The €13 million investigation into the 'Grace' foster home abuse case has said it cannot establish that marks and bruises on her were the result of serious physical or sexual abuse.
Correspondent Marc O'Driscoll examines the near 2,000-page report to highlight some of the commission's key points.
'Grace' is the pseudonym of a woman now in her 40s who has been in the care of the State all her life and who has profound intellectual disabilities and is non-verbal.
A commission of investigation report published today found that there was a "fundamental failure" on the part of the South Eastern Health Board and the HSE in their duty of her care.
However, while the final substantive report on the first phase of the Farrelly Commission into the so-called Grace case did find evidence of "serious neglect" and "financial mismanagement," it did not find any evidence of sexual or emotional abuse.
The commission refers to Grace’s foster mother and father as Mrs X and Mr X - who are both now deceased - to protect her identity.
Grace resided with Family X between the ages of 10 and 30, a period spanning 1989 until her move to residential care in 2009.
Grace continued to live with that foster family in the southeast of the country for ten years after concerns were first raised about alleged neglect and abuse in the home.
In 2016, due to mounting pressure over the case, then taoiseach and Fine Gael leader Enda Kenny confirmed he would establish a commission of investigation into the case if re-elected.
Today, a report by that commission of investigation was published. It runs to almost 2,000 pages over six volumes, but it does not contain an executive summary.
The chair and sole member of the Commission of Investigation is senior council Marjorie Farrelly.
To date, the Commission of Investigation has cost in the region of €13.6m. It has gathered 312,000 pages of documentation over the past eight years and heard evidence on 251 days.
Its final report deals with matters relating to decision making in and management of Grace's case from July 2007 to 1 March 2010.
‘Grace’ not available to commission
The report states that owing to her disability and lack of speech, evidence from Grace was not available to the commission and it relied on hearing the evidence of other people and through considering records and documentation.
Among the commission’s key findings are that it was "not satisfied that the evidence was such as to establish that marks or bruises sustained by Grace was as a result of her having been subjected to physical abuse."
The evidence did not establish that Grace had been subjected to sexual abuse over the years that she lived with Family X, nor did it support a finding that there had been "emotional abuse of Grace."
The evidence to the commission also did not establish neglect of Grace in the provision of food and sustenance to her over the years she lived with Family X.
However, the commission is satisfied that there was "neglect in the standard of care provided" by Mrs X to Grace, based on evidence given in relation to Grace’s clothing and personal hygiene.
Neglect finding
There is also a finding of serious neglect on the part of the foster mother in relation to the lack of attention to Grace’s dental care and to not ensuring that she attended a day centre more regularly and more consistently.
In addition, there was a level of financial mismanagement or abuse by Mrs X of Grace’s Disability Allowance in breach of her duties as an agent.
Amongst the range of findings, the commission’s report found that there was a "general absence of oversight and monitoring" of Grace in her placement by the South Eastern Health Board and the HSE during her placement in Family X.
The report states that this was a "fundamental failure" by the South Eastern Health Board and the HSE in their duty of care to Grace in the circumstances.
The report today has also included a statement on Part X of the commission’s terms of reference around further work that it could undertake.
Read more: 'Grace' case report: Many children arguably still falling through cracks
No planned second phase
The commission concluded that a planned second phase of investigation into the placement of 47 other children at the same foster home should now not go ahead.
The commission concludes that there is an absence of information with respect to matters to do with the role or conduct of public authorities around seven cases identified, similar to the type of concerns raised in respect of Grace, apart from two, which were already examined.
Meanwhile, the commission does not identify further information which would point to the merits of embarking on further investigation in relation to how the protected disclosures by whistleblowers were treated or the treatment of those making protected disclosures
Following the commission’s findings, the Government has now decided that "there is not a clear basis" for moving forward to a phase two of the investigation and the Commission of Investigation will be dissolved.
Department of Children response
In a statement today, a spokesperson for the Department of Children said: "In that context and on the advice of the Attorney General, there were a number of factors to consider carefully including the absence of a clear recommendation by the commission that further investigation is warranted; the challenges and evidentiary considerations in carrying out a second phase investigation including the fact that Mr and Mrs X are both deceased; the length of time and detailed work undertaken to date in the context of three substantive reports on Phase 1; and the considerable cost incurred to the State to date.
Read more: 'Grace' case report unable to establish physical or sexual abuse
"Following extensive consideration of these matters by Minister for Children, Disability and Equality in consultation with the Attorney General's Office Government today has taken a decision that there is not a clear basis for moving forward to a Phase Two of the Commission of Investigation. The Commission will be dissolved pursuant to Section 43 of the Commissions of Investigation Act 2004, on submission of the final report on costs."
The commission has been facilitated with a final short technical extension to 23 May 2025 to ensure that outstanding matters in regard to legal costs and archiving are completed and for submission of the final report of the commission on costs.
Meanwhile, the Government now intends to undertake what it has termed as "an expert-driven, non-statutory safeguarding exercise" in order to identify learnings from the commission’s findings to inform present day safeguarding policies and practices.
The seven people referenced in the commission's statement on Part X and/or their representatives will be invited to participate in this exercise, to share their lived experience, if they wish to do so.
