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Summary Report concerning the Health Service Executive's handling of an application to foster three children
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Summary Report concerning the Health Service Executive's handling of an application to foster three children.
Emily O'Reilly
Ombudsman
April, 2007
Three sibling children had been living in mainstream residential care on a voluntary basis with a Health Board from June 1997. As their mother had died, their father who was unable to look after them, had consented to the children being placed in voluntary residential care. In June 2000, an aunt and uncle of the children offered to foster them and the three children moved from residential care into their home. It was hoped that the placement would work out and that the children would remain with their relatives on a long-term basis. Unfortunately, difficulties developed during the placement and in March 2001 the children's relatives notified the Board that the placement had irretrievably broken down. They indicated that they could no longer continue caring for the children and requested that the Board make alternative arrangements for their care by 1 June 2001, when they planned to go abroad on holiday. Since there were no other family members in a position to care for the children, the Board was under considerable pressure to make arrangements for the children's care.
Ms Lisa Brown (not her real name), the complainant, had been employed in a temporary capacity by the Board as a child care worker in the residential home where the children were originally cared for. She was a key worker with two of the children whom she had come to know very well following their mother's death, and she had always maintained an interest in them. Ms Brown and her partner, Mr Paul Murphy ( not his real name) often took the children on outings and a strong bond had developed between them. The couple put themselves forward as possible foster parents for the children should the placement with their relatives break down.
When the placement with the children's relatives ran into irretrievable difficulties in March 2001, the children's social workers met with Ms Brown and her partner to discuss the possibility of them becoming foster parents to the children. The couple had been renting a one-bedroomed flat so these discussions centred around the provision of accommodation (i.e. adequate housing) for the couple and the three children. The question as to whether Ms Brown would give up her job to look after the children on a long-term basis, and the requirements of the fostering assessment were also discussed.
These discussions resulted in proposals for approval being sent forward by the social workers to the General Manager of the Board (who had administrative responsibility). They provided that, in addition to the normal fostering allowance, a payment of an enhanced allowance of €380 pw would be paid to Ms Brown. This amount was equal to her basic salary, and would allow her to give up her job and foster the children on a full-time, long-term basis with effect from 1 June 2001. The General Manager referred the proposal to the Child Care Manager for advice as to whether this was a viable package. (The Child Care Manager's role was to advise with regard to child care and family services). He considered the plan and (in his capacity as Acting General Manager while the General Manager was on annual leave) obtained the approval of the Assistant Chief Executive to the proposals, because of their financial implications for the Board. The Child Care Manager, however, at his own discretion, confined the approval which he sought to the proposals for the three month period from June to August 2001. He understood that the plan was to place the children temporarily in the care of the couple and, in his view, there was no long-term commitment to the arrangement. He felt that he could not determine whether they would be suitable parents to foster the children on a long-term basis until they attained eighteen years of age.
The complainants claimed that it was their understanding, and also the understanding of the social workers, that the fostering arrangement which they had agreed to enter into, was intended to be long-term in nature. The couple understood that this would involve them looking after the children until they reached eighteen years of age. As mentioned above, sanction to the fostering proposal had only been approved by the Board from June to August 2001. The Child Care Manager claimed to have verbally advised the couple of the position. However, Ms Brown and Mr Murphy claimed that they were never advised by the Board that the arrangement to pay Ms Brown's salary in addition to the fostering allowance, had only been sanctioned for a three month period. Had they been so advised, they never would have proceeded with the arrangement.
On the understanding that the arrangement was intended to be long-term, Ms Brown and Mr Murphy felt under considerable pressure to source accommodation by 1 June 2001. They claimed that they had discussed the issue of accommodation with the social workers, whom they said had advised them against renting, as this could have meant further moves for the children. They further claimed that the social workers had advised them to purchase a property in a location which would be convenient for access visits to the children's father.
This meant that they had to buy a more expensive house, which was closer to an urban area, than they might otherwise have considered. The Board, however, denied these allegations indicating that the provision of suitable accommodation was a matter for the couple in the first instance. Despite their best efforts, the couple encountered a delay in finalising the purchase of a house which would accommodate themselves and the three children. The purchase of their house did not materialise until the following month in July 2001.
