RATIONALE, OBJECTIVES AND CONTINUING RELEVANCE

The overall aim of the Programme is to promote and protect the health and wellbeing of children and families, particularly those who are at risk of abuse and neglect. The HSE, through the National Service Plan, sets out annually the level of services to be provided on behalf of the State. Child welfare and protection services are primarily delivered by the HSE, with support from the non-Governmental sector.

The delivery of services under the programme requires a considerable degree of interface with a range of other programmes / care groups, including primary and secondary care, mental health, addiction and homeless services. There is also a strong interface with other bodies and agencies which have a responsibility to deliver statutory services to children such as the Department of Education and Skills, the National Education Welfare Board, Irish Youth Justice Service, An Garda Siochana, the Court Service, the Probation Service, the Department of the Environment, Community and Local Government and the Department of Social Protection. By bringing these services together as part of the new Department of Children and Youth Affairs there should be the opportunity to create better synergies and more streamlined services.

The programme is consistent with Government policy as articulated most recently in the new Programme for Government and previously in the national strategy document ‘Agenda

for Children’s Service’ and the Implementation Plan prepared following the publication of the Report of the Commission to Inquire into Child Abuse.

The establishment of a dedicated Department of Children and Youth Affairs reflects the priority which is attached by Government to promoting the development of children’s services. The Government has also committed to fundamental reform of the delivery of services by transferring child welfare and protection services from the HSE to a dedicated Child Welfare and Protection Agency to be established.

11.3 PROGRAMME EFFECTIVENESS

There has been some improvement over recent years in the delivery of services. However, it is widely acknowledged that child welfare and protection services require fundamental re-organisation and reform. A wide ranging programme of reform has commenced under the direction of a recently appointed National Director. At an operational level, this needs to be supported by the delivery of key structural reforms.

The immediate priorities for the programme in 2011 are the meeting of statutory requirements, regulations and standards for the sector. This includes:

• Delivering statutory services, including foster care, special care, after care, youth homelessness, and adoption services;

• Implementing the actions of the Commission to Inquire into Child Abuse (Ryan Report);

• Implementing recommendations of internal and external audits of services e.g. HIQA’s recommendations for children in care and child protection, and the HSE’s National Audit of Foster Care;

• Implementing the Task Force Report and the Strategic Review of the Delivery and Management of Children and Family Services;

• Supporting the roll-out of the Revised Children First National Guidance, including the provision of training and advice;

• Maintaining and developing family support services and ensuring the provision of aftercare services are strengthened.

There are indications that the number of children requiring care has increased over recent years. This is reflected in the latest figures for the total number of children in the care of the State. A number of factors are thought to have contributed to this, including increase in parental addiction and more recently the rise in unemployment and the cost of living.

Table 11.1: Trend in Number of Children in Care 2007-2010

2007 2008 2009 2010

5,322 5,347 5,689 5,964

The HSE National Service Plan, 2011 commits to delivering on the statutory requirement that every child in care should have a written care plan and an allocated social worker.

While good progress is being made in this regard the HSE is still some way short of this requirement.

The latest available information from the HSE indicates that the number of children in care nationally at the end of April 2011 was 6,122. Of those children 5,441 (90%) had a written care plan in place. This represents a significant improvement on the position in mid-2010 when 82% of children in care had a written care plan. The breakdown by care type nationally of children in care who had a written care plan in place was as follows:

• Residential Care: 93.3%

• Foster Care: 89.4%

• Foster Care with Relatives: 87.3%

• Other Care Types (e.g. at home under care order): 88.9%

The HSE further reported that nationally, 94.6% of all children in care (all care types) had an allocated social worker. Again this represents a significant improvement on the position in mid 2010 when 86.5% of children in care had an allocated social worker. The breakdown by care type nationally is as follows:

• Residential Care: 96.7%

• Foster Care: 95.3%

• Foster Care with Relatives: 92.5%

• Other Care Types (e.g. at home under care order): 95.8%

11.4 PROGRAMME EFFICIENCY

The children and families service is required to contribute to the overall pursuit of efficiencies / savings across all areas of the HSE. The 2011 budget shows a reduction of

€14m over 2010. However, as indicated, the increase in the number of children in care is giving rise to significant cost pressures in the current year and the HSE has particular statutory obligations to meet in this regard.

A number of key improvements and efficiencies are being progressed by the HSE, including:

• Introduction of flexible working hours to reduce overtime spend and contribute to the provision of more cohesive services.

• Better deployment of staff with appropriate skills to ensure adequate resources to meet assessed need.

• Implementation of the PA report of management structures in the Children and Family Services.

• Development of clear lines of accountability, quick decision making and re-organisation of resources through regular management meetings with the regional representative’s clinicians and national office staff.

• Improved monitoring of performance through monthly exception reports.

The HSE is also seeking to progress the development of a National Child Care Information System which will greatly assist in both front line service delivery and the provision of management information. This is an area which requires particular attention and improvement.

Given the specialised nature of the services provided and significant issues such as continuity of care and carers which materially affects outcomes for children in the care of the State, it is considered that services should be provided in-house where possible. While the HSE uses external providers on occasion it is seeking to effect a reduction in the use of private services through the establishment of a national resource management structure.

A number of areas have been identified as having the potential to provide for efficiencies / income generation. Areas which might be considered in this context include:

Table 11.2: Areas identified to provide further efficiencies – Child Welfare &

Protection

€m Reduction in private care placements TBQ Reduction in use of agency social workers and social care staff

TBQ Restructuring of the Guardian Ad Litem TBQ

Service

In addition to the above the HSE, in 2010, incurred expenditure of €100m in respect of foster care payments. A decision will need to be made on whether to change the level of this payment. A reduction of 5% would generate a saving of €5m in a full year assuming no increase in the number of children in foster care. However, in considering this issue the Government will need to be mindful that a significant reduction in the rate of foster care allowance is likely to give rise to an additional demand for residential care at higher cost.