10,992 entries for Inspections - State

On 2nd November 1976, the Department of Finance, in response to a series of representations to the Taoiseach seeking the provision of a salary scale for childcare workers and the general financing of the homes, outlined its position in a letter which stated: ..before any radical changes are made in the current arrangements for providing State aid for these homes, every effort must be made to rationalise the child care system by reducing the number of homes to reflect fully the dramatic fall in the number of children in care from about 2,900 to 1,200 over the past 10 years. While it is appreciated that this fall in numbers resulted in the closure of some homes and enabled desirable improvements to be brought about in the standard of care of those remaining, it seems clear that there is still scope for rationalisation to produce economies in staff numbers and administration generally which would help to ensure that the system as a whole operates at a minimum cost in terms of public funds. The Minister is not convinced that the small group concept would suffer from phasing out smaller homes in favour of utilising the capacity of the larger homes. In this context the analogy of high-density social housing may be cited to refute the view, put forward by the Department of Education, that only small buildings are suited to family-type units for children in care. As in the case of social housing, economic and budgetary factors must play a significant role in determining our system of child care.

On 19th November 1976, a further meeting took place between the Departments of Finance, Education and Health to discuss the funding of the homes. One of the issues raised was the disbursement of £150,000, a savings made in 1976, on the basis that additional expenditure was sought on the expectation that advances would have been made during the years in the financing of homes. However, on 14th December 1976, the Department of Finance wrote to the Department of Education stating that ‘the making of special grants as proposed at this stage would be premature....and in the circumstances it is regretted that sanction as sought must be refused’.

On 4th March 1977, the Tanaiste and the Parliamentary Secretary to the Department of Education met with representatives from the Conference of Major Religious Superiors (CMRS)340 to further discuss the financing of the homes. At the meeting the Tanaiste informed the delegation that the capitation fee was to increase from £18 to £22 with effect from 1st January 1977 and that he had established an inter-departmental group to examine the issue. The delegation from the CMRS outlined their disappointment at the level of the increase and highlighted that the report they had commissioned indicated that a rate of £40 was needed. On this basis, they felt they would have no option but to close a number of the homes and restrict further entries to the homes. The delegation highlighted: the problem they faced in relation to the salaries of staff: they also mentioned a number of subsidiary matters which needed attention including the arrangements for making payments and the provision of medical care for the children in the homes. They saw it as a State responsibility to ensure that children in care were properly looked after. They accepted that there was necessarily a lot of delicacy about the relationship between the State and the Religious Organisations involved in the provision of care. It could be assumed, however, that if the present difficulties were overcome the Religious Orders would wish to continue to make the same contribution as they are now making.

The inter-departmental working group mentioned by the Tanaiste, was established by the Minister for Health in February 1977 with the following terms of reference: Having regard to the analysis and recommendations made in the McDonagh and Kidney Reports, and to the decision in principle to adhere to the capitation system of financing, to (a) calculate a reasonable level of capitation payment at current prices; (b) recommend how such a rate, in real terms, might be introduced on a phased basis; (c) consider the implications of leaving salary determination for individual workers with the management of the homes; (d) make recommendations on the suggested next steps.

At a meeting of the inter-departmental group on 4th February, 1977 it was reported that the group accepted that the major problem facing the residential homes was one of finance. Reference was made to the various representations which had been received in recent months expressing dissatisfaction with the level of financing of residential homes. The main contention in these representations was that the existing capitation grants are not sufficient to enable the payment of adequate remuneration to the staff employment in the homes. Mr. Matthews said that the salaries were as low as £16 per week and that persons in receipt of such low salaries had a legitimate grievance. The policy of group homes necessitated more staff notwithstanding that the overall number of children was decreasing. Another problem is that some of the religious orders are threatening to pull out of such work, and in any event the number of vocations had declined significantly in the last twenty years.

