Jun 5, 2010
Child, Young Person? Is standardised service failing Ireland’s youth?
As Fiona has already observed the deaths of children in care raise serious questions regarding the capabilities of the HSE and the adequacy of support services in Ireland. However, as well as highlighting general problems within the Irish care service, the recent admissions by the HSE are indicative of greater issues which have thus far been neglected. Key amongst these is the ability of the HSE to meet the needs of service users effectively and to maintain responsive, appropriate services for the diverse range of needs which it encounters. This problem is becoming increasingly clear, particularly in relation to young people – not children – in state care.
Despite the title of the report regarding their deaths, both Young Person A and Young Person B were not children, they were young adults. As such their needs were very different. At the time of their deaths, both were moving out of the care system into aftercare projects. Their support needs related to independent living and post-secondary education pathways. They were not entirely dependent on adults, they were moving to independence. This does not mean that intensive support was no longer necessary, it means that their support needs altered significantly. Tragically, and most worryingly for the HSE, though their needs changed the services available to meet their needs did not.
Though individual failings exist, it would not be productive to interpret the current crisis in the HSE as a capability failing by individual employees. The attribution of blame to particular factions within the social care system, while attractive, will achieve very little in the long term. Rather, it is vital that this crisis be used to reconsider the purpose and dimensions of the HSE. As the failure of social services to provide appropriate support points to a systemic tension within the HSE it is important that we now question what an appropriate service looks like.
Asking these questions is crucial if we are to respond to the current problems effectively. For example, as Fiona rightly noted, the provision of B & B accommodation to young people moving out of the care system is incredibly problematic. That said, the provision of independent housing is central to support young people move from dependence to independence. Responding to the use of B & Bs by building more care homes or extending the period of foster care to 18 would be equally problematic and prohibitive. Such an approach could serve to deny young people a say in where they live, further augmenting the powerlessness felt by many young people care.
That said, there is another problem which we must consider in light of the current crisis – the remit of the HSE. As it stands, the HSE manages all health and social care services. While theoretically, given the connection between both of these, this seems a logical approach, practically it is almost entirely unworkable. Notwithstanding the overlaps between the work of practitioners in health and social care, there are also distinct differences which need to be recognised. Recognition of these differences is particularly important in light of the limited resources available to the HSE. Put simply, by managing both health and social care, the HSE puts itself in a postition whereby it has to budget the provision of hospital beds against the provision of aftercare programmes. Within this context, the fact the limitations in services available to young people with a range of very complex needs is hardly surprising.
The deaths of young people in care were tragic and inexcusable. But, considering the current structures and systemic approaches in place, and the rigidity of HSE services and inability for social care practitioners to be flexible, they were also partly inevitable. If an appropriate service is flexible and responsive, then the current situation shows that the HSE is far from fit for purpose.
