomplished or issues escalated. Further details of the tasks undertaken or underway were set out in my April reply.

In addition, since April my Department has sought expressions of interest for the Family Support Agency board which will form a shadow board pending the legal establishment under the Child and Family Agency Bill which has now been published.

In respect of referral pathways, HSE Children and Family Services are piloting programmes in selected geographical areas to ensure the most effective response to all referrals. Currently, all child welfare and protection referrals are channelled through social work departments, where child protection is prioritised. The revised referral pathways are intended to ensure a service is provided for all referrals at a level that is most appropriate to the problem presented. The intention is that the lessons learned from the early roll-out of this method of dealing with referrals will be applied across the country.

Question 6: Oberstown campus development

To ask the Minister for Children and Youth Affairs when a single management structure will be in situ in Oberstown to oversee the development of the campus including the integration of the three existing schools, and to outline, including the timeframe, the remaining steps in the process to ending the practice of detention of children in St Patrick’s Institution by mid-2014.

As previously stated in response to various Parliamentary Questions, we are the first Government to:

• have ended the detention of 16 year olds in St Patrick’s Institution.
• provide capital funding, of €50 million, for the development of National Child Detention Facilities in Oberstown.
• have extended the remit of the Ombudsman for Children to include St Patrick’s Institution.
• have established a dedicated multidisciplinary assessment and therapeutic care team for children in detention and special care.
• revised campus rosters and management structures at Oberstown.
• moved to close St Patrick’s Institution.

With respect to the development of National Child Detention Facilities in Oberstown, this project is required in order to give effect to the Programme for Government commitment to end the practice of detaining children in adult prison facilities. My officials have, in conjunction with the Office of Public Works, completed the design process and secured planning permission for the capital development. The tender process is being managed by the Office of Public Works at present and an announcement on the outcome of this process will be made shortly. The project will result in an increase in the overall detention capacity on the campus from 52 places at present to 90 places in total, along with associated education, visiting and other facilities. The required capacity to enable the assignment of responsibility for all children under the age of 18 years to the Oberstown campus is to be delivered in the first phase of the project, by mid 2014.

There is legal provision under the Children Act 2001 for 24 male bed spaces in Trinity House School, 8 female bed spaces in Oberstown Girls School, and 20 male bed spaces in Oberstown Boys School. However, only 16 of the certified 24 male bed spaces in Trinity House School are currently available for use due to staffing issues. The Irish Youth Justice Service, which is based in my Department, is currently in discussions with management and staff on the Oberstown campus to reconfigure staffing and accommodation in order to meet the increased demand for male bed places from the courts. I have also noted a substantial increase in demand for male bed spaces on the Oberstown campus in 2013 compared to 2012. This has been primarily but not exclusively driven by an increase in the number of boys aged 16 years old on admission detained in Oberstown. The Irish Youth Justice Service has identified a trend since late 2012 of a higher number of such children being detained in Oberstown compared to the situation which applied when this age group was the responsibility of St Patrick’s Institution. This increase in demand from the courts merits further consideration, particularly since the Central Statistics Office has recently recorded a general reduction in crime trends overall in the community.

The first-ever campus-wide staffing roster, with a set of harmonised conditions for hours worked, was implemented on 25th February 2013 following protracted negotiation and agreement between staff and management at the Labour Relations Commission. I wish to acknowledge the cooperation of staff with the implementation of the LRC agreement to date. A number of outstanding issues are the subject of ongoing discussions in conjunction with implementation of the campus wide roster, the ongoing industrial relations process on the campus and the Haddington Road Agreement.

I have obtained Government approval for an amendment to the Children Act, 2001. The Bill includes an enabling provision which will allow for the merging of the three current children detention schools into one single cohesive organisation. The Bill is at drafting stage at present with Parliamentary Counsel and it is my aim to bring it to the House later in 2013. This will ensure that a single unified management structure is in place and fully operational when the proposed new development on the campus is completed. In the interim my Officials are making arrangements for the appointment of a campus manager to drive the change management programme in Oberstown. The arrangements for the recruitment and appointment of this manager will be made in the coming weeks, in conjunction with the Public Appointments Service (PAS). It should be noted that the existing Board of Management has responsibilities in relation to each of the three schools.

