Some failings from 2018 McCabe probe remain

Five years after a damning report that had huge ramifications for both An Garda Síochána and the Irish government, an inspection by HIQA into Child Abuse Substantiation Procedures (CASP) found some issues have still not been fully addressed.

The examination by the health watchdog was carried out over three days in September 2023, and reviewed 12 months of files prior to inspection.

While ‘Substantially Compliant’ across the board, HIQA found that CASPs in Cavan and Monaghan suffered from “protracted timelines” that ultimately were “not consistently met”, therefore impacting Tusla’s ability to safeguard unidentified children “who may be at risk”.

Some of the failings linked back to the Health Information and Quality Authority’s 2018 investigation, carried out after a Disclosures Tribunal fully vindicated Garda Sergeant Maurice McCabe.

The issue at the heart of the inquiry concerned the opening in 2013 of a file by Tusla about a false allegation of child sexual abuse involving Mr McCabe.

The “clerical error” occurred around the time that Mr McCabe was highlighting Garda malpractices in the investigation of crime and road policing.

The file was circulated to the gardaí at the time, but in 2014 Tusla became aware that an error had been made but did not contact Mr McCabe to inform him.

He only became aware of it in 2017 when assembling a legal case over his treatment as a Garda whistleblower.

The report of HIQA’s statutory investigation, published in June 2018, took place once the Tribunal had finished its work. The report made clear the root cause of failures in the Mountnugent man’s case, stating that a suite of wide-sweeping reforms were necessary in order to improve governance arrangements, as well as managing allegations of abuse.

HIQA found that procedure up until and during the time of inspection last year “did not fully address the findings of the HIQA 2018 investigation”, with three case referrals open to Tusla for between 21 months and over four years.

Many of the other cases reviewed by inspectors found that case deadlines surpassed the 60-day recommended CASP timeline. Only one was deemed to have been progressed within the prescribed timeframe, taking over seven and a half months to complete.

In the 12-month period prior to inspection, a total of 38 cases were referred to the CASP at various stages of development.

At the time of inspection there were 41 open CASPs including three held by the Regional Sexual Abuse Support (SAS) team.

There was no waiting list for additional caseload.

For the same period four cases reviewed by inspectors were on the CASP waiting list for between three and five months from when they initially transferred. The delay in allocation occurred in the last quarter of 2022 and the first quarter of 2023 and attributed to “issues with CASP staffing”.

Inspectors found evidence that children with cases open to the CASP team “continued to be supported” through Child Protection and Welfare and Child-in-care teams. “There was good two-way communication between these teams and the CASP team. Where child protection concerns were identified as part of the CASP, referrals were made to the screening and preliminary enquires team in a timely manner,” said the report published last week.

Of 24 cases reviewed by HIQA, 11 or almost half had “gaps in supervision”.

Four cases had a gap in case management over three months, and three a gap of six months plus.

An additional four cases had no supervision records on file, with one open to CASP for 11 months. A review found only one record of the case being discussed in that same period.

The case, HIQA noted, had been “identified” as one in which communication updates to the service user were “not in line” with the timelines outlined in the CASP policy. “As a result, although supervision sessions were held regularly, the absence of a process to ensure all cases were discussed on a regular basis meant that there were significant gaps in relation to case management and oversight on some cases.”

A review of adherence to CASP timelines, meanwhile, found deadlines were “not consistently met”, and this impacted on “the ability of Tusla to act in a timely way to progress safeguarding actions for not as yet identified children who may be at risk”.

Of the 24 files reviewed HIQA found 19 open and five closed. Four cases were initially referred to Tusla in 2022 under 2014 legislation. The length of time these cases were open at the time of the inspection varied from eight days to 11 months.

Three of the cases referrals had been open to Tusla for between 21 months and over four years.

“The area manager advised that one of the reasons the preliminary enquiry (PE) stage can take an extended period of time was the recognition that making a disclosure of abuse can be traumatic for the child or adult,” explained the report.

In one case, at PE stage for over 100 days, the child making the disclosure “did not wish to speak to a Tusla social worker about the disclosure” and would only speak with a member of An Garda Síochána.

CASP inspectors found evidence the area manager had “recently established” a requirement for social workers to seek area manager approval for timeline extensions. The area manager advised that this “did not always mitigate against delays”, as often the delays were outside the control of the team, for example, where case workers awaited the completion of the An Garda Síochána specialist interview with the child or parental consent to view recordings.

Only one case was found to have progressed and completed all CASP stages in the 12 months since the introduction of the child abuse substantiation procedure. However, while this case was considered to have been progressed within the prescribed CASP timelines, inspectors found that commencing the preliminary enquiry to provisional conclusion took a total of 223 days or over seven and a half months.

Inspectors found that the inputting of case information and timely management sign off on the Tusla Case Management System (TCM) “needed to be strengthened to ensure that the information held on children and adults files and data used for reporting and auditing purposes was accurate”.

They reviewed management records including the minutes of Tusla Cavan Monaghan Quality and Service Improvement meetings, chaired by the area manager, and found these to contain “clear actions to address organisational risk, with regular review of operational challenges or barriers to service improvement”.

Inspectors also reviewed the area’s risk register and found one risk item logged in the 12-month period covered by inspection. This was logged in August 2023.

Inspectors finally also found evidence from a review of the CASP June 2023 service improvement plan and audits undertaken that had led to learning and changes, which were implemented.

Changes required to the service, as highlighted by HIQA in the report, were to be complied with by December 28 last.

‘Overwhelmingly positive’

In response to the findings of the report, Tusla issued a statement welcoming its publication, and noting that it had detailed “a number of good practices” by staff and managers in the service area.

“Tusla is pleased with the overwhelmingly positive findings of this HIQA inspection, and we are proud of our staff for their dedication to providing a quality service. The Agency continues to work with all persons affected by an allegation of abuse with the appropriate sense of professionalism, urgency, compassion, and respect whilst also adhering to legislation, policy, and best practice,” said Eilidh Mac Nab, Tusla Regional Chief Officer, Dublin Northeast.

In respect of delays in the CASP process and timelines, Ms Mac Nab said: “While there were reasons for these delays, such as challenges or restrictions in engaging with alleged victims and alleged abusers”, there was an acceptance that certain procedures were “less efficient” than they could be.

To address these concerns, she said: “Targeted improvements have been put in place. The area has agreed a compliance plan with HIQA to ensure that deficiencies noted in the report are rectified as soon as possible.”