Monageer Report: Motion.

Wednesday, 27 May 2009

Seanad Eireann Debate
Vol. 195 No. 13

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Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  I move:

The Fine Gael Party decided we needed to discuss the Monageer report in this House. It is particularly relevant that we are discussing a contemporary report as opposed to a historical report into children’s services here. It is particularly relevant also that the Monageer report should form the key item for our discussion in Fine Gael Private Members’ time.

At the outset I extend sincere sympathy and condolences to the relatives of the Dunne family on the tragic deaths of their family members two years ago. It is not the purpose of this debate to contribute in any way to their distress but rather to examine the lessons that can be learned from the report, such as it is, that is available to us.

  5 o’clock

The Monageer report is what we call a redacted report. Many people have asked the meaning of “redacted”. It means that huge sections of the report are blacked out. Pages 92 to 106, inclusive, and 109 are blacked out. Further along in the report pages of the recommendations are blacked out also. What we have is a redacted report into a tragic event. One could call it censoring or that it is not the fully story, and it raises serious questions. It is edited, deleted, suppressed and we do not know the reasons for that. That makes it difficult to read the report because we do not have the full information which the inquiry team wished to give the Government. I understand that is on legal advice from the Attorney General.

A committee of three people produced the report but we do not have the report in full. We do not have the full details of what happened and we do not have the full recommendations. It is very difficult, therefore, to act on the report. That is the most serious problem we face in regard to this report. I do not know the reason the procedures led to this outcome but that is what happened.

Our motion is an attempt to ensure, as in the Kelly Fitzgerald case, that the report is referred to a committee of the Houses of the Oireachtas where it can be considered and we can ensure its recommendations are acted upon, implemented and monitored.

Seven out of the 26 recommendations and 15 of the 31 conclusions in the report are blacked out. The report raises a range of concerns and wide-ranging questions about current child protection services in the country. It raises questions also about an out-of-hours social work service. This tragedy happened on a Saturday when an out-of-hours social work service was not available.

[767]I ask the Minister of State, who I understand may have to leave shortly, to re-examine the information he has been given about the costings of an out-of-hours social work service because they may not be the amount the Minister has quoted, which was €15 million. An out-of-hours service available to the gardaí, curates and a range of people is very important and might have prevented this tragedy.

Another key issue in the report is that the Children First guidelines are not applied consistently across the State. There is a strong recommendation in the Ryan report on that very issue. The Ryan report is a contemporary report which states that those guidelines are not applied consistently across the State and recommends that they should be so applied.

Because so much of it is blacked out it is difficult to understand the vital lessons that must be learned from the Monageer report. If we cannot learn lessons from this tragedy, how can we avoid a similar tragedy occurring again? I look forward to hearing what the Minister of State has to say about the way he intends to proceed with this report. He has tabled an amendment to the motion which states that whether the report can be referred to the committee will depend on further legal advice. I ask him to bring the House up to date in that aspect. I hope he will be able to tell the House that this report will be referred to the relevant committee.

In recent years we have had many reports on the neglect of children, not just the Ryan report, which is the most dramatic and comprehensive report ever produced. It is the most comprehensive report ever published in the history of the State into child protection and child care services, and it is a damning indictment. In more recent years, however, we had the Kilkenny incest case, the Kerry babies case, the Kelly Fitzgerald case, the Madonna House report, the McColgan report, the McCoy report, the Hynes report and now the Monageer report. What we see in this report is that the risk to children remains and there is an absence of urgency in putting in place the necessary measures to ensure our children are protected and potential tragedy averted.

There is a group of children who are currently very vulnerable. I do not have time to go into all of the details but the Health Service Executive 2007 report contains a good deal of detail. The immigrant children who have gone missing in this country are a key vulnerable group as are the 247 children in adult psychiatric inpatient care facilities. We also have the closure of local child and family services throughout the country to any case but the most urgent psychiatric emergency. That is the position today. The vast majority of those services throughout the country only take the most acute psychiatric emergency referrals, and we still do not have the out-of-hours social work service.

People are frustrated that child protection is not getting the priority it deserves. The inquiry team acknowledged that the fundamental problem has been the State’s failure to provide an out-of-hours social work service. The Minister must respond on that later.

I want to raise a number of issues in the report which are of major concern, the first of which is the assessment of the early intervention teams throughout the country. A great deal of criticism has been expressed about the way they are acting currently. Major problems are being experienced including files not being sent from Donegal to Wexford and consent needed before any files or information is sent, which means clients get lost along the way, so to speak. There is a good deal of information in the report about that and we need a plan of action to address it. That is a most serious problem. We are putting money and resources into early intervention teams and if they are not working effectively we must understand the reason and take action.

On the Disability Act 2005, this was a very vulnerable family who needed intervention from the disability services. They did not get the kind of intervention that was needed.

This report focuses mainly on frontline staff. There is no analysis of management. That aspect is missing from this report. There is a chronology of events and of whom the family had [768]contact with, but there is no analysis of the findings before the report makes its recommendations. The inquiry team, wrongly in my view, excluded the resource issues. How do we know the front-line staff dealing with the family had the resources they needed, if the inquiry excluded resource issues from its terms of reference? It is extraordinary that this was done in the current climate.

A number of points should be made about the people who responded to this situation. Sensitivity was shown by the undertaker when she saw what was essentially classic pre-suicide behaviour. She attempted to get help. I hope the people who worked so hard to try to help this family do not feel guilty about what they did. They really tried. Many people made efforts. The gardaí were contacted out of hours and made several efforts to ensure services were available. However, no key worker was ever appointed to this family so there was nobody to whom the gardaí could go. They had no pre-existing information on which to act.

A great deal more could be said about the suicide risk issue, and I am sure Senator Mary White will comment on this. I cannot accept the report’s conclusion that it was not clear that anything could have been done that would have prevented this terrible tragedy. With proper assessment and management, a key worker, proper assessment of the family and perhaps the involvement of psychiatric services, there might have been a different outcome. Huge issues arise from this report. I do not have time to comment on the Minister’s response regarding what he intends to do. He intends to appoint a type of super manager, but if there are insufficient people in the front-line services, a super manager will be unable to do his or her job.

I commend the motion. A lack of co-ordination of services is apparent from this report. I could say a great deal more about it but I do not have sufficient time. This motion would put in place a framework for ensuring that the recommendations are implemented and enforced.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I second the motion. When considering what happened in this case we should not focus on the family involved but on how it points to what is happening in the health service. As somebody who is involved in the health service, I am under no illusions about what is happening. There are numerous families with issues involving neglect, physical and emotional abuse and possibly even cases of sexual abuse. We are inclined to react faster when the latter come to light because of its serious nature but sometimes we are inclined to drag our heels with cases of emotional neglect. There is a focus on trying to work with the families. There can be problems with drug and alcohol abuse as well as the sheer inability of some parents to look after themselves and their children. These are not just isolated cases. There are thousands of children in those circumstances at present.

This mirrors what is happening in the rest of the health service. We manage our health and social services as if we were in a war. We are fire fighting with these services but we allow some matters to fall through the cracks. What is considered good procedure and good policy are not implemented because everybody is under pressure and stressed out or they cannot cope with what they are doing. The first impression one gets from the report is that many of the social workers and front-line staff are not talking to each other. One must ask why that is happening. Is it because the procedures are just a mess or is it that all the individuals on the front line are just too busy and stressed out to do things right? Then a disastrous situation such as Monageer occurs, there is a report about it and recommendations are made, but nothing significantly changes.

The circumstances of any disaster or crisis such as this, involving children, that has occurred in this country in the past few years are similar throughout, regardless of whether it happens in Roscommon or County Wexford. I have never seen a Minister who has responsibility for these issues crack the whip and insist on changing things in a way that will work. It does not [769]happen. We do not have 24-hour social worker cover. Social work is a different job from what I do as a doctor or from what a garda does. Regardless of whether it was a priest, myself or a garda who called to that house, we are not trained nor do we have the legal responsibility to deal with what was happening in that house that night. It would have to have been a social worker.

I cannot say whether we would have saved the lives of that family. However, if the social worker service is in place and is running efficiently, we will save the lives of the next family in a similar situation. That is the way we must think in this regard. The 24-hour cover must be put in place in a way that will work properly. There must also be communication between the different services. It is clear from the report that people did not bother finding out what the personnel in Donegal were thinking. People did not care what the general practitioner thought, as long as the boxes were ticked. The “attempted to make contact” box was ticked and then it was forgotten. That is the situation.

