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Children 'Unsafe' in Special Care Units

Irish Times, 16 December, 2010 by Jamie Smyth, Social Affairs Correspondent

HEALTHCARE professionals have expressed “grave concerns regarding the safety for children and staff” at one of the State’s special-care units housing the most vulnerable children in care.

Inspectors at the Health Information and Quality Authority said Coovagh House in Limerick was in “crisis”. They strongly criticised major failings with the HSE’s special care system, which means children could remain “unsafe” when they are locked up in secure units.

Special care units were established following a High Court order in the late 1990s, which found the State had a duty to provide care to the most disruptive children. This year has seen an increase in the number of children admitted to these units following media focus on the deaths of teenagers under the care of the HSE.

Four reports published by inspectors on the authority’s website yesterday found “significant failings” in: governance and management; staffing, training and support; management of behaviour; and premises, safety and support in the special care system.

“There was no coherent national structure for the strategic development or operation of the services,” said inspectors, who acknowledged there was evidence of some good practice in some aspects of the special care service.

All three special care units in Ireland – Coovagh House in Limerick, Ballydowd in Dublin and Gleann Alainn in Co Cork – suffered severe staff shortages, a lack of clarity on lines of accountability and a crisis of confidence in the national special care and high support management team. But the inspectors raised particular concerns about Coovagh House, which can provide care for up to five young people at one time.

“Inspectors found that Coovagh House was in crisis . . . and also [found] correspondence issued by local managers and HSE monitoring office to the national special-care and high-support management team describing the crisis within the unit and highlighting their grave concerns regarding safety for children and staff,” said the report.

Inspectors noted governance of Coovagh House was transferred to the HSE’s national management structure in 2009. This coincided with a “significant deterioration in staffing and management levels”. The appointment of an acting manager in August enabled the unit to regain “some stability”, they said.

Inspectors identified high levels of persistent aggression, threats and assaults against staff and damage to property at all three units. They found 20 of the 109 staff were unqualified and there was a significant increase in the use of agency staff compared to their last inspection in 2009.

Staffing shortages meant there were minimum therapeutic interventions available to children in special care, and inadequate supervision of staff in some units. Major shortcomings were identified in governance and management, including poor communication between operational and national management and insufficient consideration of risks, as well as issues regarding security and accommodation when accepting referrals.

The authority makes seven recommendations to the HSE:

  • Appoint a national director for children’s services (this happened this week)
  • Develop and publish a national strategy for special care
  • Review national governance of special care services
  • Appoint one monitoring officer for all special care units
  • Implement past recommendations on tracing and tracking children in special care
  • Ensure it complies with all legislation and regulations
  • Provide a monthly progress report to the authority and Minister for Children on special care.