HSE culture found wanting once again

IT is disappointing that the Ombudsman for Children Niall Muldoon has reported that the Health Service Executive failed to ensure that children in some residential care centres were not exposed to unnecessary risk.

It is all but incomprehensible that in a society so very recently shaken to its core by historical revelations of child abuse, this kind of regulatory neglect is even possible.

It is more than disappointing that the Ombudsman reported that the HSE imagined that monitoring the facilities between scheduled inspections — usually every three years — was an option rather than an obligation.

How could anyone with the vocational empathy or instincts needed to do this job effectively, to protect children as they must be protected, imagine that an announced inspection once every three years represented the kind of oversight needed to ensure the highest standards were in place and that the children dependent on these facilities were not needlessly exposed to risk?

The health authority may point to staff shortages, though that defence hardly seems entirely credible, but it is hard not to think that it is an institutional cultural and management issue, one sustained by the fact that there never seem to be any persuasive sanctions imposed on HSE managers, no matter what scandal is uncovered.

Just like bankers too powerful to bear the consequences of poor investment or lending decisions, our health service managers seem an untouchable cabal despite a litany of scandals that would, or at least should, make any person with a modicum of professional pride or self-respect blush.

Dr Muldoon’s report was prompted by governments’ failures to implement the Ryan Commission’s recommendation that all residential centres for children be inspected effectively and independently. While this failure is not at all surprising, it stands in stark contrast to the resounding assurances given when the Ryan report was published, that our child protection services would be overhauled and match best standards.

State-run children’s units have been overseen by the Health Information and Quality Authority for some years and 127 facilities run by private for-profit and voluntary concerns are inspected by the Child and Family Services, an agency recently renamed Tusla. Dr Muldoon warned that some of the almost 350 vulnerable children using those facilities because fostering was not an option for them have received inadequate services because the HSE allowed their centres to stay open when it should have known they were in breach of statutory regulations.

The HSE’s shortcomings across a range of issues may be as a result of inadequate funding, but nevertheless it is hard not to imagine that better outcomes might be possible, even with the resources available. It is hard not to think too that these shortcomings, despite the commitment and energy of the majority of health service employees, will continue to undermine our health services until political intervention insists on real change and effective sanctions.