Repeated failings identified in management of the care of ‘Grace’

There were repeated and systemic failings in the management of the care of “Grace”, an intellectually disabled woman left in foster care for two decades despite concerns about physical and sexual abuse, a Commission of Investigation has found.

Two interim reports from the commission led by Marjorie Farrelly SC, running to 800 pages in total, identify system failings by the South Eastern Health Board and specific failings by health workers who were in charge of the care of Grace in a foster home in the southeast of the country.

The first report covers the period from 1989 to 1996 when Grace reached adulthood, covering the role of public authorities in her care and protection and the arrangements where her foster home was identified, while the second report covers the period from 1997 to 2007.

The reports by the commission, which was established in 2017 by then taoiseach Enda Kenny, were published by Minister for Health Stephen Donnelly and Minister for Disabilities Anne Rabbitte on Friday.

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The commission found that Grace was placed in foster care along with other vulnerable adults and children despite her foster parents – identified only as “Mr and Mrs X” – having criminal convictions.

The investigation could not conclude whether Mr X’s convictions for larceny and theft dating back to 1966 and Mrs X’s convictions for larceny in 1988 would have prevented them from being approved as foster parents for Grace in 1989, “but considers that it is unlikely to have done so.”

The HSE was unable to tell the commission whether there was a policy within the South Eastern Health Board in or around 1989 that would have prohibited children from being placed in the care of individuals against whom there were criminal convictions.

Grace remained in their care until 2009 despite allegations of abuse.

The commission found that in the care and decision-making in Grace’s case from 1997 to 2006 there was an “ongoing lack of clarity about Grace’s legal status as a vulnerable adult”.

There were “misconceptions about the role and legal status of Mr and Mrs X and Grace’s mother with respect to decision-making for Grace”, and there was “ongoing confusion and misunderstanding” about what had happened in Grace’s case in 1996.

There was an ongoing failure to seek legal advice or to follow through on the issue of wardship, an inconsistent approach to monitoring, failures in information sharing and working with incomplete information and an absence of proper supervision and oversight.

The commission found “paralysis around interconnection between care decisions and legal considerations”, a “lack of co-ordination and follow through” and “delay, indecisions and u-turns.”

Failings in her care and overarching systemic issues affecting Grace’s case “resulted in her case disappearing from view within the health board” from the time she was aged 18 to 28.

Out of sight

The commission said that the reactive rather than proactive manner in which the disability service operated, together with the absence of oversight and regular file reviews, “contributed to Grace’s case falling through the cracks and out of sight in 2001”.

The commission said it was satisfied that representations on the case made to politicians, including by Grace's foster father, were handled by Fine Gael ministers Michael Noonan and Austin Currie when they were in the Department of Health in 1996 and by their officials, "within the scope of accepted custom and practice operated within the department".

Actions taken by them do not constitute an “intervention” in Grace’s case and they fully respected the health board’s position as decision-maker in her case, the commission concluded.

The commission has been granted an extension until July 2022 to complete the final phase one report into the case.