AS I SEE IT
BY MARIANNE HERON
Some things simply don’t change do they? It’s two millennia since Roman satirist Decimus Juvenal penned his books of verse but some of his observations are every bit as applicable today. Take one of his memorable quips, ‘Quis custodiet ipsos custodes’ (who guards the guardians?), from a satire on the problem of enforcing accountability on those who are meant to be responsible.
In the last months there has been a litany of failures by bodies charged with the governance of standards for care of the most vulnerable: children and the elderly. We thought that things were safe when the unacceptable was happening. If the watch dogs were aware they remained mute and did not act.
The watch of Children’s Health Ireland (CHI) has seen a series of shocking revelations, including unnecessary hip operations for children, the use of unauthorised springs to treat scoliosis sufferers and unacceptable practices around waiting lists and allegations of toxic behaviour. It has left the future of the body charged with overseeing the enormous transformational move from the three children’s hospitals – Tallaght, Crumlin and Temple Street – to the endlessly delayed, new children’s hospital- in-doubt, while its chair and four members of the body have resigned.
Given the gargantuan nature of the task, the structure of the CHI, set up in 2018 by the Minister for Health, is unusual. The 12-member board who report to the CEO of CHI are all voluntary; eight members are appointed by the board itself and four by the minister. They can meet up to 25 times a year – in 2023 they met just six times. After the CHI were grilled by the Oireachtas Health Committee TDs expressed zero confidence in the body. Why not suitably qualified and appointed board members, to avoid the charge that insider interests may be unhealthy? Why not leave responsibility standards at the existing children’s hospitals with the HSE and the Health and Information Quality Authority (HIQA)?
Watchdogs need to have teeth, or at least access to remedies when standards fail. The nursing homes scandal put the structure of HIQA under the microscope. The numerous complaints about the two Emeis nursing homes where abuse to and neglect of elders were exposed in the RTE Investigates programme should have been enough to threaten the homes involved with closure.
HIQA’s remit for ‘safer better care’ doesn’t allow this, nor does it investigate individual complaints but is supposed to oversee standards and carry out inspections. A report on the risks to quality of care due to the privatisation of the nursing home sector (75% are now privately owned) which has been commissioned is a bit like closing the door after an unattended horse has bolted.
In the health sector previous problems threaten to erupt again. The 2018 cervical smear check scandal which caused tragedy and death for Vicky Phelan and others prompted a national outcry. Now it has been reported that actions are being taken by a number of women who have developed cancer following false negative results.
In areas relating to children’s health and safety there are long standing issues that remain unresolved. The Child and Adolescent Metal Health (CAMHs) body continues to be under-funded and under-resourced, with 900 young people on the waiting list in Cork and 1,400 in Wexford and Waterford alone.
Children continue to go missing or to be at risk of exploitation under the watch of Tusla/ the Child and Family Agency, the very organisation set up in 2014 to protect children. The most prominent case was that of six-year-old Kyran Durdin from Drogheda who was on Tusla’s radar but whose disappearance was not reported for two years. Over a three-year period 53 other children died while UCD’s Sexual Exploitation Research Programme (SERP) found children, mainly girls, were being abused by men while under Tusla’s care.
All of the situations above are the responsibility of the Minister for Health with the exception of Tusla, which is under the Minister for Children, Equality Disability, Integration and Youth.
The disturbing thing about lack of accountability for poor governance is that the effect is far wider than the individual cases involved. The result is that people no longer trust the very institutions that are meant to take care of their families and safeguard the most vulnerable.