In the intervening period, the Child Care Manager had sought a copy of Ms Brown's resignation from her job with effect from 1 June 2001, and Ms Brown tendered her resignation from that date. The children's aunt and uncle had gone abroad on holiday, and so an arrangement was put in place whereby the children were cared for in a shared capacity by the couple, in Ms Brown's parent's house, for the first two weeks, and by their relatives on their return from holiday, until the couple's new house was ready. However, following Ms Brown's resignation on 1 June 2001, the Board declined to pay her the amount previously agreed by way of salary replacement, as the children were not full-time in her care. Instead, the Board implemented a revised financial arrangement whereby a pro-rata payment was made for each day she cared for the children. The children's aunt and uncle also received a pro-rata payment during this period. However, Ms Brown was not advised when she tendered her resignation that the Board would only pay her a pro-rata daily amount in respect of each day she had the children in her care. The Board indicated that this financial arrangement was to continue until the children moved into the full-time care of the couple which was then re-scheduled for 13 August 2001.
Individuals who put themselves forward as foster parents must undergo a formal assessment by a social worker and obtain approval from a Placement Committee before they can be accepted and approved. This process takes a minimum of six months to complete and is usually carried out before children are placed with prospective foster parents. Ms Brown and her partner were concerned that they might not pass the fostering assessment and claimed that they had been reassured repeatedly by the children's social worker (but not by the social worker who undertook their assessment) that they would not fail their assessment. Due to a shortage of social work staff the couple did not begin their fostering assessment until July 2001, and the children's toys and clothes were moved into their new house.
The couple arranged to have the bedrooms decorated for the children and enrolled them in the local schools. On 9 August 2001, four days before the children were due to move in with the couple on a full-time basis, the couple were contacted by the children's social worker and advised that the children's aunt and uncle had changed their minds and wished to continue caring for the children. Their natural father also wanted them to remain with their relatives. The couple were advised that the Board was considering the situation and would contact them when a decision had been made. The couple were very upset because they said that they had received repeated assurances from the children's social worker that, should the relatives change their minds and seek to continue to foster them, the Board would not allow it. The Board had indicated to the couple that the decision had been taken out of the relatives’ hands due to the placement continuously being in a state of crisis. However, due regard had not been given to this scenario by the Board. As indicated previously, these children were in the voluntary care of the Board, and it would have been extremely unlikely that a care order would have been granted by a Court under the circumstances, particularly when there were no health or safety concerns regarding the children's care with their relatives.
The Board determined that it had no choice but to leave the children in the care of their relatives. Ms Brown and her partner claimed that the collapse of the fostering process had left them in straitened financial circumstances as a result of following the Board's advice. They had purchased a four bed-roomed house and Ms Brown had resigned from her job to care for the children. In addition, Ms Brown had lost an opportunity to apply for a competition for a confined permanent health board post which was held in June 2001, because part of the fostering arrangement was that she would resign from her job to look after the children full-time. When Ms Brown went to compete at a later stage for permanency, following the collapse of the fostering process, she found that she was disqualified since the educational requirements had changed in the intervening period.
Following the sudden and unforeseen breakdown of the planned fostering arrangement in August 2001, the couple asserted that there was no information forthcoming from the Board for a period of two weeks. They stated that despite many calls to the Board to enquire about the children's future, no decision regarding the placement was forthcoming.
Eventually, a social worker called out to their home and advised them that the Board had no option but to let the children remain with their relatives, and they asserted that this lack of communication heightened their upset. The couple said that the children's clothes and toys were left in their house for one month afterwards, which was insensitive and added to their upset. The Board accepted that while it was left in a difficult position, it should have accorded greater priority to communicating with the couple in relation to the change in circumstances.
