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Ombudsman for Children launches report on Jack’s* Case: How the HSE and Tusla provided for and managed the care of a child with profound disabilities

Jack’s Case: how the HSE and Tusla provided for and managed the care of a child with profound disabilities has been launched by the Ombudsman for Children’s Office (OCO) today. The report details the OCO’s investigation into the care of Jack, an eight-year-old boy, who was first referred to the HSE Disability Services when he was 4 years old.

Jack suffered brain damage and other significant life changing injuries in a road traffic accident abroad in 2016, resulting in him requiring 24/7 care in all aspects of his life. Following the accident Jack’s mother returned to Ireland with him where he was admitted to hospital immediately.
In January 2018 the OCO was alerted to Jack’s case after being contacted by the hospital multi-disciplinary team who were concerned about how long it was taking for an exit plan to be put in place for him by the HSE. Despite being cleared by his doctors to be discharged from hospital in 2017, Jack remained living between different hospital settings for two and a half years.

As the OCO preliminary examination was ongoing, a referral was made to Tusla by a medical social worker when Jack’s mother expressed concern that she would not be able to properly look after him at home. This referral was rejected by Tusla along with follow up referrals by a medical team, on the grounds that there were no child protection concerns and was a matter solely for the HSE.

In February 2020, the HSE under the auspices of a charitable organisation, placed Jack in the care of a host family. Within this arrangement Jack is able to attend school where he has two classmates.

After carrying out investigations into the handling of Jack’s care by the HSE and Tusla, the OCO made a number of findings, including:

• The administrative actions of both agencies had a negative impact on the boy’s life. Despite being medically ready for discharge from hospital in August 2017, Jack remained living between hospital settings for two and half years;

• Systemic failures by the HSE to provide adequate support and services to children like Jack, with disabilities, who were living in inappropriate settings. The HSE revealed at least a further 356 children with disabilities were assessed as requiring residential care placements;

• Tusla’s conclusion that Jack’s needs were solely a matter for the HSE was improperly discriminatory on the grounds of disability;

• Jack’s eventual placement with a host family by the HSE Disability Services was made without any legal or formal regulatory framework or proper authority.

Commenting on the report’s findings, the Ombudsman for Children, Dr. Niall Muldoon, said: “There is no doubt that Jack’s report makes for grim reading. As our investigation shows, the tragedy of Jack’s accident and subsequent life changing injuries for both the little boy and his family, was compounded by unacceptable delays and mismanagement of his care by the State, which was supposed to have his best interests at heart. The OCO believes that if the HSE and Tusla had worked together at an early stage Jack may have had the opportunity, with adequate support, to grow up with his family.

“It is the view of the OCO that every child should have the right to grow up with their families or in a home setting, and that no child should forfeit that right due to a lack of resources, services or proper co-ordination by State services.”

In order to address the issues that arose in Jack’s case, and to ensure other children across Ireland are not similarly impacted, the OCO made a number of recommendations to the HSE and Tusla including:

• HSE Disability Services should immediately and systemically review all cases where a child remains in hospital settings beyond their medical need;

• HSE Disability Services should engage with the Department of Health to ensure services and funding are in place to support the right of children with disabilities to grow up at home with their families;

• HSE Disability Services should conduct a national review of the current need for alternative care for children with disabilities whose parents or carers are assessed as being either not willing, or not able, to provide for their ongoing care;

• Tusla should immediately issue guidance to all social work areas, that child protection and welfare referrals about children with disabilities must be assessed and managed the same as all other referrals and in accordance with national policies and procedures.

Dr Muldoon continued “Sadly, we are aware of other parents of children with disabilities who have left their children in a variety of settings such as Emergency Departments, disability respite centres and schools in a desperate attempt to force the State to provide much needed services. This is profoundly wrong, particularly against the backdrop of Ireland’s ratification of the United Nations Convention on the Rights of People with Disabilities (UNCRPD) in 2018.

“We have made far reaching recommendations both in relation to Jack and for the system as a whole, to ensure that children across Ireland are never again impacted by any of these issues. We are pleased to note that since these recommendations were made, the CEOs of the HSE and Tusla issued a joint response to the Ombudsman for Children, fully accepting our recommendations.

“Since then, Jack’s care plan has been reviewed and all agencies are now working together with Jack’s mother and host family to meet his needs. Jack has also been provided with a range of services, medical equipment, and an individualised budget to meet any emerging needs. Tusla has assigned a liaison person to Jack’s case through their family support Meitheal service. The HSE and Tusla have also agreed to arrange an assessment of whether Jack’s current host family arrangement complies with all safeguarding requirements.” Dr. Muldoon concluded.

The OCO notes, that:

• Both agencies have agreed to sign off on, by the end of 2020, a new framework for a holistic assessment of children who are deemed to have been inappropriately placed or remain in hospital settings;

• The HSE and Tusla have agreed to undertake a national review of the current need for alternative care for children with disabilities and produce a report by the middle of next year outlining the requirements to ensure a comprehensive service to these children and their families;

• The HSE acute hospital services will be joint signatories to the HSE/Tusla Joint Protocol (2020). This will ensure there is improved inter-agency cooperation when supporting children with disabilities who may need a residential placement and will include children who are deemed to be inappropriately placed in hospital settings.

Commenting on the report’s findings, the CEO of Tusla, Bernard Gloster, said:
“This report highlights significant shortcomings in how Jack’s case was dealt with, and we accept both the findings and recommendations of the OCO in full. We had already begun a process of significant improvement in the past year from another OCO report ‘Molly’ and we are now including in that the recommendations from ‘Jack’.

“Since joining Tusla in 2019 I have been clear that children require a co-ordinated and integrated response and it is our responsibility as state agencies to form this response around their needs, and not the other way round. To this end, we recently agreed further joint working protocols with the HSE including funding arrangements and case management in shared cases involving Tusla/HSE.

“While there are many situations that are the sole remit of one or other of our agencies there are also many where a shared response is required and we must ensure that children with both disabilities and welfare needs do not meet barriers. It is important we are challenged by and continue to improve services as a result of the work of the OCO,” Mr. Gloster concluded.

For further information contact:

• Claire McGreal, Ombudsman for Children’s Office, 087 344 6564,
• Síle Murphy, Q4PR, 086 028 8132,

Notes to editor

Jack* – not his real name
To download a full copy of Jack’s* Case see