The HSE has given the Public Accounts Committee (PAC) a 24-page report outlining its response and handling of instances of “savage abuse” involving disabled children and young adults in a foster home.

In those documents to the PAC, the HSE included previously unpublished findings and recommendations contained in the Conal Devine report into the abuse of one victim between 1989 and 2009. The Devine report has been withheld from publication on foot of a request from Gardaí, who are is still investigating many of the allegations concerned.

However, we know now that the HSE has accepted the recommendations of the Conal Devine Report and has admitted failures in care to the victims, who were housed in this foster home in the South-East.

The Irish Examiner today can reveal those recommendations and the HSE’s response to them.

Devine recommendation:

As a matter of urgency, the HSE should finalise and adopt a policy for the protection of vulnerable adults with a disability for uniform application throughout the HSE.

HSE response:

“Following the establishment of the Social Care Division in mid-2013, this project was prioritised and a sub-group of the management team undertook the completion of the project in 2014.”

Devine recommendation:

The HSE should ensure that the policy for the protection of adults with a disability is also adopted by all voluntary bodies and nominated service providers.

HSE response:

“In December 2014, the HSE launched its safeguarding policy: Safeguarding Vulnerable Persons at Risk of Abuse — National Policy and Procedures. This policy applies to HSE and HSE-funded services in social care and ensures a consistent approach across social care to safeguarding concerns. A new service arrangement has been put in place which governs the delivery of service by voluntary sector agencies on behalf of the HSE. The service arrangements include an arrangement to comply with the National Safeguarding Policy.”

Devine recommendation:

The HSE should develop a clear governance structure to be implemented by the HSE and other relevant agencies to support the placement of adults with a disability in family-type settings

HSE response:

“A national working group was established in 2011 and reported in February 2012 with recommendations on the development and implementation for the model for respite/host families in community settings. Host families must also be fully briefed and receive clear instruction on safeguarding, complaints, incident reporting and intimate-care guidelines.”

Devine recommendation:

Consideration should be given to developing a protocol around contact between service users and their families, being mindful of service users’ wishes.

HSE response:

“The current practice is that when a service user requests a visit with their family, the service engages with the family and arranges the visit. In some instances, the service user has no immediate family and arrangements are put in place to have a befriending scheme, where individuals from the community visit people with disabilities. Every effort is made to ensure the service user’s voice is heard and their wish 

Devine recommendation:

Pending the introduction of formal protocols for liaising with An Garda Síochána, the inquiry team would recommend protocols be adopted as an interim measure and that clear protocols are ultimately included in a national protection of vulnerable adults with a disability.

HSE response:

“Since the Devine report, quarterly and half-yearly review meetings were put in place with An Garda Síochána, locally.”

Devine Recommendation:

Social work management should ensure that staff working in this area receives appropriate supervision, direction, and support to ensure that their practice in the protection and support of adults with an intellectual disability is of a high standard.

HSE response:

“It is important to reassure those concerned, and the wider public, that the HSE did not wait for the report’s publication in order to improve the service and management deficiencies identified in the childcare and disability services and to act on the recommendations of the report.”

Devine recommendation:

The inquiry team would strongly recommend that consideration be given by the HSE to the implementation of a formalised performance management/appraisal system.

HSE response:

“Accountability arrangements are such that each staff member and team is clear regarding role, expectation and fit within the organisation in line with the Performance Accountability Framework for the Health Services. These leadership competency frameworks have been developed in the recruitment, development, and retention of staff across clinical, management, and administrative grades.”

Devine Recommendation:

The inquiry team acknowledges that if an adult lacks the capacity to make a decision on healthcare, as a general rule, no other party has the legal right to make a decision on their behalf. The Ward of Court system is cumbersome and outdated. The language and concepts used in the legislation are inappropriate to the current understanding of mental illness, mental impairment and legal capacity.

HSE response:

“The HSE notes the views expressed by the inquiry team. Issues of capacity and decision-making can be extremely complex and there are, invariably, significant problems in seeking legal resolutions in relation to protection of vulnerable adults, who may lack decision-making capacity.

The Conal Devine report addresses in a comprehensive fashion all of these issues and, while it is not possible to publish the report at this time the recommendations reflect the learning which needed to be addressed and the resultant improvements and actions taken are outlined in section two and in the responses to the recommendations.”

Separately, the HSE has insisted a significant range of improvements have been implemented in childcare and disability services to “address the service and management failings” identified in the Conal Devine report.

It says the range of improvements are to ensure that the learning from both the Devine and Resilience Reports are fully implemented.

The HSE says it is committed to:

* A consistent approach to protecting vulnerable people.

* A “no tolerance” approach to any form of abuse and neglect.

* A culture which supports this ethos.

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