The three children remained in their aunt and uncle's care, and Ms Brown applied for, and was successful in regaining, temporary employment in her former post. However, by October 2002 the placement with the children's relatives was in a state of crisis once again. The Board approached Ms Brown and her partner a second time with a view to them fostering the three children. The couple agreed to enter into the process again, provided the Board agreed in writing to replace Ms Brown's salary, which at that stage had increased to €700 pw, in addition to paying the fostering allowance. The Board agreed to consider their request and to advise them of their decision within six weeks.
However, it was not until September 2003, some eleven months later, that the Board responded negatively to the couple indicating that it no longer had authority to make discretionary payments.
The Department of Health and Children had issued a Circular in July 2001 which discontinued discretionary foster payments from 1 August 2001, including enhanced payments, and a revised increased rate of payment came into effect for all foster parents, excluding medical and educational expenses. The Board indicated that the Department of Health and Children had issued no direction in relation to special foster care situations, and as such, all decisions must be made within the parameters of the existing policy or guidance. The Assistant Chief Executive of the Board advised that there was no scope to make payments over and above the prescribed rates, and that he did not know why this had not been communicated to the couple in October 2002.
Ms Brown and her partner, Mr Murphy felt that they and the children had been unfairly treated by the Board both in August 2001 and again in 2002/2003. They complained in writing through the Board's complaints process in the matter. As they were not happy with the extent and outcome of the Board's examination of their complaint, the couple contacted my Office towards the end of 2003.
Following the establishment of the Office of the Ombudsman for Children in April 2004, all new complaints relating to the welfare of children made after that date are proper to that Office. Complaints made prior to that date fell to be investigated by my Office. My Office's approach to the complaint focused primarily on the actions of the Board and how these had affected the couple.
Following a preliminary examination of the issues, which included in-depth discussion with the couple and the submission to me of a detailed report by the Chief Executive Officer of the Board, I decided to initiate a formal investigation of the complaint, as I considered that there was prima facie evidence of maladministration in the Board's handling of the issues.
The first step entailed the forwarding by my Office of a Statement of Complaint to the Health Board. During the course of the investigation, members of my staff interviewed a range of health board personnel who had been involved in the case. These included:-
The evidence which was obtained during the course of these interviews was analysed by my staff, in conjunction with the Statement of Complaint, under the various headings included in that Statement. These included:-
Drafts of the information or evidence obtained during the course of the interviews were forwarded to all interviewees in the Health Board, and their comments were included, where appropriate, in the draft Report.
This draft Report, which included a list of my findings, was sent to the Health Service Executive (HSE) corporate (which replaced the health board system in January 2005) for further observations and acceptance. My final Report, which I presented in July 2005 to the Health Service Executive contained the following findings:
1. Ms Brown and Mr Murphy had a very strong basis on which to consider that the placement of the three children would be long-term in nature, subject to the approval of the Placement Committee. This understanding was supported to a considerable extent by the social workers involved with the case.
2. The Board gave insufficient consideration in 2001 as to what the position might be if the children's aunt and uncle changed their minds again and opted to continue providing care for them, and failed to alert the couple as to the possible consequences should this happen.
3. The Board failed to give the couple written notification of the original financial terms approved in May 2001 to allow the couple to foster the children with effect from 1 June 2001. In addition, Ms Brown was asked to produce a copy of her resignation from her job without any such notification being furnished to her. The absence of any direct written notification to the couple at that time constituted unsound administrative practice.
4. Ms Brown was asked for a copy of her letter of resignation and she felt under considerable pressure to resign from her job by 1 June 2001, despite the fact that the Board was aware of the delay in relation to the purchase of the house.
5. The Board failed to advise Ms Brown before she resigned from her job that, instead of fully replacing her salary, it would make only a pro-rata payment to her for each day she cared for the children.
6. When a letter confirming the terms of the arrangement eventually issued from the Team Leader on 18 June 2001, it made no reference to the revised pro-rata arrangement which had been decided by the Child Care Manager earlier that month. This letter gave a commitment to the couple that an enhanced allowance would be paid to them for the duration of the time that the children would be in health board care. This, in effect, provided the couple with incomplete and erroneous information.
