HIQA find significant areas of non compliance in Louth/Meath Tusla services

Local Tusla services in the Louth/Meath region were found to be non compliant in four out of five categories according to a recent report carried out by the Health Information & Quality Authority (HIQA) across three days in April this year.

The inspection found that management systems could not ensure that children and families received a timely service in line with legislation, policy, regulations and standards.

Staff shortages were flagged as a major reason for the shortfalls while the report praised the work of management in trying to mitigate the impact of vacancies, stating:

“The service area was under pressure as staff vacancies impacted on services delivered to children and families. This occurred despite the best efforts of the management team, including workforce analysis, meetings with HR and participation in a national recruitment and retention forum.”

The area manager acknowledged that they were not adhering to Tusla national standard business processes and did not have the resources to ensure compliance.

Louth/Meath services were found to be “substantially compliant” in the area of staff skills and management but the report noted that the number of staff was an issue.

Services were found to be “non-compliant” when it came to compliance with standards with the report stating that significant improvements were required in the monitoring and oversight of waitlisted cases, including the quality of safety planning, so as to ensure that children and families were safe while they waited for a service. 

And that: 

“Caseload management, case supervision and the provision of formal supervision to staff required improvement and children’s records were not adequately maintained.”

Local services were also deemed to be “non-compliant in three other areas when it came to ensuring that 

• Timely and effective action was taken to protect children 
• Children and families have timely access to child protection and welfare services that support the family and protect the child
• All reports of child protection concerns are assessed in line with Children First and best available evidence

Inspectors found there were unassessed risks to children as the service was not in a position to respond to referrals as required with preliminary enquiries often being significantly delayed in many cases. 

The time between Tula’s preliminary enquiry and initial assessment stages was also criticised as resulting in a situation where  “safety was unknown for children while they awaited assessment.”

“This meant that systems and processes in place were not effective in ensuring appropriate safeguarding actions were taken in respect of all children awaiting a service.”

While the report noted that immediate risk to children was responded to, more needed to be done to improve wait times and improve case recording. 

Where plans were inadequate or of poor quality, inspectors could not determine how the plans were reviewed, monitored and updated regularly in response to changing circumstances in a family to ensure their effectiveness.

Completed initial assessments demonstrated that the analysis of risk and children’s needs were of a good standard and appropriate recommendations for action were identified. 

But that the service area was not in adherence with Tusla time frames for initial assessments and best practice, with some cases drifting for long periods.

The report finishes with a detailed compliance plan and time frame in which it must be implemented (the latest improvement date is 15 November 2022) to address the above issues to the satisfaction of inspectors. 

Following the report Tusla released a statement stating:

“Today’s publication of a HIQA inspection report on Tusla’s Child Protection and Welfare services in the Louth Meath area was focused on the management of child protection and welfare referrals. The Louth Meath area received 5,473 referrals in the 12 months prior to the inspection.

“The report found that the area has a well-established Area Manager and the majority of the teams were highly skilled and experienced. Inspectors found that where a child is at immediate risk, they receive an immediate protective response, and where risks were identified within referrals that were effectively managed.

“The screening of referrals, which is the first step taken by a child protection and welfare service to identify children who are at risk, was completed in a timely manner and records evidenced immediate actions taken to ensure the safety of children when required. 

Speaking about the report, Eilidh MacNab, Regional Chief Officer, Tusla Dublin North East, said:

 “Oversight by HIQA assists us in striving for the best possible standards. However, on this occasion, due in part to challenges in the areas of staffing and capacity we have not reached the expected standards. These issues being experienced by the agency are a common concern for many other European social and health care providers.

“Tusla continues to be proactive in its recruitment efforts – for example through bespoke graduate social care worker and social worker campaigns and offers of employment to all social work graduates. Locally, we have taken a number of steps to address these issues, and a significant recruitment effort is underway in the area and this will increase capacity and improve timeframes. 

While there are many examples of the good practice in the area on a day-to-day basis, and the majority of those who we work with reported positive experiences, we have further work to do to ensure that children and families in Louth Meath receive a timely service.”

Improvements required in the operation of the service include:

• Addressing staff vacancies and resource deficits to ensure compliance with standard business processes for the completion of preliminary enquiries or initial assessments.
• Completion of actions in the compliance plan agreed with HIQA.
• All cases that were awaiting allocation were reviewed.

Tusla receives consistent and robust regulation and oversight by various external bodies, including HIQA. This oversight assists us in ensuring that our practices deliver good quality and appropriate services for children and families. 

The Louth Meath Recruitment, Retention & Wellbeing Strategy will continue to be implemented over the course of 2022 and 2023, and we will be monitoring the plan to ensure progress across these areas. Staff retention is a key strategic priority for the Agency and is one of the cornerstones of the new Tusla People Strategy (2022 to 2024).