On the same day, the Tanaiste and Minister for Health held a meeting with representatives from the Council for Social Welfare341 regarding the financing of Residential Homes. At the meeting the Council’s representatives explained that there was considerable urgency attached to the provision of increased financial aid for the homes which otherwise, in many instances, would have to close because of the level of indebtedness. There was particular difficulty about the very low level of salaries that the homes were now paying to many of their staffs and the managements could no longer stand over this. The Tanaiste told the deputation that the capitation rate was being increased from £18 to £22 with effect from 1st January 1977 and that an inter-departmental working group was looking urgently at what further steps needed to be taken to overcome the immediate difficulties and that this group would report by 31st March, 1977. Members of the deputation also assured the Tanaiste that from the Hierarchy’s point of view there would be no problem about such matters as staffing being more rigidly controlled than had hitherto been the case. The briefing note prepared by the Department of Health for this meeting provides an overview of the thinking of key officials in the Department of Health at this time. The note firstly outlined the reasons for the request to meet. It outlined (a)The Council for Social Welfare is a Committee of the Catholic Bishops Conference. At its meeting in October last the Committee received a request from the Conference of Major Religious Superiors that the Hierarchy should approach the Government regarding the serious situation that is emerging in residential child care centres as a result of the lack of any salary structure for the child care staffs in those centres. (b)The Conference of Major Religious Superiors represents the Orders which are, inter alia, involved in the running of residential child care centres. Notwithstanding their approach through the Council for Social Welfare they wish to put their case direct to the effect that (i)they have exhausted all options known to them in trying to keep the homes in operation and (ii)the present capitation grant system in quite ineffective and that they are seeking a system of financing as outlined in the Kidney Report.’

The note then went on to highlight ‘key points which may arise during discussions’ and they were identified as: (i)What is the State’s position in relation to these children? What role do the Orders (existing managements) see themselves playing in the future? The State must, ultimately, where the parents fail ensure that the children receive proper care. The Orders may wish (although there is not much evidence at present to suggest this) to make a significant contribution in this area as part of their vocational work: in order to retain autonomy and flexibility they may, if possible, wish to share the burden of financing at least part of the costs. At a minimum, they presumably intend to remain in the management of the homes, if the States support is seen in their terms to be reasonable. These are issues which might be explored during the meeting. (ii)Why are the Departments adhering to a capitation system of financing at this stage? After all nearly all ‘Health Institutions’ are now financed on a budget basis! (a)it would probably be better, in the interests of the children involved, if the essential vocational nature of child care were retained and emphasised. This can best be done where there is a flexible approach between management and staff on conditions of work, leave arrangements, recruitment etc. and ‘a code of best practice’, rather than formally negotiated minimum national standards, is generally applied. (b)A capitation system enables the managements to retain a reasonably autonomous and flexible approach to the running of their homes. (c)Once a budget system is introduced, statutory involvement must occur on a wide range of management issues e.g. numbers and types of staff, salary levels, leave arrangements, recruitment and removal from office. (d)A budget system will be considerably more expensive to the State, certainly in the long term. It could, within a relatively short time, lead to a doubling in real terms of existing costs. (e)A longer term decision about a change in the method of financing could be better made when a number of possible alternative approaches to child care have been developed and explored. For example, a widening of the scope and level of support for fostering; the establishment of small domestic type homes with two house parents: or the wider use of homemakers could reduce the number of children in residential care and make alternative systems of financing more attractive. These are the types of options that the Departments would hope to discuss with the managements when the immediate ‘crisis’ has been overcome.

The 15-page report of the Interdepartmental Working Group on Financing of Children’s Residential Homes was completed on 24th March 1977 and suggested that a reasonable rate of capitation should be in the region of £28-30 per week. The Group also considered it prudent and desirable to examine alternative forms of care for children: (a) with a view to developing more effective, efficient and acceptable forms of care; (b) in order to identify issues which may need to be agreed with the staffs concerned and could possibly be very significant in negotiations on future pay and conditions; (c) before the future staffing and structures in residential homes are examined in more detail. Alternatives to residential care might include use of homemakers and full-time helps to keep families together or support ‘inadequate’ parents; development of boarding out arrangements, with special training for foster parents of difficult or disturbed children; and development of small group homes in residential areas which could be run with part-time domestic help.342

The report recommended an early meeting with the Conference of Major Religious Superiors to acquaint them with their thinking and how best to resolve the pay issues in relation to residential care. The report also noted that ‘in this connection, it is significant to note that the members of the hierarchy who met the Tanaiste on 4th March emphasised that increased controls on the homes would be acceptable to the Hierarchy’.

