The Health Information and Quality Authority (HIQA) has today published an inspection report on the child protection and welfare service operated by the Child and Family Agency (Tusla) in the Carlow/Kilkenny/South Tipperary service area.

HIQA is authorised by the Minister for Children and Youth Affairs under Section 8 (1) (c) of the Health Act 2007, to monitor the quality of services provided by Tusla to protect children and promote their welfare. HIQA monitors the performance of Tusla against the National Standards for the Protection and Welfare of Children and advises the Minister for Children and Youth Affairs and Tusla.

HIQA conducted a triggered themed inspection of the child protection and welfare service in Carlow/Kilkenny/South Tipperary in October and November 2017. The inspection was triggered following the findings of a foster care inspection in the area, unsolicited information received by HIQA, and concerns arising from an inspection of a residential centre in the area. This themed inspection aimed to assess compliance with the national standards relating to managing referrals to the point of completing an initial assessment.

Of the six standards assessed, one standard was substantially compliant, and five standards were non-compliant, all of which were identified as major non-compliances.

The quality of screening of referrals made to the service was poor. Background checks were not always undertaken as part of the screening process, and frameworks to determine thresholds of harm and levels of risk were not consistently applied during screening. Some referrals that required immediate intervention, such as physical abuse allegations, did not have timely intervention, and children for whom there had been multiple referrals over time did not receive a consistent response.

The area operated a waiting list for children and families after the referral had been screened, and at the time of inspection there were 213 cases on a waiting list for an initial assessment. However, there was no formal system in place to review the waiting list and no plan to address the backlog. Waiting lists were not effectively managed and this resulted in children potentially being left at risk.

The quality of initial assessments varied from good to very poor. Where assessments were of good quality, children’s needs and circumstances were comprehensively assessed. Where assessments were poor, children’s needs were not adequately assessed and risks were not satisfactorily addressed. Due to staff shortages, one office in the area stopped conducting initial assessments on medium and low priority cases for a period of two-to-three months earlier in 2017. In addition, the systems in place for notifying An Garda Síochána of allegations of abuse were not robust.

The oversight of child protection and welfare cases in the area was poor. Out of 133 cases reviewed by HIQA, 27 cases were escalated to the area management for assurance that appropriate action had been taken to address outstanding risks. Some cases had been closed when an initial assessment should have been carried out.

Overall, HIQA found significant systematic deficits across a number of areas in the duty, intake and assessment team. Governance and oversight had not been effective in delivering the service. This was evident in the following areas:

• Oversight of the waiting list was ineffective and there was no plan to address the backlog.
• Recording of individual supervision was poor.
• Audits undertaken by Tusla in 2016 had identified many of the deficits found on this inspection, but no effective action had been taken to address them.
• There were risks associated with the information system in the area and the management team were unable to tell inspectors how many children’s cases were closed to the service.

Therefore the assurance methods in place were not effective.

HIQA wrote to the service director and subsequently met with him to outline these concerns and received a written response. Assurances to indicate that these concerns would be addressed were provided, some of which were to be completed by December 2017, with the remainder due for implementation by the end of quarter one, 2018.   

The Carlow/Kilkenny/South Tipperary service area has provided an action plan response to address the non-compliances identified on inspection.