There comes a time when the bland language of corporate responsibility no longer suffices for the task of describing a system that daily causes pain and suffering for the most vulnerable in society. That point appears to have been reached by the Children’s Ombudsman, Niall Muldoon.
In a strongly worded letter sent to Health Service Executive chief executive Bernard Gloster earlier this year and published this week by The Irish Times, Dr Muldoon charges that the HSE has “seriously failed in its duty to uphold the rights of children to the best possible healthcare”. He describes an “apparent dereliction of duty by the State, through the HSE” in the areas of mental health and disability services. He finds it “particularly galling” that there is an “ongoing disregard as to how to fix these issues” as they are “not new”.
Coming from the person tasked with defending the rights of the country’s children, Dr Muldoon’s words should carry a particular moral and institutional force. But the chronic shortfalls and dysfunction that bedevil the State’s provision of these vital services have long been a public scandal. Many families across the country have testified to this, and it has been the subject of two recent damning reports. Dr Muldoon draws on this evidence to paint a picture of chronic systemic failure and its devastating consequences.
While inadequate resources clearly form part of the problem, the Department of Health points to significant increases in overall mental health spending since 2020. But the Ombudsman’s letter focuses on how inadequate co-operation between different parts of the health service continues to frustrate and challenge children and their families.
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The HSE, he writes in one damning passage, has too many siloed agencies and services “who do not, and apparently will not, work together to ensure the best interest of the children they are charged to care for”.This is a serious charge. Taken alongside his assertion that there is no appetite or impetus for change within the system, it raises important questions.
Who are the individuals and agencies that prioritise their sectional interests over the needs of sick children? How should they be held to account? Is the extensive – some would say sprawling – management apparatus of the HSE incapable of driving the necessary changes and if so what must be done to address that?
Dr Muldoon’s letter calls for greater involvement by the Department of Equality in delivering mental health services for the young, although whether spreading responsibilities across additional departments will lead to better services is uncertain. Ultimately the answers, difficult though they may be, must be found by the Department of Health and the Government itself.