Most kids in children’s homes left without voice in consultation on services

The Health Information and Quality Authority is launching a consultation process to get children in state care more involved in guiding inspections and monitoring of those services.

“Our goal is to help services improve so that every child who needs support receives it in a way that meets their needs,” said HIQA’s Head of Children’s Services, Eva Boyle, according to a press release.

“The feedback we receive from children and young people will guide how we engage with young people in the future and help create an open, supportive environment where they can build positive futures, they are confident in,” she said.

But around 500 children in the care of the state, who live in children’s homes run by private companies and charities, won’t be consulted.

That’s because HIQA doesn’t monitor those homes and it’s only going to consult with children in care settings it oversees – children in foster care, and in Tusla-run children’s homes. 

“We can only engage with individuals living in services under our remit,” a HIQA spokesperson said.

That means only about 14 percent of kids living in children’s homes in the country will get to participate, said Terry Dignan, chair of the Children’s Residential and Aftercare Voluntary Association, an umbrella body for charities that run children’s homes. 

“We would therefore welcome a similar study that would include the 86 percent of children in residential care who are living in private and voluntary residential care,” Dignan said. 

“With a particular focus on children in unregulated care settings, whose needs and experiences, we believe, may be different to those in statutory care settings,” he said. 

Children’s homes run by charities and private companies are monitored and inspected by Tusla. Tusla hasn’t yet responded to a query sent Tuesday as to whether it will run a similar consultation process for the services that are not inspected by HIQA.

Asked whether anyone would be consulting with the kids living in care homes not monitored by HIQA, a spokesperson for the Department of Children said it’s committed to realising the rights of children and young people to be heard, under the UN Convention on the Rights of the Child.

It’s consulting with them regarding its new national policy framework on alternative care, which it intends will articulate a long-term vision for the care service. 

“The voices and views of children will be central to the National Policy Framework, from its development to delivery,” the spokesperson said. 

The scope of the research

It might not be immediately obvious to everyone reading the HIQA press release that some of the children in state care are not included in the consultation process. 

It says that HIQA inspects statutory children’s homes. But those are a small minority of the children’s homes in Ireland.

Most children in residential care live in homes run by private providers. 

Inside the scoping review, linked in the release, it says that there are 5,823 children in the care of the state – but it doesn’t say how many of those come under HIQA’s remit and therefore the scope of this consultation. 

The report says HIQA inspects statutory and non-statutory foster care services, statutory children’s residential centres, Oberstown Detention Campus and special care units – which are secure facilities for children in care.

The HIQA spokesperson said that the purpose of the consultation process is to improve its own inspections. “The aim of this project is to increase the participation of children and young people in HIQA’s inspections of social services under its remit.”

Other children living in children’s homes not inspected by HIQA could not be included, she said. “HIQA cannot engage with children in services outside its remit.”

The spokesperson for the Department of Children said that, “The HIQA National Standards for Children's Residential Centres 2018 require that children in residential care services should be provided with access to accessible information, are listened to, and are enabled to participate in making informed decisions about their care.”

But that is not the same as being consulted in order to influence the procedures used in the inspections and monitoring of care services. 

The HIQA scoping review notes: “A key challenge when implementing a child’s right to be heard is ensuring that due weight is given to their views. Simply listening is not sufficient, and adults need to be open to being influenced by those views.”

Why isn’t HIQA the regulator?

At the core of the problem is the fact that HIQA, established as the health and social care inspectorate, doesn’t inspect most children’s homes. 

It also doesn’t have full regulatory powers over most Tusla-run children’s homes, even though it does inspect them. 

Why is responsibility for regulating children’s homes split between HIQA and Tusla? Why is Tusla responsible for inspecting and enforcing standards in the children’s homes it funds private companies to operate – why not HIQA?  

A spokesperson for the Department of Children did not answer directly. 

“A robust regulatory framework exists for residential care services for children,” the spokesperson said. “This is to ensure that the vulnerable children placed in these settings receive safe and high-quality care that meets their needs.”

The Health Act 2007 established HIQA as the inspectorate for health and social care, including children’s homes, as defined in the Child Care Act, 1991.

The act “allows for HIQA to register designated centres – which can incorporate all children's residential centres – run by Tusla, the voluntary sector and private companies,” the Minister said later, in response to a parliamentary question. 

Indeed, news reports from around the time HIQA was established say that there was a plan, at that stage, to transfer responsibility for the inspection of all children’s homes to HIQA. 

In 2009, there were around 350 children living in 160 children’s homes in Ireland, according to the Irish Examiner. Around 80 of those were run by the Health Service Executive (HSE) and were inspected by HIQA. The other 80 were run by non-state entities and those were inspected by the HSE. 

“HIQA will take over inspection of all of these centres once the relevant legislation is commenced,” says the article. 

In 2010, the then Minister for Children, Fianna Fáil TD Barry Andrews, said that he intended to task HIQA with inspecting facilities for children in care living in children’s homes run by private operators, according to the Irish Examiner. 

But it didn’t happen. The HSE continued to inspect the homes run by private companies and charities.

In 2013, the Ombudsman for Children, Niall Muldoon, started an investigation into the HSE inspections of children’s homes. 

That investigation found weaknesses in the HSE inspections process, including a shortage of inspectors, few announced inspections, and no standardised processes and procedures across the country. 

The Ombudsman called on the government to transfer inspection of these centres to HIQA without delay. 

“The process of inspecting, registering and monitoring these residential centres is an important safeguard for children who are living there,” Muldoon said. 

“By seeking to have HIQA take over this process, I am looking to create confidence in the independence and consistency of the process for overseeing the homes of some of our most vulnerable children,” he said.

Around this time, Tusla was created, and the HSE transferred to it the responsibility for children and family services.

In 2018, it was still the plan for HIQA to take over inspecting all children’s homes, according to a response from then Minister Katherine Zappone, to a parliamentary question. Regulations were on the way to make it happen, she said.

“What this will mean is that all new and existing children's residential centres will need to meet national standards and regulations in order to be registered to operate by HIQA,” she said.

But that still hasn’t happened.