Major non-compliance issues at Cork child welfare services - HIQA

Major non-compliance issues at a child protection and welfare service in Cork have been found, according to a report published by the health watchdog.

The Health Information and Quality Authority conducted a risk based inspection in January to assess compliance with national standards relating to children placed on the Child Protection Notification System (CPNS).

The report says that of the five standards inspected, four were identified as major non-compliances.

It says governance arrangements in place for the CPNS required strengthening.

Improvements were also required, according to HIQA, in the oversight of cases, staff supervision, the review of complex cases and inter-agency arrangements, particularly where children had a disability or mental health issues. 

Methods of assurance were underdeveloped in the service area and, as a result, there was an inconsistency in the quality of service provided to children on the CPNS.

In September 2019, HIQA received a copy of a local review that was undertaken by the Cork Service Area. 

The review was "in response to a serious incident" relating to a child on the Child Protection Notification System.  

At that point, HIQA sought assurances from the Cork service area manager in relation to all children on the Child Protection Notification System. 

The response received by the Authority did not provide satisfactory assurances. 

As a result, HIQA undertook an inspection of the Cork service area. 

At the time of the inspection, there were 105 children whose names were entered onto the child protection notification system and who were subject to a child protection safety plan. 

The area manager told HIQA inspectors that the delivery of the child protection and welfare service faced significant challenges in securing legal orders for children, implementing the Tusla national approach to practice to ensure children were safe, and delays in replacing social workers and social work team leaders who had left their jobs. 

Today's HIQA report says there was no system in place to provide assurance to the area manager for children on the Notification System.  

Group supervision carried out with the Principal Social Workers is described as "ineffective" at providing assurance on the service delivery for all children on the Child Protection Notification System.  

A review of supervision records of the Principal Social Workers showed there was a "limited focus on children" on the CPNS and they were not consistently discussed.  

HIQA says reporting arrangements for these children was "weak" and it found the quality of social work supervision on individual cases was "mixed and lacked sufficient rigour". 

Two serious incident reviews undertaken in the area were inadequate according to the report.  

HIQA is of the view that those reviews did not contain good quality analysis of the specific situations, and limited learnings were identified. 

The Authority points out that social work teams within the Cork service area did not carry out any formal quality assurance auditing of children on the Child Protection Notification System. 

Risk management, relating to these children was poor, it says. Risks that had been identified did not have measures put in place to mitigate against them.  

Risks identified in quality assurance reports and serious case reviews were not managed through risk management processes, which, it says is not in line with the Tusla risk management policy. 

In a statement Child and Family Agency Tusla acknowledged HIQA's concern over "certain aspects" of the Child Protection Notification Service. 

Tusla says the supervision structures have been changed to improve the supervision, monitoring and governance in this area.  

It says the oversight assists it in ensuring that our practices deliver good quality, timely and appropriate interventions and services for children, and spans a number of Tusla services including alternative care and child protection and welfare services. 

Many of these reports highlight the many positive examples of good practice, such as inspection reports in recent weeks on children's residential centres. 

Others highlight areas where improvements are required, and we are aware that we have further work to do in a number of our care settings, it says.

Acting Area Manager for Tusla in Cork Kieran Campbell said HIQA's report had helped the agency to make "significant" improvements.

"We remain committed to improving the care and safeguarding of children in Cork and all other children in our care and are satisfied that the child protection practice in the area provides safe and effective care," Mr Campbell said.

RTÉ's Southern Editor Paschal Sheehy has been looking at the HIQA report in detail:

- This inspection was conducted after HIQA received a copy of a local review of a serious incident involving a child on the Child Protection and Notification System. HIQA sought assurances in relation to all children on the Child Protection and Notification System in Cork. HIQA said these assurances were not satisfactory. Therefore, this inspection was conducted.

- The inspection was carried out between 14-16 January of this year by four HIQA inspectors.

- Child and family services are organised into 17 areas; Cork is the highest child populated of those areas in the country, with a child population of 134,000.

- This report refers to 105 children in Cork city who were on the Child Protection Notification System and were the subject of a Child Protection Safety Plan.

- Children on the Child Protection Notification System are those who are assessed as being most at risk within the child protection service. 

- Major non-compliance is the most serious adverse finding HIQA could make in this report. Four of the five areas examined were majorly non-compliant, meaning a significant risk was posed to the safety, health and welfare of the children involved.

- Tusla's area manager told HIQA that the delivery of child protection and welfare services faced significant challenges. HIQA said governance arrangements required significant improvement.

- HIQA said governance meetings were ineffective. There was no system in place to provide assurance to the area manager. There was a lack of timely progress in addressing child protection concerns. Group supervision carried out by the area manager with principal social workers was ineffective. The quality of social work supervision was mixed and lacked sufficient rigour.

- Risk management relating to children on the Child Protection Notification System was poor.

- It is of significant concern to HIQA that weak governance arrangements, delays in the completion of quality assurance reviews, corresponding delays in implementing improvements, mixed quality case supervision and lack of robust review of complex cases meant that the area manager could not be assured on the quality of service provided to children on the CPNS. 

- HIQA said governance of children on the Child Protection Notification System was poor. Risk management was not implemented in line with Tusla policy. There was no local robust system to report on compliance. Reviews of serious cases undertaken were inadequate.

- HIQA said initial Child Protection Conferences did not take place in a timely manner.

- HIQA said 17 out of 18 cases did not have safety planning meetings.

- Overall, HIQA found that the service to children on the Child Protection Notification System was of poor quality and fell short of the expectations of Tusla management.

- HIQA also found that poor inter-agency co-operation between Tusla and the HSE also meant critical decisions could not be implemented.

Additional reporting: Paschal Sheehy