10,992 entries for Inspections - State
BackThe Task Force concluded, in relation to the homes, that because responsibility rested with two Government Departments, while almost all the facilities are provided by voluntary bodies supported by State grants, no coherent systematic planning procedures existed for children in residential care. Accordingly they recommended that responsibility for all children’s Residential Homes should be vested in the Minister for Health. The Task Force also recommended that, as far as possible, residential facilities should be situated near the homes of children who will require such care. They considered that different kinds of residential facilities were required to meet the differing needs of children and recommended that: [each] area of the country, roughly coinciding with existing community care areas of the health boards, should have access to one identified residential centre located in or adjacent to the area. These centres, should be multi-purpose in nature in the sense that they should cater for the ordinary needs of the area through the provision of short-tem or medium-care for children of all ages from the area.344
In addition the Task Force recommended that ‘small community centres for about 4 or 6 children would be required’ to cater for children with delinquent tendencies and for other children with serious personal problems who require intensive, personalised care. This was accepted by the Department of Health who stated they were: examining, in consultation with the health boards, the feasibility of existing residential facilities adapting their structures and revising roles and objectives to facilitate development along these lines. The Minister’s aim is to have under his aegis a comprehensive and inter-locking locally based child care system serving the needs of identified communities. Residential homes would be only one of the elements within this system with a very specifically defined, though complementary, role to play. Homes will fall into one of the categories..., each category being given clear objectives for the service they are providing. Homes will, it appears, tend to be small units, providing a defined service for a clearly identified client group. Indeed, the process of changing to the smaller family style residential unit is now well advanced although there remains a small number of homes still operating along old institutional lines. Plans are almost complete to replace three of these institutions with purpose built group homes in the immediate future.
Following the aforementioned Government decision of 13th August 1982, an inter-departmental committee comprising officials of the Department of Education, Finance, Health and Justice was established to review the operation and financing of the homes. The inaugural meeting of the Committee took place in the Department of Health on 17th December 1982 and subsequently met on 12 occasions. Following a detailed discussion at the inaugural meeting, the Committee adopted the following terms of reference: (1)to determine the financial system most appropriate to children’s Residential Homes, based on an examination of their financial records and their perspective financial position; (2)to recommend appropriate transitional financial arrangements on transfer of responsibility for the 24 Residential Homes (former Industrial Schools) from the Minister for Education to the Department of Health; (3)to identify acceptable cost and other guidelines appropriate to monitoring and financing children’s residential homes in the future. 345
The final report of the Committee was completed in September 1983. It explored in detail the emergence of the capitation system of fund and the pros and cons of that system of funding. The increase in the capitation fee from the early 1970s is shown in Table 1.<br><table><colgroup><col></col><col></col><col></col><col></col></colgroup><thead><tr><th></th>
 <th><strong>Central authority</strong></th>
 <th><strong>Local authority</strong></th>
 <th><strong>Total</strong></th>
 </tr></thead><tbody><tr><td><strong>01/07/1972 </strong></td>
 <td></td>
 <td></td>
 <td></td>
 </tr><tr><td><strong>01/04/1973 </strong></td>
 <td>£5.70</td>
 <td>£5.30</td>
 <td><strong>£11.00</strong></td>
 </tr><tr><td><strong>01/04/1974 </strong></td>
 <td>£6.50</td>
 <td>£6.00</td>
 <td><strong>£12.50</strong></td>
 </tr><tr><td><strong>01/01/1975 </strong></td>
 <td>£7.80</td>
 <td>£7.20</td>
 <td><strong>£15.00</strong></td>
 </tr><tr><td><strong>01/01/1976 </strong></td>
 <td>£9.00</td>
 <td>£9.00</td>
 <td><strong>£18.00</strong></td>
 </tr><tr><td><strong>01/01/1977 </strong></td>
 <td>£11.00</td>
 <td>£5.70</td>
 <td><strong>£16.70</strong></td>
 </tr><tr><td><strong>01/02/1977 </strong></td>
 <td>£15.00</td>
 <td>£15.00</td>
 <td><strong>£30.00</strong></td>
 </tr><tr><td><strong>01/02/1978 </strong></td>
 <td>£16.25</td>
 <td>£16.25</td>
 <td><strong>£32.50</strong></td>
 </tr><tr><td><strong>01/03/1978 </strong></td>
 <td>£17.00</td>
 <td>£17.00</td>
 <td><strong>£34.00</strong></td>
 </tr><tr><td><strong>01/03/1979 </strong></td>
 <td>£19.25</td>
 <td>£19.25</td>
 <td><strong>£38.50</strong></td>
 </tr><tr><td><strong>01/06/1979 </strong></td>
 <td>£20.50</td>
 <td>£20.50</td>
 <td><strong>£41.00</strong></td>
 </tr><tr><td><strong>01/03/1980 </strong></td>
 <td>£23.25</td>
 <td>£23.25</td>
 <td><strong>£46.50</strong></td>
 </tr><tr><td><strong>01/01/1981 </strong></td>
 <td>£27.00</td>
 <td>£27.00</td>
 <td><strong>£54.00</strong></td>
 </tr><tr><td><strong>01/01/1982 </strong></td>
 <td>£34.00</td>
 <td>£34.00</td>
 <td><strong>£68.00</strong></td>
 </tr></tbody></table>