In some respects, there are many policies and bureaucracy in place that make this worse. The issue of consent is one. Let us be realistic about this. Consent can be a barrier in these cases. I have no wish to trample on the rights of individuals but it can be very difficult to get individuals who require the help of the social services to this degree to fill out forms so one can send a copy of the form to Dublin, from where it can be forwarded to Donegal to get the reports sent back. We need to be a little more sensible in how we run our services. The files should automatically move with the patient so if somebody who is a recognised official from the social work services in Wexford and has the required authority rings up for a form, it is sent to them. Nobody looks for these files for some Saturday morning reading over a cup of coffee. If the right official in Wexford makes contact with a reasonable official in Donegal, that will protect the confidentiality of the clients and family involved. Instead, we bog ourselves down with unnecessary bureaucracy because we think we are protecting the family. Look where that got us. It cost the lives of every one in that family.

The Minister should show that type of leadership and make changes. There is too much glibness. The Government is growing tired. I cannot say that for the Minister of State present, Deputy Trevor Sargent, because he is new to the Government but the incumbents that preceded it appear to have grown tired. The Minister for Health and Children, Deputy Mary Harney, when push came to shove, said at a health committee that she would publish this report. Has anybody seen it? Has anybody heard the Minister say she would publish it? No. Once she had done her soundbite for the media, that was that. This is the problem. We do not have a Minister who says: “Good God, I cannot let this happen again.”

I foresee what is happening in the social services today being the basis for the next commission on abuse in 20 years. The same type of dead-hand complacency and carelessness about what is happening is present across the upper levels of the system. Just as was the case 20 years ago, some of us who were not in positions of authority would have heard about what was happening. However, I am sure the Minister will have seen from the commission report that there were reports to the Department of Education and Science and to other people in authority who could have done something about what happened in those institutions long before they were dealt with. We now see the same type of devil-may-care attitude at the upper echelons of health service management.

That is why I compare it to a wartime situation. In such situations, things are chaotic. That is what is happening on the front line of social services at present, but it is the time these people need direction from the top. I know the social workers and public health nurses who are involved in these cases, and they are doing their best. They send their recommendations to [770]what is called their back office but things get lost or fade away somewhere between there and the people who make the decisions. The result is crises such as this across the services.

We must spend money on the 24-hour social worker service and we will probably have to spend money on beefing up some front-line services. There should be a focus on leadership. We constantly talk about leadership, taking responsibility, doing the job and not pandering to special interests fearful of what might happen. Being very realistic about what we can achieve, we can get this thing sorted out. I do not believe we will solve all the problems. However, when something happens I hate reading reports that glaringly state the cock-ups that happen could have been prevented or at least minimised. That is what I would like to see happen.

Senator Mary M. White: Information on Mary M. White  Zoom on Mary M. White  I welcome the Minister of State and would like to bring him up to date. For the past week we in the Chamber have been constantly discussing the Ryan commission inquiry into child abuse. The bottom line is that our country does not value children’s lives. The Ryan commission highlighted that tens of thousands of defenceless children were abused, physically, emotionally and sexually, under the care of the State. Sharon Grace was depressed and walked into the hospital in Wexford seeking help. As it was out of hours for the HSE, she took her two children aged four and three, went to Kaats Strand and drowned herself and her two children. Very recently we have had the case of neglect by the mother and incest in Roscommon. There was total and utter neglect of those children. There was also the Monageer tragedy that we are discussing today. There is a litany of children who are ignored by the State. Many of us in the Chamber believe hundreds of children are at risk because of the lack of proper systems.

If I were the Minister of State with responsibility for children and youth affairs, I would immediately take the initiative to have social workers available after hours and at weekends. It is unforgivable that in this civilised country we do not have social workers available after 5 p.m. and on Saturdays and Sundays, and that we do not have an after-hours helpline that people can ring at a time of crisis. In the earlier debate on the report of the Ryan commission, I said that most of the abuse in reformatory schools took place at night. Many of those people cannot sleep and need help during the night when all that is available is the doctor on call or to visit the accident and emergency unit. For God’s sake, that is not good enough. In the North there is a 24-hour service that people can ring. Thankfully we have the Samaritans. However, that is a voluntary group. Our State has an obligation to the children of this country. The Ryan report made it clear that tens of thousands of children were abused under the care of the State. Not having an out-of-hours social workers service is also neglect by the State. I find it unforgivable and cannot understand it.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  Is the Senator moving the amendment to the motion?

Senator Mary M. White: Information on Mary M. White  Zoom on Mary M. White  I must be.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The Senator probably does not want to move the Government amendment in light of what she has said.

Senator Mary M. White: Information on Mary M. White  Zoom on Mary M. White  I move amendment No. 1:

I hope the Attorney General will give permission for the Monageer report to be published.

Senator Liam Twomey: Information on Liam Twomey  Zoom on Liam Twomey  She is back in the camp again; the Minister of State is okay.

Senator Mary M. White: Information on Mary M. White  Zoom on Mary M. White  I had to look up what the word “redacted” meant in the dictionary. I found this edited report useless. However, it did recommend: “The provision of a national out of hour’s Social Work Service structured and resourced to ensure an appropriate response to all serious child protection and welfare concerns.” Many people, including the Minister, have said there is no proof that if this service were available this family would not have died. However, that is an intellectual response and argument. As a layperson and having produced my document on suicide, it is clear that even giving a person five minutes of professional time can save their lives. My proposal was that there should be a national 24-hour helpline available seven days a week staffed by psychiatric nurses or social workers who can decide whether an immediate response is required and the person should go to hospital, or whether chatting to them for a while or saying they could go the next day would be adequate. It is savage that we do not have this service. If a person is depressed, we do not have an adequate after-hours service. What good is the doc on call service for a person who is so bad? How accessible are the accident and emergency units during the night? The Monageer report is hopeless in the sense that so many of the conclusions and recommendations are blacked out.

An earlier speaker mentioned the adequacy of the social work service, with which I fully agree. From my experience in business I know the Irish bureaucracy is extremely badly managed. Everybody is left to his or her own devices. Nobody supervises the workers. To manage a social work service we need a supervisor managing a certain number of people and checking on them all the time to see if they are doing their work. It is not appropriate to leave it as a free for all with people doing their thing their own way. Some of them can be brilliant and some will be meandering and nobody getting anywhere.

The bottom line is that we need the full report. Of course I will be voting with my party tonight. However, we need the report published. Hundreds of children are currently at risk. I said this afternoon that separated children in care and children in St. Patrick’s Institution are not supervised. There is no independent supervising. Children’s care must become a mantra and the country must not be the hell that TheNew York Times last week described the Ryan report as showing. We need to get the Children First guidelines carved in stone so people know that our country protects its children. Up to this time we cannot say we are doing that.

Senator Feargal Quinn: Information on Fergal Quinn  Zoom on Fergal Quinn  I welcome the Minister of State for this pertinent debate. I have no problem supporting the Fine Gael motion. When I discovered that the Garda Commissioner, Fachtna Murphy, and the HSE chief executive, Professor Brendan Drumm, were the only two people who have technically seen the report, I realised we must do something about it. The report into the Monageer tragedy is as notable for what it omits as for what it includes. It is difficult to believe the chief executive officer of the Health Service Executive, Professor Brendan Drumm, may read the report, including the sections which are blacked out in the published version, but may not pass on to his staff any of its recommendations. It is not surprising in light of this approach which does not make sense that some people have labelled the report a whitewash.

The reputations of individuals appear to take precedence over the protection of children and reform of the system. All over the country, there are not enough social workers. I support the [772]motion seeking to have the report published in full. Perhaps it could be published without personal references. It is not possible for Senators to determine if this option is possible because we cannot read the full report.

It is shocking that if a child is not deemed to be at immediate risk, the case is placed on a list to be assigned a social worker. Currently, the names of 6,500 at risk children are on a list and child protection services outside Dublin are only available during office hours. I am aware from gardaí of the problems the force faces when something goes wrong at weekends or after hours when children are placed in Garda stations or prison cells because suitable places are not available.

One of the key recommendations in the report is to establish a national out-of-hours social work service. I understand this proposal is unlikely to be implemented for cost reasons, which is unacceptable. However, I welcome the decision to introduce a new emergency foster care system for at risk children.

Other sections of the report point to a disjointed communications system in the Health Service Executive and failures on the part of the Garda Síochána. The system lost track of Adrian Dunne and his family because they moved so many times. Many nurses have records on vulnerable families who they are unable to locate. The suggestion that social welfare payments should be linked to the community nursing scheme, if implemented, could help address this problem. The introduction of a measure along these lines could offer a solution.

The Monageer report states that even if the Garda or HSE social services had called to the home of the Dunne family during the weekend in which the deaths occurred, the tragedy may not have been averted. I gather gardaí drove past the house but did not call. This conclusion is too convenient. Given the significant difference highly qualified social workers can make, it is inaccurate to dismiss the influence they could have had in the case of the Dunne family.

The provision of services is urgently required. Mr. Des Kavanagh, general secretary of the Psychiatric Nurses Association of Ireland, stated that for resource reasons mental health services are only available on a voluntary basis and described the current position was “a bit chaotic” and “unacceptable”. Mr. Kavanagh also noted some positive outcomes from the tragedy, including the response of the Wexford mental health services in establishing mental health liaison officers and nurses in the accident and emergency unit of Wexford General Hospital as well as the appointment of a suicide screening nurse who is available to work with general practitioners. It is intended to extend this service, which currently covers one half of County Wexford, to cover the entire county.

