Horrifying, unbelievable, gut-churning.
These were the words used by people who read the grim details of both the National Independent Review Panel (NIRP) report on the rape of an older woman ‘Emily’ and a HSE social work review in the nursing home where Emily lived.
Social workers found unreported concerns about the sexual and physical abuse of a further 21 women in the same nursing home. I spoke with many seasoned politicians and professionals this week, disturbed to read that older women repeatedly tried to tell staff about their abuse and were not believed.
Gavin Jennings on RTÉ's summed up their reaction.
"How could this happen?" Jennings asked of HSE chief Bernard Gloster.
"How could an elderly woman be raped in a HSE-run nursing home by a man who was paid to look after her, when there had been several other allegations of sexual assault by other people in the same home against the same man and that according to the review panel, they weren’t believed, reported on or followed up on?"
The answers are complex and embedded in the reality that older people and people with disabilities, particularly those in care settings, are not viewed as equal citizens with equal rights in modern Ireland.
In 2021, the Brandon Report highlighted 108 sexual assaults of people with disabilities living in a HSE service, assaults which occurred with the full knowledge of staff and managers.
The muted response to news about the sexual abuse of older people and people with disabilities also highlights societal ageism. On July 19, when the ‘Emily’ reports were released, key advocacy organisations tweeted about and advocated on behalf of young rape victim Ciara Mangan.
Those same advocacy organisations were, however, completely silent on social media about the sexual assaults reported by over 20 older women in a State-run nursing home. This is ageism in action, where the abuse of older women is considered less worthy of attention. It is essential to remember that the HSE is rooted in our wider society, reflecting societal values and attitudes to abuse.
Still, Bernard Gloster had the unenviable job of explaining to the country why despite a National HSE Safeguarding Office, a HSE Adult Safeguarding policy, access to a safeguarding social work team and education, the most basic procedures still failed in the nursing home.
In his interview, Mr Gloster clearly recognised the need for change in HSE safeguarding culture and governance. The new chief executive has inherited a dysfunctional approach to adult safeguarding in the organisation he now leads. There is little meaningful accountability and a ‘too many chiefs’ approach. Those same chiefs often lack the expertise to deliver the most basic and essential steps in safeguarding in a timely fashion.
The lack of operational safeguarding knowledge at senior HSE management level is evidenced in the delay of the development of a sexual safety policy for frontline staff in HSE care settings.
One may have thought the rape of Emily in 2020 or 108 sexual assaults in the Brandon case reported in 2021 might have immediately triggered such a policy, yet it was not until February 2023 that the HSE National Safety and Quality Committee noted "a sexual safety policy is currently being developed".
Meanwhile, the Brandon report found the HSE management "disregarded the advice and guidance offered by the safeguarding and protection team in terms of how serious safeguarding concerns should be dealt with".
The Irish Association of Social Workers continue to receive reports from social workers advising that their expert safeguarding guidance is disregarded by senior managers with less expertise.
Mr Gloster himself acknowledged the safeguarding and protection team and HSE management in the Emily case held conflicting views over how many files of residents in the nursing home should be reviewed.
The social work team who identified 21 unreported concerns related to sexual and physical abuse in just 32 files, felt with staff resourcing they could complete a review of over 70 files in a reasonable time frame. HSE management did not agree. Valuable time was wasted.
Three years on from the original assault, we have to ask if further examination of these files is warranted at this stage, unless requested by individual families or to provide comprehensive learning for the organisation, as to the true scale of the unreported concerns.
Jackie McIlroy, an independent safeguarding social work expert, is now tasked with this decision and others. Her welcome appointment signals a new approach to adult safeguarding in the HSE, one led directly by the new CEO.
Since his appointment in March 2023, Bernard Gloster has taken a pro-active interest in adult safeguarding, meeting families, external professionals and other stakeholders. This, along with his experience as CEO of Tusla, gives him a good understanding of the problematic safeguarding culture in the HSE and importantly, some of the solutions previously ignored by his organisation.
Mr Gloster’s response to the Emily case is revealing. He has appointed an external expert with no previous links to the HSE to review both reports and consider wider safeguarding issues. He named what so many of his colleagues in the HSE had previously resisted and readily accepted the failure of staff to listen to women reporting abuse is itself a form of institutional abuse.
This unexpected acknowledgement is almost unheard of in the HSE and signifies Mr Gloster understands public trust is enhanced when organisations are open and honest about failings. He also committed to appoint a chief social worker to create clearer governance structures and ensure those most qualified to make safeguarding decisions can do so.
People who are pre-disposed to harm others will always exist within health and social care services, just as they exist within wider society. The HSE cannot eliminate all future risks, but it can create governance structures and safeguarding culture which maximises opportunities to prevent abuse and support victims.
Eighty per cent of nursing home residents live in private nursing homes. The introduction of legislation transformed culture in child protection and Government must now introduce adult safeguarding legislation.
One of the most heart-breaking lines in the Emily report described how a woman (now deceased) told a carer she was raped and "nobody believes me". That line has stayed with me.
Her story and those of the other unheard women in the Emily case must drive change in Irish society, ensuring all women, regardless of age or health, are supported when they report abuse.
