Q&A: Care home scandal
The Cabinet is to consider today whether or not to set up a commission of investigation into issues relating to a foster home in the south-east. What is all the fuss about?
Questions have been mounting for years about the handling by the HSE and its predecessor, the South East Health Board, of abuse claims at the foster home.
It has been claimed that health officials failed to act on concerns of alleged physical and sexual abuse at the home.
The issue has been kept in the public eye in recent months due to hearings of the Dáil Public Accounts Committee (PAC), which has been examining protected disclosures by two whistleblowers.
Another hearing on the issue, under the chairmanship of John McGuinness, takes place today.
Amid mounting pressure to take action, Junior Health Minister Kathleen Lynch is also rushing to Cabinet today seeking its support for a commission of investigation.
The commission would sit in private and would have the power to compel witnesses, search premises and seize documents.
There have been a few investigations into this issue already. Do we really need a commission of investigation too?
Indeed, there have been more than a few investigations.
But the minister believes the commission of investigation model is now necessary, as "for a number of reasons, it has been difficult to establish the facts with certainty".
She said it was "clear that there have been failures in protecting vulnerable people in our care".
What investigations have there been to date?
The HSE has commissioned two independent reviews, neither of which has been fully published.
The reports were compiled by consultant Conal Devine and consultancy firm Resilience Ireland.
The Devine report, looking at the care of one girl, was completed in 2012, while the Resilience review looked at 46 other children and was completed last year.
Taken together, when associated legal costs are factored in, they have cost over €500,000 between them.
A senior counsel, Conor Dignam, is reviewing the circumstances surrounding the commissioning of those reviews after concerns were expressed by the PAC.
The HSE has said it cannot publish the review reports in full until gardaí give the go-ahead.
Gardaí are on their second major investigation of issues related to the foster home.
The first one, looking at allegations of abuse in the foster home, failed to result in any prosecutions.
The second is now focused on whether health service staff were negligent through failing to act quicker to stop referrals to the home and by failing to remove children sooner.
To date, no one has been charged with any offence and no health official has been disciplined.
How many children could be involved?
Some 47 children, many with intellectual disabilities, were placed at the foster home between 1983 and 1995.
It is not clear how many of them may have been abused.
One of these, known variously by the pseudonyms 'Grace' and 'Rachel', is believed to have been neglected and badly sexually abused.
Unable to speak and with a profound intellectual disability, she was referred there as an 11-year-old in 1989.
Although referrals to the home stopped in 1995, Grace was not removed and remained there, apparently largely forgotten, until 2009.
Has the HSE admitted it got things wrong?
To a certain degree it has, but the full extent of the HSE's failings have not been specified.
The HSE has said it is apologising to all those who received poor care at the home. In particular it apologised to Grace "for the significant failings of the service in meeting the service user's needs" over an extended period.
However, the issuing of the apology was initially bungled.
An apology was supposed to be issued at a meeting set up with Grace and her social worker in December, but none was made. The HSE compounded the issue when it continued to insist an apology had been made, only to relent last week. A formal apology has since been issued. A legal case being taken on Grace's behalf against the HSE is not being contested.
Just how badly treated was Grace in the foster home?
According to a dossier supplied to the PAC by one of Grace's social workers, when she finally left the home in 2009, she had to have seven teeth removed under general anaesthetic because her oral hygiene had been completely neglected. The social worker believed she was severely sexually abused over a prolonged period and may not have been the only victim.
She also claimed Grace was never brought to a doctor and received no schooling.
What warnings signs were missed or simply not acted upon by health authorities?
According to the social worker's dossier, the Brothers of Charity ended its association with the foster home in the early 1990s after becoming aware the family had been "dishonest" about the number of children in their care.
Then in 1992, concerns were expressed by a family about their daughter and an allegation of sexual abuse was made. The complaint was dropped after a threat of legal action by the foster family. It appears the health board did not investigate the issue further.
In late 1995, a further allegation of sexual abuse was made.
The health board decided to cease placing children in the care of the family. But for reasons which have never been explained, Grace would stay there for a further 13 years.
While out of the home on a visit to a day service for people with intellectual disabilities in 1995, a 17-year-old Grace was reported to be "wolfing down" her dinner, stealing food, stripping off her clothes, banging her head against the wall, screaming, and laughing uncontrollably. There was bruising on her body that her carers could not explain.
A report from the health board's area medical officer stated she weighed five stone.
Did no one try to remove her?
The health board did decide to end Grace's foster care arrangement at the home.
But this was appealed by the foster family, who petitioned the Department of Health. It would be 2009 before she was eventually removed.