Health Boards under fire for lack of accountability

BY ROISIN DE ROSA

This week saw the opening of a High Court inquiry into into the East Coast Health Board's running of Newtown House, a place of ``secure accommodation'' for disturbed young people who needed special care. The inquiry was ordered by Judge Peter Kelly in November last following the death from a drugs overdose in Dublin of 15-year-old Kim O'Donovan, who had absconded from Newtown.

The inquiry is unprecedented in the balance of power and functions of executive, judiciary and legislature. It comes amidst reports of results of an independent investigation into Newtown. This has revealed that disturbed children were locked for days in rooms on punishment, children had limbs broken during the use of ``restraints'', that care staff were often untrained and less than equal to the very difficult work they had to do, and that the needs of the children for counselling were rarely met.

Over at least five years, Judge Kelly found himself continuously obliged to violate the rights of children by sending them to prisons or mental hospitals. This was because the Health Boards, despite his court injunctions, and even a threat to imprison the government ministers responsible, had continuously failed to provide suitable accommodation with adequate care.

A heartrending plea from Kim O'Donovan, in a letter to Judge Kelly, was read to the court on Tuesday. ``I am asking you, as a human being, to send me somewhere else which might be more suitable to my needs.'' Sheelagh Murtagh, manager of Newtown House, told the court on Tuesday that she had not sent this letter because ``Judge Peter Kelly was not on the list of people with whom Kim O'Donovan could correspond''.

Behind these revelations lies the Health Board, which, in the absence of political accountability, has been obliged, by Judge Kelly, to make itself accountable in a court of law. The Health Board is a somewhat reluctant participant. It initially questioned Judge Kelly's power to order such an inquiry but it has subsequently acceded to his demand.

Judge Kelly's inquiry is a case of a court of law having to substitute itself for a political process that is ineffective in delivering transparency or accountability. Councillors, who make up around a half of the membership of health boards, have largely acted as a rubber stamp for repetitive governments' failure to deliver adequate health and care services.

The shortage of properly qualified and adequately paid care workers and counsellors lies at the heart of the problems in Newtown House, and the failure of the health boards to provide sufficient places to accommodate these children. This is only the tip of an iceberg that runs throughout the health system. There is a dire shortage of social workers.

Bernard Harbour of IMPACT points out that a recent study of the National Social Work Qualification Board estimated there were at least 660 additional posts required to meet service requirements. In consequence, social workers are run off their feet, working under appalling stress, dealing only with emergency abuse cases, rather than having sufficient resources to enable them to provide a preventative care system.

Many of the children who fall into this category of disturbed kids needing secure accommodation would never have reached this stage had social worker care workers been available to families in the first place. Because the workload carried by social workers is excessive, working conditions become intolerable, and social workers then tend to seek employment elsewhere.

The position is exactly comparable to nurses, where inadequate numbers mean that hospital wards close and beds lie idle, which makes conditions for nurses increasingly intolerable, with the consequence that they leave to work elsewhere. Meanwhile, waiting lists for hospital treatment get longer for those who do not have the money to pay.

In the case of social workers, there are only two universities, Cork and Trinity, which run the four-year degree course in social work. There is a built-in shortage of social workers, which itself ensures that social workers will seek work anywhere rather than in the health boards' care areas.

At the end of the day, the fault lies with the health boards, which act as a convenient shelter for government in its unwillingness to fund adequate health and social care. Judge Kelly has broken new ground in requiring that one health board answers in a court of law.

Revelations which came to light two weeks ago, that health boards had deliberately illegally charged dependents for the step down care facilities for elderly relatives, show the extent of abuse which goes on under the cloak of the health boards.

Maternity units to close after all

The relationship between government and health boards was revealed this week in Louth and Monaghan, where, despite the thousands of people in Dundalk and Monaghan who called for the maternity units in their towns to be kept open, the units, it seems, will close at the end of this month.

Sinn Féin's Caoimhghín Ó Caoláin and Arthur Morgan brought the matter to their local councils, and obliged their council representatives to support the maintenance of the units on the North Eastern Health Boards. The North Eastern Health Board changed its position and voted in support of appointing the necessary consultants to maintain the two units.

However, the management of the Health Board has not made these appointments, and consequently the units will close, flouting the decisions made by the board members.

The Health Boards and their management must be made transparent and accountable to the people. It is a matter of restraining the abuse of power by the bureaucracies of the quangos.

Kim O'Donovan's suffering and death may, with the help of Judge Kelly, have opened up the question of responsibility of power. But councillors, as democratically elected representatives, have the duty to find the answers.

Shortage of social workers

Ena Johnston and her husband are waiting to adopt her nephew, baby Paul, who is now 14 months old and currently living in England. Baby Paul's father died quite suddenly, and his mother wants Ena to look after him in Ireland.

Procedures require that social workers confirm that the placement is suitable. But there weren't any social workers in Tallaght available to do this work. Social workers came over from England, checked out the family, reported entirely favourably that Ena Johnston's family would be an excellent placement for baby Paul. But there has been no social worker available since last August to carry out the same procedures here. Repeated letters and phone calls to the head social worker in Care Area 4 have simply gone unanswered.

Last Friday evening, Ena Johnston and Sinn Féin councillor Seán Crowe were desperately contacting social workers and the Minister for Children, Mary Hannafin, to get a document that would allow Ena to bring baby Paul back with her when she goes this week to England to sign legal documents. But Baby Paul, who has had five different foster parents already, has to go to yet another new foster home, just because social workers in Tallaght lack the staff to go out to do the inspection that the law obliges them to do, before Baby Paul can come back to Ireland.

Sean Crowe has worked relentlessly to get the social workers to do their job. ``This is not the fault of social workers, but of the Health Board which has allowed this Care Area to be so short of staff that it cannot meet the work load,'' he says.