The Monageer report is vital in that it highlights deficiencies in the child protection and mental health systems. It seems, however, that a tragedy must take place before action is taken. The report appears to suggest that upholding the rights of individuals takes precedence over health and social services. It certainly took precedence over the well-being of the children who lost their lives.

The Monageer report is not the first report to be censured and by not making anybody accountable, it is debatable that it will provide an incentive to make services better and more responsive. For this reason, I support the motion.

I am concerned that a similar incident could occur. We cannot blame others for the problem as achieving a solution is in our own hands. Senator Mary White made an interesting contribution. Citizens are concerned about the Monageer tragedy and hope we will find a solution which helps avoid similar cases in future.

[773]I welcome the Minister of State, Deputy Barry Andrews, to the House. I understand he was unable to attend earlier. My concern is that the well-being of children does not take precedence over the protection of individuals who may have been involved in this case. By blacking out such a large part of the report, we are protecting the individuals involved and failing to protect children. I support the Fine Gael Party motion and urge the Minister of State to find a way to publish the report, possibly by substituting pseudonyms for the names of those who it seeks to protect.

Senator Jim Walsh: Information on Jim Walsh  Zoom on Jim Walsh  The case we are discussing is not unique as similar cases have occurred in Ireland and other jurisdictions. Such events challenge us all to find ways to try to prevent their recurrence. Nevertheless, one must draw distinctions between different incidents. Given that we have just concluded a three-hour debate on child protection issues arising from the Ryan report, it is understandable that the focus of this debate should be on child protection. The issue, however, is wider than that and includes the issue of mental health.

There have been other cases in which children were killed by their parents. We need to be mindful that no parent in his or her right mind would even contemplate carrying out such an act. Senator Mary White made an interesting observation on the unfortunate case involving the Grace family in County Wexford. In that case, a mother sought to speak to a social worker only to find the service was not available. She subsequently went to the River Slaney and she and her children drowned. That case focused attention on the need for an out-of-hours social work service.

I am not certain the Monageer tragedy mirrors the tragedy of the Grace family. Based on the report, it seems there was a considerable degree of planning involved. As we have seen in other cases, including in other jurisdictions, when one partner snaps in circumstances where there has been conflict between a husband and wife or cohabiting partners, he or she may take the children away with the unfortunate result that both they and the parent and question are killed. These are usually spur-of-the-moment cases.

In the Monageer case, I find it difficult to see how social services could have acted to prevent the outcome. We need to examine such matters, rather than simply prescribe what appear to be plausible and ready-made solutions which may not yield significant results or improvements. It struck me reading this report that the couple involved appeared to most outsiders — there is nothing in the report to suggest otherwise — to be getting on satisfactorily themselves but kept to themselves. The report underlines that Adrian Dunne’s IQ was 64 and he was perhaps bordering on mild mental handicap, and that his wife, Ciara, was a slow learner.

The report recognises as well that both families, in particular the O’Brien family, had little interaction with them. Therefore, they did not have that wider support which often is fairly essential and necessary. Indeed, there was a great tradition of that in this country in the past where there might have been three generations of a family living together. I suppose economic circumstances may well have dictated that happening but there definitely was a social benefit derived from that. Indeed, anybody who has been to China will have been struck by the fact that such a system is still very much in operation. There are many benefits, particularly for the development of the children where they have the support and loving care of both grandparents and parents. This family appeared to have cut itself off from that.

I am also very much of the view that while there will always be exceptions, many families live their lives well in privacy and look after their children well. While the State has a supportive role, there is this line between supporting and protecting, or perhaps interfering, and that is a difficult balance to achieve. It is easy in hindsight in this instance to look and state that inter[774]vention would have been desirable, and nobody would disagree with that. According to the report, approximately four weeks before the tragedy the family visited a sports shop. As Liverpool Football Club supporters, they were looking for some Liverpool paraphernalia — a Liverpool teddy or something — but the mother actually remarked to the person in the shop that she wanted to put it in the coffin with a child. Equally, on 4 April when they rang the undertaker anonymously and made certain inquiries of one of its staff, they talked about pre-planning a funeral, not only for themselves but for their children. That would indicate to me that this was something which was being planned in advance.

It is interesting that also in that conversation the person who took the call felt that the gentleman, Adrian, who was on the telephone was being prompted by a lady behind him. Nobody will ever know. Who can go back into the minds of people who were in that situation? Whatever the cause, it is most unfortunate for them, for their children and, indeed, for their wider families. It was a terrible tragedy to befall them and, unfortunately, others have had to experience the same pain and grief.

I commend the Garda, the priest and the undertaker who were involved and who conscientiously did what they felt was reasonable and right. I am inclined to agree with the report that this was a situation where a social worker’s intervention would probably not have made a difference to the outcome. I am not even sure whether the intervention of a psychiatrist would have made a difference.

It brings me back to the entire area of mental health and people who become suicidal or depressed, many examples of which we see for a variety of reasons. Often those who know or live closely with such persons express surprise that this should happen and it is that area we should concentrate on and try to develop so that such instances can be minimised. Such instances probably will never be totally avoided. If they were, it would be great. At least they can be minimised.

Senator Eugene Regan: Information on Eugene Regan  Zoom on Eugene Regan  No doubt this is one of those terrible tragedies about which it is difficult to speak. Suicide is always a difficult subject, particularly in this case when it involves an entire family. The “what if” question in a suicide situation is especially difficult, both for all the members of the wider family and all those who had any interaction with the people who, essentially, are the victims of this situation.

The report is comprehensive and detailed and makes some key recommendations. Those of which we can read seem very relevant to improving the system of health care and care of children.

However, there are some flaws in this report. One of the fundamental flaws is not in the terms of reference which have been given but in the interpretation of the terms of reference. The terms of reference include: “To identify the services sought or required and contacts made by or in respect of the Dunne family from public and other relevant services.” The next main provision is: “To examine the way in which public and other relevant services ... responded to any requests and contacts ... discharged their functions ... [and] ... co-operated with each other.” This is interpreted to mean that it must be examined in a broad sense, that the terms of reference, “require them to examine the provision of public and other relevant services rather than the performance of any individual person involved in the provision of such services”, and yet it goes on to state that, necessarily, “an analysis of service provision will involve consideration of its provision by individuals”. Therefore, there is a contradiction in the interpretation of the terms of reference and how the inquiry team came to this conclusion is puzzling.

[775]The section of the report dealing with the interpretation of the terms of reference states: “It is the view of the Inquiry Team that the identity of each person has been protected to the extent possible consistent with the fulfilment by the Inquiry of its terms of reference.” If that is so, why is there the various instances of editing to which I will refer. It states in its interpretation of the terms of reference that, “the Inquiry Team has endeavoured not to attribute fault to or comment adversely on any individual”. In a somewhat contradictory statement the report states that where adverse comments are made in respect of individuals, they would be advised and be given the opportunity to make a submission.

Why, if we are holding an inquiry and the Government wants to get to the bottom of a subject, do we speak in such general terms? Why do we not identify those who are responsible? I am not suggesting in this inquiry that any individuals are particularly responsible for specific faults which led to this specific tragic event, but the entire methodology is flawed. I do not know who influenced or suggested this interpretation to those carrying out this inquiry, but it destroys confidence in so many other such inquiries into what went wrong in specific individual cases. Why not identify people? Why not get to the bottom of these issues? Then we can learn. However, we cannot learn from generalised findings and recommendations which do not attribute any responsibility or accountability to an individual. Where those who operate the system at no point feel that they have a responsibility because they will not be named or identified or have blame attributed to them under any circumstances, there are no consequences. How can anyone be confident that the system can be improved by virtue of this type of inquiry? This is a general point on which the Minister of State may have opinions. Perhaps he will explain the rationale for this approach and whether it was the intention of the inquiry’s terms of reference. He made a statement to the effect that the inquiry was about learning, not about apportioning blame, which suggests that he endorses this methodology. This is where the problem lies, as we are failing to improve the health care system, the operational systems and the sense of personal responsibility.

I do not know what the problem is with the Fine Gael motion, which is to have the report referred in full to the Joint Committee on Health and Children for its consideration of the report’s substance, submissions and recommendations. This anodyne amendment compliments the Minister of State. In fairness, the report was commissioned and presented, but I qualify my compliment in terms of the manner in which it was presented. I draw the House’s attention to one phrase in the amending counter motion. It states: “contingent on legal advice, to refer the recommendations, including those redacted, to the Joint Oireachtas Committee on Health and Children for their information and consideration with a view to the State taking on all the learning to be gained from this Report”. This phrase often appears in discussions on this type of case. We are constantly in a learning process, but there is no responsibility, past or future, or accountability.