Since taking over responsibility for the children detention schools, I have also engaged fully with the HSE on the implementation of a new mental health service for children in detention and in the special care / high support system. This is known as the Assessment, Consultation and Therapy Service (ACTS). Good progress has been made and the posts for addiction counsellor and speech and language therapist have been filled with the psychology post due to be filled in September, 2013. Representatives from the children detention schools, HSE and IYJS have been working together over the last two months to identify an appropriate mental health screening system that can be used in the children detention schools and to develop training for staff. Training is due to take place in September 2013 with a view to implementing mental health screening for all young people in the detention system before the end of December 2013. I welcome the ongoing development of this important service on the Oberstown campus, which was a key recommendation of the Ryan Commission on child abuse of 2009.

In conclusion, a very substantial change programme is underway on the Oberstown campus. Oberstown’s expanded remit will see it accommodate all children detained in the State in a child specific environment from the middle of next year. The Government has provided dedicated capital funds for this purpose. I recognise that significant operational change is also required. Major change has already been achieved and my Department continues to work with the Board of Management, the staff and their representatives to expand the range and quality of services on the campus.

Posted on

17 October 2013: Questions to the Department of Children and Youth Affairs, for answer before the meeting of the Committee on Health and Children.

Question 17: Family participation in HSE reforms in disability services

Question 18: Emergency medical card procedures for terminally ill

Question 19: Paediatric hospitals integration

Question 17: Family participation in HSE reforms in disability services.

Can the Minister outline the Department of Health’s strategy and objectives in terms of family participation in the major strategic reforms currently being undertaken by the HSE in the area of disability services?

The HSE and the DOH acknowledge the importance of involving service users, parents & families and wider community in the planning organisation & delivery of services with people with a disability. In this context, the development of a partnership approach between all these stakeholders has been an important part of the model of service over many years. A range of both formal and informal processes are in place to give effect to this strategic objective.

At a national level, the National Consultative Forum (NCF) which was established by the HSE is the mechanism for bringing these key stakeholders together.
The forum includes representatives of the various umbrella bodies representing service providers e.g. Federation of Voluntary Bodies, The Disability Federation of Ireland (DFI), the Not for Profit Business Association, a number of bodies representing families or service users are involved e.g. Inclusion Ireland and National Parents and Siblings Alliance. The National Disability Authority is also represented as are the DOH & HSE.

Similar fora have been developed at regional and local level. In addition to the above, the development of many of the key strategic policy documents have included such representation e.g. the Report on Congregated Settings, New Directions the HSE’s policy document on the development of day services and the Policy on Progressing Disability Services for Children and Young People. As these strategic policies are being implemented, the HSE is ensuring that local implementation groups provide for the involvement of service users and/or parents & families as active participants.

The current process, for implementation of 0-18 Children’s Service model, as outlined below, is a good example of the processes being put in place to ensure full participation by service users, parents & family representatives.

Children’s Services Model:

• Membership of the National Coordinating Group includes Inclusion Ireland CEO and 2 parent representatives
• A subgroup on Communications was established to focus on improving communications with all stakeholders, including parents..
• The programme’s recent Local Implementation Group (LIG) Lead Workshop included a presentation by the Special Needs Parents Association representative on how to involve parents in the LIG from a parent perspective which was extremely very well received. Guidelines on Parent and Service User representation on Local Implementation Groups was developed with input from Special Needs Parents Association and Inclusion Ireland and shared with LIG Leads Subgroup on development Outcome Focused Performance Management Framework for Children and their Families” included a parent’s voice in the working group. Ongoing work being done at local level across the country to hold parent information/briefing sessions in order to inform parents of the proposed changes and to seek parental involvement on the local

Question 18: Emergency medical card procedures for terminally ill.

Can the HSE clarify the procedures in place in the event that an emergency medical card issued on the grounds of terminal illness (and therefore not subject to means test requirement) needs to be renewed after six months, to ensure that the renewal process will be on the same basis as the initial application – i.e. on the provision of evidence from the GP or hospital consultant of the terminal nature of the condition – and the applicant will not be asked to provide details of means?

The HSE can issue a medical card where a Doctor or a Consultant certifies that there is a terminal illness. Where a patient is terminally ill in palliative care, the nature of the terminal illness is not a deciding factor in the issue of a medical card in these circumstances and no means test applies. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible. The HSE monitors such cases and can renew the clients’ eligibility if necessary. In such circumstances there is no assessment of means.

Under the provisions of the Health Act 1970, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants.

