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.

Child and Family Agency Bill, 2013, Second Stage.

Wednesday 27 November 2013

http://www.kildarestreet.com/sendebates/?id=2013-11-27a.75#g85

The Minister is, as always, very welcome to the House, especially so given her introduction of the Bill before us. It provides us with immense potential to streamline and co-ordinate services for children. It is a huge and impressive undertaking involving three source agencies – the HSE, the Family Support Agency and the National Educational Welfare Board. I see the evidence and appreciate the seriously hard work that has been done by the Minister personally and her departmental officials. I thank Liz Canavan, assistant secretary at the Department, for a thorough briefing on the Bill yesterday afternoon and also the Minister for her clarification at the briefing.

I fully agree that what we are striving for now is to get the agency operational by 1 January 2014, the establishment date. In that vein, I wish to be very clear that I am approaching this Bill in as supportive and constructive a manner as possible. Any issues I raise are in the context of the fact that we are all striving to produce the best possible agency. I will do everything I can to ensure the Bill’s passage through this House.

I followed closely the Bill’s passage through the Dáil. I acknowledge and welcome the fact that the Minister has made significant changes to the Bill, in particular following suggestions from civil society organisations such as the Children’s Rights Alliance and Barnardos primarily. We have a unique opportunity to ditch ineffective systems and to finally make sure that children get the treatment they deserve, and that families get the supports they require also. I am concerned about the emphasis on management and the centralisation of services. I understand it in part but I fear the creation of a bureaucracy. What we want to do is ensure consistent standards throughout the country. An effective and accountable child and family agency will be a monumental step forward for a country that has so spectacularly failed some of the most vulnerable children in the past.

We must ensure consistency and standardised practice on the ground. This opportunity has been a long time coming. I thank the Minister for bringing it to fruition. We know that history is unforgiving. As the Minister outlined, there have been more than 30 reports. We must learn from our failings and demonstrate clearly that is the case. We are duty bound to get this right and everyone is striving for the best outcome for children. I will submit a number of amendments on Committee Stage and Report Stage in an effort to strengthen the Bill before us today. I will make every effort to ensure the Bill’s passage through the House. I look forward to a fruitful debate.

I commend the Minister on her role in securing Government approval of a proposal to strengthen legislation on aftercare, by introducing a statutory right to an aftercare plan. This will be done by way of an amendment to the Child Care Act 1991 and is an essential component to ensure stability in care and to enable young people to make the transition from care to independence in a safe, progressive, tailored and appropriate way. The Minister may be assured of our support when she brings this landmark legislation through the House.

At this juncture I want to focus on how we can ensure that we give the new agency the best start possible and restore public confidence in our child and family services. The Minister mentioned the referendum on children and when I travelled around the country, the biggest concern related to how people had been treated in the past by the agencies or how they perceived they would be treated. These perceptions are significant with regard to how people feel and we should not diminish those feelings. It is important we find ways to instil confidence in this new opportunity we are discussing today.

We heard in the news today about the potential overrun in the HSE. I will not get into a debate on that, but it gives rise to more concerns about the resources that will be transferred from the current HSE operations to the Child and Family Agency. Can we guarantee there will be enough of a budget transfer to do what is planned today? Can we guarantee there will be no loss of services? What improvements can we expect? I am concerned the agency may start with a deficit. That would be like a ball and chain being added on the starting line. I fear that the transfer of resources may mean the transfer of a deficit. This would be totally unacceptable. We have an opportunity with this new agency and we need to use it. During Committee Stage, I will look more closely at the details of the budget for the agency, particularly with regard to outsourcing. We know the agency has a budget of approximately €545 million, and I understand €100 million of that will go to outsourcing. I will seek further clarity on that on Committee Stage.

The issue I want to focus on today is the issue of special care. The issues in this regard are indicative of some of the issues I am raising about confidence and how we go forward. Under the special care order of the Child Care Amendment Act 2011, only children and young people aged from 11 to 17 with serious emotional and behavioural difficulties that put them “at a real and substantive risk to his or her health, safety, development or welfare” and who are unlikely to receive special care or protection “unless the court makes such an order” can access these facilities. An example of this may be a child who is self-harming, suicidal, abusing drugs and-or alcohol, where all other attempts by the Health Services Executive have not stabilised the current, serious situation. Rightly, one has to go to the High Court to obtain such an order. This is an appropriate safeguard due to the nature and seriousness of such intervention and the restriction of the individual’s liberty.

The recent report by the HIQA into Rath na nÓg raised serious concerns. The response from the HSE was to close the facility, which was relativity new. One could be forgiven for thinking as a result of that action that there is no demand for places. However, I understand there are currently 16 children on a waiting list for places and as many as 40 children who have not got onto the waiting list in need of a special care placement. Having read the definition, I cannot understand how there can be a waiting list for special care.