The report also commented that: The homes’ current financial position under capitation is also a consequence of the manner in which the service is organised. Each home is independent and privately run and could have children maintained in it by any one of the eight health boards, or the local authorities and the Department of Education. The former industrial schools constitute the major element of residential capacity and statutory overall responsibility for their operations at present rests with the Minister for Education. However some 70 percent of children in them have been placed by the health boards. This has inevitably created a grey area as to which authority controls budgets, ultimately decides care standards and determines the client group to be served by the homes. It would appear that this, coupled with the development of the capitation deficiency payments system has given individual homes freedom to design their own care programmes without regard to any concept of overall care policy, standards or clear definition of the type of child to be served.
Ultimately, the Committee rejected the capitation method of financing Residential Homes and recommended ‘the funding of residential homes by way of annual allocation, based on budgets agreed with the local health board for projected expenditure, and paid monthly in advance’. The Committee also noted that while the proposed transfer of responsibility for the homes from the Department of Education to the Department of Health was a welcome step in clarifying responsibility, this by itself would not be sufficient. It argued that: It must be coupled with a clear statement of overall policy in elation to residential care services setting out the rationale for care of each client group intended to be served by the homes, standards of care to be provided, both in relation to accommodation and maintenance, and to the quality of the care input from staff. We have found no evidence of the existence of such a statement without which in our opinion the monitoring process cannot function.
On 25th October 1984, the Department of Finance wrote to the Department of Health agreeing with recommendations of the Committee.
A key recommendation of the Committee was that the Department of Health, ‘as a matter of urgency formulate and promulgate service objectives in relation to the care of children to guide health board policy’. In late 1984, the Department of Health produced a detailed memo on the operation of residential care in Ireland as well as outlining a philosophy for the future operation of residential care in Ireland.346 In relation to the operationalisation of the recently agreed budget system of funding, the memo reported that: Responsibility for financial control of individual homes rests with an officer designated by the local health board’s Finance Officer. They have reported coming up against a number of problems in implementing the budget system one being with homes’ accountants and auditors. In the case of some homes Officers had serious doubts abut their objectivity and hence the impartiality of the accounts submitted. Also, officers found that the homes’ accountants were over-estimating pay and non-pay expenditure for ‘bargaining’ purposes. Discrepancies also appeared in the number of staff actually employed in the homes as against alleged complements returned at various stages to the Department. All this resulted in long delays before homes could be told of their budgets for 1984. Hopefully, most of this can be put down to teething problems and the mutual understanding arising out of this year’s exercise should facilitate speedy agreement to budgets next year.347
The memo went to outline that within the 41 Residential Homes managed by the Department of Health, some 1,200 places were available, but that they were rarely full to capacity. More significantly, the memo noted the ongoing decline in the number of children in residential care, the primary reason for this being ‘the Department’s policy of trying to maintain children in their own family setting as long as possible or placing them in foster care instead of in a residential home’. The memo acknowledged that there would always be a need for residential care for certain categories of children, but that: Based on past trends expansion in the number of residential places available in children’s homes appears unwarranted. In fact, our view is that residential provision in children’s homes should stabilise at something below 1000 places by the end of this decade. This will require a reduction in the size of some homes, which we hope can be achieved through our capital programme, and through the possible closure of some individual units.348
On the registration and mechanisms of entry to residential care, the memo reported that: The new Child (Care and Protection) Bill will contain proposals to repeal the sections relating to industrial schools in the 1908 Children Act and those relating to the approval of homes in the Health Act 1953. These provisions will be replaced by a registration procedure, which will apply to all children’s homes including homes, which are not subject to controls at present. (It should be mentioned that the only homes whose operations are currently subject to statutory regulation are the certified industrial schools. The 1953 Health Act simply requires the approving of homes for the bringing of children into care; it does not specify any requirements as to operations, standards etc). They will also contain provision for a new admissions to care procedure, and for the removal of the power of the courts to commit children directly to residential care. In future it is intended that all children in residential care be placed only after full assessment by the health boards’ social work service. Mainly because of the recent decline in religious vocations, the bill will enable health boards to directly provide residential care for children. Generally speaking the provisions in the bill are broad and enabling. The important regulatory provisions and controls on the homes, their procedures, practices and inter-face with the health boards, will have to be dealt with in regulations under the new Act.349