The report is meant to guide the House in the formation of policy and legislation. If recommendations are edited, redacted and deleted, how can the report provide a guide to policy? It is said that the Attorney General and outside counsel have advised on the necessity to edit the document, but has the former advised——

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  The Senator’s time has expired.

Senator Eugene Regan: Information on Eugene Regan  Zoom on Eugene Regan  ——on the motion to present the full report to the joint committee for consideration? The point of the motion does not concern the Government’s redacting of a published public document.

[776]An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  The Senator, to conclude.

Senator Eugene Regan: Information on Eugene Regan  Zoom on Eugene Regan  What is the legal impediment to referring the report in full to the joint committee? The Kelly Fitzgerald case set the precedent for this. Will that precedent be followed?

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  I welcome the Minister of State at the Department of Health and Children, Deputy Barry Andrews.

Minister of State at the Department of Health and Children (Deputy Barry Andrews): Information on Barry Andrews  Zoom on Barry Andrews  I want to address some of the issues raised. I apologise for needing to step out at the beginning of the debate. Several speakers have referred to the Kelly Fitzgerald inquiry. While I do not want to be overly defensive, the comments made about that report by the then Minister for Health, a member of the Fine Gael Party, in 1996 are worth reflecting on. He stated:

He was attacked by Opposition Members, those in my party, and accused of a cover-up. The same is being repeated today in that I am being accused of a cover-up. The only difference is that we are on different sides of the——

Senator Eugene Regan: Information on Eugene Regan  Zoom on Eugene Regan  I have not used that word.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  It was used in the Lower House.

Senator Eugene Regan: Information on Eugene Regan  Zoom on Eugene Regan  We are discussing this House.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  The Houses of the Oireachtas. Fine Gael made the accusation. If Senator Regan is resiling from it, he should make that clear. The accusation was made on behalf of his party——

Senator Eugene Regan: Information on Eugene Regan  Zoom on Eugene Regan  On a point of order, I made specific statements. The Minister of State has attributed something to me, although I do not necessarily disagree with it. I have addressed particular comments and questions to the Minister of State and I ask that they and nothing stated in the Lower House or elsewhere be dealt with.

Senator Jim Walsh: Information on Jim Walsh  Zoom on Jim Walsh  That is not a point of order.

An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  The Minister of State indicated that the point was made by a party in the Lower House.

Deputy Barry Andrews: Information on Barry Andrews  Zoom on Barry Andrews  I stand over my comments. Let us not be overly sensitive. A member of the Senator’s party said something in the Lower House about this report. If we cannot discuss such things, we cannot have a full debate. Let us stick to what has been said in public and be honest about it. If we cannot comment for the reasons suggested, we would be overly constrained. My original point was worth highlighting.

Senator Walsh stated that familicide, the killing of an entire family, is a growing problem. This is true. Research shows that approximately 90% of cases are not preventable. It is a [777]stark and challenging statistic that gives social workers no consolation, comfort or cause for complacency. The report refers to the family’s isolation, which is also true, since it was moving all the time, but improvements have been made. There is an exciting pilot scheme in Wexford and Dún Laoghaire, where the Cluain Mhuire service is trying to educate the areas’ health professionals to detect incidents of psychosis in young people and others. The current opinion is that detecting it earlier will avoid unhappy consequences. This scheme, one of several developments in mental health services since then in Wexford, is welcome.

Regarding Senator Regan’s comments, the inquiry was independent. The suggestion that influence was brought to bear on the committee in conducting the inquiry is not well grounded. I stress that the committee conducted its affairs independently.

I welcome the opportunity provided by the House to reflect on the publication of the report of the Monageer inquiry. It has been a difficult and emotional time for the families concerned and I wish to convey the sympathies of the Government and the House to the families on the tragic losses of their loved ones.

  6 o’clock

In the first instance, I would like to state that it was always my intention to publish as much of the report as was legally possible following the completion of the work of the inquiry team and the presentation of its report. I am pleased that this has been achieved. When the report was received in October, I undertook to have it examined to determine what could be legally published. When this work was finalised, the report was published in its redacted form. It was left to the legal advisers to examine the report from a legal perspective and to consider the implications of publishing its full content, cognisant that a delicate balance needed to be found between protecting individual rights and the sharing of knowledge with health professionals and the wider public. In publishing the report, I did what I was legally empowered to do. Publication of the redacted report will facilitate greater awareness of the needs of families and will improve the response of service providers, and that is its value.

The provision of appropriate, robust and responsive child welfare and protection services is a key priority for me, as Minister of State with responsibility for children and youth affairs, and the Government. The report of the Monageer inquiry identified a number of issues regarding services for children and families, and my office, the HSE and the Garda Síochána are taking actions on the report’s recommendations.

There has been substantial media coverage of this report in the period following its publication. All debate on services provided to children and families is to be welcomed. However, there has been a disproportionate focus on the issue of the material redacted from the report. I have stressed, and continue to do so, that what has been published has been done so on the basis of what could be legally released into the public domain. This in no way detracts from the significant learning that can be achieved.

The chief executive officer of the HSE and the Garda Commissioner received copies of the full report in their capacities as heads of the statutory bodies with responsibilities for matters which were the subject of the inquiry. It is intended this will enable the redacted recommendations to be addressed in so far as they apply to their respective organisations.

My aim in publishing the report was two-fold, namely, to assist health and social care professionals in examining the systems they operate and work within and improving and enhancing those systems to ensure gaps in service are identified and addressed, and to allow the public in general and those in positions of influence to be informed about the circumstances of this tragic case, so that in future they might be alerted to warning signs, however slight they may seem at the time.

[778]Public vigilance can and should be promoted in this way. Senator Walsh rightly pointed to the vigilance of members of the public, in particular the undertaker and the curate who visited the family just before the tragedy.

I appreciate the sensitivities of the information divulged in the report, but I feel it is important practical lessons are learned from reports such as this. We should be reminded that the key message of the Children First guidelines for the protection and welfare of children is that responsibility for protecting children must be shared by all adults. Grounds for concern should be immediately reported to the statutory authorities and those who report concerns in good faith will be afforded all the protections afforded by the law.

The Government and the HSE have been quick to respond to the findings, conclusions and recommendations of the report. There are a number of recent initiatives I would like to draw to the attention of the House. I am pleased to acknowledge the new proposals unveiled in recent weeks by the HSE to support a more integrated health and social care system. The plan is to put in place a post under a national director for service integration to address the service needs of children and families across the HSE. This is the first time such an appointment has been made in respect of health and social services for children.

Co-ordinating these services to provide an integrated multidisciplinary solution with good communication and clarity of roles and responsibilities goes to the heart of the recommendations of the Monageer inquiry report. I can confirm to the Seanad I had a meeting with the HSE today to progress this matter further.

Another major development, and one which addresses some of the communications issues identified by the inquiry team, is the establishment by the HSE in February 2009 of a task force to standardise policies and procedures for child protection and welfare services across the country, to be completed by the end of this month and implemented in June. This task force has involved detailed, in-depth consultation with social work staff and management in the HSE around the country, and will set national standards across the HSE.

It has examined issues around the reform of social work services, analysis of key management information flows and the definition and implementation of standardised business processes. From June 2009, the HSE intend to operate a place of safety service for children to enable the Garda to place children in a safe environment when they have to remove children from a situation of extreme risk.

The HSE is putting in place a more integrated multidisciplinary approach to out-of-hours services, building on existing general practitioner, acute hospital and mental health services, to ensure people seeking services outside normal working hours can be provided with appropriate advice, information and support, and in emergency situations access to specialist staff, such as professionals working in the areas of mental health and suicide prevention.

The HSE is commencing a comprehensive review of nursing services in the community, which will cover public health nursing services as part of the HSE transformation programme and development of primary care teams. This review will have regard to the role, function and reporting relationships of public health nurses and community registered general nurses, and will take specific account of the public health nursing service for children under five years of age by reviewing systems currently in place.

In March 2009, the HSE initiated a process, led by a small group with experience in early intervention team services, to prepare a framework for the delivery of early intervention [779]services, covering both statutory and non-statutory providers, to ensure a standard and consistent approach to the delivery of such services.

The findings of the Monageer report will be incorporated into Garda practices and procedures to complement the Children First guidelines, which provide a framework for the Garda Síochána and the HSE to deal with the sensitive area of child welfare and protection. Co-ordination between the Garda and the HSE will be a priority over the next number of months. Considerable progress has been made on missing children, and protocols have been developed around that, as well as the place of safety initiative I referred to earlier.

These actions have been taken in the context of this inquiry and the publication of the redacted report. This shows the value of this inquiry and proves I was correct to take the course of action I did in having the report published. The learning from this inquiry is already being put to good use, and my determination to improve services as a result of this learning is bearing fruit. This is what we should be concentrating on, because we must look forward, learn and improve our responses in a co-ordinated and focussed way in the best interests of children.

