10,992 entries for Inspections - State

For those working in the area of child welfare, particularly, social workers and care workers, the Health and Social Care Professionals Act 2005 provides for a system of statutory registration for 12 health and social care professions,49 to ensure that health and social care professionals providing services are properly qualified, competent and fit to practice. This is the first time such professionals are regulated under statute. The Act also provides for the establishment of a fitness to practice structure to deal with complaints and other disciplinary matters.

The Social Services Inspectorate (SSI) was set up on an administrative basis in 1999 to inspect social services in Ireland. The inspectorate emerged from the recommendations of the Report on the Inquiry into Madonna House, which reported in May 1996 and recommended that an Inspectorate of Social Services be established on a statutory basis, which would have responsibility for ‘quality assurance and audit of childcare practice in all areas of personal social services, including the children’s residential sector.’50 From 1999 to 2007 the work of the SSI focused on children in care, primarily on inspection of residential care. In 2004 a pilot inspection of foster care services was conducted and this was followed in 2006 with inspections of two private foster care agencies. The SSI conducted inspections of statutory residential childcare services (i.e. services managed by the Health Service Executive (HSE), formerly the health boards), under statutory powers contained in section 69 of the Child Care Act 1991. SSI inspectors are authorised to enter any premises maintained by the HSE under the Act and examine the state and management of the premises and the treatment of children there and examine such records and interview such members of staff as they see fit. The Department of Health and Children administered it until May 2007, when it was established on a statutory basis as the Office of the Chief Inspector of Social Services within the Health Information and Quality Authority (HIQA).51

In addition, the Ombudsman for Children’s Office was established in 2004, following the Ombudsman for Children Act 2002, which commenced in its entirety on 25th April 2004. The Ombudsman for Children can investigate an action by a public body, a school or a voluntary hospital where it appears that the action has or may have adversely affected a child, and the action was or may have been taken without proper authority, taken on irrelevant grounds, the result of negligence or carelessness, based on erroneous or incomplete information, improperly discriminatory, based on an undesirable administrative practice, or otherwise contrary to fair or sound administration. The Ombudsman for Children can investigate an action on her own initiative or where a complaint has been made to her. A complaint can be made by a child or by an adult on behalf of a child.52

The development of guidelines on the reporting, investigation and management of child abuse cases in Ireland began at a meeting in the Department of Health in May 1975, the purpose of which was to discuss the problem of ‘non accidental injury to children’ that had been brought to the attention of the Department by medical consultants from Crumlin and Harcourt St Hospitals. It was agreed at the meeting that (1)there was a significant problem of non-accidental injury to children in Ireland; (2)that the position should be examined and procedures suggested for dealing with such cases and for ensuring the co-operation of parties dealing with such cases; and (3)that a central register of such cases should be examined.

Following the meeting, a committee was established to address the above issues, comprised principally of medical doctors, a superintendent public health nurse, a senior ISPCC officer, a medical social worker and two civil servants. A sub-group was subsequently formed to draw up a detailed memorandum on the matters considered by the Committee. Emerging from this, and assisted by information obtained from British authorities, the first report of the Department of Health Committee on Non-Accidental Injury was published in March 1976, providing a basis for all subsequent child abuse guidelines issued by central government.53

The focus of the Department of Health report was essentially clinical, emphasising the need for early identification of ‘battered’ children. It provided an ‘index of suspicion’ to assist the identification of child abuse, which was almost entirely based on physical symptoms of injury, with a proportionately marginal emphasis on ‘nutritional deprivation, neglect and emotional deprivation and trauma’.54 It defined the case conference as an essential part of the ‘team effort’ required for the investigation and management of suspected non-accidental injury (NAI). Overall responsibility for calling the conference was assigned to the Director of Community Care (a medical doctor) though the delegation of this function ‘to a senior member of his medical staff’ was permitted. The list of suggested attendees demonstrated a clear expectation of significant involvement by hospital staff in the management of the case.

The report also recommended the establishment and maintenance of what it described as a ‘central registry’ of cases ‘to act as a reference for personnel concerned to ascertain whether a child was already widely known to different medical practitioners, hospitals or social workers as a case of suspected or diagnosed non-accidental injury. The placement of the register in a paediatric department, health board or the ISPCC was mooted, with the suggestion that, in Dublin, it should be administered by a senior medical officer in the child health section of the EHB to facilitate medical involvement and medical confidentiality. While it was also suggested that ‘every effort should be made to provide adequate community care services to the families involved’, and awareness-raising amongst community agencies was recommended the report and its recommendations were primarily intended for medical staff. Responsibility for overall coordination of services was to belong to the Department of Health, while it was recommended that the health boards establish area committees, which would comprise of appropriate health board staff and hospital representatives.

Although the responses of some professional bodies e.g. the Irish Association of Social Workers and the Eastern Health Board Senior Social Workers Group, were critical of the 1976 report’s over-concentration on the detection of physical signs of child maltreatment, and its neglect of the emotional, psychological and social dimensions of child abuse, the template laid down in this report formed the basis of the guidance documents that followed it over the next decade. Guidelines up to 1987 were based on a conceptualisation of child abuse as ‘non accidental injury’, which could be addressed by a sound system of reporting, with medical and legal interventions. A Memorandum on Non-Accidental Injury to Children was published in 1977, based largely on the 1976 report.55 The Memorandum acknowledged that its focus was mainly on physical abuse; stating that ‘in cases of injury arising from emotional deprivation or neglect, the evidence of such injury might not always be as clear cut’ and that procedures for intervention in such cases would have to be considered separately. The nature of the earlier recommended ‘central register’ had been changed, reflecting some disagreement about its purpose and function, which had been specified in written responses to the 1976 report. It was now recommended that a ‘list’ be kept by the Director of Community Care ‘to help assess the extent of the problem’ and to provide information to other professionals on whether a child had previously suffered a NAI. It was suggested that the list be reviewed regularly with details ‘expunged’ when suspicions proved to be unfounded.

