Health Information and Quality Authority publishes National Children in Care Inspection Report 2008

Date of publication:

The Health Information and Quality Authority has today (Wednesday 4 November 2009) published its National Children in Care Inspection Report 2008. The Report reviewed the findings of 38 inspections of children’s residential care centres operated by the Health Service Executive (HSE) and of foster care services operated in a HSE region, carried out by the Authority in 2008. 

The Report found evidence of good practice. However, it also highlighted serious deficits in standards aimed at safeguarding vulnerable children, including lapses in vetting procedures for staff and foster carers working with children. The Authority’s concerns were communicated to the HSE following each inspection and an action plan to address these concerns, which incorporates the national recommendations made by the Authority, has been sought from the HSE.

Dr Marion Witton, Chief Inspector of Social Services within the Health Information and Quality Authority, said: “Over two-thirds of relative foster carers (who are relatives of the children they are caring for) in the HSE region reviewed had not being comprehensively vetted by the HSE, as required under foster care regulations and standards. Such a practice is unsafe.”

The Authority’s Report also found that only 40% of relative foster carers in the HSE foster service reviewed were allocated a social worker, a finding which was of considerable concern as individuals providing care to children should be supported and monitored in accordance with the recognised standards.

Of the 156 children in foster care reviewed by the Authority, 12% had not been allocated a social worker.

“There were a number of areas of foster care practice which need to improve including the assessment and training of foster carers, the provision of out-of-hours emergency social work services and the monitoring of child protection concerns,” Dr Witton stated.

The Authority also examined residential care settings, including community-based children’s residential care centres and special care units. The Authority found that almost one-third of centres inspected were not compliant with all the requirements of vetting staff. Dr Witton commented: “This mostly related to having an insufficient number of references. However, there were also a small number of unacceptable breaches relating to Garda Síochána clearance.”

The Report highlights the fact that in a number of centres, staff did not have a clear and consistent approach for the management of difficult and unsafe behaviour of children outside the residential centre including sexual exploitation and alcohol. In one fifth of the community-based residential centres and high support units inspected, children were absent on a regular basis and engaged in behaviour which gave reason for serious concern.

The standard on care planning was not met in almost half of the centres inspected by the Authority in 2008. In four centres there were insufficient or no care plans in place for children in preparation for leaving care.

In almost half of the centres inspected in 2008, the professional supervision of staff was inadequate or not taking place at all. In three centres, inspectors highlighted the need for staff members to notify serious child protection concerns through the Children First Notification system.

Almost half of the community-based residential centres, and high support units, were not in full compliance with statutory requirements relating to fire safety. Fire safety practices in each of the three special care units needed to improve. Recommendations from health and safety audits were not implemented in one-fifth of the centres inspected.

Dr Witton also expressed concerns about the failure of the HSE to register and inspect centres for separated children seeking asylum. In 2008, only two of the three centres and none of the six designated private hostels were registered.

The Authority also found that in some instances, breaches of regulations and standards brought to the attention of senior HSE managers by HSE monitoring officers had not had any impact. This lack of follow up must not be allowed to continue.

Dr Witton concluded that the Authority has requested the Board of the HSE to nominate a National Director to be accountable for developing and implementing an action plan against the recommendations in the Authority’s Report. Progress against this action plan should be reported to the Board of the HSE.



  1. Effective and efficient care planning is particularly important in special care units due to the short periods of time children reside in these units. It is also important that care plans are in place and address and prepare for the future care of the child prior to him/her leaving the special care unit.
  2. All children in care should be given information on complaints procedures and told about how to make a complaint, in accordance with their age and ability.
  3. It is critical that all staff are aware of serious risks to which children in care may be subject. The early identification of risks and the appropriate staff action to keep children safe is an area which needs to improve.
  4. All providers must ensure that all staff employed to work with children in care are appropriately vetted prior to taking up employment in services for children.
  5. Best practice guidelines must be adhered to regarding the identification, assessment and management of risks for outings and challenging behaviour.
  6. All relative/non-relative foster carers should be assessed, monitored, supervised and supported in line with regulations.
  7. All foster carers require the support of a link worker and the care they provide to children should be supervised on a regular basis.
  8. All children in foster care should have an allocated social worker.
  9. The rights of children in foster care should be acknowledged and practices should support expressions of these rights.
  10. Contact with birth families is important to children in foster care and should be actively pursued and maintained where appropriate.
  11. Out-of-hours social work services for foster care services are essential to ensure that foster carers are supported in providing care to children.
  12. The monitoring of foster care services is necessary for the continuous improvement of services provided.
  13. The HSE needs to have a clear vision, and effective organisational arrangements in place, to ensure that appropriate residential care and foster care services are available to children who require these services.
  14. Arrangements must be put in place to ensure that staff receive regular support and supervision and are provided with training, on an ongoing basis, to carry out their functions effectively.
  15. Effective care planning ensures the needs of children are identified. A child’s care plan should describe services to be provided and prescribe outcomes to be achieved. The care plan should be kept under continuous review with the active involvement of the child, care-givers and family.
  16. The HSE must ensure that aftercare plans prepare children for leaving care and make provision for aftercare arrangements. Planning with children in care is essential, especially as they grow towards adulthood. Helping children make the transition from care to independent adult living is a process that has many stages and takes several years. It should start when children are in their mid-teens and continue until early adulthood. Each child should have a clear plan outlining the different stages with clarity on the financial, emotional and practical support on offer.
  17. Best practice guidelines must be adhered to regarding the identification, assessment and management of risks for outings and challenging behaviour.
  18. Children aged 12 and under should only be placed in residential care in exceptional circumstances.
  19. The HSE must ensure that it registers and inspects all private and voluntary centres and hostels where children in care are placed and in particular, hostels for separated children seeking asylum.
  20. Providers of children’s residential services should implement all action plans as recommended by the Authority in its inspection reports.
  21. The Board of the HSE should nominate a national director to be accountable for developing and implementing an action plan against these recommendations and progress against the action plan should be reported to the Board of the HSE.


    Further Information: 

    For further information please contact:
    Marty Whelan, Head of Communications and Stakeholder Engagement
    01 814 7481 / 086 2447 623

    Notes to the Editor: 

    There are approximately 5,500 children in care in Ireland. Most children in care in Ireland (approximately 4,851 or 89%) are in foster care services, provided by both relative and non-relative foster carers. Approximately 7% of children in care (400) are in residential care. The remaining 4% (approximately 198 children) include children living at home under supervision orders and separated children seeking asylum aged 17 who are living in private hostel accommodation. A census of children’s residential services is carried out by the Authority during October each year and the findings are highlighted in chapter 2 of the report. The data indicates that between 2006 and 2008, there has been a 4% increase in the number of children in care.

    The provision of residential care for children is provided in both the statutory and non-statutory sectors. 50% of children’s residential services were provided by the non-statutory sector in 2008. At the time of the Authority’s census in 2008, there were 67 children aged 12 and under residing in residential care.