The memo went to outline a philosophy for the use of residential care for children, which was to be issued to the regional health boards. The objective of residential care was: to meet, in co-operation with other elements of the child care system (e.g. family support services, day care, fostering and adoption,) clearly defined deficiencies in the lives of certain children, for whom placement in a residential centre for a given period of time, is considered by professional opinion to be the best means of achieving their well being and security. These children will include those who: have been rejected; are being neglected or ill-treated; lack parental control; are sleeping rough or are involved in minor delinquencies; have a short-term crisis in their home e.g. illness of a parent. Residential care programmes should be designed to enable such children to return to family life as soon as possible given their needs, their family situation and other circumstances.
Children should only be given a long-term placement in residential care where: it has been definitely established that the child has no effective family to which he can return and substitute family care such as adoption and foster-care is inappropriate or cannot be made available. The latter cases could include children who are in need of care and control, additional to that available within their own homes, which cannot be provided in the community or have problems such as acute emotional deprivation or severe disturbance. It might be emphasised, however, that your Board’s child care services should be based on the principle that the family setting is the best one unless it is clear that the child’s well-being demands otherwise. (emphasis in original).350
When admitted to residential care, the memo outlined that it: should create the least amount of disruption in a child’s life, consistent with his total needs. A facility should be as accessible as possible to the child’s home. Where appropriate, every effort should be made to enable the child to retain a relationship with is family, especially where it is envisaged that he will return home in the short to medium term. Residential homes should provide for the child a stable, secure environment with a standard of living equivalent to the national average. The home’s environment should be enriching and stimulating and compensate for whatever deprivation the child may be experiencing.
In April 1986, the Department of Health published a Report on Health Services covering the period 1983-86. On the funding of child care services, the report outlined that: A new system whereby the local health board funds children’s homes directly on the basis of agreed budgets was introduced on the 1st January, 1984 to replace the highly unsatisfactory capitation system in operation for over a hundred years. Homes had found that despite regular revisions, capitation rates tended to lag behind real increases in the cost of looking after children and did not take account of differing cost structures in the homes. As a result, by the end of 1983 some homes had accrued considerable deficits. These deficits, totalling almost £1 million were cleared in 1984 in conjunction with the introduction of the budget system. The new funding arrangement is sufficiently flexible to enable health boards to respond to the particular needs of each individual home having regard to its staffing and clientele. It also brings homes and boards into a much closer working relationship than before. This gives boards a useful opportunity to re-organise the residential sector on a regional basis, broadly on the lines recommended by the Task Force on Child care Services. Each health board is now considering residential provision for child care in its area and hopes to agree future roles and functions with each of the homes in the near future.351
However, a short number of years later in 1989 the Report of the Commission on Health Funding concluded352 that: An issue of importance to child care services in recent years has been the role of residential homes, most of whom are operated by voluntary organisations. A small number are owned and operated by health boards. The homes have been funded directly by health boards on the basis of agreed budgets since 1984; this replaced an unsatisfactory capitation system. It has been submitted to us that some homes are over-selective in accepting placements, making it difficult to find accommodation for the more difficult cases. On the other hand, some of the voluntary organisations involved have submitted to us that they could not cope with children who would seriously disrupt the running of the home and cause strain to those already cared for there. It would therefore seem that the relationship between the homes and their funders should be changed. Both parties should negotiate to supply care for children who need it; the homes would become more accountable for the services they provide and the funders would make reasonably long-term contracts to ensure cover for the difficult as well as easier cases. We therefore recommend that Area General Managers should enter into formal contractual agreements with homes to ensure that the required range of care is available in each area. The homes would then be funded on the basis of an agreed level and type of service described in paragraph 17.37 .353