The HSE commissioned PA Consulting Group to do a strategic review of the delivery and management of child protection services. Their approach focused on four key headlines:

1. Governance – are there clear lines of responsibility, accountability and authority in delivering children and family services?
2. Strategy and service delivery model – are there clearly articulated goals and service models to deliver positive outcomes for children?
3. Service delivery – how are people delivering services?
4. Performance management – how are people currently assessing performance?

A summary of the findings is presented below.

1. Governance and Management Structure

There are significant variations in the delivery structures across Local Health Offices and roles are often unclear:

• The current management structure can be traced back to the Health Boards. It has not fundamentally changed with the establishment of the HSE.
• The roles of Principal Social Worker and Child Care Manager (CCM) are central to delivering child protection yet they are particularly confusing and unclear.
• The role of General Manager and Local Health Manager… varies between Local Health Offices and it is unclear to what extent both roles are required for effective delivery.
• The Team Leader role is critical in allocating and assessing cases. They have a lot of authority, yet many do not have significant experience particularly in urban areas (see table 46, appendix A).

The structure is complex with unclear responsibility and authority for decisions:

• There is no clear connection between senior management and the front-line.
• Authority for managing financial resources in unclear.
• It was not clear to external agencies or other HSE services who is responsible for child protection.

The management style of service delivery tends to be reactive, crisis driven:

• Collective management structures vary between LHOs and are constrained by the poor quality of information that is used to inform decision-making on the service.

2. Overall Strategy and Service Model

There is confusion on the model for child protection:

• The needs of children are secondary to the needs of the delivery system.
• Child protection is clearly articulated at national level… However, the HSE has struggled to convert this national framework to a sensible model for delivering child protection.
• The HSE has still not agreed how it is going to implement the Agenda for Children’s Services – the national policy framework for children and family services developed by the OMCYA in 2007.

3. Service Delivery

There is unnecessary variation in how child protection services are delivered. In particular there are variations in:

• How cases are allocated and the length of time children can expect to wait.
• How children and their exposure to risk of abuse is assessed.
• Different definitions and ‘threshold’s apply across LHOs. For example a ‘case’ can refer to a family or an individual child. There is particular confusion as to ‘threshold’ levels for protection and welfare.

Children’s needs come second to the demands of the service:

• Children and their families interact with different services and agencies in different ways without the services conferring on what the child needs.
• The quality of care planning is very mixed.
• The effectiveness of case conferences is uneven – key people from across services are not always represented and decisions not followed-through afterwards.
• The HSE has failed some critical groups notably travellers and unaccompanied children.

What the data tells us about service delivery:

• Child protection resources are not allocated according to need in the area.
• Across LHO areas there are variations in staffing levels that are not indicative of need. Child protection workforce is still predicated on legacy staffing levels fro the old health boards, rather than the requirement for resources in each LHO
• Years experience and length of service of staff vary by LHO, ranging from 4 years in some of the busiest Dublin LHOs to 12 years in some rural LHOs with lower referral volumes.
• The LHO approach to case allocation and management is inconsistent. In some LHOs, a high proportion of cases are not allocated to a social worker. Whilst the definition of case allocation varies, the data points to an unnecessary degree of variance in approach and suggests potential risk in unmanaged cases on waiting lists.
• Available outcome information such as the proportion of the child population in care, and the length of stay in care, is highly variable by LHO.

4. Performance Management

• There are significant inadequacies in the HSE infrastructure which make financial reporting on child protection difficult. Financial management information is not sufficient to manage the service as it cannot allocate and prioritise resources. Budgets are unclear, and accountability for spend is disconnected from decision-making regarding the service.
• Data is not collated and interpreted to distil key messages for those managing and delivering the service, such as demand levels, service activity and efficiency, and crucially the outcomes delivered for children.