The memorandum laid quite strong emphasis on the requirement for staff training in the various medical and community based services for children and families to improve ‘knowledge, awareness and vigilance’. It also acknowledged that there may be legal deficiencies requiring reform and therefore recommended review to identify desirable legal changes and innovations. It also drew attention to the necessity for An Garda Síochána to be notified if a possible breach of criminal law was indicated.

Denis Greene, in one of the first published commentaries on legal aspects of non-accidental injury to children, observed that: while I have acted for the Eastern Health Board and its statutory predecessors for many years, it has really only been in the past decade that I have been called upon to deal with cases involving children at risk. They have increased in number steadily over that period. I cannot say whether this indicates a real increase in absolute terms or whether the frequency of occurrence is not greater than in past years but more cases are being discovered because of the larger number of social workers now working in the community. Possibly both factors are involved.56

In 1980, the Department of Health published the first complete set of Irish child protection guidelines, entitled Guidelines on the Identification and Management of Non-Accidental Injury to Children.57 A list of potential clinical indicators of child abuse was again provided, and the necessity for the co-operation of non-health board professionals was emphasised. As the title implies, the focus was still heavily on physical abuse of children, with ‘nutritional deprivation’ and ‘signs of general neglect’ merely cited as part of the ‘index of suspicion’ of NAI. The roles of the Directors of Community Care were more clearly defined as responsible for the management of child abuse in their areas, representing a slight shift to the community from the hospital or clinical setting reflected in the earlier documents. Recommended procedures for the investigation of reports, and the ‘monitoring and co-ordination’ of child abuse cases were outlined, the case conference retained a central position and the maintenance of a ‘list’ of suspected and actual cases of non-accidental injury was again recommended. The rights to involvement of parents in case conferences or decision making were not mentioned. Another set of guidelines with the same title was published in 1983 with basically the same contents with slightly more detailed guidance on the transfer of information and the role of the health boards in circulating the guidelines. Despite the fact that there was some awareness amongst child protection services at that time of child sexual abuse, it was not mentioned in the guidance.58

A more radical change was evident in the next set of guidelines, issued in 1987. A name change to Child Abuse Guidelines signified a broadening out of the concept of child abuse from NAI to encompass sexual as well as physical abuse.59 The Irish Council for Civil Liberties sponsored report into child sexual abuse in Ireland in 1988 argued that: Discovery of child sexual abuse as a major problem is recent in Ireland, as it is internationally, and has developed rapidly. In 1983, the Irish Association of Social Workers hosted a pioneering workshop on child sexual abuse, from which a working party and the Incest Crisis Service developed. By 1985, the Rape Crisis Centres were identifying survivors of child sexual abuse as a major client group.60

In recent years historians have explored the degree to which knowledge of the sexual abuse of children was known in Ireland before the 1980s, in most cases examining the work of the Carrigan Committee. In June 1930, the Government appointed a committee ‘to consider whether the following Statutes require amendment and, if so, in what respect, namely the Criminal Law Amendment Act, 1880, and the Criminal Law Amendment Act, 1885 as modified by later Statutes, and to consider whether any new legislation is feasible to deal in a suitable manner with the problem of Juvenile Prostitution (that is prostitution under the age of 21).’61 The Committee was chaired by William Carrigan, KC Perhaps the most significant submission received by the Committee was from the Garda Commissioner at the time, Eoin O’Duffy. O’Duffy reported on what he viewed as general immorality of the country: an alarming aspect is the number of cases with interference with girls under 15, and even under 13 and under 11, which come before the courts. There are in most cases heard of accidentally by the Garda, and are very rarely the result of a direct complaint. It is generally agreed that reported cases do not exceed 15 percent of those actually happening.62

O’Duffy recommended that the Criminal Justice Amendment Act 1885 required revision. Noting that there were 31 prosecutions for defilement of girls under 16 in Dublin City between 1924 and 1929, and that ‘offences on children between the ages of 9 and 16 are, unfortunately, increasing in the country’ and ‘cases have occurred recently in which children between 4 and 5 have been interfered with’, 63the age at which such defilements should be classed as a felony should be raised from 13 to 16. In addition, any attempt to commit this offence should be classed as a felony. He also added that for any offences against girls under the age of 13, he strongly advised the ‘cat’ be used and ‘not just a few strokes, but the most severe application the medical advisor will permit, having regard only to the physical condition and health of the offender’.64The Committee reported in August 1931, and made 21 recommendations, broadly endorsing the recommendations made by O’Duffy and others, including raising the age of consent to 18 and extending the time period for commencing a prosecution.65

The other notable change in the Guidelines was the emphasis on inter-agency cooperation, and the clear identification of the roles of various professionals, such as the community care social worker, public health nurse, the child psychiatrist and ‘others’ including teachers, day care staff and residential staff. The role of the Director of Community Care in investigation and management was given a strengthened position in comparison to the dominant role of hospital staff in previous guidance. However, the emphasis was still on assaultive abuse and neither neglect nor emotional abuse was given any specific or separate consideration. Physical abuse and sexual abuse were described in terms of signs and symptoms rather than definitions, thus excluding contextual factors such as intention of the alleged perpetrator, the age differential or relationship between themselves and the victim, or the environment in which abuse occurred.