A key finding of the inquiry states that even if Garda or social services had called to the Dunne family during the course of the weekend, it is likely the tragedy would not have been averted. Notwithstanding this, it is incumbent upon us to take every possible action to address issues of inter-agency and inter-personal co-operation and communication, and to develop, to the best extent possible, an approach to identifying and intervening in situations where children and families may be at risk.

It is impossible to create a catch-all remedy, but the steps I have outlined go a long way in terms of the ongoing development of a pro-active, preventative approach to dealing with families in need. In this context, I also note the ongoing work to develop a greater understanding of the phenomenon of familicide.

To further our understanding of the complexities of this occurrence, the HSE established a group headed by Geoff Day, director of the National Office of Suicide Prevention, in 2008. The work of the group is focusing on identifying risk and protective factors and the measures that can be taken to minimise such risks.

I would like to inform the House I am currently in the process of obtaining legal advice on the issue of appraising the Oireachtas Joint Committee on Health and Children of the substance of the redacted recommendations of the report. Whatever course of action I will be in a position to take will have to be taken in line with the legal advice I receive, and in a manner and context which ensures the rights of those involved are protected and no reputational damage is suffered. I await further clarification in this regard.

For the moment, I expect to have comprehensive legal advice on the issues involved in the next number days and I assure the House I will act on the basis of that legal advice promptly and decisively. I thank the House for the opportunity to speak on this issue.

Senator Michael McCarthy: Information on Michael McCarthy  Zoom on Michael McCarthy  I welcome the Minister of State, Deputy Andrews. To put this in context, the Fine Gael motion states:

[780]The Government amendment, in that context, sounds general enough and, contingent on legal advice, the Labour Party will support the Fine Gael Private Members’ motion. It is most important we see transparency and accountability, particularly regarding the recommendations of this report.

I wish to begin by touching on the whole issue of mental health and suicide and, to use the Minister of State’s own term, familicide. How many of us thought two years ago we would be discussing such an appalling tragedy in this House? It is so sad that just over two years ago, Adrian Dunne, his wife Ciara and their two small girls, Shania and Leanne, died in appallingly tragic circumstances. The whole country was touched and saddened by the horror that visited that household on the day or night in question.

It is linked to the issue of mental health. Despite the efforts made, there is still a major taboo regarding mental health and, in particular, negative mental health. I am reminded of the television campaign which ran in recent times, and used a succession of people of all nationalities and ethnic backgrounds, and people who were or were not famous, who all spoke about mental health. It is a question of whether it is positive or negative.

There is still a major taboo about it. A lot needs to be done to help people who have negative mental health, such as providing community facilities and home services. I do not think anyone in this House does not know somebody who, unfortunately, has been affected by depression. We all know it leads, in some cases, to a situation where people feel they cannot go on and, unfortunately, revert to suicide. The difference between that general affliction for the population and this case is that, unfortunately, the warning signs were all there. The alarm bells did go off but for a variety of reasons no action was taken.

No matter how we attempt to understand it, we will never understand the thinking behind this appalling tragedy. What makes it all the more gut-wrenching is the fact that there were warning signs. It almost defies belief that no action was taken when somebody who on the face of it appeared to be healthy and to have a healthy partner and children attended an undertaker and inquired about ordering two coffins for adults and two coffins for children. It is tragic to say the least, with horrifying consequences, that the non-professional in this case in terms of health services, namely, the undertaker, raised the issue with the health professionals. We heard much in recent days from the Commission to Inquire into Child Abuse about what was covered up, but in this case the clergy also brought the case to the attention of the health professionals. It is sadly ironic that the non-professionals in this case acted above and beyond the call of duty.

The other side of the argument is that the professionals, in particular the social workers, were operating a 9 a.m. to 5 p.m. Monday to Friday service. In an ideal world it might be possible to do so, but in reality one cannot switch off one’s afflictions involving negative mental health on a Friday at 5 p.m. and turn it back on Monday morning when people are back in the office. I do not wish to apportion blame to the social workers or the Garda. I am just touching on the circumstances leading up to this appalling tragedy. For example, members of the legal profession were all aware of the case but there was a complete and absolute breakdown in communications. If we are to learn anything, surely to God we can have an out-of-hours service that is meaningful and resourced with staff who are ready to attend to situations where it is clear the safety, health and welfare of children is at such huge risk.

I am forced to use words such as “sad” and “tragic” repeatedly. One of the findings of the report suggested that intervention might not have prevented the tragedy. We are aware that the late Mr. Dunne was anything but transparent in his dealing with the Health Service Execu[781]tive. That makes it even sadder to think that if intervention were available it might not have saved this family.

The report on the Monageer inquiry contains 26 recommendations, including seven that have been blacked out. I am aware the Minister of State has received legal advice and he has a legal background himself. Legally, there is a good case for such an approach but it does nothing in terms of the lessons we need to learn from this incident if we say the legal advice is that we cannot do it. We need to put in place a remedy for that. We need to make the information that was blacked out available, if not to the Oireachtas joint committee then to the Houses in some shape or form at least to create the impression that we are beginning to understand the full import of what happened and that we are willing to implement the recommendations.

One of the recommendations is that where a member of the Garda Síochána receives a report and has reasonable grounds for believing there is an immediate and serious risk to the health and welfare of a child, he or she should take immediate action to ensure the safety of the child and, where necessary, to invoke section 12 of the Child Care Act. The inquiry team also highlighted the public health nursing service offered to children under five as being critical in identifying children in need of intervention. That goes back to the point on the importance of the provision of the resources and necessary powers to intervene. Unfortunately, in this particular case the report tells us we might not have prevented the tragedy. The report went on to say that it was unclear whether the systems currently in place are sufficient and recommended a review.

If we are to learn anything about the appalling tragedies in this particular case we must ensure we have a full publication of the recommendations and the Government takes action. I say that as sensitively as I can. We need to take action to ensure no one loses his or her life unnecessarily. On the face of it, the Monageer case looked like a suicide and three murders. However, that is not the case. What happened is simply appalling but we need to learn from it and to implement the report’s recommendations in full. For the sake of others who may be in that type of situation where the risk is high, I urge the Minister of State to ensure the resources are in place to deal with them.

Senator Maria Corrigan: Information on Maria Corrigan  Zoom on Maria Corrigan  I welcome the Minister of State. He has spent a considerable part of his day in the House. This report was produced following an incredibly sad event. I extend my sympathies and condolences to the Dunne and O’Brien families. Every time the case is referred to on television or in the newspapers a particular photograph of the family is used. I find it difficult to look at that photograph as the faces of the two little girls in particular seem so full of hope, life and happiness. If I find it difficult, I can only imagine the upset, grief and distress caused to the members of the families when they see it.

So much of the report is blacked out that a discussion of it is of limited value. I accept the Minister of State’s actions were taken in good faith. I understand that to date only a couple of people have had access to the full report. Does he consider that the limited number of people who have been furnished with the full report are sufficient to ensure we learn the maximum from the report? That is a big responsibility to place on a couple of people. Professionally, my reading of the extracts that are available makes it clear it is essential that at least one person who has access to the full report should have a background and experience in disability to gain the maximum from the report.

I second the amendment to the effect that the Minister of State, subject to legal advice, will make the full report available. It is essential that we take whatever lesson is to be learned and apply it. If for some reason legal advice does not make it possible for the full report to go [782]before the Oireachtas Joint Committee on Health and Children, I suggest a small group with the appropriate expertise could be established that would have access to the full report to ensure the maximum lesson possible is learnt from the report and that it is applied in practical ways across front-line services, and to have responsibility for developing a concrete plan for the implementation of what has been learned.

I welcome a number of specific recommendations from the part of the report available to us, including the focus on early intervention services and the need for standardisation, and the recommendations on the need for the responsibilities of individuals to be spelled out, with regular reviews and in-service training. In particular, I welcome the recommendation on communication. That is an area that will always be difficult to address across such wide and disparate services.

One factor that makes it especially difficult is the professional balance that is required on occasion between maintaining confidentiality and ensuring safety. One of the points that comes across strongly from the bits of the report to which we have access is that it appeared that individual clinicians, practitioners and team members had different pieces of the stories on their files but that the first time all that information became available was when each person handed it over to the review team who compiled the report. The lesson for us is how seemingly disparate bits of information could paint a very different picture when considered collectively. We will always struggle to achieve a balance given the professionalism required of us to maintain confidentiality and given circumstances where it is not necessary to breach that confidentiality. Sometimes when people only have pieces of a story that do not flag an immediate concern, they do not share that information with other professionals.

I welcome the recommendation on the out-of-hours social work service. I am aware of the points the Minister of State made on the limited resources. Is it possible to be creative with this? I welcome the commitment the Minister of State gave us this evening on the place of safety service from next month. With new contracts, is it possible to look at out-of-hours social services a bit differently? Maybe we do not always have to have a nine to five work rota. Is it possible to vary that a little bit and to have an extended service?