7. Whilst it is clear that Board sanctioned the payment of an enhanced allowance to the couple for a three month period only, the finding outlined in the preceding paragraph is indicative of a subsequent serious failure in communication which led to confusion as to whether the payment of an enhanced allowance was or was not time specific (i.e. for a three month period only).
8. While the couple may have received encouragement to purchase a house, which may, in turn, have led to misunderstandings, I found no evidence that the fostering arrangements were made conditional on house purchase.
9. While the couple did receive reassurances from the children's social worker in relation to the likely outcome of the fostering process, and while there was a delay, for staff resource reasons in initiating the process, nothing emerged from my investigation which would suggest that the assessment process, to the extent that it had proceeded, was conducted other than in accordance with the relevant regulations.
10. There was a serious failure in communications with the couple immediately following the change in circumstances in August 2001. The Board should have given priority to maintaining telephone contact with the couple in order to keep them informed of developments following the breakdown of the plans.
11. There was a serious breakdown in communications between the professionals involved which resulted in the Fostering Assessment Social Worker for the couple not being informed by her colleagues that the fostering plans had fallen through.
12. The delay of almost one year in advising the couple of the Board's decision not to pay them an enhanced allowance on the second occasion can only be described as completely unsatisfactory, and contrary to fair or sound administration.
13. The decision making process in relation to the second approach lacked coherence, direction, and in its latter stages, focused unduly on an aspect which was not relevant to the particular individual circumstances of the case. (This related to whether or not the needs of the children could be met by special foster care). Overall, the decision making process was not in accordance with good administrative practice.
14. The Foster Care Regulations, 1995, Section 14(2) provide that a "health board may, in addition to the allowance referred to in sub article (1) and subject to any general directions given by the Minister, provide such financial or other assistance as the Board considers necessary to enable foster parents to take care of children placed with them by the Board". Given these provisions and the uncertainty within the Health Board surrounding the payment of an additional allowance in this case, together with the absence of a developed policy and procedure with regard to special foster care from the Department of Health and Children, I consider that it was open to the General Manager, in conjunction with the Assistant Chief Executive, to seek written clarification from the Department of Health and Children regarding the possibility of paying an enhanced allowance to the couple.
15. In the interests of sound administration, the Board's own investigation of the complaint, in principle, should not have been dealt with initially by any individual who already had an involvement in the matter.
16. The couple were adversely affected by the above failures of the Board, and both suffered extreme stress, anxiety and upset as a consequence.
Consequent on my findings, I recommended that the HSE should:-
1. Establish communication again with the couple with a view to initiating a fresh application for assessment as foster parents to the children.
2. In the event that such an application was approved by the Placement Committee, the HSE commit to payment of an enhanced allowance to the couple in addition to the foster care allowance on the basis of the original written agreement to them in June 2001. The enhanced allowance to be paid on the basis that it is compensation for loss of earnings due to the need for one or other of the couple to be available on a full-time basis for the children. The amount should continue to be paid for as long as the children are in the couple's care as foster parents under the regulations.
3. Pay a sum of €5,000 to the couple to cover the adverse effects experienced by Ms Brown and Mr Murphy and to reflect the time and trouble occasioned to them by the actions of the Board outlined in the findings above.
4. In the light of my findings in the report, review communications procedures at social worker level, and between the social worker and administrative grades.
5. In the light of my findings in the report, review record keeping practices at social worker level.
6. In the light of my findings in the report, review its procedures for dealing with complaints in the social work area to ensure compliance with the principles of good complaint handling and with good administrative practice.
All of the foregoing recommendations were accepted by the HSE. At the conclusion of my original report I made the following observations:
"One voice is absent from this composite outline of the report, and that is the voice of the children. As Ombudsman, I deal with the complainants, in this case, the couple wishing to foster the children, and the public body that is the subject of the complaint, in this instance, the Health Service Executive (formerly the Health Board). Nonetheless, I wish to make the following observations.
