Daming report on 'chronic shortfall' in Laois and Midlands Tusla resources for children at risk

A daming report on child protection services in Laois and the Midlands has found that chronic resource shortages mean that children and families do not receive the Tusla service they when required.

The Health Information and Quality Authority (HIQA) has just published an inspection report on the child protection and welfare service operated by the Child and Family Agency (Tusla) in the Midlands service area.

It found the shortcomings are resulting in high priority neglected children waiting up six months to see a social woker. When families are waiting for help they also get little or no communication from Tusla about what help they will get or when.

In a statment to the Leinster Express / Laois Live HIQA said it conducted a focused inspection of this child protection and welfare service between 25 and 27 November 2024 to validate "assurances" received from the child protection agency Tusla about the "integrity" of its data on unallocated cases. The inspection was also carried out to assess the management of cases from referral to the allocation to a social worker and until a preliminary enquiry or initial assessment was completed.

The November inspection assessed the level of compliance with six of the National Standards for the Protection and Welfare of Children, and found the service was substantially compliant with two standards and not compliant with four standards.

HIQA says it found that while there were structured management systems in place for the governance and oversight of unallocated cases, the volume of referrals to the service, the number of unallocated cases and the workload of staff meant that these systems were "not effective".

"This meant that it was not possible to ensure that all children and families in need of a service received it within a reasonable time frame," said a statement.

It added: "While the service was fully staffed to its approved whole-time equivalent staffing levels at the time of the inspection, there was a chronic shortfall in resources to meet the demands of the service. Many children and families were waiting prolonged periods for the completion of preliminary enquiries and initial assessments. This meant that the level of risk to these children was not assessed in a timely manner and children and families did not receive the service they needed within a reasonable time frame".

For example, HIQA inspectors reviewed a case relating to siblings who were allegedly neglected. The inspection report said the case was referred in March 2024 and screened within 24 hours.  However, the preliminary enquiry did not start until 10 weeks later, and took four weeks to complete.

The report said a decision was made to proceed with an initial assessment and the case was identified as a high priority case. As this was deemed a high priority case, the case was reviewed twice by team leaders, in April and again in August, with high priority status remaining.

"Despite this, the case was not allocated until October 2024, 15 weeks after the preliminary enquiry was completed and 27 weeks after the initial referral. Inspectors found several cases where these reviews were completed, including consideration of priority level, but this did not impact the timeline for allocation," said the report.

The inspection also found that there had been a systems breakdown in validating and communicating data to management at a regional and national level from October 2023 to May 2024. As a result, inaccurate data about unallocated cases was provided to HIQA. While this system of validation was rectified in June 2024, at the time of the inspection, inaccurate data continued to be published on the Tusla website.

HIQA says a paper-based system is used in the Midlands to screen new referrals, which was later uploaded to the Tusla Case Management system (TCM). This resulted in some cases having inaccurate dates recorded on TCM for when the referral was screened. This meant oversight at regional and national management levels were impacted.

The health service watchdog found that a lot of improvement is needed to help children. MORE BELOW PICTURE.

"While there was clear evidence that experienced, skilled social workers and social care leaders were carrying out challenging work, the level of referrals to the Midlands service area and the high number of unallocated cases, meant there were delays at both preliminary enquiry and initial assessment stages of the assessment process. This meant the quality and safety of the child protection and welfare service, from referral through to the initial assessment stage, required significant improvement to ensure it met the needs of all the children and their families who required the service.

"Where cases were allocated, there was clear and effective communication with children and their families. However, where children and families were on waiting lists, there was either no communication or communication was poor. This meant that in many cases children and families were not informed about how long they would be waiting for a service from Tusla," it said.

A  Tusla statement said it received over 9,500 child protection and welfare referrals in the 12 months prior to the inspection in  Laois, Longford, Offaly and Westmeath.

It noted that "importantly", all new referrals to the service were found to be screened within 24 hours, and immediate action is taken in all cases where children were at immediate risk of significant harm.

It admited that despite the efforts of staff and management systems were "challenged" to address the risks associated with the capacity of the area to safely manage the volume of referrals, the growing complexity of referrals, and the high number of unallocated cases.

Tusla said it has an action plan to bring it into compliance, which has been accepted by HIQA. Among the steps to be taken include actions to address capacity issues in the service, and improvements have already been implemented to ensure that information governance and reporting is accurate.

Gerry Hone is the Tusla Interim Director of Services and Integration.

“Oversight by HIQA assists us in striving for the best possible standards. However, on this occasion, due to challenges related to the increasing volume of referrals and the capacity of the service to deal with this increase in demand, we have not reached the standards expected.

“All unallocated cases are subject to oversight. Tusla continues to be proactive in its efforts to address challenges in capacity, and as part of this the Agency has moved to a more multi-disciplinary way of working. As such, Children and young people may be allocated social workers and other professional roles, such as social care leaders, under the supervision of social workers, as needed.

“Locally, we have taken a number of steps to address the issues identified, and significant efforts are underway in the area to increase capacity and efficiencies,” he said.

The statment added that Tusla has embarked on an integrated reform programme which aims to ensure timely, equitable, integrated and consistent practice across the service areas. A key pillar of the reform programme was the design and implementation of the Local Integrated Service Delivery Model.

Tusla said it receives consistent and robust regulation and oversight by various external bodies, including HIQA. This oversight assists us in ensuring that our practices deliver good quality and appropriate services for children and families.

The inspection report and compliance plan can be found here www.hiqa.ie

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HIQA is authorised by the Minister for Children, Disability and Equality under Section 8(1)(c) of the Health Act 2007 to monitor the quality of services provided by the Child and Family Agency (Tusla) to protect children and promote their welfare. HIQA monitors Tusla’s performance against National Standards for the Protection and Welfare of Children and advises the Minister and Tusla.

In 2023, HIQA commenced a risk-based monitoring programme to monitor service areas where over 25% of children were unallocated a social worker.

In July 2024, HIQA received information from the Regional Chief Officer that principal social workers and team leaders in the Midlands service area were allocated significantly high numbers of cases. HIQA  says it wrote to the Regional Chief Officer who responded with additional information which highlighted the disparity between the published number of unallocated cases and the actual number in the area. It also highlighted significant delays for some children referred to the service in having assessments completed or a service being provided to them and their families.

Data provided by Tusla from October 2023 to July 2024 indicated that the unallocated cases in the Midlands child protection and welfare service did not rise above 16%. As a result, the Midlands service area was not included in HIQA’s 2024 provider programme which inspected service areas where at least 25% of children had not been allocated a social worker in child protection and welfare or foster care services. However, HIQA says Midlands service area data was found to be "inaccurate".