In a memorandum to Government from the Department of Health, dated 18th April 1977, it was noted that the CMRS was seeking a substantial increase in the capitation rate and ‘in the absence of a favourable response, eight homes will be closed and further seventeen will refuse new admissions’. It noted that the Inter Departmental Group found that a capitation rate of between £28 and £30 per week was necessary and sought agreement to negotiate an increased capitation rate of not more than £30 per week. The Minister for Finance in his comments on the memorandum noted that State support for the homes increased from £0.8m in 1972-73 to an estimated £1.6m in 1977 and that he considered: that £30 per child per week should be the absolute limit of the Government grant in the current circumstances and that the Conference of Major Religious Superiors should be firmly informed accordingly. In his view the Government should not in any circumstances concede to unreasonable demands from any quarter whether it be the Conference of Major Religious Superiors or a more humbly titled organisation. It should be quite feasible to place most, if not all, of the children concerned in good homes within the community, to the advantage of the children, if an allowance of a lesser amount that £30 was payable to each child. In this connection it is relevant to point out that the highest weekly allowance currently payable to foster parents by Health Boards is understood to be of the order of £10 per child.

The Minister for Health in response to the comments made by the Department of Finance noted that ‘it would always be necessary to have some children in residential care and that this form of care will be relatively expensive’.

On 20th April and 11th May 1977 a series of meetings took place between the relevant Departments and the CMRS on the issue of financing the home and on 18th May 1977, a meeting took place between the CMRS and the Local Government and Public Services Union with representatives of the Departments of Health and Education in attendance. Following these meetings it was agreed that the capitation rate would be increased to £30 per child per week and that scales of pay and other conditions for child care staff would be recommended by the Union to their members. The Department of Health noted: Notwithstanding the recommendation for a budget system, the Department of Education (which has administrative responsibility for the majority of the residential homes) still strongly favours the straight capitation system on the grounds that it gives the homes greater freedom to manage their own affairs and to decide their own priorities. They accept, however, the necessity to have the capitation rate adjusted regularly to allow for the effects of inflation and to provide reasonable remuneration for the staff, having regard to the nature of their work.

In September 1979, a further review of the financing of residential homes was undertaken, with terms of reference to: carry out a study of the organisation, staffing and financing of homes providing residential care for children under the Ministers for Education and Health to establish: the existing financial position in each home, including the extent of the deficit, and to make recommendations on the appropriate arrangements to be made in event of a decision to finance the homes on a budget basis, including the appropriate level of staffing and other costs involved, procedures for the agreement of an annual budget through Health Boards and the phasing in of a budget system; and a realistic interim capitation made for 1980.

To aid their deliberations, the committee undertook a survey of the financing, staffing and organisation of the homes and replies were received from 38 homes catering for approximately 1,200 children. The committee found that the average cost of maintaining a child in residential care averaged £51.13 per child per week, albeit that wide variation was evident. The report also found that the estimated cumulative deficit in the homes was expected to be in the region of £1.5m. The committee agreed in principle that the financing of homes would transfer to a budget system when the resources permitted. To deal with the deficits, a system of capitation (deficiency payments) was established, totalling payments to the homes of £54,000 in 1980, £402,300 in 1981 and £777,700 in 1982. The cumbersome nature of payment was also highlighted. Three Ministers are involved in the making of the necessary regulations. Adjustments in the level of payment are justified on historic costs e.g. increases in the cost of living index in the previous year and pay awards under National wage Agreements. Given the high level of inflation, this means that the homes are continuously in debt, and a number have considerable overdrafts. In addition, the present system where the home may receive payment from four different sources – the Departments of Education and Justice, local authorities and the health boards also lead to delay.

The Final Report of the Task Force on Child Care Services also contributed to the discussion stating: The present capitation system of contributing to the financing of residential centres has been found unsatisfactory, particularly in the case of centres having relatively few children. We understand that consideration is already being given to the making of arrangements to have residential homes placed on a budget basis and we recommend that this system be extended to all centres as soon as possible.343