Mr. Finbarr Colfer:

There is a process for transitioning people from congregated settings but, in the interim, it is about maximising the safety of people who currently live in such settings. In the context of the cultural question, what struck me when the questions were being asked is that we have engaged with many providers and we have seen changes not just in terms of reducing the incidence of safeguarding issues but also in terms of promoting people's rights and quality of life. I gave some examples of that earlier. One of the interesting things is that when one engages with a situation such as a congregated setting, the main cultural issue is usually institutionalised care practices. People who work in those centres have a certain perspective on what their job is and how they should do it. People who live in the centres get their food from a centralised kitchen and their clothes are washed in a centralised laundry. They have no sense of engagement with or control over their day-to-day living. We challenge that in our inspections. We try to maximise within that environment how people can be promoted in terms of engaging with their own self-care.

In some centres, for example, providers have installed kitchens in their units and involve residents more in the preparation of their day-to-day meals. A difference for residents can be seen arising even from that small action, but what is interesting is that staff, too, begin to see the impact of that action and start to take some pride in what is being delivered, the changes that are happening and the enhancement from what is happening.

Culture is really important, and I agree with the previous speakers in respect of the role of legislation in that culture. I mentioned earlier the kinds of issues we were seeing when we started carrying out inspections, particularly in congregated settings. We have challenged that, including by cancelling a registration in some congregated settings. We have required providers to implement improvements in all those congregated settings and that has driven cultural change. We have seen staff change their approach to practice and to the support of residents. Nevertheless, the difficulty is that over time in congregated settings, there can be a reversion to previous practices and there is a high risk of that. Professor Kelly referred to the issue of people who move from congregated settings to community-based settings, where the practices can follow them. It may, therefore, become an institutionalised practice in a small home in the community. Again, that is something we will and do challenge in our engagement. One organisation whose centres we have registered and which we monitor moved a large number of people to community settings. We have found we are now challenging that organisation in terms of institutionalised care practices within the community settings, but it has made very good progress on improving the rights of the remaining residents within the congregated setting. Culture is the key to all of this.