A MASSIVE overhaul of the HSE's social services is being planned in the wake of shocking revelations about the care system.
A total of 196 children in care died between 2000 and 2010, the Independent Child Death Review Group's report has revealed.
Among the tragedies uncovered was the case of a baby girl left in the care of an eight-year-old sibling the night before she died.
The HSE had known about the family involved for four years before the child was born.
Barnardo's Ireland chief Fergus Finlay said today he is hopeful the damning nature of the document will make a difference.
"I think there are some signs that some of the lessons are being learnt. There are structural changes under way and there are legislative changes under way," Mr Finlay said.
The fundamental problem was assigning responsibility for child services to the HSE, "which was hugely overburdened with a 1,000 other crises", he added
"Children never ever got priority. The tragedies [revealed in the report] are all traceable to a system that was fragmented, under- resourced, poorly managed and above all where there was no sense of absolute priority," Mr Finlay said.
The report exposes situations of horrific domestic violence and substance abuse in which children were left to survive.
Harrowing details reveal cases of sexual abuse and mental health problems from an early age.
Children's Minister Frances Fitzgerald described the findings as "deeply disturbing" and indicated there is to be a complete review of existing child protection services.
Ms Fitzgerald said the report shows the need for "an utterly reformed system of state care and intervention".
Of the children who died, 112 were from causes such as suicide, unlawful killings and overdoses.
Compiled by Geoffrey Shannon and Norah Gibbons, the report recommends the establishment of an emergency response unit within the Department of Children and Youth Affairs.
Mr Shannon said the document is a "devastating indictment" of the care system.
The failures exposed in the report have already led to legal actions against the State and more are understood to be on the way.
Gordon Jeyes, the HSE national director of child services, said disciplinary action has been taken against some staff. He could not say whether anyone had lost their job.
The report recommends the law be changed to allow access to court cases in which child welfare issues are at stake.
In addition, children in care should be entitled to continuing support after they reach 18.
Ms Fitzgerald said a new child and family support agency will be established, taking over from the HSE. The report revealed that files within the HSE on children in its care were in "complete disarray".
Some files were closed even though the parents involved were addicted to drugs and alcohol. Mr Jeyes pointed out that some staff members went above and beyond their professional responsibilities to support children.
The family of tragic teen Danny Talbot (19), who died in 2009 of a suspected drug overdose, said it was upsetting to see what had happened.
His aunt, Donna Lamb, said they have been campaigning for answers for years and are angry it has taken this long.
The report recommends new inquiries in five cases, including the death of Daniel McAnaspie (17), who was killed having absconded from care in 2010.
His sister, Cathriona McAnaspie, has called for a full inquiry as soon as possible.
Two men are awaiting trial for his death.