OPINION: All fatalities of children are sad. They are best served by investigations free to target individual cases which can detect systemic problems
WHEN IRELAND was last examined by the United Nations Committee on the Rights of the Child in 2006 on its progress in advancing children’s rights, the government was asked about its policy for investigating the deaths of children.
In particular, members of the UN committee sought information on mechanisms to monitor any of the State’s direct or indirect responsibility for child deaths. At that time, Ireland had no such specific mechanism in place.
We have moved on since then and the Government will have a different answer when it next appears before the committee. However, it is timely to reflect on the value of mechanisms for reviewing the deaths of children systematically and on what more could be done to align the approach in Ireland with international best practice.
In April 2007, I recommended to the then minister for health and children that consideration be given to the establishment of a mechanism to review systematically child deaths in the State, following concerns raised through our investigatory work. Such mechanisms have been established in many jurisdictions and, while their functions and natures vary, their basic aim is to reduce the number of preventable child deaths.
There are two main types of review process internationally: one that focuses on individual case reviews; and another which takes a broader, quantitative look at trends in child death at a population level. Both processes are geared towards achieving a better understanding of the factors that contribute to child deaths so that they can be tackled in a more effective way.
The response in Ireland to this issue has focused largely on individual reviews of the deaths of children in care or who were known to child protection services. It is clear that not all child deaths are preventable and that unusual circumstances can lead to tragic outcomes in spite of timely and considered interventions on the part of State agencies. Individual cases can, however, shed light on systemic problems and point to ways in which the services we provide to children and families can be improved.
Two groups have been put in place in Ireland to examine cases of child death. In March 2010, the government established an independent group to carry out a retrospective examination of completed reviews of deaths of children in care from 2000 to 2010. In the expert hands of Geoffrey Shannon and Norah Gibbons, we can expect significant guidance on the deaths of children in care arising from this examination.
In terms of contemporary case reviews, the Health Service Executive established a National Review Panel in June 2010 to qualitatively review cases under criteria specified by the Health Information and Quality Authority. This review panel – chaired by another leading expert in the area of child protection, Dr Helen Buckley – published its first annual report and a number of individual case reviews last October.
The National Review Panel’s first annual report stated that the Hiqa guidance places virtually impossible obligations upon it. The report rightly raises the question of whether it is necessary or beneficial for every case to be reviewed by the panel or if it would be preferable to adopt a more targeted approach to extract the maximum learning from selected, representative cases. It is legitimate to ask if there are other operating methods that would better deploy the limited resources available, while ensuring that the purpose of the review process is not undermined.
I have previously advised the Government that to fully satisfy our international human rights obligations (in particular article 2 of the European Convention on Human Rights), investigations into the deaths of children in respect of which the State may have had some direct or indirect responsibility should be independent, both institutionally and in practice. Although the National Review Panel is functionally independent of the HSE, it has been established under its auspices. I believe guaranteeing its institutional independence would enhance the mechanism and align it more closely with international best practice.
State inaction on the matter contributed to the death of children in care becoming politicised to an extent, while preventable deaths and accidents arising from more “everyday” scenarios have received little attention.
It is appropriate that children who have suffered abuse should be the initial focus of mechanisms established by the State to examine child death. However, we should not forget the other contexts in which children sadly die, whether through accidental injury in the home; sudden infant death; as a result of risk-taking behaviour; or in any another way. Many professionals already raise concerns regarding these types of deaths, including coroners, paediatricians, public health specialists and health researchers.
Ireland has certainly travelled a distance on the issue of child death since it was last questioned by the UN in relation to it. We must strive to ensure that the approach adopted in Ireland conforms to international best practice.
In this regard, the Government needs to take the necessary steps to enhance the system in place for investigating child deaths by ensuring it is not overburdened and is fully independent. Achieving this is not simply about learning lessons in order to improve services; it is fundamentally about demonstrating respect for the life that has been lost.
Emily Logan is Ombudsman for Children