Three reports published today by the Health Information and Quality Authority show considerable variations in the quality, safety and management of Health Service Executive (HSE) foster care services in the Dublin area.

The Authority found significant and serious shortcomings in the duty of care to a number of children in foster care in the HSE Dublin North West and Dublin North Central local health areas.

Some of the main findings in these two areas included:

• lengthy periods when children were not visited by a social worker
• that between a third and half of the children in foster care did not have a social worker assigned to them
• significant deficiencies in the vetting, assessment and approval of carers, particularly relative carers
• serious concerns in relation to child protection practices and the assessment of child protection concerns
• evidence of some extremely poor record keeping and information management practices
• poor governance and management of foster care services
• practices that were not always child centred
• inconsistent social work practice
• that HSE fostering services in both areas were in a state of crisis at the time of the inspection.

A separate inspection by the Authority in HSE Dublin North local health area found foster care practices to be mostly safe and well organised.

Dr Tracey Cooper, Chief Executive of the Authority said: “We had immediate concerns in Dublin North West and Dublin North Central areas having found that many children were being cared for by carers who had not been appropriately vetted and many children did not have a social worker nor were they seen by a social worker for significant periods of time, sometimes years.”

As a result of the serious concerns in relation to child protection and safeguarding practices in Dublin North West and Dublin North Central, the Authority halted its standard inspection process of foster care services and expanded its inspection to include a review of all cases of children in foster care in these areas.

Once these concerns emerged in Dublin North West and North Central, from the initial review of data provided by the HSE to the Authority, the Chief Executive of the Authority wrote to the Chief Executive of the HSE bringing its concerns to his attention and seeking an immediate response.

The HSE developed an action plan to begin addressing immediate deficiencies in relation to foster care services in Dublin North Central and Dublin North West as notified by the Authority.

“In Dublin North West and Dublin North Central, both of which were poorly managed, there was evidence of non-compliance with the child care regulations and a lack of recognition at senior management level that the child care regulations exist to safeguard and protect vulnerable children. The findings in these areas showed an unsafe approach to protecting and safeguarding children – this is unacceptable” said Dr Cooper.

However, in the Dublin North area, the Authority’s inspection found a service that was managed to a good standard and was staffed by a consistent team who satisfied inspectors with their child-centred focus and approach to their work. There was also good leadership from both senior managers and social work managers.

“Some improvements were required in the foster care service in Dublin North, but overall, the service provided was of a good standard and markedly different in outlook and provision compared to the services provided in Dublin North West and Dublin North Central,” commented Dr Cooper.

Dr Cooper said, “The HSE has failed in its statutory duty of care to a significant number of children in the Dublin North West and Dublin North Central areas and the impact on many of them has been a negative one. This serious and unacceptable situation should never have been allowed to happen and the HSE must ensure now that it is providing effective, accountable services and safeguarding children to a safe standard across the country.

“The fact that these shortcomings have been known for a number of years and were still present in 2009 and 2010, outline serious deficiencies in the effectiveness of the accountability, governance and management of these services, and the lack of emphasis on a child-centred culture at all levels of the HSE, but more significantly at senior management level. This needs to be addressed and resolved with immediate effect. Consequently, the Board of the HSE must satisfy itself that the recommendations contained in these reports are being effectively implemented, with clear delegated accountability across the services, and that where deficiencies exist, they are addressed promptly and on a sustainable basis” concluded Dr Cooper.

Following these reported inspection findings, it is important for the HSE to demonstrate and publicly assure children who are, or may be in the future, in the care of the State, their parents and their carers, that the safety, protection and best interests of children are central to the delivery of its services.

The Authority has made a series of recommendations to the HSE, at both a local and national level, and will be following up on their implementation in the Autumn of 2010.

Dublin North West Inspection Report | Executive Summary

Dublin North Central Inspection Report | Executive Summary

Dublin North Inspection Report | Executive Summary

Further Information: 

For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 814 7481 / 086 2447 623
mwhelan@hiqa.ie

Notes to the Editor: 

Dublin North West
The inspection found evidence of significant deficiencies in relation to these services. HSE data showed that nearly half of the children in foster care in the Area did not have a social worker assigned to them.

The HSE did not check that all children in foster care were safe through social work visits. It did not ensure that all children were being cared for by assessed and approved carers. It did not check, through the care planning process, that all children were in the right placement and whether some could be returned to their birth families. It did not keep information about children safe or record information consistently and the system for managing allegations made by children against foster carers was unsafe.

The findings from this inspection indicated that the HSE fostering service in Dublin North West was in a state of crisis at the time of inspection.

The inspection did find some evidence of good practice with children who had been assigned an allocated social worker, while children in the sample group interviewed by inspectors presented as being well cared for, and carers interviewed spoke highly of the social workers.

Dublin North Central
The inspection found evidence of significant deficiencies in the provision of these services. HSE data showed that a third of the children in foster care in the Area did not have a social worker assigned to them.

The HSE Dublin North Central did not check through social work visits that all children in foster care were safe or that their needs were being met. It did not check through the care planning process that all children were in the right placement and whether some could be returned to their birth families. It did not ensure all children were cared for by fully assessed and approved carers.

The findings from this inspection indicated that the HSE fostering service in Dublin North Central was in a state of crisis at the time of inspection.

The system for managing allegations made by children against foster carers was unsafe. The evidence demonstrated an unsafe approach to protecting and safeguarding children in foster care in the Area and was unacceptable.

The HSE senior management did not engage in appropriately assessing risk and there was evidence of a lack of a meaningful response by senior management to concerns articulated by its own social work staff.

The inspection also found some evidence of good practice with children who had been assigned a social worker, while children in the sample group interviewed by inspectors presented as being well cared for and carers interviewed spoke highly of the social workers.

Dublin North
Inspectors found that overall, the National Standards inspected in relation to foster care were met in the majority of cases. Inspectors were satisfied that the social workers and foster carers were creating an inclusive culture of participation and partnership with parents which inspectors found had such a positive effect on the children.

Inspectors found a good standard of social work practice in a sample group reviewed in detail by the Authority’s inspectors. The children in the sample were visited by their social workers frequently and regularly and saw them in private as required by regulation. Care planning and reviews were occurring in line with the requirements of regulation and were of a high standard.

There was evidence that the children’s parents and foster carers were consulted in the preparation of the care plan and reviews. Generally, parents and foster carers received copies of minutes of statutory review meetings. Of particular note was the comprehensive quality of social histories on file. Overall, most of the standards were met in full.