Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

I join in the welcome to Dr. Tracey Cooper and her colleagues. I also join in welcoming the advent of the inspection regime for residential services for people with a disability. In this context, I wish it to be clear that in this discussion there is no distinction between physical and intellectual disabilities, nor between State, voluntary and private providers.

I am taken aback by the scale of what is being undertaken by HIQA, given everything else for which it has responsibility, never mind its very ambitious plan up to 2015. HIQA is responsible for overseeing 9,800 people in residential care, 1,700 residential services in various locations and entities and 88 service providers across the State. What is the position on staffing as regards its capacity to take on this further responsibility? Is it possible to provide an indication if staffing levels have been increased in order to cope with this additional workload? I note that Dr. Cooper describes it as a landmark moment. I agree. HIQA is now in a position to begin this vital work. However, allied to the question of staffing and looking at some 1,700 entities, is this a Golden Gate Bridge situation or worse, that by the time the work is completed it will be time to start all over again in order to cover the whole gamut of the challenge? I ask Dr. Cooper to give the committee an understanding of how she believes HIQA is geared for the task.

Dr. Cooper referred to instances of failure to comply with the Act, standards and regulations. Such a failure is an offence, about which there is no question, and a repeat will result in consequences which can include immediate cancellation of a centre's registration, which would be a very serious matter. In the current under-resourcing of the health service public facilities suffer greatest as they have the least wriggle room in which to compensate for any loss of a funding stream. There is a risk that repeated failure to achieve 100% compliance could have very serious consequences. I have previously expressed to HIQA my concerns, as have other voices, that while HIQA's reports are hugely welcome and nobody questions its purpose and intent, sometimes these reports have been used or misused by the HSE and the Department of Health to give effect to other agendas such as a reduction in services and even closure. This is not desirable. I have a great fear that under-resourcing could result in situations that would have very detrimental impacts and consequences, certainly not what HIQA would have intended. I ask Dr. Cooper to comment further.

Referring to infections associated with health care, HCAI, Dr. Cooper has described as inexcusable that this fundamental and avoidable patient safety issue would not to be considered a priority by every member of staff, management and the respective health providers. It is time for us to go way beyond the word "inexcusable". As a society, we need to ratchet up our attitude, to make it absolutely clear to all concerned that this is not just inexcusable but rather criminal neglect. I will describe it as bluntly and baldly as such. It is way past inexcusable. If the message comes from this meeting that we will not tolerate anything less than 100% compliance, it will be a good starting point. I hope HIQA will take the same view.

The statistics Dr. Cooper has provided show one third non-compliance. I am not for one moment suggesting it only involves those who are front-line providers, but they certainly have the first responsibility. As members of society visiting families or friends, we have a shared responsibility to ensure the highest standards of hand hygiene. It is described in Dr. Cooper's remarks as "internationally recognised as the single most important preventative measure against HCAI." We need to be very clear that there is an absolute responsibility on everyone. Excuses can no longer be made. Can Dr. Cooper demonstrate what she refers to as demonstrable improvements in subsequent inspections? She has indicated the facts about first inspections. Have second inspections found demonstrable improvements?

On this particular matter, Dr. Cooper has stated that when HIQA begins the licensing system, it will expect avoidable and unnecessary harm to patients to be substantially reduced. I return to the point that it is no longer sufficient to declare that it will be substantially reduced; harm must be eliminated. We need to address this issue in that vein because anything else demonstrates laxity or a degree of tolerance. What penalties are imposed when 100% compliance is not adhered to? In noting non-compliance, can HIQA inspectors identify and expose those who are failing to comply? HIQA's reports deal with hospitals, but it is down to individuals. The figure of 33% represents 33% of staff who are responsible. Can we move this onto a new level and start to identify people and repeat offenders? That is how to begin to make an impact to eliminate this very serious threat to our health.