Three young children are at the heart of this investigation, despite the fact that the complainants and those complained of are adults. It is now eight years since those children were placed in voluntary care following the tragic death of their mother, and the shuttling between relatives, institutional care and the part time and sporadic care of the couple began. Their early childhood is now over, one child has already reached adolescence and the other two are not far behind. My recommendations, which I believe to be fair and balanced, provide a possible opportunity to retrieve the situation before too much more of the siblings’ childhood is gone".
Two further years have elapsed since my original report was presented to the HSE. I have deliberately delayed publishing this summary version to provide all concerned with an opportunity to consider the options available to them. Currently, the children remain in residential care, although Ms Brown and Mr Murphy continue to have regular contact with them. A key factor relating to the children's welfare was to ensure that they were always kept together in whatever caring arrangement was made for them. One of the children was disinclined to leave residential care as she had come to view it as her permanent home. It has not, therefore, been possible for the couple to proceed with the fostering plan as provided for in my recommendations.
In publishing a summary report at this stage, my purpose is to highlight the need for improvement in the lines of communication between the various social workers involved in fostering cases, and the need for greater clarity between the professional and administrative grades as to what is or is not achievable. In this particular case, it was clear to me that the social workers at the coal face were striving to secure permanent foster care arrangements for three children who had challenging needs. They had sought approval to a financial package in May 2001 which would enable the arrangement to work on a long-term basis, subject to the approval of the placement by the Fostering Placement Committee. The Child Care Manager, however, sought to limit financial approval for a three month period only, since in his view, there was no long-term commitment to the arrangement.
The couple were not advised that financial approval to the arrangement had only been given for a three month period, and acted in good faith to secure accommodation for themselves and the children. Ms Brown resigned from her job, as agreed, to care for them following a request at the end of May 2001 from the Child Care Manager to view a copy of her resignation. This request by the Child Care Manager did not appear to be compatible with his assertion that the arrangement was temporary and short-term in nature.
I was concerned that the couple had been given a number of reassurances by the social workers with regard to the arrangements which did not materialise. Reassurances with regard to what might happen if the children's relatives insisted on keeping the children appear to have been given, as were assurances with regard to the fostering assessment which had not been undertaken due to staffing shortages within the Board.
Ideally, the fostering assessment of the couple should have been completed before the children were to be placed with them. In such instances, where the welfare of children is at stake, and a considerable commitment is being made by prospective foster parents, it is incumbent on the HSE to be open and clear in their dealings with their clients. HSE staff at all levels must work closely together and communicate in a proper way with each other, and with their clients, if such arrangements are to be successfully managed.
In the interests of sound administration, important communications to clients should always be made in writing, and in a timely manner, so that clients know exactly where they stand. The complainants did not receive any communication in writing from the Board whatsoever, confirming the proposed arrangement, until their solicitor requested it in June 2001 when the couple were signing for their house. It was inevitable that the confusion evident between the social workers and the administrative staff would impact negatively on the prospective foster parents.
It is my view that while rules and regulations are important in ensuring fairness, they should not be applied so rigidly or inflexibly as to create inequity. Whilst I appreciate that the Circular from the Department of Health and Children discontinued discretionary payments to foster parents in July 2001, no guidance had issued to health boards from that Department with regard to children who had special fostering needs.
These three children did not require special foster care, but they had challenging needs, and it was the professional view of the social workers that their placement with Ms Brown and her partner would be in their best interests and would work well. Indeed, one social worker wrote "that a couple who are willing to look at fostering three siblings with the needs these children have are like gold-dust in my experience". It was generally agreed amongst the social workers that it did not make economic sense to leave the children in residential care and that a home placement was the preferred option for them, if the match was right. The General Manager was concerned, however, about setting a precedent which might have knock on effects for others in foster care. Had an enhanced allowance been made available to the couple following the second approach in October 2002, it could have allowed the couple to proceed with a fostering assessment and these three children might have had an opportunity to live with them as a family unit, before they came to view residential care as being their permanent home.
It is my hope that by publishing this summary report, lessons can be learnt for the future in terms of how public bodies exercise their onerous responsibilities for dealing with the welfare of vulnerable children in society.
Emily O'Reilly
Ombudsman
April, 2007