Some social workers here have 'between double and triple' as many cases as their English counterparts, leading to some children being put on a waiting list to be assessed, writes Eithne Donnellan, Health Correspondent
THE BLOND-HAIRED, blue-eyed little boy was born on March 1st, 2006. He died in a blood-spattered cot in London on August 3rd, 2007, having suffered eight fractured ribs and a broken back. In his short life he suffered horrific abuse, much of it at the hands of his mother's boyfriend, despite being on a child-protection register from the age of 10 months and having had 60 visits from care workers.
Earlier this week the head of children's services in the borough where this child - known only as Baby P - died was dismissed from her post. Four others, including the council's leader, resigned or were taken off child-protection duties after a damning report on the way Haringey council dealt with child-protection issues was presented to government.
The report found the council failed to identify children and young people at immediate risk of harm and to act on evidence. Agencies worked in isolation from one another and without effective co-ordination, there was poor sharing of information, insufficient evidence of supervision by senior management and poor child-protection plans.
Meanwhile Kirklees Council in the UK yesterday announced an independent serious case review into the dealings social work agencies had with the family of Shannon Matthews, who was kidnapped by her own mother. The council placed Shannon on the child protection register five years before she was kidnapped. The announcement came amidst serious concerns about the way Shannons mother, Karen, who was this week convicted of kidnapping the nine-year-old, was caring for her children.
THE BABY P case has shocked people in Britain and beyond and many on this side of the Irish Sea are wondering if a similar tragedy could happen here. After all, a paediatrician who spent time as a junior doctor working at a number of Irish hospitals, including Mullingar General, failed to spot that the baby had a broken back when she examined him at a child-development clinic two days before the baby died. She did not carry out a full examination because the child was "miserable and cranky". The General Medical Council in the UK suspended Dr Sabah al-Zayyat's registration as a doctor on November 21st.
The Minister for Children, Barry Andrews, and the Health Service Executive say it's impossible to rule out a similar tragedy occurring here. "The very nature of the provision of child welfare and protection services means that in many cases social workers and health professionals are dealing with children at considerable risk of injury, abuse or worse. In such a setting, it is virtually impossible to give cast-iron assurances that tragedies cannot happen," Andrews said.
Hugh Kane, assistant national director with the HSE with lead responsibility for children and families, agrees. He says its impossible to say something similar will never happen in this State but feels as sure as he can be that systems are in place to prevent such an occurrence.
Others are not as convinced, however, that all that can be done is being done. Kenneth Burns, a lecturer in social work at University College Cork, says short-staffing of social services here means many social workers are overstretched.
He points to the fact that in the Baby P case the child's social worker, Maria Ward, who visited the child many times, had responsibility for about 15 other cases at the same time, which was considered locally to be a heavy workload. "The worry here is that social workers in Ireland would have at least between double and triple that . . . And the worry about that is the quality of their response, given they may be stretched," he says.
Given the shortages, some children are put on waiting lists for child-protection assessments, he says. "The worry would be, one, that there are children out there who need assessments who may not be getting them and, two, there are children who are ostensibly on the books but may not be receiving the level of supervision and support that they require due to gardaí, public health nurses, social workers and others being stretched in terms of what is expected of them."
He suspects the pressure on social work teams here, some of whom lost members when vacant posts were suppressed to cut costs at the end of last year, will only increase in the current economic climate.
A national review of HSE child and family services for the year 2005, details of which were only published last April, illustrates the pressure the service is under. It found that in north-central Dublin some children were waiting up to a year to be allocated a social worker. There was also a waiting list of 374 cases in the north Dublin area that had not been properly assessed, and, in north Cork, staff admitted children at risk were unable to receive prompt attention and intervention as services were under strain.
The Irish Society for the Prevention of Cruelty to Children and Barnardo's are also concerned there is still no out-of-hours service in most regions, despite a number of high-profile tragedies such as those of the Dunne family in Monageer, Co Wexford. A report into that tragedy, in which a mother, father and two children were found dead in their home three days after the family visited an undertaker to arrange their funeral, is now with the attorney general for legal advice on its possible publication.
Mary Nicholson of the ISPCC says her agency has been calling for a number of years for more robust, comprehensive child-protection and welfare services. "While there is probably a lot of good work going on in the child-protection and welfare services, some areas are overloaded and this can lead to only the very worst cases being investigated," she says.
A review earlier this year of compliance with the Children First guidelines, ordered by the Minister for Children in the aftermath of the publication of the Ferns inquiry report, found "variations" in the way they are implemented across the country. It also found that sharing of information between professionals and organisations in relation to children at risk of abuse "is not happening in the way it was envisaged".
The Ombudsman for Children, Emily Logan, was sufficiently concerned about this to launch her own investigation into how the guidelines are being adhered to. She has written to each of the HSE's 32 local health offices, as well as the Department of Health and Children, for information in this regard.
Alan Shatter, Fine Gael's spokesman on children, says there is a "terrible inevitability that a child here will suffer a similar fate" to Baby P.
"The truth is our child-protection services are chaotic, unco-ordinated and grossly inadequate. As a consequence, there are hundreds of files relating to children reported to be at risk gathering dust on the shelves of offices of the HSE, unallocated to a social worker for proper assessment and investigation."
Crucially, he says, the HSE lacks "real-time" information on what is going on in its child-protection services, noting that it hasn't yet produced a report on services for 2007 even though the end of 2008 is approaching.
Also of concern, he says, are different practices across the country. A HSE report on child-protection services for 2006, published only recently, showed that while 33 per cent of reported cases of child abuse in the HSE Dublin/Mid-Leinster area were confirmed, only 7 per cent of such reports were confirmed in the HSE South area.
"The only conclusions that can be drawn from these statistics are that one of these areas is not properly applying the Children First guidelines and that children in the Munster area are at greater risk of death, physical injury or sexual abuse than children in the Dublin/Mid-Leinster area," says Shatter.
INEKE DURVILLE, PRESIDENT of the Irish Association of Social Workers, says of the Baby P case: "It's very difficult to say it could never happen here." But she stresses that social workers here are very well trained. However, because of their workload, they have to prioritise cases. "There is inevitably a risk when you prioritise," she says.
"The main aim of social work is to be preventative rather than reactive. But if the service is short-staffed, most of the work is reactive . . . people call it the fire brigade service."
Hugh Kane of the HSE admits the service is more likely to intervene when things become problematic.
"We have been looking at how we might restructure how we provide our social work services," he says. It's likely the outcome will be ensuring that there are dedicated staff to deal with all types of cases, both emergency work and routine referrals, so that all areas are covered rather than just the "high-end child-protection stuff".
"I don't think it's just a matter of more social workers. I think it is about how we do our business," he says.
Pressed on whether he is confident children at risk in Ireland are being properly looked after in our system as it is currently structured, he replies: "As far as I can humanely be sure of, yes."
Kenneth Burns fears any plans the HSE has to improve services will be put on hold given the current economic climate. "I've asked social workers here in the past couple of days about why it hasn't happened here and their view is that there is still a sense that there is a good local knowledge in the area, that professionals still have good links with and co-operation with communities . . . they felt that at one level that may be part of the reason here why things haven't got that far."