I welcome the recommendations regarding familicide and the suggestions that it may be of interest to the State to undertake research at some stage. The report identifies vulnerable families and family support, mental health and child protection. It also identifies disabilities and the subsequent vulnerability arising for families and children as a result of disabilities. Given my background, I would like to address this issue for a moment.

I believe that disabilities and the challenges arising from them played a very significant role in this case. There are many aspects of the description of family life that is consistent with challenges encountered through disabilities. These include the information provided to us in this report on budgeting, the isolation of the family, the accumulation of debt, being picked on within the community, hoses being placed through the letter box and eggs being thrown at the window. These are all consistent with the identification of people with disabilities as being vulnerable. Other issues include planning and an ability to keep and maintain appointments. People with disabilities face similar challenges. I accept that disability issues are not identified within the generic HSE services where there is no existing background in disabilities, but I note from the report that both Adrian and Ciara had been identified at a young age as having presented with special needs.

One lesson that we could take from the report is that there is an emerging need to help people with mild intellectual disability. These people might leave the special school system or [783]special class system in schools, and because they are leaving the Department of Education and Science, there is no automatic link with support services at 18 years of age. They can often fall through the cracks in the system and they only come to the attention of support services and the authorities. For young women, such difficulties include early pregnancy and for young men they include running into problems with the law. This is an area that would be well worth identifying. From my personal experience, I know that people with mild intellectual disabilities who try to establish family lives for themselves can encounter ordinary difficulties that become serious if they do not receive support at an early stage. We then only become aware of these difficulties when they lead to a child protection issue for their children.

Senator Joe O’Toole: Information on Joe John O'Toole  Zoom on Joe John O'Toole  I welcome the Minister of State to the House and I wish him well in dealing with this. I listened carefully to what he said and I also listened to what Senator Corrigan said. Although I do not support the Government’s counter motion, the points made by the Senator at the end of her speech are very important.

I referred to the case earlier about the murder of the 14 year old girl in Sligo. I will not comment on the innocence or guilt of anybody charged, but the real issue is that the child came from a family with problems. That child was on our books but she was dead for one year before anybody started looking for her. There is something wrong with that.

I remember chasing up the background to two horrific murders about 15 years ago. One of them was a murder in Clontarf where a man in his own home disturbed a burglar and the burglar hacked him to death with a golf club or some implement that was nearby. The guy was found guilty of murder and is serving life for it. I checked back on him and I found out that when he was four years of age in junior infants class, his teacher and his principal asked for a psychological assessment. This happened well before the establishment of NEPS. Before he reached 11 years of age, that school twice pleaded for support for that child from a dysfunctional family, claiming that he was clearly heading for trouble, and he committed murder afterwards. Nothing was done.

Another well known case was that involving Brendan O’Donnell in Clare. He murdered a mother, a child and a priest. I decided to look at the background of Mr. O’Donnell and how he behaved as a child in primary school. In junior infants, the school authorities expressed their concern about him. He used to lie on his mother’s grave in the middle of the night when he was four, five and six years of age. The school asked for help and support, but it was not there.

I put these examples forward to back up the point made by Senator Corrigan and the Minister of State about the need for early intervention and to deal with issues in an appropriate way. They also highlight the need for mandatory reporting. The two examples showed that the schools took the initiative, even if it did not do any good in the long run. There should be consultation at school level where all the different groups involved in dealing with a difficult child come together. There might be a probation officer, a health board officer, a worker from the Society of St. Vincent de Paul, a psychologist and so on. These people sometimes do not know about the others. I have come across many instances of that, so the information should be put together at primary school as that is where all the children attend.

I have much respect for the Minister of State. I listened very closely to his speech as I wanted to hear why he did not publish the report in full. He spoke about the need for a delicate balance to be found between protecting individual rights and the sharing of knowledge with the public. I agree with that. People cannot be damned on the basis of a report like this. There are certainly plausible arguments to be made for not naming people, but I do not understand why the format for the Ryan commission report was not followed. Pseudonyms could have [784]been used and we could have left it at that, so that we could at least read what the report was saying. There is nothing that destroys and dilutes the impact of a Minister faster than legal advice. The Minister of State should ask Michael Noonan about that. It is only advice. The legal people are not politicians and they are not answerable to the people.

It is not just about the delicate balance on legalities. How did the Minister of State see it as a representative and the advocate of children? I accept his word if he felt that he put a balance on it here and there. What is the worst that could happen if we published it in full? How can we ameliorate that? We could put pseudonyms into the report so that it could be published in full. That is worth considering.

The Fine Gael motion asks that this report be referred to the committee. There is no reason that it cannot be referred to the committee in confidence, as a confidential document, either with the names blacked out or not. The Minister of State, on the basis of the argument he makes, has no responsibility other than to keep it from the wider group. If public representatives are to learn from this, they must be able to read the report. I accept the argument that they do not need to know the names of the people. However, they do need to know how the process worked or did not work. There is a certain offensiveness — I accept this is not his intention — in the Minister of State saying even a committee elected by the people to deal with this issue cannot be told.

I heard recently that senior officials of the Health Service Executive have not seen the full report either. While I do not wish to hark back to the bad experience in terms of confidentiality experienced by the Minister of State on the last occasion he was in this House, there must be trust and confidence. The person who discloses the information will be the person at fault. In my opinion, no case has been put forward to stop people who need this information to learn from it and to develop legislation from it to prevent this happening again from knowing all the facts. This could be done in private session of the committees. There is nothing unusual about that. Issues surrounding the conduct of a judge — I must be careful of my words — were discussed in private session of a committee. There is no reason this could not be done in that way. I ask that the Minister of State rethink this matter and consider addressing it in that way.

While I do not know what is and is not discoverable, I do know that no judge in the land, recognising the clear distinction and separation of powers between the Executive and the Judiciary, would find against a Minister if he, she or the Department argued they made available documentation to an appropriate committee of the House in confidence. For this reason, I believe the Minister of State’s reference in his speech to legal advice is, with due respect, a little light. There must be more to it than that, although I am not suggesting anything other than that is the case. I am sure the decision was made with the best of intentions one way or another. However, I believe this matter can be dealt with in a different way and that the Minister of State should make a decision on whom he considers appropriate to have this information. If not a member of the committee, I will not need to see it. However, I do not see why members of the committee should not be given the information in confidence. On the basis of the separation of powers, I do not believe the Judiciary would intervene in such a situation.

Senator Jerry Buttimer: Information on Jerry Buttimer  Zoom on Jerry Buttimer  Cuirim fáilte roimh an Aire Stáit. The motion before the House is important not least because of the tragedy involved but to ensure lessons are learned for the future. Senator O’Toole is correct that there is a need for joined-up thinking on this matter.

We all know that early intervention is critical and that this requires resources, action and political motivation. Similarly, there is a growing view that mandatory reporting should be [785]introduced, an issue also requiring debate. When speaking of stakeholders and the realm of people involved, including juvenile liaison officers, the Garda, psychologists, social workers, educationalists, HSE case workers and families, we must remind ourselves that it is people we are talking about.

The Monageer report leaves out much more than it contains. The motion before us is a simple one — I hope Senator Mary White is listening — which calls on the Government to send this report to committee where it can be debated in private, ensuring a frank and open discussion devoid of politics. That is what the motion is about. We must ensure a positive outcome from this report so that no other family will have this tragedy visited upon them. It is appropriate at this point that I sympathise with the Dunne family. None of us in this House can comprehend the pain which the remaining family members have to endure.

Deputy Alan Shatter, when speaking on the Ryan commission report, made a very good point. He stated: “It is clear that the culture of secrecy and cover-up is alive and well.” We cannot allow cover-ups or secrecy to continue when it comes to reports that affect people. The Ryan commission report states that the needs of the child should be paramount and that management at all levels should be accountable for the quality of children’s services. The buck stops with the Minister, the Government, the HSE and those employed to provide care. Let us not cod ourselves anymore. Let us stop the political pandering in this House. This issue requires political action by those who dictate to the HSE what should happen. That is the reality.

Where were the social services? Where are our mental health services? The report, A Vision for Change, was trumpeted as a the great new way forward. With respect, we can launch all the glossy papers and reports we want but if they are not followed up by action rather than mealy mouthed platitudes, we will get nowhere. What assessments of needs were carried out? Where were the community services? Relationships must be built up. I am only an ordinary punter who does not use fancy jargon or lexicon. We must arrive at a point whereby assessments are made and necessary action is taken. This was not done.

The Garda, local curate and undertaker acted with credible foresight in terms of what they did. What happened? They ended up on a roundabout and nothing happened. The Minister for Health and Children said nothing happened because the incident arose outside normal working hours. What about weekends? We are living in a society where an increasing number of people are at risk. Are we living in the real world? More of our people are at risk, including young families and young professional adults who are vulnerable and feel let down by society. These people are reaching out for help and we have an obligation to help them to provide them with hope.