While people with specific illnesses such as cancer are not automatically entitled to medical cards, the HSE can apply discretion and grant a medical card where a person’s income exceeds the income guidelines.

In these cases, social and medical issues are considered when determining whether or not undue financial hardship exists for the individual in accessing GP or other medical services. Discretion will be applied automatically during the processing of an application where additional information has been provided which can be considered by staff or a medical officer, where appropriate.

The HSE set up a clinical panel to assist in the processing of applications, where a person exceeds the income guidelines but there are difficult personal circumstances, such as an illness. The Medical Officer reviews and interprets medical information provided by the applicant on a confidential basis. He/she can liaise with general practitioners, hospital consultant and other health professionals as appropriate so as to determine the health needs of the applicant and his/her family and dependants.

It is important to stress that the medical card system is founded on the “undue hardship” test. The Health Act 1970 provides for medical cards on the basis of means. That is what the law states and we must operate within the legal parameters.

The HSE can also provide a medical card for patients in an emergency where they are seriously ill and in urgent need of medical care that they cannot afford.

Emergency medical cards are issued within 24 hours of receipt of the required patient details and letter of confirmation of condition from a doctor or consultant and are generally requested by a manager in a Local Health Office or a Social Worker.

Emergency cards are issued for six months on the basis that the patient is eligible for a medical card on the basis of means or undue financial hardship, and will follow up with a full application within a number of weeks of receiving the medical card.

The HSE ensures that the system responds to the variety of circumstances and complexities faced by individuals in these circumstances.

Question 19: Paediatric hospitals integration

With the Children’s Hospital Group Board appointed on 2 August 2013 to oversee the long overdue operational integration of the three existing paediatric hospitals in Dublin into a new children’s hospital, can the Minister provided us with an update on progress and the timeline for each phase?

The Children’s Hospital Group Board will oversee the operational integration of the three existing paediatric hospitals in advance of the move to the new hospital and is also the client for the new hospital. I appointed Dr Jim Browne as Chair of the Children’s Hospital Group Board last April. On 2 August I announced nine further appointments to the Children’s Hospital Group Board. The Chairs of the three paediatric hospitals are members of the Group Board. Other competency-based appointments have been made, with further competency-based appointments to be made at a later stage. The first meeting of the new Board took place on 2 October last.

On 13 September I announced that Ms. Eilísh Hardiman had been selected as CEO of the Children’s Hospital Group. This follows an open recruitment process led by the Public Appointments Service. The role of CEO of the Children’s Hospital Group is critically important in driving forward the integration of the three hospitals, and the project as a whole.

The Children’s Hospital Group Board will work closely with the National Paediatric Hospital Development Board on the capital project. The National Paediatric Hospital Development Board (NPHDB) is the body responsible for the design, building, planning and equipping of the new hospital building. Also on 2 August, I announced appointments to the NPHDB which will ensure that the necessary capital development skills are available to drive this priority project to completion, including the appointment of Mr Tom Costello as Chair. These appointments replace the transitional Board of officials from DOH and HSE who had been charged with progressing the project on an interim basis. The key post of Programme Director for National Paediatric Hospital Development Board was advertised on 4 October and will be recruited via open competition. The Programme Director will be the chief officer of the agency, will lead the project and will be responsible directly to the Board for the delivery of this priority project.

Work on developing a detailed project timeline is continuing and I expect to receive an update on this within the coming weeks. This will reflect the urgency and priority of the project and also its scale and complexity. The estimated programme will be kept under continuous review and validation by those to be charged with project delivery.

In the near term, the tender process for the procurement of a new design team is well underway, and the aim is to have the new design team in place by the end of 2013. Pre-application planning discussions have commenced and the aim is to secure planning permission by December 2014 with construction to commence in Spring 2015. A review of urgent care centre(s) configuration is almost complete; the number and location of these satellite centres in the Dublin area is a key decision, as the size, activity and infrastructure of these satellite centre(s) has implications for the main hospital brief. In parallel, St. James’s Hospital is working closely with HSE Estates and the National Paediatric Development Board in regard to the decant phase of the project.

The new children’s hospital is a priority for me and for this Government. Everyone involved in the drive to deliver the new children’s hospital capital project is working to do so by the earliest possible completion date. I am confident that the appointments made to the two Boards will ensure the new hospital is completed as swiftly as possible, with optimal design and value for money.