IN THE AFTERMATH of the McIlroy report, is the HSE capable of the change required? The recent report by safeguarding expert Jackie McIlroy is unequivocal. The HSE decision to stop reviewing the files of women in a nursing home who received care from a man subsequently convicted of rape was a ‘missed opportunity as the file review could have provided timely information on the nature and extent of possible harm caused to residents and whilst pertinent information relevant to the findings was still fresh in the minds of staff, residents and families.’

This validates the HSE safeguarding social work team who provided identical advice to the HSE at the time of their original investigation in the ‘Emily’ case. The social work team’s advice was disregarded by HSE management over a protracted period of time. It is fair to say that social workers felt helpless to do their jobs to the best of their ability and that HSE governance structures were a significant barrier to that work.

It is unsurprising it took the appointment of an independent expert for the HSE to accept advice it had already received from its own social work experts. There has been a longstanding apathy apparent within HSE management structures toward their own safeguarding teams. Social work advice was ignored in the Brandon case which involved the sexual assault of 108 people in an HSE disability service and again in the ‘Emily’ case.

Pushing upstream

Why would HSE management ignore social work expertise designed to protect the rights of vulnerable adults in their own services? The answer lies in culture. One HSE senior manager infamously told a social worker that the ‘safeguarding teams were set up to fail.’ It was a fair point. Despite the development of a HSE National Safeguarding Office, a HSE Safeguarding Policy and nine safeguarding teams across the country, social workers, the lead professionals in adult safeguarding, have limited autonomy to do their jobs.

The absence of a social work lead at appropriate senior management level, means social work expertise is often explained at national level by those less qualified to understand it.

With its focus on social justice and human rights, social work is poorly understood in the HSE. Social work perspectives challenge the traditional clinical model, which report after report shows, views patients solely through a lens of disability or diagnosis, with their broader personhood and humanity overlooked.

There is a particular tension for social workers investigating possible institutional abuse within HSE services. Social workers who investigate concerns in HSE care settings often report to managers who have responsibility for those services. Social workers often encounter a defensive culture within that structure and they can often be disregarded.

This pattern will continue while governance structures are dysfunctional and managers with less safeguarding expertise are in a position to override social work experts. Social workers want to work in organisations where their expertise is valued and the HSE is facing challenges in recruitment of social workers to safeguarding teams.

Listen to the experts

It is clear that HSE managers don’t deliberately set out to undermine safeguarding responses but rather, ‘they don’t know what they don’t know’. This is a consequence of the ‘safeguarding is everybody’s business’ mantra often quoted by the HSE; and must be replaced by an approach which emphasises ‘we need the right people with the right expertise to make the right safeguarding decisions at the right time.’

There are positive indicators. HSE CEO Bernard Gloster is genuinely interested in listening and learning and has sought external views on how the HSE ‘do’ safeguarding. Importantly he has met with the family of ‘Emily’ and puts her at the heart of his commentary on the case in a sensitive way. He commissioned a quick decision on the file review, published the report and committed to governance reform.

Gloster without equivocation, accepted that the abuse in the ‘Emily’ case met the threshold of institutional abuse.

Reform is urgently required, as the HSE with depressing regularity often defaults to business as usual. Two National Independent Review Panel (NIRP) reports warned against HSE services viewing residents through a clinical or medical lens. The ‘Emily’ reports specifically advised moving toward a social model of care which would emphasise the fact that residents lived in a home, rather than a medical facility, as seen under the medico-nursing model of care.

While the HSE accepted these findings, the membership of their new ‘Sexual Safety in Approved and Designated Centre Task and Finish Group’, circulated to HSE staff, shows little real learning has taken place. The ‘Emily’ report recommended using working groups with wide professional representation outside nursing and medicine, including family and service user representatives. This, the report advised, ‘would reduce the likelihood of allegations and incidents of sexual abuse being viewed through the lens of a medical condition.’ The majority of members of the new sexual safety group are either current or former nurses or medical doctors. Despite the invaluable, irreplaceable expertise provided by families in the ‘Emily’ report, no service user or family member was appointed.

The membership of the new group does include excellent, ethical, highly respected professionals, but additional skills were recommended, accepted and then ultimately ignored by the HSE. Instead, they opted for the ‘same old, same old’ a dominant clinical model, in strength, leading the response. If the HSE keeps doing the same things over and over, they should expect the same results.

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One sign of ‘we have listened and learned’ would be the expansion of the current Sexual Safety Working Group to ensure the recommendations and spirit of NIRP reports are reflected in membership. People who use services and their families must be front and centre of all adult safeguarding planning within the HSE.

Jackie McIlroy is due to publish another report on the reform of adult safeguarding later this year. The report is just one part of the jigsaw of measures to provide safer services to adults at risk of abuse. What the HSE does with the combined investigative reports will be a true measure of the organisation’s ability to change in this area of service provision.

Finally, the pattern of the HSE hiring social workers simply to ignore their professional advice must end. As former Senator Colette Kelleher, author of the Adult Safeguarding Bill 2017, tweeted last week, it is ‘always wise for Bernard Gloster to listen out for canaries in the mine. Social workers are that. Take heed.’