In this regard, Members need only look around their own communities. I met a couple this week whom I have known for more than 20 years, both of whom are heartbroken at not being able to conceive a child. Issues such as inter-country adoption are forcing a change in mindset and are altering emotional behaviour. Never more than now have people required the assistance of the organs of the State. We are living in traumatic times, be the issue the Ryan commission report, the Monageer report or the Kilkenny incest case. We need to be people centred and people focused and to forget about budgetary constraints. This is not about budgetary incomes but about people, including children, husbands, wives and adults.

The word “redacted” was used. Senator Fitzgerald is correct. It means blacked out or censored. The Minister of State will not publish the full report because he is afraid of what will happen. Are we codding ourselves? The report we are discussing failed to identify a motive for what happened. Are we, as Senator O’Toole said, hiding behind legal matters and so on? [786] The report has been edited, with seven of the 26 recommendations and 15 of the 31 conclusions blacked out. How are we to move forward? This is about people and not outcomes or concepts. We are speaking about human beings. The Minister of State, Deputy Haughey, knows what I am talking about.

We need a national out-of-hours social work service. Swift and appropriate action must be taken. What happened after the Garda, priest and undertaker raised their concerns? The State failed the Dunne family. This must be the last family to be so treated. It is not enough for Ministers to give us political jargon and lectures because the core duty of the State and public representatives is to protect the vulnerable in society. If the Government is not a voice for the downtrodden and the afflicted it has failed in its duty.

This report must be shared with the Joint Committee on Health and Children because we need to find out what happened and what we can do better in responding to people who need help. We can black out names if necessary but we must learn for the sake of the future. I have a difficulty with censorship based on legal advice if it causes paralysis owing to fear of litigation. By considering the report in private, the committee will be able to make recommendations on policy and legislative reforms.

I raised on the Order of Business the extraordinary situation whereby 8,000 reports of child abuse and neglect have yet to be investigated. Out of a total of 2,255 reports received in the four Cork local health offices, initial assessments were carried out on only 585 children. The HSE ignored 74% of the reports on children at risk. If the Government condones that, it has learned nothing from Monageer or the report of the Ryan commission report. I hope we no longer allow the State to abdicate its responsibilities.

Senator Rónán Mullen: Information on Ronan Mullen  Zoom on Ronan Mullen  Cuirim fáilte roimh an Aire Stáit. Níl mórán le rá agam. Is maith an rud é go bhfuil an díospóireacht seo againn inniu. Bheinn buartha dá mbeimid ag cur iomarca béime ar ghnéithe an tuarascála atá fágtha ar lár. Tá línte ag dul tríd na hailt sin. Tá contúirt ann go gcaithfimid iomarca ama ag caint faoi cheisteanna a bhaineann le cursaí dlí. Sa chás sin, b’fhéidir go ndéanfaimid neamhaird ar na buncheisteanna atá ardaithe i dtuairisc Mhóin na gCaor. I mo thuairim, is é an rud is tábhachtaí a léiríonn an tuairisc ná, gur theip ar an Stát cloí le fealsúnacht agus moltaí treoirlínte Children First. Is é sin bun agus barr an scéil. Theip ar an Stát é sin a dhéanamh.

This is a welcome debate, especially in light of the publication of the Ryan commission report. However, I caution against giving too much attention to the blackening out of elements of the report. Notwithstanding the comments made by my esteemed colleague, Senator Buttimer, if genuine legal issues exist there is a danger that our attention will be diverted away from the key issues raised by the Monageer report.

This report clearly demonstrates the lack of State compliance with the philosophy and recommendations of the Children First guidelines. It is clear the HSE is not policing itself with regard to their implementation. Interested practitioners in the field of child care have made it clear to me that oversight of HSE activities is greatly lacking. There is, for example, considerable confusion over who decides when to call a child protection case conference to discuss particular cases which arouse the suspicion of the relevant parties. There is also a lack of consistency as to when and why such conferences are called. In short, there is a lack of rational ownership of the issue. No child protection case conference was called on the Monageer case nor was a preliminary strategy meeting considered.

[787]Legislation is not the problem because the legislative framework is in place to address cases such as Monageer. The problem is, as is so often the case with the HSE, the failure to implement policies properly. With that in mind, I wish to make a passing comment on the constitutional issue of child protection. It is natural at a time when people are deeply concerned and angered by the past neglect and abuse of children that a constitutional referendum would be considered as a necessary next step. A decent argument can be made to support such a view but we must stick to the facts.

In Judge Walsh’s decision in G v. an Bord Uchtála he stated that nothing in the Constitution indicates that in cases of conflict the rights of the parent are always to be given primacy. Writing about constitutional law in Ireland, Hogan and Whyte note that an approach which places greater emphasis on the rights of children and is more protective of the important psychological relationships which a young child establishes with a caring adult can be achieved by re-arguing the constitutional principles involved and without the necessity of a constitutional amendment. It is worth rehearsing Article 40.3.1°, which states: “The State guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate the personal rights of the citizen.” Furthermore, Article 42.5 refers to the natural and imprescriptible rights of the child. The Guardianship of Infants Act 1964 clearly requires that the welfare of the child be paramount and this principle informs family law generally. It is worthy and important that we debate what more we need to do to protect children but we should remember that constitutional change or legislation may be less important than, as arose in the Roscommon incest case, asking whether the law as it stands is implemented in favour of vulnerable children.

There is a need for an independent observer to act as watchdog, unafraid to name and shame structural and professional inadequacies. Ironically, in appointing Ian Elliot as an independent outsider to oversee the implementation of guidelines aimed at the safeguarding of children, the church, by which I primarily mean the diocesan church, has shown encouraging signs of learning from past mistakes. There is no reason the HSE should not follow this model because thereby it would help to circumvent a system characterised by conflicting interests and bring clarity to a situation marked by confusion.

Senator Paudie Coffey: Information on Paudie Coffey  Zoom on Paudie Coffey  I welcome the opportunity to contribute to this debate on the tragic events which occurred in Monageer, County Wexford. It is important we hold a public debate on these issues and the effect they have on families and communities. We must reflect on how we respond to tragedies as a society. Are we learning from these difficult situations so that they never happen again? The real litmus test for civil servants and politicians is whether our responses change society for the better. I offer my sympathies to the Dunnes’ relatives and extended community. We must hope that whoever reads the Monageer report, despite the redactions or blackouts, whether they are HSE officials, those at the top of the Garda Síochána or the Minister of State himself, will follow through with action that will have an impact. It is no good reading the report and not communicating its recommendations and conclusions to effect the necessary changes in the relevant institutions or agencies. That must be the priority for all political parties and, as I said on the Order of Business, a cross-party approach is required. The leader of Fine Gael, Deputy Enda Kenny, has said that publicly.

We have come to this debate to try to improve the lot of children in our society. Fine Gael tabled this motion because we feel there is an opportunity for a committee to analyse and reflect upon this report in a detailed way and to make recommendations. That is the thrust of our motion which was proposed in good faith to ensure such tragedies can be avoided in future. We should all aspire to that goal.

[788]What are the consequences and implications of this report for service providers? How will it feed through the system down to social workers in the field? It identified a lack of resources for people at risk who are crying out for help. Can we respond when that cry for help comes on a dark winter’s night when everybody else is asleep? Most tragedies do not occur in broad daylight when everybody is at full thrust at work or in school. They happen when society shuts down for the night and vulnerable people are left isolated. When that time comes for people in darkness, are the necessary services in place for them? They are not at the moment, which amounts to societal neglect.

I can speak from some experience in this regard. My mother was a public health nurse for more than 40 years. As a child I remember growing up in a small community where people would knock on the door at all hours of the morning. Social issues were raised because my mother was the locally identified professional in the area. It was not her job but people knew they could knock on her door and that she would listen to their problems. Over the years, many public health workers, who had no social workers to support them, helped people who were in trouble. They did so voluntarily. They lived in their communities and knew everyone in the area, including the children. In the present climate, unfortunately, we have lost a lot of that personal contact. Public health nurses today do not even live in the districts they work in because they cover vast areas. That is no slight on them because they are overloaded with work, but they do not even know the families they are working with nowadays. That is the sort of society in which we live. It is a sad indictment of where we are but there is something to be learned from it.

In the Monageer case, the Garda and local undertaker responded because they knew the people involved. They referred the case to the social services for action but the State agencies that should have had the professional capacity to deal with these problems were not in a position to respond. As with public health nurses, there are fewer gardaí living in our communities. We can see that the local priest responded in a positive manner in the Monageer case but there are fewer priests in our communities. Therefore those who know our communities are growing further away from them, thus opening up huge voids in which vulnerable people can no longer find a sympathetic ear. This also concerns local gardaí, nurses and doctors who are no longer living in the communities they serve. That is the reality check and the real test for us. If they are not living in the communities they serve, how can the State provide such services? It is obliged to step in under the provisions of the Child Care Act 1991. The State has a duty of care to any vulnerable children at risk but if it cannot respond, it is not fulfilling its obligations to them.

