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

The Lancet

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