I am conscious that we are sending children to facilities abroad. For this to be done legally involves a time limit. Therefore, this involves returning to the High Court time and again to extend the period. The State is paying substantial costs both legally and for the provision of these places outside the State. Can we not develop a home grown solution that will be in the best interests of children? I am also concerned about the current arrangements around applications and placement for special care. The personnel in the HSE who decide whether to initiate a High Court application for special care are the same personnel who manage the number of special care places that are available. This is a serious concern because of the implicit conflict. Somebody said to me that the philosophy is: “If we do not have a place, we do not make an application in the first place.” Surely need and the best interests of the child should be the driving and deciding factor in whether a special care order is sought. Are we failing children today? Are we failing the 16 children on the waiting list? They have been assessed and identified as needing special care. At the least, I ask for the Minister’s assurance that this practice, as outlined, will not carry over into the new agency. There should not be a waiting list for special care.

The Minister was right to say we need to look at co-operation and bringing services together. I agree we must break down the barriers between agencies and services. We need an informed and integrated approach and for all of them to be under one roof. One of the regrets I have as we move forward with this is that children with disabilities will not be under the roof of the agency. Public health nurses will not be included either. All too often we hear that public health nurses are identifying upstream issues relating to a young child. At a recent meeting of the Oireachtas Joint Committee on Health and Children, the special rapporteur on child protection gave us what could be called a master class on children’s rights. One of the issues he raised was the issue of alcohol as a risk indicator and the need for social workers to consider this.

The issue now is how are all of these other services to communicate and liaise with the new agency. We have talked about integration and working together. Let us look for example at the Child and Adolescent Mental Health Services, CAMHS. We would assume, judging by its name, that this service would transfer to the new agency. CAMHS caters for young people up to 16 years, with an extension on occasion to 18 years. Social workers on the ground say they find it extremely difficult to access CAMHS, particularly once a child has been put into care. It is almost as if the perception is that once they are in State care, the State cannot outsource the facilities to CAMHS and will deal with them in the community. This is a further cost on the State. There is a concern that if CAMHS does not transfer to the new agency, this will further exacerbate the difficulty social workers are experiencing accessing these services for children. We have seen in the child death report the critical role that CAMHS plays. I do not understand why it is not being made part of the new agency. Is it because it does not want to be? This is a serious concern.

There is plenty more I could say, but I will keep it for Committee Stage. I am anxious to ensure the agency will be about all children and child welfare and that its remit is not limited. I do not question the Minister’s commitment, but the Bill is about outlining and putting down a foundation for the future. It is about a future when none of us will be here. We need to grasp the opportunity we have and maximise the potential of the Bill.

 

Link to Committee Stage: http://www.kildarestreet.com/sendebates/?id=2013-12-03a.189#g193

Links to Report Stage: http://www.kildarestreet.com/sendebates/?id=2013-12-05a.101#g110

Order of Business, 2 October 2013

Wednesday, 2nd October 2013

I raise with the Leader, and the Cathaoirleach, a decision made by the Dáil Committee on Procedure and Privileges, CPP, yesterday to cease allowing Members to invite non-governmental organisations to host briefings in the AV room. I learned of this not as a member of the Seanad CPP.

I learned it from Deputy Thomas Pringle’s tweet. He tweeted, “Dáil CPP closes down presentation room to NGOs too embarrassing it seems to see effective cuts inside Leinster House”. I have verified that information with the CPP.

Yesterday, I organised a briefing on the Child and Family Agency Bill 2013, which everybody says is a significant Bill. We had cross-party and group representatives at the meeting. I invited the Children’s Rights Alliance, which brought in Barnardos, EPIC, Empowering People in Care, Pain, Lifestart, the Irish Association of Social Workers, Focus Ireland, Young Ballymun, Start Strong and the Association for Criminal Justice Research and Development. They gave their collective views to Deputies and Senators on the Bill. The Bill has been delayed and will have significant changes made to it which I know were advocated by the NGOs.

The situation asks serious questions of us. I have visited several parliaments around the world and NGOs have much greater access. For example, last year I visited Wisconsin – in case any reporters are tuning in I add that I did so at my own expense – and there is a round space where NGOs can protest inside the Parliament. That allows members to have direct engagement with and the NGOs are not kept beyond the gates.

We often talk about the use of the guillotine in this House. I wonder whether this situation is an example if its over-use. I have some serious questions to ask about this matter: does the Dáil CPP have ownership rights over the AV room? Is it pre-empting a forthcoming vote? Are we only in favour of representative democracy or do we not also agree in participatory democracy? If decisions are made, we need to be involved. The rules in this House about the use of the AV room are ever changing. I would therefore welcome written guidance on what is and is not allowed. The development is a serious one and I seek urgent clarification.

The Lancet

In July 2021, Jillian co-authored an article in the world-renowned medical journal “The Lancet”