The 1916 Proclamation promised to cherish all the children of the nation equally, but we are not doing so. We realise the necessary resources are at a premium. I am on a school board of management but if children are suspected of being at risk, they are referred to social workers and may be left waiting for months, if not years, for attention. According to recent media reports, 6,500 children have been identified as being at risk, yet they have not been allocated a social worker.

Earlier, we heard from Senator Cannon that thousands of phone calls to the ISPCC remain unanswered. Society is not responding to those cries for help, so who in Government is responsible for all this? There are major lessons to be learned in this regard. Politicians, charity workers and professionals, including gardaí, nurses and teachers, are at the point of contact. Resources should be made available to them to identify children risk. We also need to allocate resources to agencies to ensure that when a cry for help comes, somebody will be in place to [789]respond. If that cry for help goes unanswered, we will have more such tragedies. We will be back in this House debating them but will have moved no further, so more communities will be suffering heartache. We must consider the people in the communities so that when the cry for help comes, we will be ready and able to respond.

Senator Frances Fitzgerald: Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  It is sad and ironic to be debating this topic on the same day we have debated the report of the Commission to Inquire into Child Abuse. In the latter case, we were told that because of legal advice none of the perpetrators of horrific crimes could be named. Therefore nobody was identified, except by pseudonyms, throughout the report. We know the reasons for that and the authors of the report said they had to do it. It is ironic, however, that on the same day we have had the first debate on that report, we are discussing the Monageer report which has so much material deleted from it.

Does it matter? Different views have been expressed on that but I believe it does matter. What happened with the Monageer report was not good enough. It should not have happened. It may have been a question of putting different terms of reference to the group that carried out the inquiry. I am critical of what the Minister of State said in his speech, which was very legalistic. It was a very legalistic response and he did not ask the questions about responsibility, accountability and putting children first. He asked what he could legally publish. I do not mean to do him a disservice but it is not good enough. He should have accepted our motion and sent the report to the committee in confidence asking it to make recommendations. I am disappointed he is not accepting our motion. He should have done so. There is a supreme irony in the fact that on the same day we have been discussing historic abuses, we are now debating a report in which accountability and responsibility are not addressed at all. That is not good enough.

The Government has been in place for 12 years during which time we have had four Ministers of State with responsibility for children. When I read the response of the Minister of State to the publication of a redacted report of the Monageer inquiry, it was as if we had never had a Minister of State with responsibility for children. It is like reinventing the wheel, going through the recommendations and saying that we will have a place of safety service. Many questions arise, but I do not have time to go into all of them now. Will the staff be available and will they be vetted? If so, who is going to do it? Is it legal to ask the Garda to act under section 12 by going to a family without evidence? In these circumstances, the Garda had no evidence, so is section 12 the correct legal response? We are going to integrate various disciplines but it is like starting from scratch. We have had ten years of Celtic tiger resources and four Ministers of State with responsibility for children but the response to the Monageer inquiry is like starting from scratch. It is not good enough for families. It is like reinventing the wheel in terms of services. We are told that €16 billion is invested in the health services every year, yet this is what we get. It is simply not good enough.

  7 o’clock

To return to the issues in the report, no assessment was made of the “at risk” nature of the family and no case conference was held. The material about this family was only brought together at the final point when the inquiry team asked for it to be brought together. This is an absolute failure. There was no referral from one part of the country to another to pick up the seriousness of the struggle which the family was having. As so eloquently put by Senator Coffey, many volunteer members of the local society responded but the professional responses were not good enough and yet no issues of accountability and responsibility were dealt with. These were totally missed.

I do not wish to intrude further on the family but it is very clear it was isolated. I want to make a very contemporary point about the family. The family was very concerned about issues [790]of debt. At present, many families are worried about debt and when they get to a stage where they feel there is no way forward, huge despair can set in. I am disappointed the report did not examine the issue of resources or that of familicide, which was critical to this case. They should have been considered in the report.

The report falls short of what we could have expected in the manner of its publication. The response from the Minister of State is aspirational and there is no guarantee the recommendations will be implemented. Similar ones have been made over the past ten to 15 years but they have not been put into effect. How much longer will vulnerable families and children have to wait to have these types of recommendations implemented? We need a Minister who will monitor and evaluate them and demand a response to ensure families who need services get them when they need them.

At present, we have a crisis in child protection in this country. Earlier today we spoke about an historic crisis in our discussions on the report of the Commission to Inquire into Child Abuse, and it is documented clearly in that report. This is why I believe we need a very strong reaction from Government. We need short-term, medium-term and long-term reactions to the report of the Commission to Inquire into Child Abuse and to the types of incidents outlined in the Monageer report. I commend the motion to the House.

Amendment put.

The Seanad divided: Tá, 24; Níl, 17.

Information on Martin Brady  Zoom on Martin Brady  Brady, Martin. Information on Larry Butler  Zoom on Larry Butler  Butler, Larry.
Information on Peter Callanan  Zoom on Peter Callanan  Callanan, Peter. Information on John Carty  Zoom on John Carty  Carty, John.
Information on Donie Cassidy  Zoom on Donie Cassidy  Cassidy, Donie. Information on Maria Corrigan  Zoom on Maria Corrigan  Corrigan, Maria.
Information on Mark Daly  Zoom on Mark Daly  Daly, Mark. Information on John Ellis  Zoom on John Ellis  Ellis, John.
Information on Geraldine Feeney  Zoom on Geraldine Feeney  Feeney, Geraldine. Information on Camillus Glynn  Zoom on Camillus Glynn  Glynn, Camillus.
Information on John Gerard Hanafin  Zoom on John Gerard Hanafin  Hanafin, John. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Terry Leyden  Zoom on Terry Leyden  Leyden, Terry. Information on Marc MacSharry  Zoom on Marc MacSharry  MacSharry, Marc.
Information on Brian Ó Domhnaill  Zoom on Brian Ó Domhnaill  Ó Domhnaill, Brian. Information on Labhrás Ó Murchú  Zoom on Labhrás Ó Murchú  Ó Murchú, Labhrás.
Information on Francis O'Brien  Zoom on Francis O'Brien  O’Brien, Francis. Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis.
Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona. Information on Ned O'Sullivan  Zoom on Ned O'Sullivan  O’Sullivan, Ned.
Information on Ann Ormonde  Zoom on Ann Ormonde  Ormonde, Ann. Information on Kieran Phelan  Zoom on Kieran Phelan  Phelan, Kieran.
Information on Mary M. White  Zoom on Mary M. White  White, Mary M. Information on Diarmuid Wilson  Zoom on Diarmuid Wilson  Wilson, Diarmuid.



Níl
Information on Paul Bradford  Zoom on Paul Bradford  Bradford, Paul. Information on Paddy Burke  Zoom on Paddy Burke  Burke, Paddy.
Information on Jerry Buttimer  Zoom on Jerry Buttimer  Buttimer, Jerry. Information on Paudie Coffey  Zoom on Paudie Coffey  Coffey, Paudie.
Information on Paul Coghlan  Zoom on Paul Coghlan  Coghlan, Paul. Information on Maurice Cummins  Zoom on Maurice Cummins  Cummins, Maurice.
Information on Frances Fitzgerald  Zoom on Frances Fitzgerald  Fitzgerald, Frances. Information on Fidelma Healy Eames  Zoom on Fidelma Healy Eames  Healy Eames, Fidelma.
Information on Michael McCarthy  Zoom on Michael McCarthy  McCarthy, Michael. Information on Nicky McFadden  Zoom on Nicky McFadden  McFadden, Nicky.
Information on Ronan Mullen  Zoom on Ronan Mullen  Mullen, Rónán. Information on David P.B. Norris  Zoom on David P.B. Norris  Norris, David.
Information on Joe John O'Toole  Zoom on Joe John O'Toole  O’Toole, Joe. Information on Eugene Regan  Zoom on Eugene Regan  Regan, Eugene.
Information on Shane Peter Nathaniel Ross  Zoom on Shane Peter Nathaniel Ross  Ross, Shane. Information on Brendan Ryan  Zoom on Brendan Ryan  Ryan, Brendan.
Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam.  

Tellers: Tá, Senators Camillus Glynn and Diarmuid Wilson; Níl, Senators Maurice Cummins and Liam Twomey.

Amendment declared carried.

Motion, as amended, put and declared carried.

[791]An Cathaoirleach: Information on Pat Moylan  Zoom on Pat Moylan  When is it proposed to sit again?

Senator Donie Cassidy: Information on Donie Cassidy  Zoom on Donie Cassidy  At 10.30 a.m. tomorrow.


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