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All 3 HSE "Special Care" Units In Crisis

HSE's childcare inadequacies in spotlight yet again

Irish Times, 16 December, 2010 by Jamie Smyth

ANALYSIS: ONE OF the most shocking revelations contained in four separate inspection reports on the provision of special-care services by the Health Service Executive (HSE) is that the children often feel more at risk when admitted to secure units than when they are on the outside.

Incidents of assault and self-harm were commonplace at the country’s secure units over the past year, while severe staff shortages and a breakdown in governance blighted a system struggling to cope with a 50 per cent rise in admissions.

Inspectors from the Health Information and Quality Authority catalogued serious failings in governance, management, staffing and the physical premises used to lock up the most vulnerable children in the care system. They conclude one of the three secure units – Coovagh House in Limerick – was in crisis, and expressed “grave concerns regarding the safety of children and staff”.

A second facility, Ballydowd, in Lucan, Co Dublin, which inspectors had already condemned in a previous report, remained open and continued to admit children despite promises by the HSE to close it. The third secure unit in the Republic – Gleann Alainn in Co Cork – fared better, although inspectors still expressed serious concern about management and staffing levels.

The inspection reports point out that the authority has highlighted the deficiencies in the special-care system to the HSE over a number of years, and criticises the executive for failing to adequately address the issue.

“The HSE has not demonstrated the capacity to devise, implement and manage a special-care service in a consistent, strategic and integrated manner,” concludes the authority, which has ordered the HSE to report within 10 days on the main conclusions.

Coming so soon after the severe failings identified in the HSE’s response to the deaths of children in care and its lack of proper oversight of the foster care system, the authority’s criticism of special-care units will raise new questions about the HSE’s ability to manage childcare services.

Minister of State for Children Barry Andrews, who visited Ballydowd in August, has in the past expressed concern about a lack of a coherent national plan to deliver special care. He said yesterday the service is best described as “drifting and lacking strong leadership” and claimed the appointment of the HSE’s national director for children and family services, Gordon Jeyes, would provide new leadership.

The HSE says it has already designed a new national special-care strategy. It says an interim national manager for special-care services was appointed earlier this month and the governance structure would be reformed next year.

Given a previous commitment to close Ballydowd, it is easy to understand why the inspectors have demanded monthly progress reports from the HSE on implementing seven key recommendations in its reports.

HIQA reports: caring for the most vulnerable teenagers 


A five-bed special-care unit based in Co Cork. There were four girls in the unit when it was inspected between October 5th-7th

Inspectors found most of the standards were met in the unit and it had a child-centred culture and ethos. But they had serious concerns about the sustainability of the management arrangements at the unit.

At the time of the inspection, the acting manager was either on site or on call for seven weeks without a break. HSE South responded by appointing a temporary deputy manager shortly after the inspection.

Inspectors found there were 11 unauthorised absences involving seven children since the last inspection in October 2009. On one occasion, two children went missing for seven days in July 2010. Staff shortages remain a problem due to sick and maternity leave. At the time of the inspection there were six relief childcare workers providing full-time cover. Six childcare leaders did not have any qualifications.


Was reinspected on October 27th. At the time there were seven children aged 13 to 16 years being cared for at Ballydowd and a separate Solas unit in Dublin

This was a follow-up inspection following a damning inspection that had been carried out in July 2010. The initial report recommended that the facility be closed and no children be admitted until the facility was brought up to standard.

The HSE told inspectors both facilities could not be closed because of a 50 per cent increase in demand for special care placements.

It plans to close the Solas Unit in January 2011 but is undertaking refurbishment to enable Ballydowd to stay open.

Inspectors found there had been some improvement to the decor of the building and care practices at Ballydowd.

They remain concerned over the unit’s ability to cope with increased demand for special care placements in light of a lack of clarity on a new national model of special care and high support services.

Source: Health Information and Quality Authority reports on special care units


Provides care for up to five young people aged between 11-17 years. It was inspected by the authority between October 5th-7th last

Inspectors identified “serious safety concerns” following a “significant period of crisis” at the special care unit. One guardian of a child said the girl felt “less safe” than before she was taken into care and several professionals told inspectors that Coovagh was unsafe for children and staff.

Serious governance issues were identified by inspectors, who criticised staff shortages. The appointment of an acting unit manager in August 2010 enabled the care unit to regain “some stability”.

There were 139 incidents over the past year– 49 assaults on staff and seven assaults on children. Staff were not trained to carry out full restraints and found it necessary to call the Garda to help put the children to bed and manage behaviour. There were serious incidents of self-harm.