We need to change system to protect our vulnerable children

CAN systems change?

When you read the report written by Geoffrey Shannon and Norah Gibbons about the deaths of children entrusted to the care of the State, you have to hope they can.

Children died because a system existed that simply had no room for their individual needs. They died because agencies and organisations within the system — and people — weren’t able or willing to work with each other. They died because the system and its people had different views about what constituted good practice, or even basic practice. They died because the system, and its leaders, were simply not accountable.

The system wasn’t just the HSE. For children, especially vulnerable children, to be safe, a few dots had to be joined up. Gardaí, teachers, public health nurses, psychologists, people who worked in voluntary agencies, even managers — they all had a role to play as well as social workers. So, in a great many cases, did people like local curates, family doctors, and of course parents and other family members.

But if one link in that chain snapped, the entire chain broke. And all too often, the HSE was the weak link.

The HSE was set up to fail. From the moment it was established, it has been beset by crisis. The single greatest skill that senior people in the HSE have learned (some of them anyway) is crisis management. Perhaps it couldn’t be any other way. A single institution was established to run around 55 hospitals, to employ 130,000 people or so, to provide an enormous range of personal, social and community services, and somewhere along the line to keep vulnerable children safe.

From the very beginning there were crises in hospitals, crises in accident and emergency wards, crises involving MRSA and other previously unheard-of viruses, crises in cancer diagnosis and misdiagnosis. And a host of other crises — not to mention the fact that after several years of piling in more money than they knew what to do with, there was suddenly no money left for the basics.

And from the very beginning no one really knew what the HSE was. Did it implement policy, or actually create policy? What role had successive ministers for health? Who was in charge of deciding, for example, where a national children’s hospital should go? Why was there such apparent conflict, for instance, about the co-location policy pursued for several years. Did the HSE want, or not want, a two-tier approach to health? In the middle of all this mess, is it any wonder that the HSE failed in its statutory responsibility for children? Not only should it not have had that responsibility, but there were members of the board of the HSE, throughout all its formative years, who didn’t even know they had it.

Not once in its first five years was the subject of vulnerable children even discussed at board level. Not until there was a crisis — because that was the way the HSE did things. The system only responded when it failed.

So now there is a valiant attempt going on to change the system. Responsibility is being taken away entirely from the HSE and being entrusted to a new agency. That new agency will get the budget (it hopes) the HSE used to spend. It will have new leadership, new legislation, new direction, new practice and standards, new accountability, a new vision and focus. In other words, it will have a strategy.

But will there be change? The American business writer Peter Drucker once famously said that “culture eats strategy for breakfast”. In other words, if you change everything but don’t succeed in changing the culture, the failures of the past are bound to be repeated again.

And there is of course every risk of that. That’s why, among other reasons, the proposed referendum on the rights of children is so important. It can be the catalyst for a change in culture.

The referendum is vital in its own right, of course. It has been said again and again over the last few days that one of the things all the children and young people in the Gibbons/Shannon report had in common was that no one listened to them. And that’s true too of the tens of thousands of children whose tragic and brutal histories were told in the Ryan Report. There is a real opportunity now to give every child in Ireland a constitutional right to be heard, and what a profound impact that would have on the culture over time.

And not just that. As I understand, the wording under consideration now would also give children a right to be protected, and a right to have their welfare regarded as paramount. Correctly worded, changes like these would also move us all a million miles away from a culture where children don’t matter enough.

But the other major impact will come from the debate. We have debated crucial issues in the past, even to the point of being bitterly divided among ourselves about them. We’ve never taken a cavalier attitude to changing our constitution — it has to be important, and it has to reflect a deep interest for all of society.

So when we have changed the constitution, especially on some of the more intimate, personal and family issues, we have sent a strong signal to the political and legal systems that we are changing direction as a society. And the system has always adapted to that signal.

The debate we’re going to have about the rights of children, just as much as the decision we make in the end, will be part of the signal we want to send. I meet parents everywhere who want only the best for their children. I have campaigned alongside parents who want nothing more than to vindicate the rights of their children. I believe in my heart that we, all of us, want to send a signal that the things that have happened to children in the past must never be allowed to happen again.

The debate is under way already, and to judge from some of the commentary sides are being taken — even before any wording is published. If some have their way, the debate will be couched in terms designed to make us even more afraid of an uncaring and/or incompetent State.

But that’s not what this issue is about. It’s about what happens when children have no rights of their own. It’s about what happens when children have no voice.

None of us want to change the Constitution in order to allow things to go on as they did in the past. This is our chance to tell the State what we want for our children, how we want them to be respected. In having this debate we have a chance to put down a marker about the kind of public policy choices we want to see for the future. In making this decision we have a real and lasting chance to define a better future for every future generation of children.

We can change the system, because we can demand a fundamental and permanent change in the culture. It can’t happen quickly enough.